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  #1  
Old 12-11-2013
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Question CK Concepts Discussions

A 35-year-old woman is brought in to the emergency room (ER) with disorientation and confusion. Her husband states that she had been experiencing a fever, generalized malaise, and arthralgias for the last 4 days. This morning, when she awoke, she was unaware of her location and did not recognize her husband. She also complained of a headache. Previously, she has been well and does not take any regular medications. She is employed as a nurse in a local ER and last worked 1 day prior to developing her present symptoms. She does not use alcohol or tobacco. Her vital signs are blood pressure (BP), 165/95 mm Hg; pulse, 101 beats/min; temperature, 38.6C (101.4F); and respirations, 15 breaths/min. She is jaundiced and there are nonpalpable purpura covering the lower extremities. Auscultation over her posterior and anterior lung fields reveals vesicular breath sounds bilaterally with no wheezes, rhonchi or rales. S1 and S2 are auscultated over the precordium and no murmurs, rubs, gallops, or added sounds are heard. Her abdomen is soft and nontender. Percussion of the liver in the midclavicular line reveals a 9-cm liver span. The spleen is palpable 3.5 cm below the left costal margin. There are no detectable masses in the abdomen. Rectal examination is normal. Laboratory investigations reveal the following:
Blood
Hemoglobin (Hb) 9.1 g/dL
Hematocrit 27%
Mean corpuscular volume 84 μm3
Mean corpuscular Hb 27.2 pg/cell
Platelet count 11,000/mm3
Prothrombin time 14 seconds
Partial thromboplastin time (activated) 37 seconds
Reticulocyte count 11%
Bilirubin, total 1.9 mg/dL
Bilirubin, direct 0.2 mg/dL
D-dimer 22 ng/mL (N = 0300 ng/mL)
Fibrinogen 300 mg/dL (N = 200400 mg/dL)
Blood urea nitrogen 30 mg/dL
Creatinine 2.8 mg/dL
Lactate dehydrogenase 900 U/L
Leukocyte count 9800/mm3
Beta-human chorionic gonadotropin Negative
Blood film Numerous schistocytes
Urine
Urine analysis Proteinuria and microscopic hematuria
What is the most likely diagnosis?
A. Disseminated intravascular coagulation
B. Glanzmann thrombasthenia
C. Hemolytic uremic syndrome (HUS)
D. Idiopathic thrombocytopenic purpura
E. Thrombotic thrombocytopenic purpura (TTP)
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  #2  
Old 12-11-2013
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for me its E...before to read options for it was liike like hepatic encephalopathy..
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  #3  
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Can PTT be elevated in TTP or ITP ?
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  #4  
Old 12-11-2013
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yep it is TTP
PTT is normal in both - TTP and ITP
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Old 12-11-2013
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Quote:
Originally Posted by olivegarden View Post
Can PTT be elevated in TTP or ITP ?
on this question ppt is normal (normal value for ptt 25-40).TTP/ITP/HUS have normal PTT
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  #6  
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it is E TTP,
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  #7  
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An 18-year-old African-American woman arrives by ambulance at the emergency department with severe abdominal pain. The pain began 3 hours ago and is excruciating and unremitting. She has never had an episode of this nature before. The patient is awake but disoriented. Vital signs are temperature 37.8C (100.1F), blood pressure 90/55 mm Hg, heart rate 125 beats/minute, and respiratory rate 29 breaths/minute. The patient’s breathing is characteristic of splinting pain. Abdominal examination shows acute left upper quadrant and lateral tenderness at the inferior costal border. The white blood cell count is 10,000 cells/mm3 and the hemoglobin is 5.9 g/dL. The most important step in the management of this patient is



A. Emergent phlebotomy
B. Hydroxyurea
C. Oxygen and bed rest
D. Splenectomy
E. Transfusion of packed red blood cells

Last edited by olivegarden; 12-11-2013 at 06:22 PM. Reason: wrong statement in it
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  #8  
Old 12-11-2013
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Quote:
Originally Posted by olivegarden View Post
An 18-year-old African-American woman arrives by ambulance at the emergency department with severe abdominal pain. The pain began 3 hours ago and is excruciating and unremitting. She has never had an episode of this nature before. The patient is awake but disoriented. Vital signs are temperature 37.8C (100.1F), blood pressure 90/55 mm Hg, heart rate 125 beats/minute, and respiratory rate 29 breaths/minute. The patients breathing is characteristic of splinting pain. Abdominal examination shows acute left upper quadrant and lateral tenderness at the inferior costal border. The white blood cell count is 10,000 cells/mm3 and the hemoglobin is 5.9 g/dL. The most important step in the management of this patient is



A. Emergent phlebotomy
B. Hydroxyurea
C. Oxygen and bed rest
D. Splenectomy
E. Transfusion of packed red blood cells
i would go with E
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Old 12-11-2013
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Quote:
Originally Posted by MedicalExaminer View Post
i would go with E
Treatment of the acute crisis involves transfusion of blood products and supportive care with intravenous fluids, oxygen, and pain control. Given the potential for mortality, and because sequestration recurs in the majority of cases, splenectomy is generally recommended after the acute event remits.
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  #10  
Old 12-12-2013
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yes E is the answer !
This is the patient's first episode, obviously spleenectomy would not be appropriate.
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  #11  
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Embarrassed

A 22-year-old developmentally impaired male is seen in the Emergency Department due to leaking around a surgical G-tube that was placed 1 week ago and has been used for enteral feeding for 5 days. Inspection reveals the tube has pulled out. How should this be handled?

A. Insert a Foley catheter into the tract and aspirate. May use for feeding if gastric contents are easily aspirated

B. Insert a Foley catheter into the tract and obtain tube contrast study prior to using for feeding

C. Remove tube and admit patient for observation

D. Remove tube and obtain stat CT scan of abdomen

E. Return to operating room for closure of gastrotomy and placement of a new tube
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  #12  
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Quote:
Originally Posted by olivegarden View Post
A 22-year-old developmentally impaired male is seen in the Emergency Department due to leaking around a surgical G-tube that was placed 1 week ago and has been used for enteral feeding for 5 days. Inspection reveals the tube has pulled out. How should this be handled?

A. Insert a Foley catheter into the tract and aspirate. May use for feeding if gastric contents are easily aspirated

B. Insert a Foley catheter into the tract and obtain tube contrast study prior to using for feeding

C. Remove tube and admit patient for observation

D. Remove tube and obtain stat CT scan of abdomen

E. Return to operating room for closure of gastrotomy and placement of a new tube
E i guess . What os the source of your tricky surgical qs
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  #13  
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Hi Tamta,

the correct answer is B, REPLACED catheters should undergo a contrast study to
avoid intra-abdominal leakage.
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  #14  
Old 12-12-2013
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26 YO women has a history of very intense relationships. She loves her current boyfriend very much, but they fight on a daily basis , sometimes to the point of physical aggression. After such fights she often experiences a feeling of detachment, as if she is not connected to her own body. After one such argument ,the patient is convinced that her boyfriend is trying to kill her. This feeling persists for several months. Now she begins to feel as though her family is on the plot as well. Today she locked herself in the bedroom and calls the police, refusing to come out unless they arrive to protect her. What is the most likely diagnosis?

A. Borderline Personality Disorder

B. Drug Intoxication

C. Hyperthyroidism

D. Hypothyroidism

E. Schizophrenia

F. Schizophreniform Disorder

G. Schizoid Personality Disorder

H. Schizotypal Personality Disorder.
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  #15  
Old 12-13-2013
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Quote:
Originally Posted by hunkpratikcool View Post
26 YO women has a history of very intense relationships. She loves her current boyfriend very much, but they fight on a daily basis , sometimes to the point of physical aggression. After such fights she often experiences a feeling of detachment, as if she is not connected to her own body. After one such argument ,the patient is convinced that her boyfriend is trying to kill her. This feeling persists for several months. Now she begins to feel as though her family is on the plot as well. Today she locked herself in the bedroom and calls the police, refusing to come out unless they arrive to protect her. What is the most likely diagnosis?

A. Borderline Personality Disorder

B. Drug Intoxication

C. Hyperthyroidism

D. Hypothyroidism

E. Schizophrenia

F. Schizophreniform Disorder

G. Schizoid Personality Disorder

H. Schizotypal Personality Disorder.
Borderline
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  #16  
Old 12-13-2013
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I think its schizophrenia (paranoid type)

Borderline personality disorder includes "Splitting" which I cant see in this question.
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Old 12-13-2013
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Quote:
Originally Posted by olivegarden View Post
I think its schizophrenia (paranoid type)

Borderline personality disorder includes "Splitting" which I cant see in this question.
Yeah i agree whats the answer

Still these trick intense relationships loves him argues severly
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  #18  
Old 12-13-2013
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the aswer is A: BORDERLINE.

these patients can be paranoid & feel dissociated in times of stress, that's what the explanation for this question is !

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  #19  
Old 12-13-2013
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This one is tricky!!!!
Borderline personality disorder ??
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  #20  
Old 12-15-2013
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Quote:
Originally Posted by Krazy View Post
This one is tricky!!!!
Borderline personality disorder ??
Yes that's the correct answer
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  #21  
Old 12-16-2013
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Cool ortho

A 49-year-old previously well man is brought to the emergency department after being involved in a head-on motor vehicle accident. He has a shortened right leg that is externally rotated and that he refuses to move. An X-ray demonstrates a displaced femoral neck fracture. What is the most appropriate next step in the management of this patient?

A. Arteriography of the hip
B. Hip hemiarthroplasty
C. MRI of the hip
D. ORIF of the hip
E. Total hip arthroplasty
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Old 12-16-2013
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B. hip hemiarthroplasty
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Old 12-17-2013
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Answer is ORIF URGENTLY

ARTHROPLASTIES are usually done for elderly.
Here ORIF is done to prevent Avascular necrosis of femoral head !
Angiography is not at all indicated here.
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