This is a great example of a poorly written question. Is the infant still sedated from the surgery or ventilated? What is even happening to the surgical site? Why is analgesic therapy not already on-board post surgery? Why is this author such a douche-bag?
Perhaps the world will never know.
"Placenta appears complete but torn" - if it's torn and only appears complete, rather than being confirmed as complete, how can you rule out retained placental tissue? You wouldn't just assume it was complete at a complex delivery, it would require confirmation.
This one made no sense. Celecoxib is already the strongest NSAID. I would rather give Dexamethasone. Which works along a seperate mechanism of action.
To diagnose hypertension, there must be a hypertensive emergency >180/120, evidence of hypertension related end organ disease if greater than 160/100, or measurements in the office showing bp of greater than 130/80 at least three times. The measurements must be spaced over a period of weeks to months.
Male (XY) + Encapsulated organisms = X linked (Bruton) agammaglobulinemia
Remember: S pneumoniae is a gram positive lancet-shaped diplococcus and is the #1 cause of MOPS (meningitis, otitis media, pneumonia, sinusitis)
N meningitidis is a gram negative diploccocus
WTF is this x-ray. I would be better off pepper-spraying myself in the eyes and looking at a good x-ray than this shit.
I do not even begin to see spondlolololisthesis here.
He's had heat stroke for 2 days???? I get the elevated CK and body temp (all pointing to heatstroke), but the fact that he was a temp of 106 and has been symptomatic for 2 DAYS makes the whole heat stroke diagnosis weird to me.
Nystagmus is almost always pathological unless congenital. Especially gaze evoked nystagmus is almost always pathological.
BPPV btw is head movement induced nystagmus, which isn't the same as gaze evoked. Gaze just means moving eyes whereas bppv usually the nystagmus comes from moving the entire head.
The rest are normal findings for age, except e, which could be normal pupil size for any age.
This question is actually a lot deeper than it looks. It is not about "when do you treat thrombocytopenia", which you DO treat when they have bleeding like in the question. This question is about management of ALL which has specific guidelines. According to uptodate, as long as platelet levels are about 20,000 in ALL, you are good to go for a bone biopsy.
Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history
Is this sarcoidosis? I think that accounts for the erythema nodosum, hypercalcemia, and hilar findings.
You know they could throw us a bone or something... Tell us the uterus is boggy at least, or hard, or ANYTHING AT ALL REALLY....
I love these shit pictures. It's like some old angry dude opened a text book from the 1950s and took a picture with his razor phone then uploaded the picture using windows 99.
This was so free I thought I wandered into a Canadian hospital for a minute.
this question would be a lot easier if the answer choice was worded "spinal epidural hematoma"
My reasoning: We know she has preeclampsia, so what other information might be helpful? - platelets could evaluate for HELLP and AFLP - everything else has no indication. US pelvis is a weaker choice given patient has no documented signs of abruption (pelvic pain, vaginal bleeding, FHR abnormalities)
If you're ever unsure and it seems like it's not cancer. You slam the "Reassure" answer choice with passion.
Tricky! Yes, fecal occult blood test would pick up hemorrhoid blood and this is a male <50yo, so case closed right?
Wrong! Hematocrit = 35% --> hgb = 35/3 = 11.7 < 13.5 (normal)
Why is he anemic? Do a colonoscopy.
This is a normal x-ray!
Like veggievendor said, this is a kid with sickle cell disease and limited hip ROM, so check the hip for osteonecrosis
I came here to chew bubble gum and F**K this exam. Instead I got ran train on by all these questions.
Also, my media player didnt even work. I spent like 20 minutes trying to make it work. FML
Latent TB Treatment:
Can anyone who got this right explain how they ruled out chancroid? This is the definition I have for chancroid which I thought fit the image/text description (multiple increasingly painful sores and lymphadenopathy), but was incorrect:
"Patients present with extremely painful suppurative ulcers that may be single or multiple.Infection begins as a papule, which quickly progresses to a pustule and subsequent ulcer formation. Painful inguinal lymphadenopathy with subsequent ulceration, usually unilateral, develops in approximately 50%."
im convinced you cannot differentiate this from chancroid
Welcome back to Step 1 minutae... Useless crap they make us memorize, hell not even memorize.
Breast cancers are one of the most common malignancies to be associated with hypercalcemia. Most often the hypercalcemia is due to osteolytic metastases and hence portends a bad prognosis. A significant number of the patients with breast cancers (up to 15%) show hypercalcemia in the absence of metastasis.
Hypercalcemia is relatively common in patients with cancer, occurring in approximately 20 to 30 percent of cases. It is the most common cause of hypercalcemia in the inpatient setting.
Imagine a world where the author put things like kidney stones, constipation, altered mental status or GERD. But, no. We get the first level of hell where all these authors take fat Shits on the students. "Thank you sir - may I have another?"
Patients who complain of persistent RUQ pain after cholecystectomy should be evaluated for post-cholecystectomy syndrome
Evaluated via abdominal imaging (e.g. ultrasound) followed by direct visualization (e.g. ERCP, MRCP) to find and remove the stone.
Lactose Intolerant I guess? Not Celiac. Kind of a bullshit question.
TSS: sunburn like rash particularly on the palms and soles and very rare
Meningococemia fits better for a college-age girl who has been living in cabins/dorms and cannot be aroused/altered mental status
thajoker's comment is spot on
And: decreased upward gaze is a normal sign of aging, not always parinaud syndrome
Can dogs look up?
pressure (decubitus) ulcers
diabetic foot ulcers
venous stasis ulcers
Doxazosin is not given because he has a history of orthostatic hypotension.
kids start to take first few independent steps by 12-18mo
Bone marrow examination is generally not required for the initial evaluation in most cases of unexplained isolated thrombocytopenia in children. This child has pancytopenia and therefore requires a bone marrow aspiration.
IV contrast dye used for pulmonary angiography worsened the renal insufficiency(inc in serum CR). Adequate hydration before IV contrast in patient with renal insufficiency can prevent this.
SO Pulmonary Angiography has dye that shouldn't be used in CKD.
Why does the question need to be like a book in length. I was balancing like 20 ideas with her F**King diabetes and HTN. WTF
dx of htn in kids requires BP measurements at 3 different visits:
kids: ≥ 95 percentile
adolescents (≥ 13y): ≥ 130/80