I am done Guys! - drmaxdias

[ArchivalUser]

hey

plz cud u tell me how to go abt revising the last one week? my email id dchop137

regards

[ArchivalUser]

A question where in a 42 yo comes for a health maintenance after 4 years; he has had no problems thus far; cholesterol exam at last visit was 180 mg/dl. I think that was total cholesterol. So now we had to suggest him some tests; I picked non-fasting total cholesterol levels. Other significant option was Pneumococcal vaccine, but that is not indicated.

quansar; I agree with increased venous return; but I do not think that kind of an explanation was there in the options.

Also, I do not remember about the time of presentation of the child with medical femoral condyle swelling.

Ok, one question with ST depression; V3-V6 I think. They asked about the next step. I do not remember if coronary angiography was there. We do not do Echo for sure; I picked cardiac enzymes (Troponin is done for ischemia, and infarction, and is ordered in acute coronary syndromes). That was my rationale. Comments!

[ArchivalUser]

for the cholesterol question, after the total cholesterol screening test, you do fasting lipid profile study (which includes LDL, VLDL, TG, and et al). There is a similar q in both kaplan qbank and UW.

for ST elevation, for further dx, yes, you need to order cardiac enzyme profile after abnormal findings in EKG. but for ST depression, you may not see anything abnormal in enzyme profile... angiography and echo are not indicated at this moment...I do not know, hard to tell before seeing the complete q. setting...

[ArchivalUser]

That total cholesterol was done at his last visit; so I guess we got to repeat it. Remember for men > 35 years, we have to do it annually. This guy is coming after 4 years. And the fasting tests were not an option there.

The scenario was that of an ischemic acute coronary episode; ST depression in V3-V6, and they asked for the next best step, and the options included no treatment.

[ArchivalUser]

agree with u drmaxidas...on the cholesterol ......fasting levels only done if high non fasting TC and/or if multiple risk factors present when risk stratification done.....even if fasting was an option it wud be the wrong one

also agree on the acute coronary episode...if non responsive and persistent pain even on giving NTG then wud be NSTEMI/USA......enzymes wud be ordered if no rx option

about the complex adnexal mass q i dont think we do USG guided percutaneous biopsy for ovarian masses.....we do laparoscopy or explaratory lap and do a biopsy and immd frozen section.....though they might not have been in the options

[ArchivalUser]

Thank you for the answers ronaldo; I think both Laparotomy, and Laparoscopy were in the choices. But aren't we to make a diagnosis first?

[ArchivalUser]

for the cholesterol q, yes I agree. I did not see that the last test was done four years ago...probably he was advised for some conservative rx at the time such as life style changes...so now yeah we do another total cholesterol screening test....

for the ST-depression things...rest often leads to a reversal and is not a sign of infarction
it may be caused by hypokalaemia or endocardia hypoperfusion... I do not see the role of cardiac enzyme profile here, unless the pain persists after rest and sublingual nitraglycerol...and EKG now shows more prominent changes...

[ArchivalUser]

for the ovarian mass question, please see reference here at Mayo Clinic...

http://www.mayoclinic.org/adnexal-tumors/diagnosis.html

Biospy could be done with fine needle aspiration under U/S guidance..

[ArchivalUser]

the diagnosis is made in the OR drmaxdias....with the histopathologist there examining the frozen section right there and letting them know the diagnosis.....im not sure what to pick though betn laparoscopic or laprotomy..will go with laparoscopic visualization and biopsy

[ArchivalUser]

sorry, found another one here . I think Ronaldo is correct. we use laproscopy to biopsy of ovarian mass..

Biopsy and staging
Ovarian cancer is diagnosed by taking a sample of the tumor (biopsy). The tumor material is examined by a pathologist, a physician who specializes in diagnosing diseases by looking at the cells under a microscope. There are several ways to collect a biopsy of an ovarian mass.


"Laparoscopy is the usual first step in confirming the presence of a mass and obtaining a tissue sample for biopsy. Laparoscopic surgery uses small incisions and specially designed instruments to enter the abdomen or pelvis. (This type of operation is widely used to remove the gallbladder.)


If the mass is small, it may be possible to remove the entire mass during laparoscopy. Usually, the surgeon removes the entire ovary.


If the mass is larger that 2.75 inches (complex mass) or 3.5 inches (solid mass) on ultrasound, removal will probably be through conventional surgery. This procedure, called exploratory laparotomy, involves making a larger incision in the skin and abdominal muscles to gain access to the pelvic region.

" http://www.emedicinehealth.com/ovarian_c...ge5_em.htm