Decubitus ulcer is a pressure sore that could be anywhere on the body, and in this case is on the head because the baby can't move.
Ecthyma gangrenosum is an infection usually seen in patients who are critically ill and immunocompromised. The characteristic lesions of ecthyma gangrenosum are haemorrhagic (bloody) pustules that evolve into necrotic (black) ulcers, which doesn't really fit the description here.
Kerion is an abscess caused by a fungal infection, and likely wouldn't be ulcerative
Recluse spider bite would have more severe systemic symptoms in a child (weakness, fever, joint pain, hemolytic anemia, thrombocytopenia, organ failure, disseminated intravascular coagulation, seizures, or death) and you would see puncture wounds.
I didn't think atypical TB or scabies made sense so I didn't go into those.
Even though most small cell lung cancer shows up in late stages, and only 2% of people diagnosed are alive after 2 years, people still frequently get treatment. Usually this is both chemo and radiation, but the chemo comes first to shrink the cancer so you don't have to radiate as large an area. Chemo + radiation is also sometimes used as paliation. (https://www.ncbi.nlm.nih.gov/books/NBK482458/)
"Nerve conduction studies (NCS) and needle electromyography (EMG) are valuable for confirming the diagnosis of GBS and for providing some information regarding prognosis. In addition, electrodiagnostic studies are useful in classifying the main variants of GBS as demyelinating (eg, acute inflammatory demyelinating polyneuropathy) or axonal (eg, acute motor axonal neuropathy" UTD
Nobody has mentioned this but I think another thing that helps with this answer is that the boy was infected with all these that he was immunized for. A 12 month old should've had immunizations for H. flu, and Strep pneumo, yet he was still getting sick. This makes me think he isnt making proper antibodies --> therefore a B cell issue
The patient has SCLC (histo description: uniform, small round cells w/darkly staining nuclei). This type is unresectable (only rare cases of small tumors w/o node involvement), responds to chemo and radiation initially, given more so as palliative care.
High Calcium and low phosphorus --> probably has high PTH.
Vitamin D - leads to absorption of both calcium and phosphorus, so you would have high Ca and Ph. PTH - differentiates between Ca and Ph, it increases Calcium in the body and decreases phosphorus in the body.
BMI โฅ40 --> Gastric Bypass candidate. BMI โฅ35 + comorbidity --> Gastric Bypass candidate.
She has already tried weight loss without success. Plus she is a compliant patient (diet, insulin regimen, and daily glucose monitoring)
Everyone has a story and a struggle, and weight is not dependent just on our effort or workout regimen. Genetics, microbiome, and many other factors play a role. Let's not judge these patients but help them!
so you just open a bitch up without any other workup whatsoever? stupid question
I thought I heard in a Divine podcast that if the labs showed pretty clear gallstone pancreatitis you could just skip the US and go right to ERCP. Guess not.
NPPV is approved for hospice patients for palliative reasons.
This patient is struggling to breathe, which is probably causing her some degree of suffering.
NPPV is non-invasive, and could alleviate her pain while not being a curative measure.
Was anyone thinking calcium pyrophosphate? Inflammatory joint, patient with RA, no organisms seen on FNA, would be treated with steroids?
Shouldn't early salicylate OD cause resp alkalosis? I thought only late salicylate OD caused increased anion gap metabolic acidosis. I chose Methanol given her eye sxs and I thought aspirin should be ruled out due to the timing of her OD
UTD:
Stabilization - Circulation
A child with exertional heat stroke may require 60 mL/kg or more of normal saline.
Rapid cooling
For children receiving treatment for heat stroke in the hospital, we suggest evaporative cooling rather than cold-water immersion. Evaporative cooling is preferred for hospital treatment of heat stroke in children because it does not interfere with efforts to maintain monitoring and ongoing resuscitation in unstable patients. Cold-water immersion is associated with significant discomfort, shivering, agitation, and combativeness; and is not clearly more efficacious for rapid cooling in the pediatric population. When evaporative cooling is not available, cold immersion is suggested.
https://www.uptodate.com/contents/heat-stroke-in-children
TL;DR
Why echo and not angiography?
From UTD:
Aortic disease
As recommended in the 2010 American College of Cardiology/American Heart Association/American Association for Thoracic Surgery thoracic aorta guidelines, echocardiography is recommended at initial diagnosis and at six months to assess the aortic root and ascending aorta in patients with MFS
Approach to diagnosis of MFS
MFS is most commonly diagnosed using the 2010 revised Ghent Criteria. These are based on the presence or absence of family history, physical examination, imaging of the aorta, and genetic testing in some cases.
The revised Ghent nosology puts greater weight on aortic root dilatation/dissection and ectopia lentis as the cardinal clinical features of MFS and on testing for mutations in FBN1. For the aortic criteria, aortic root Z score calculators are available for children and adults.
In the absence of family history of MFS
For individuals without a family history of MFS, the presence of one of any of the following criteria is diagnostic for MFS:
Aortic criterion (aortic diameter Z โฅ2 or aortic root dissection) and ectopia lentis.
Aortic criterion (aortic diameter Z โฅ2 or aortic root dissection) and a causal FBN1 mutation.
Aortic criterion (aortic diameter Z โฅ2 or aortic root dissection) and a systemic score โฅ7.
Ectopia lentis and a causal FBN1 mutation that has been identified in an individual with aortic aneurysm.
https://pubmed.ncbi.nlm.nih.gov/20591885/
TL;DR Echo for aortic diameter
What the hell is going on here? Still no answer that makes sense. We have:
Put it all together: RIGHT tension pneumothorax
But why the hell are breath sounds decreased on the LEFT? That alone made me switch to some crazy heart crushing atelectasis answer. I honestly thing the R/L mixup may be a typo because without that the question is simple.
Still confused about this one. I guess it depends how you read that last line:
"Which of the following potential flaws is most likely to invalidate this study?"
If you read it as which flaw is most likely to be present, then I guess selection bias is most likely.
If you read it as which flaw, if present, is most likely to invalidate the study, then that type I error would be 100% likely to sink the results, guaranteed. Guess they meant the first one... Because yes p=0.01 so it's not likely they had a type 1 error.
Beef with this q.
Step Prep has the answer on this one: diaphragmatic hernia.
this question is funny, considering that post-exposure antibiotic prophylaxis is indicated "regardless of vaccination status", I guess this would be a correct option if the "study partner bad fever" were a confirmed case
you dont see a cherry rod spot on fundoscopic exam picture - indication for fluorescein angiography to CONFIRM the diagnosis. they need to ask a different question if they want us to pick doppler. nbme always wins=(