Find study materials for any course. Check these out:
Browse by school
Make your own
To login with Google, please enable popups
To login with Google, please enable popups
Don’t have an account?
To signup with Google, please enable popups
To signup with Google, please enable popups
Sign up withor
On physical examination, involves a burn with intermittent bullous formations over the dorsum of the hand. The burn appears to have involved epidermal and dermal layers with varying amounts of the subcutaneous layer. skin is numb and nontender. The color is white with areas of gray, brown, and red with a single thrombosed vein over the thenar eminence. leathery appearance with small parts having a waxy appearance.. The treatment of choice
On physical exam his weight is 70kg, his blood pressure is 160/80 mmHg, pulse 90/minute, respirations 26/minute with stridor, and temperature 98 degrees Fahrenheit (36 Celsius). His oxygen saturations with a nonrebreathable mask are at 98%. He is transferred off the hard board and onto the bed. His clothing is removed, most of which is charred and burned. The skin over the anterior parts of the legs, groin, torso, chest, and face demonstrate a moist, waxy white appearance. The skin is severely painful and there are numerous blisters. When gentle pressure is applied the skin blanches. There are some facial burns, singed nasal hairs, and carbonaceous sputum. As the primary survey of the patient continues, plain films are taken of the cervical spine to evaluate cervical spine alignment, and chest to evaluate inhalation injury.
On physical exam his weight is 70 kilograms, his blood pressure is 160/80 mmHg, pulse 90/minute, respirations 26/minute with stridor and temperature 98 Fahrenheit (36 Celsius). His oxygen saturations with a nonrebreathable mask are at 98%. He is transferred off the hard board and onto the bed. His clothing is removed, of which most is charred and burned. The skin over the anterior parts of the legs, groin, torso, chest and face demonstrate a moist, waxy white appearance. The skin is very painful and there are numerous blisters. When gentle pressure is applied the skin blanches. There are some facial burns, singed nasal hairs and carbonaceous sputum. As the primary survey of the patient continues, plain films are taken of the cervical spine to evaluate cervical spine alignment and chest to evaluate inhalation injury.
(Indications for endotracheal intubation and mechanical ventilation include significant or rapidly progressive upper airway edema (as above), tachypnea with use of accessory muscles of respiration (as above), arterial hypoxemia <70 mmHg despite oxygen therapy, and the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen less than 200.)
On physical examination there is an ecchymotic area over the right side of the chest. There is also subcutaneous emphysema. Breath sounds are absent on the right side, the trachea is deviated to the left, and the right hemithorax is tympanic to percussion.
The best initial management of this patient is
As the patient's primary care physician, you would like to respect the patient's autonomy, but are concerned about the consequences of her decision to forgo treatment. She has indicated to you that she understands the proposed treatment options and that she understands how they relate to her situation. You decide to
The patient's profile is most consistent with
Chest x-ray is normal. What is the most likely diagnosis?
Examination shows a lady who is anxious, with a pulse of 110/min, BP of 110/60, Resp 25/min., Temp of 99.2F, Weight 220 lbs, with 2+ edema of the right leg and 1+ on the left. No sacral edema is noted. Heart is sinus with an S4. Lungs are clear to A/P. Abdomen is unremarkable with normal bowel sounds.
ECG showed sinus tachycardia without ST-T changes. ABG showed PO2 of 88, PCO2 of 32, and pH of 7.47. CXR was normal. V/Q scan showed low probability lung perfusion findings. The most suggestive factor that favors the diagnosis of pulmonary embolism is which of the following
Sensation to pin and temperature are diminished on the right side of the face. .....
Physical examination is unremarkable. Lungs are clear to auscultation bilaterally. Liver function tests show normal results and the patient is HIV-negative. His chest x-ray is normal. A purified protein derivative (PPD) test is placed and read 48 hours later. Results show a reaction of 12 mm of induration.
When you admitted her to the hospital, you knew that nothing could be done. The hospital's social work department has been working on placing her in a hospice program. Her medical therapy had already been maximized prior to admission, and she continues to receive supplemental oxygen, inhaled albuterol, and antibiotics. You tell the nurse that you'll be right there, and upon arriving at the hospital you and your student head straight for her room. You can tell that she is dying as soon as you walk through the door. Her breathing is terribly labored and her respiratory rate is 36. She has a strained look on her face, and is obviously suffering. Three of her family members are in the room, and ask that you please do something to stop her suffering. Her nurse is summoned, and you request 10 milligrams of intravenous morphine. Almost instantly, the grimace leaves her face and her respiratory rate decreases to 24. The pulse oximeter next to her bed drops from 93% to 88% on 100% non-rebreather. She is still clenching the bedrails with grim determination, and perspiration rolls down her cheeks. "Isn't there anything else you can do?" the family asks. "She looks so uncomfortable. She wouldn't have wanted it this way." You had discussed her poor prognosis on many occasions with several family members, and made sure that her living will was complete and that a copy was on her chart.
The family members have long been prepared for the inevitable, and all agreed that she should be kept as comfortable as possible. "I could give her more morphine," you say, "to let her go in peace." "No you can't," the helpful medical student points out. "Her pulse ox is already low, and she can't stand any more respiratory compromise. It'd be like assisted suicide, and that's only legal in Oregon." The bewildered family turns to you, visibly more upset at the prospect of watching mom suffer any more than she has already.
Physical exam reveals a quiet male in moderate to severe respiratory distress. Vital signs show: pulse 115; BP 90/50; respiration 18; Temp 38.2° C (100.7° F). HEENT shows dry mucous membranes. Lungs show decreased breath sounds and crackles on the left; cardiac exam is significant for tachycardia. Abdominal exam is nonspecific. No abnormal reflexes are noted. Initial laboratory studies show: Na 132; K 4.2; Cl 97; HCO3 25; Glucose 265. ABG reveals pH 7.26, pCO2 55; pO2 79; O2 saturation 90%. CBC shows a normal H/H with WBC count of 14K, the serum is reported as very lipemic. Chest X-ray shows an LLL consolidation. The patient has a
What is the most likely cause of her symptoms?
Others are serum glucose 106 mg/dl, sodium 138mmol/L, chloride 102mmol/L, potassium 4.2mmol/L, bicarbonate 29mmol/L, BUN 18mmol/L, creatinine 1.0mmol/L. Which of the following has been shown to improve life expectancy in a patient like this?
On examination, he has no pallor but has some whitish plaques in the mouth; chest was clear on auscultation and no abdominal signs. Laboratory studies are shown in the table....
On examination, you noted a middle-aged orally intubated male. Temperature 99.4° F, pulse 145/min, BP62/34 mm Hg (he breathes above the ventilator at a rate of 36 cycles/min even). His breath is shallow and he has diminished breath sounds in his right hemithorax. The next most appropriate thing to do is:
His examination revealed a young male in severe respiratory distress with temperature 99.2° F, pulse 102/min, respiration 40/min, BP165/95 mm Hg, and a pulse oximetry of 66%. He was thus intubated at the site by the EMS personnel because of lack of improvement on 100% non-rebreathing mask. His chest X-ray shows bilateral alveolar and interstitial infiltrates. The arterial blood gas on the mechanical ventilation is set at a rate of 12cycles/min, tidal volume 500mls, and FIO2 1.0 is; PH 7.52, PCO2 30, PO2 55,O2 saturation 88%. What is the most likely diagnosis?
She is mostly bothered by the fact that she has to 'catch' her breath because of pain on inspiration and when coughing. She has no known past medical history, is not on any medication, and has no pertinent family history. She denies any medication use, including over the counter medicines.....
Her CXR is normal
What is the most likely diagnosis?
The rare condition Lymphangioleiomyomatosis is diagnosed.
.....The culture was significant for a gram-negative bacillus that was a lactose fermenter; mucoid; and VP positive. The organism is a known cause of nosocomial infections and strains are known to produce extended spectrum B-lactamases (ESBLs). The organism most likely causing this nosocomial infection is
Vital signs are:BP 95/55; pulse 110; respiration 14; Temp 37.4° C (99.3° F). Orthostatic evaluation shows a positive tilt. HEENT: NCAT, mucous membranes are dry, and areas of pigmentation are noted. Lung exam is clear. Cardiac exam reveals distant heart sounds and tachycardia. Abdominal exam shows mild, diffuse tenderness without guarding or rebound. Patient's skin is dry and appears very tanned. No bruising or other rashes are noted. Laboratory studies show Chem 7: Glucose 80; Na 130; K 5.2; Cl 100; HCO3 21 BUN 55, Creat 2.2. The patient's most likely affliction is
The patient is admitted and immediately treated with intravenous ceftriaxone and tobramycin. After 24 hours, the patient remains febrile and blood cultures are negative. He complains of a sore throat and examination reveals white plaques in his pharynx and on the upper palate. A diagnosis is made and anti-infective therapy with amphotericin B is initiated. After 48 hours, blood cultures are positive and identification of the organism confirms the diagnosis. What is the most likely cause of the patient's illness??
Physical exam reveals a disheveled male who appears older than his stated age. Vital signs show: BP 155/80; pulse 100; respiration 16; Temp 37.5°C (99.5°F).
HEENT exam reveals a marked aroma of alcohol. Heart and lung exams are unremarkable. Abdominal exam shows mild, diffuse tenderness without re-bound or guarding. Neurologic exam reveals lateral rectus palsy, marked bilateral nystagmus, and an ataxic gait. Short-term memory is poor.
From the choices provided, determine the etiology of this patient's complaints.
You are quickly called to the bedside and examine the patient. You also note that throughout the day the patient has made only 50 cc of recorded urine output.
Which of the following is a possible underlying explanation for these lab results?
Physical examination reveals a restless, dehydrated; average nourished person, as well as sinus tachycardia (heart rate 97 beats/minute) and epigastric tenderness on palpation. Blood pressure is 140/95 mmHg and Chvostek's sign is positive; the remainder of the physical examination is normal. During the examination she suddenly develops an attack of tetany. Which of the following disorder is, according to your opinion, the most likely cause of tetany?
Vital signs are: Temp 37.8° C (100.04° F); pulse 105; BP 110/70; respiration 10, and shallow. Initial studies show a CBC: WBC: 13.5; H/H 14/42; Chem 7: Na 132; K 3.1; Cl 85; HCO3 35. Obstruction series shows a massively dilated stomach with minimal distal gas noted. UA shows SG 1.025, no cells, urine chloride is 8 mEq/L. Which of the following best describes this patient's acid base disorder?
Vital signs show: BP 172/95; pulse 110; respiration 18; Temp 37° C (98.6° F). Lung exam reveals fine rales at the bases. Cardiac exam reveals distant heart sounds with a 3/6 systolic murmur. Positive S3 and S4. Abdomen is mildly, diffusely tender. The cardiac monitor shows a sinus tachycardia with tall peaked T waves. EKG reveals a sinus tachycardia with shortened PR and QT intervals and tall peaked T waves in the precordial leads.
The most rapid management of her electrolyte disorder includes
Vital signs show: BP 90/55; pulse 115; respiration 14; Temp 37.4° C. (99.3° F). Orthostatic evaluation shows a positive tilt. HEENT: NCAT, mucous membranes are dry, and areas of pigmentation are noted in the buccal area. Lung exam is clear. Cardiac exam reveals distant heart sounds and tachycardia. Abdominal exam shows mild, diffuse tenderness without guarding or rebound. Patient's skin is dry and appears hyperpigmented over the elbows and knees with scattered areas of vitiligo. No bruising or other rashes are noted. Laboratory studies show Chem 7: Glucose 75; Na 130; K 5.2; Cl 100; HCO3 21 BUN 55, Creat 2.2. While waiting for definitive test results, the immediate treatment for this patient is
Physical exam reveals a lethargic male who moves to deep pain but has no intelligible speech. Paramedics have given the patient Narcan with no change in his status but have withheld glucose bolus due to a high dextro stick reading. Vital signs read: pulse 115; BP 90/50; respiration 18; Temp 38.2° C (100.7° F). HEENT shows dry mucous membranes. Lungs are clear. Cardiac exam is significant for tachycardia. Abdominal exam is nonspecific. Neurologic exam shows him to be responsive only to pain, with withdrawal. No abnormal reflexes are noted. Initial laboratory studies show: Na 118; K 4.2; Cl 97; HCO3 17; Glucose 950. ABG reveals pH 7.34, pCO2 25; pO2 79; O2 saturation 90%. CBC shows a normal H/H with WBC count of 14K, the serum is reported as very lipemic. Chest X-ray shows an LLL consolidation. The initial treatment should be
Vital signs show: pulse 130; B 70/45; respiration 18, with a Kussmaul pattern; Temp 37.9° C (100.2° F). HEENT shows dry mucous membranes and a fruity odor to her breath. Lungs are clear. Cardiac exam is significant for tachycardia. Abdominal exam shows diffuse tenderness, without rebound or guarding. The initial treatment should be
(The major differential diagnosis is that of primary polydipsia (compulsive water drinking). Compulsive water drinkers are able to excrete hypertonic urine after a period of water deprivation, whereas patients with DI cannot.)
Sign up for free and study better.
Get started today!