Questions below, explanations welcomed thanks!
43. 67 y/o postal worker comes to physician 1 day after 5 min. episode of weakness and numbness in right (dominant) hand while at work. No visual problems, headache, weakness, numbness in lower-extremities. Currently ASx. Smoke 1 PPD 45 years. He has not seen a physician in 40 years. Pulse 85 bpm, irregular, BP 140/90. Lungs are CTA. Pulses palpable. Carotids bruit heard bilaterally. Heart sounds normal except frequent premature beats. Neuro exam shows no abnormalities. An EKG shows normal sinus rhythm with multiple atrial premature contractions. Best next step?
A) ECHO
B) Carotid duplex US
C) Heparin
D) TpA
E) Warfarin
My guess is ECHO
42. 47 y/o with chafed skin on inner thighs, armpits and under breasts. History of panniculitis 2x requiring admisiion for IV-antibiotics. BMI 67, physical shows inner thighs with erythema, active fungal intertrigo. Extensive scarring of axillae and submammary areas. Pelvic exam shows thick white curdy vaginal discharge. Exam of perinuem shows poor hygiene. Best long-term maangement for this patient?
A) Oral fluconazole
B) Oral tetracycline
C) Sensitivity guided antimicrobial therapy
D) Panniculectomy
E) Gastric bypass
Asks for best long-term management - gastric bypass?
1. A 37-year-old primigravid woman at 26 weeks' gestation comes to the physician for a routine prenatal visit. She has a 12-month history of pain of the left wrist with occasional numbness of the palm. She uses a computer keyboard every day at work and at home. Her symptoms were previously alleviated with regular breaks from keyboard use and occasional use of ibuprofen but have become more difficult to control during her pregnancy. Her pregnancy has been otherwise uncomplicated. There is tingling of the index and middle fingers of the left hand with percussion of the volar wrist. The remainder of the examination shows no abnormalities. Pelvic examination shows a uterus consistent in size with a 26-week gestation. Which of the following is most likely to confirm the diagnosis?
A) X-rays of the hands and wrists
B) Electromyography
C) MRI of the hands and wrists
D) Arthroscopy of the wrist joints
E) Nerve conduction studies
Answer is not B -- is it A (rule out fractures - but she is pregnant maybe MRI???)
43. 67 y/o postal worker comes to physician 1 day after 5 min. episode of weakness and numbness in right (dominant) hand while at work. No visual problems, headache, weakness, numbness in lower-extremities. Currently ASx. Smoke 1 PPD 45 years. He has not seen a physician in 40 years. Pulse 85 bpm, irregular, BP 140/90. Lungs are CTA. Pulses palpable. Carotids bruit heard bilaterally. Heart sounds normal except frequent premature beats. Neuro exam shows no abnormalities. An EKG shows normal sinus rhythm with multiple atrial premature contractions. Best next step?
A) ECHO
B) Carotid duplex US
C) Heparin
D) TpA
E) Warfarin
My guess is ECHO
42. 47 y/o with chafed skin on inner thighs, armpits and under breasts. History of panniculitis 2x requiring admisiion for IV-antibiotics. BMI 67, physical shows inner thighs with erythema, active fungal intertrigo. Extensive scarring of axillae and submammary areas. Pelvic exam shows thick white curdy vaginal discharge. Exam of perinuem shows poor hygiene. Best long-term maangement for this patient?
A) Oral fluconazole
B) Oral tetracycline
C) Sensitivity guided antimicrobial therapy
D) Panniculectomy
E) Gastric bypass
Asks for best long-term management - gastric bypass?
1. A 37-year-old primigravid woman at 26 weeks' gestation comes to the physician for a routine prenatal visit. She has a 12-month history of pain of the left wrist with occasional numbness of the palm. She uses a computer keyboard every day at work and at home. Her symptoms were previously alleviated with regular breaks from keyboard use and occasional use of ibuprofen but have become more difficult to control during her pregnancy. Her pregnancy has been otherwise uncomplicated. There is tingling of the index and middle fingers of the left hand with percussion of the volar wrist. The remainder of the examination shows no abnormalities. Pelvic examination shows a uterus consistent in size with a 26-week gestation. Which of the following is most likely to confirm the diagnosis?
A) X-rays of the hands and wrists
B) Electromyography
C) MRI of the hands and wrists
D) Arthroscopy of the wrist joints
E) Nerve conduction studies
Answer is not B -- is it A (rule out fractures - but she is pregnant maybe MRI???)
