1.) A 22 yr. old landscaper is brought to the ER by ambulance 15 minutes after a piece of heavy equipment rolled onto his pelvis. At the scene, paramedica stabilized him on a backboard and administered oxygen via face mask. VS on arrival are tmep 36.5C (97,7F), pulse 120/min, resp 24/min, and Bp 100/65 mmHg. Pulse oximetry shows an Oxygen sat of 98% while the pt. is breathing room air. The pt. airway is intact and Breath sounds are excellent B/L Pulses are palpable in all four extremities. Exam of the pelvis discloses the injury shown in the photograph. Which os the following is the most appropriate next step?
A. Administration of I/V crystalloid solution
B. Contrast urethrography
C. Endotracheal Intubation
D. Nasogastric intubation
E. transfusion of PRBC
F. X-Ray of the pelvis
2.) A 67 yr. old man with a hx of COPD is brought to the ER by his family. he is in mild respiratory distress with respirations 32/min and some accessory muscle use. On P/E he is alert and afebrile. Chest exam is significant for B/L lower lobe wheezing, loud upper airway sounds, and cough productive of thick, yellow sputm. In addition to administration of antibiotics, Which of the following is the most appropriate Tx at this time?
A. Immediate Intubation and mechanical ventilation
B. Initiation of bi-level positive airway pressure (BiPAP) ventilation and admission to medical ICU
C. Serial inhaled albuterol Tx
D. Serial inhaled salmeterol Tx
E. Suppliemental Oxygen via 40 % venture mask
I think C..??
3.) A 67 yr. old man is brought to the ER by ambulance because of two episodes of chest pressure and mild SOB that occurred at rest. The first episode occurred 1 1/2 hrs. ago and subsided spontaneously 20 min later; the second episode began 30 min ago and has persisted. He ha snot had nausea or diaphoresis. Paramedics placed an I/V line and initiated 2L/Min oxygen via nasal cannula and aspirin therapy. On arrival in the ER the pt says his chest pain is slightly improved and now rates it as a 5 on a 10 point scale. medical Hx is remarkable for type 2 DM, COPD, and HTN. routine medications include glyburide, amlodipine, and ipratropium-albuterol inhaler, and 81 mg aspirin. the pt. appears moderately obese. VS: temp 37.2C (99.0F), pulse 88/min, resp 18/min, and Bp 165/95 mmHg. Pulse oximetry on 2 L Oxygen via nasal cannula shows an oxygen sat 98%. P/E discloses no JVD or bruits. Auscultation of the lungs discloses decreased breath sounds with mild, end expiratory wheezes. Cardiac exam discloses a regular rate and rhythm with no audible murmurs, rubs, or gallops. the remainder of the P/E shows no abnormalities. Which of the following is the most appropriate immediate next step?
A. Inhaled albuterol-ipratropium therapy
B. I/V metoprolol therapy
C. I/V N/G therapy
D. 12 Lead ECG
E. portable CXR
I think D...??
1- is there away that you summarize the findings of patients pelvic image?!
2- Suppliemental Oxygen via 40 % venture mask
3- EKG
@studyingnstudying - thanks for your reply i agree with you. But -
1. For ques 2 - why not B or D? I got this right but i am still confused.
2. For ques 3 - why not C ?
PedsResi: Email me; Eyakuboff927
4.) A 12 yr old girl with SLE diagnosed 1 yr. ago is brought to the office by her parents for a routine FU. Since the diagnosis was made, the pt. has been treated with prednisone, methotrexate, and hydroxychloroquine with good response. She has continued to report occasional mild frontal headaches, fatigue, and arthralgias; however, results of serial lab studies during the past 2 months have been within the reference ranges. he rparents state that the child has missed 20 days of school during the past 4 months; the mother says, " We don't like to send her to school when she's not feeling well. Besides, with her condition, we're concerned about sending her to school where she could be exposed to children with contagious illnesses." the pt. says that she misses seeing her friends when she misses so much school. She is 150 cm ( 59In; 50th percentile) tall and weighs 42kg( 93 lb; 50th percentile). VS tep 37.2C( 99.0F), pulse 80/min, resp 14/min, bp 110/72 mmHg. P/E discloses no abnormalities except for mild discomfort on passive motion of her elbows, wrists, and knees. results of her most recent lab studies obtained 2 wks ago are shown below
Blood
HB 12.5 g/dl
WBC 4500 /mm3
ESR 20mm/hr
s/ antinuclear antibody (ANA) titer was 1: 1280; her ANA has been stable for three consecutive months. Which of the following is the most likely underlying cause of this pt.'s. excessive school absences?
A. Depression
B. Exacerbation of SLE symptoms
C. Malingering
D. School phobia
E. Vulnerable child syndrome
I think E...??
5.) A 68 yr. old man with a hx of rectal ca comes tp the office because of pelvic pain for the past month and minimal urine output for the past 3 days. He had an abdominoperitoneal resection of a stage III rectal cancer 20 months ago, followed by postoperative chemotherapy and radiation therapy. he has HTN that is controlled with labetolol.VS: temp 37.4C (99.3F), pulse 70/min, resp 18/min and Bp 140/90 mmHg. he is slightly overweight and looks tired. Chest is clear. Cardiac exam is normal;. Abdominal exam shows a left lower quadrant stoma with stool in the bag and a well-healed midline incision. No masses or organs are palpable. The perineum is well healed. the pt. canot produce a urine specimen oon request, and no urine is obtained by cath. Diagnostic studies show extrinis bladder compression and V/L hydronephrosis with a large mass noted in the pelvis. results of lab studies shown:
Serum
Nitrogen 70mg/dl
Creatinine 5.5 mg/dl
Na+ 136 mEq/dl
K+ 4.8 mEq/L
Cl- 103 mEq/L
HCO3 26mEq/L
Blood HCT 34%
WBC 8400/mm3
Which of the following is the most appropriate next step?
A. B/L percutaneous nephrostomy
B. Cystoscopy
C. Laparotomy for resection of the pelvic mass
D. Placement of ureteral stents
E. Suprapubic cystostomy