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87yr old f with severe dementia fever chills lethargy agitation for 2 days. Her temp is 101F (38.3c)
Examination show tenderness to lower abdomen and right costovertebral angle. Lab
Leukocyte count 18,000
neut 65%
band 20%
lympho 15%
Urine.. RBC 20hpf
wbc 50hpf
granular cast positive
Bacteria few
what is the most likely diagnosis?
1. Allergic interstitial nephritis
2. glomerulonephritis
3. Pyelonephritis
4. Retroperitoneal abscess
5. Tubular necrosis.
i picked 5 thats wrong..
thank you....

its pyelonephritis . "right costovertebral angel tenderness "

chose this and it was right when i did it two days ago

another q.. A previously healthy 82y old man present with 2months h/o dec energy, 3.2kg weigh loss during this time due to loss of appetite. He appear mildly emaciated. he is 5f 7in tall, weight 60kg (132 lb). BMI 21kg/m2, Temp is 37c (98.6f) Pulse is 68/min, BP is 90/50. Lungs are clear, no murmurs heard on cardiac examinations.
Labs..
Hb 14g/dl
leukocyte 7500/mm
seg.neutr. 56%
Eos 23%
Lymp 14%
Monocytes 7%
Serum.
Na. 128
K. 6
BUN. 30mg/dl
Cr. 1.6mg/dl
what is the most appropriate next step in DX
1. ACTH stimulation test
2.three serial test of stool for ova and parasite
3.measurement of urine PH
4.blood culture
5.HIv antibody test
6. renal ultrasonography
7. Bone marrow biopsy..
3 is wrong...
thank you..

ACTH STIMULATION TEST

HYPOTENSIVE HYPERKALEMIC HYPONATREMIA =ADRENAL

thank you.. can you plz give me your skype id or email.. i have few other i would like to discuss,, its so hard to type all those questions here...

@hakuna matata sorry could you post the qn number of the qns u need answers(eg medicine mastery series form 1 qn 5 ) . and il try answering them. no need to type the qn
thanks

q no. 2, 5 8, 18 33 39.. do you have ans to these,, thank you..

@hakunamatata those are mastery series medicine form one or two ?

med 1