USMLE CD Q, block 1, #35 - triplehelix

[ArchivalUser]

A 65-year-old man who is quadriplegic as a result
of multiple sclerosis is hospitalized for treatment
of left lower lobe pneumonia. His temperature is
38.1EC (100.5EF), pulse is 95/min, respirations
are 12/min, and blood pressure is 120/80 mm Hg.
He appears malnourished. Rhonchi are heard at
the left lower lobe of the lung on auscultation.
Examination of the heart, lymph nodes, abdomen,
and extremities shows no abnormalities. There is
a 1-cm area of erythema over the sacrum with
intact skin and no induration. Neurologic
examination shows quadriparesis. Test of the
stool for occult blood is negative. Which of the
following is the most effective intervention for this
patient™s skin lesion?
(A) Frequent turning
(B) Use of wet to dry dressings
© Whirlpool therapy
(D) Broad-spectrum antibiotic therapy
(E) Surgical debridement

[ArchivalUser]

aaaaaa
bed sores

[ArchivalUser]

A.

[ArchivalUser]

The correct answer is A. Quadriplegic patients, who are unable to sense pain or shift body position, are at high risk for developing decubitus ulcers over areas of constant pressure (e.g. sacrum, occiput, heels). Malnutrition and moisture (from perspiration, urine due to loss of voluntary bladder control, etc.) as seen in this patient, further increases the risk of skin breakdown. The area of erythema over this patient™s sacrum likely represents an incipient sacral decubitus ulcer. Treatment for small and superficial areas of skin breakdown includes nutritional support and relief of continued pressure over the area by frequent turning and cushioning. Ulcers that are extensive or extend more deeply into the subcutaneous tissue, muscle and fasciae may require surgical treatment, with debridement (choice E) of necrotic tissue and wound coverage by skin flap procedures. Antibiotics (choice D) are not indicated in the absence of infection.

Ari Vederci

[ArchivalUser]

Here are the released answered to the USMLE CD

http://rapidshare.com/files/26158967/S2_...leased.pdf

Ari Vederci