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
Stabilization - Circulation
A child with exertional heat stroke may require 60 mL/kg or more of normal saline.
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.
Why echo and not angiography?
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 ≥2 or aortic root dissection) and ectopia lentis.
Aortic criterion (aortic diameter Z ≥2 or aortic root dissection) and a causal FBN1 mutation.
Aortic criterion (aortic diameter Z ≥2 or aortic root dissection) and a systemic score ≥7.
Ectopia lentis and a causal FBN1 mutation that has been identified in an individual with aortic aneurysm.
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
"Carotid pulses are decreased. A systolic bruit is heard over the abdomen at midline. The left femoral pulse is absent and the right femoral pulse is decreased. A left femoral bruit is heard." ^What in the hell is going on here? I'm freaking out about her absent femoral pulse meanwhile they just want to ask about ACE inhibitors...
And on that subject, how do ACE inhibitors not decrease intravascular volume? "This class of agents effectively inhibits the conversion of angiotensin I to the active vasoconstrictor angiotensin II, a hormone that also promotes, via aldosterone stimulation, increased sodium and water retention. The ACE inhibitors, therefore, are capable of lowering blood pressure primarily by promoting vasodilatation and reducing intravascular fluid volume." https://pubmed.ncbi.nlm.nih.gov/2188439/
"They work by causing relaxation of blood vessels as well as a decrease in blood volume" https://en.wikipedia.org/wiki/ACE_inhibitor
Obviously angiotensin is the safest answer but I am beyond baffled about how "decreased intravascular volume" is incorrect. Anyone?
Was anyone else torn because you thought the colonic hydrogen travelled backwards up the entire gut to be exhaled via mouth fart? So that the small-bowel must have decreased pH?
Maybe just me...
Well apparently that's not how the test works. Or the human body. "The hydrogen produced by the bacteria is absorbed through the wall of the small or large intestine or both. The hydrogen-containing blood travels to the lungs where the hydrogen is released and exhaled in the breath where it can be measured." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155069/
What does "central hilar opacification bilaterally" on x-ray represent?
What is that black sliver on here retina?
This is hilarious, did anyone else think it could be viral pericarditis, which in another question required prompt evaluation with an echo. I initially thought EKG, then echo, then NSAIDs as the order. Apparently, we just skip the diagnosis and go straight to NSAIDs in these patients now. Unbelievable.
What a dumb question, there's literally a UWorld question about how a girl with a hx of seizures faked one and how you need to do neuro testing if they have no post-ictal confusion. I'm sorry, why are we even entertaining this if she has NO post-ictal confusion?
I'm sorry but how the hell are you supposed to know it's vulvar when it says nothing about the vulva. I was between that and polyps, but put polyps because it was on the perineum? Like how the hell is that the vulva?
Yes, this is Gilbert syndrome. Here's my beef with this question: UDP-glucuronosyltransferase is a liver enzyme. Conjugation takes place in the liver, not the serum.
Here's how you can diagnose Gilbert syndrome according to UTD: "A reduction in hepatic bilirubin-UGT activity, which is approximately 30 percent of normal" https://www.uptodate.com/contents/gilbert-syndrome-and-unconjugated-hyperbilirubinemia-due-to-bilirubin-overproduction
Here's a picture from UTD of the enzyme sitting HAPPILY WITHIN THE HEPATOCYTE: https://www.uptodate.com/contents/image?imageKey=GAST%2F52393&topicKey=GAST%2F3578&search=gilbert%20syndrome&rank=1~53&source=see_link
So how is this a "deficiency of serum glucuronosyltransferase"?
Meanwhile, according to FA2020 p394, Gilbert syndrome also causes "impaired bilirubin uptake." Aka "Impaired hepatic storage of serum bilirubin"
My rage knows no bounds.
The only reliable way to differentiate between PCP and cocaine on these exams:
Weird facts about PCP intoxication: