Archer 106.... - forever07

[ArchivalUser]

106) A 46 year old man is seen in your office for complaints of severe fatigue over the last one week. The patient was diagnosed with chronic Hepatitis – C infection 2 weeks ago for which he was started on Interferon and Ribavirin. On examination, his vitals are stable and he is afebrile. Conjunctivae are notable for pallor.  Abdominal examination is benign except for mild splenomegaly.
Laboratory investigations :
WBC count of 3,ooo/µl
Hemoglobin of 5.8gm%
Platelet count of 60k/µl.
Total protein 6.8gm%
Albumin 3.2gm%
Total Bilirubin 3.2gm%
Direct bilirubin 0.8gm%
SGPT 52 U/L
SGOT 66 U/L
Alkaline Phosphatase 110U/L
Haptoglobin < 5.8
Reticulocyte count of 6.0%
Lactic Dehydrogenase 1200 IU/L
Serum creatinine 1.0
Peripheral blood smear reveals reduced platelets, polychromasia and anisocytosis. His laboratory tests 4 weeks ago were normal except for mild elevations in his liver enzymes.  The immediate next step in managing this patient is :
A) Parvo virus B19 antibodies
B) Endoscopy
C) Plasmapheresis
D) Stop Ribavrin
E) Intravenos Methylprednisolone
 

[ArchivalUser]

Hb 5.8...actually pt need blood transfusion as well.

D or E

[ArchivalUser]

105) A 66 year old man presents to your office with complaints of productive cough and low grade fever for past two days. He denies any sick contacts. On physical examination, his temperature is 100F, breath sounds are reduced in left lower lobe. A chest x-ray reveals left lower lobe infiltrate. Laboratory investigations reveal WBC count of 12,ooo/µl with 80% neutrophils. Sputum gram stain and cultures are sent for. Blood cultures have been obtained and are pending.  He received a Flu vaccine about one month ago but never received a pneumococcal vaccine. The next important step in managing this patient:
A) Oral Azithromycin
B) Oral Levofloxacin
C) Admit the patient
D) Swallowing evaluation
E) PPD skin test

B or C

[ArchivalUser]

I think its D? for q 106

[ArchivalUser]

C for q 105, age more than 65

[ArchivalUser]

IN Q 106 its seems like interfron indused marrow suppression so wanted to say stop Interferon but thats not the otion here.

How about B19 caussing Aplastic Anemia

I will go for A ... pt is stable now no Active bleeding

Whats the ans

[ArchivalUser]

IN Q 105

Looking at CURB 65 score he has only 1 point

But I think he should still get admited

will Go for C

[ArchivalUser]

106- This is pancytopenia due to hypersplenism- since the marrow is cellular with a retic count of 6% and positive markers of hemolysis- low haptoglobulin, high indirect bilirubin and high LDH along with splenomegaly on physical exam.

Hence, maybe endoscopy is the answer- to look for signs of worsening portal hypertension..
Ideally, I would have thought that a splenectomy would be a decent option.

[ArchivalUser]

105.

INDICATIONS FOR HOSPITALIZATION — Determination of whether a patient with CAP can be treated safely as an outpatient or requires hospitalization is essential before selecting an antibiotic regimen. Severity of illness is the most critical factor in making this determination, but other factors should also be taken into account. These include ability to maintain oral intake, likelihood of compliance, history of substance abuse, cognitive impairment, living situation, and patient functional status.

Summarized briefly, prediction rules have been developed to assist in the decision of site of care for CAP. The two most commonly used prediction rules are the Pneumonia Severity Index (PSI) and CURB-65. The PSI is better studied and validated, but requires a more complicated assessment.

CURB-65 uses five prognostic variables:

Confusion (based upon a specific mental test or disorientation to person, place, or time)
Urea (blood urea nitrogen in the United States) >7 mmol/L (20 mg/dL)
Respiratory rate >30 breaths/minute
Blood pressure [BP] (systolic

[ArchivalUser]

last One. Age more than 65 years.