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Welcome to atypicalgowda’s page.
Contributor score: 3


Comments ...

 +0  (step2ck_form6#39)

morbidly obese with poor medical compliance, and "attempted weight loss" has been unsuccessful. So you shall get her weight down by other mean → Gastric bypass


 +0  (step2ck_form6#6)

this lady has lost a lot of fluid. sudden change in posture triggers the LOC → which is orthostatic hypotension


 +1  (step2ck_form6#14)

Threatened (eg, vision change) or confirmed vision loss in GCA requires high-dose intravenous glucocorticoids (eg, methylprednisolone 500-1,000 mg daily), followed by oral therapy with a slow taper over several months to prevent worsening or contralateral vision loss.  Temporal artery biopsy can confirm the diagnosis of GCA; however, therapy should be started immediately when the diagnosis is suspected and should not be withheld while awaiting confirmation. UWorld qid: 3164


 +0  (step2ck_form7#32)

malar rash, arthritis, nephritis syndrome, ana+ = SLE.

atypicalgowda  the swelling around PIP joint(dactylitis) confused me towards mixed connective tissue disorder, but it should have Raynaud's, dactylitis, arthritis, and inflammatory myopathy. UWorld qid 3324 +1

 +0  (step2ck_form7#45)

I answered doppler u/s as that is how you diagnose testicular torsion. going straight to OR also makes sense

atypicalgowda  Surgery never should be delayed on the assumption of nonviability based upon a clinical estimate of duration of torsion. Some patients with a prolonged period of symptoms may have had intermittent torsion or a partial torsion and testicles that are salvageable. --uptodate +1
lindasmith462  So I've gotten way too obsessed with this question. If it was testicular torsion you would do doppler first. You only go straight to surgery w/o imaging if the clinical presentation is a definitive dx of torsion. (This pt only has n/v and testicular swelling - no mention of hard testis on palpation, high riding testis, absent cremasteric reflex). I agree this is more likely an inguinal hernia (w/ the superior swelling and overlying skin changes) although they don't mention a discrete mass which is lame. Even then - the NBS would be to try a manual reduction before surgery (but IDK w/o a mass what are you reducing?) this question is bad +




Subcomments ...

submitted by sugaplum(376),

sclera injection and munchies

In the words of afroman. I was gonnna go to work....but then I got high...

drdoom  I was gonna get up and find the broom but then I got high .. +2  
atypicalgowda  My room is still messed up and I know why +  
drdoom  (yeah-he-yeahhhh!) +  
ronabobonafofona  Omg this is so obvious when re-reading it. Can't believe I missed that. +  


malar rash, arthritis, nephritis syndrome, ana+ = SLE.

atypicalgowda  the swelling around PIP joint(dactylitis) confused me towards mixed connective tissue disorder, but it should have Raynaud's, dactylitis, arthritis, and inflammatory myopathy. UWorld qid 3324 +1  


I answered doppler u/s as that is how you diagnose testicular torsion. going straight to OR also makes sense

atypicalgowda  Surgery never should be delayed on the assumption of nonviability based upon a clinical estimate of duration of torsion. Some patients with a prolonged period of symptoms may have had intermittent torsion or a partial torsion and testicles that are salvageable. --uptodate +1  
lindasmith462  So I've gotten way too obsessed with this question. If it was testicular torsion you would do doppler first. You only go straight to surgery w/o imaging if the clinical presentation is a definitive dx of torsion. (This pt only has n/v and testicular swelling - no mention of hard testis on palpation, high riding testis, absent cremasteric reflex). I agree this is more likely an inguinal hernia (w/ the superior swelling and overlying skin changes) although they don't mention a discrete mass which is lame. Even then - the NBS would be to try a manual reduction before surgery (but IDK w/o a mass what are you reducing?) this question is bad +