deborah212 Posted October 6, 2010 Share Posted October 6, 2010 What is wrong (ie incorrect) with this physical exam, and why? Gen- Elderly male, conversive, NAD CV- IRRR. +S4. No murmurs or rubs. JVP at 7cm. Pulm- CTAB Abd- +BS soft/NT Ext- No edema. EKG: AF with ventricular rate of 96. Quote Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted October 6, 2010 Share Posted October 6, 2010 I'll take a stab at this! The CV and EKG findings don't match the Pulm and Ext findings. I would think if left heart failure exists, then one would hear some type of congestion in the lungs (wheezes, rales). If I were guessing, I'd guess this is right heart failure (which would result in left failure also), which is why the JVP is increased, and under these circumstances I would expect peripheral edema. Quote Link to comment Share on other sites More sharing options...
deborah212 Posted October 7, 2010 Share Posted October 7, 2010 Good thinking. Not what I'm going for, which is partly my mistake. I should have specified that JVP measured at 2cm from sternal angle or 7cm from right atrium. So in our patient, the JVP is normal. You are right though, that had the JVP been 7cm from sternal angle, he would likely appear fluid overloaded (rales and edema as you described) on physical exam. Look again at the physical exam and the EKG. Quote Link to comment Share on other sites More sharing options...
deborah212 Posted October 12, 2010 Share Posted October 12, 2010 What is wrong (ie incorrect) with this physical exam, and why? CV- IRRR. +S4. Bueller? The S4 heart sound is heard at the the end of diastole when the atrial contraction causes blood to hit a stiffened ventricle. You should not hear an S4 in someone who is in atrial fibrillation as they have lost this "atrial kick." The atrium is fibrillating, not properly contracting. Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted October 12, 2010 Share Posted October 12, 2010 (edited) A 8yo child steps on a nail while wearing her shoes (Flip Flop). She is otherwise healthy, has a very minimal puncture wound to her left heel, and the x-ray is negative. What treatment can you offer her outpatient? Edited October 13, 2010 by MikeyBoy Clarification Quote Link to comment Share on other sites More sharing options...
kirkc18 Posted October 12, 2010 Share Posted October 12, 2010 Td update to start but what kinda shoe was the pt wearing? Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 13, 2010 Administrator Share Posted October 13, 2010 DTaP if not already immunized? Quote Link to comment Share on other sites More sharing options...
delco714 Posted October 13, 2010 Share Posted October 13, 2010 Dtap if not utd, clean the wound, topical abx, wrap and if they are worried follow up. Tell them the signs of an infection and to come back if it swells, causes more/different pain, and redness spreads. Hope that is right! Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted October 23, 2010 Share Posted October 23, 2010 What I was looking for was pseudomonas coverage for a pediatric patient. Yes, all the above management options above are correct and technically you can get away with no antibiotic coverage for a nail/tooth pick puncture wound w/out signs of bacteremia. However, in an ED without adequate f/u, it may be nice to give some coverage. Since FQs are out, a nice choice may be Bactrim (even with its <30% coverage vs Pseudomonas) it is the best option in this particular instance before having to break out the anti-pseudomonas or 3-4th cephalosporins. Again, I'm only a student and not an ER veteran by any means... this was just what I was pimped on :) Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted November 11, 2010 Share Posted November 11, 2010 Rank the glucocorticoids by potency, Weakest--->Strongest Quote Link to comment Share on other sites More sharing options...
ATCPA?? Posted November 30, 2010 Share Posted November 30, 2010 Here is a question from the ortho dept. What are the s&s of compartment syndrome? How do you confirm compartment syndrome? What is the treatment of choice? Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted December 14, 2010 Share Posted December 14, 2010 Here is a question from the ortho dept. What are the s&s of compartment syndrome? How do you confirm compartment syndrome? What is the treatment of choice? The 6 Ps- Pain out of proportion, pallor, paresthesias, poikilothermia, paralysis, pulselessness DX- by compartment pressure (can't remember the exact name) TX- Remove cause if early, otherwise fasciotomy Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted December 14, 2010 Share Posted December 14, 2010 You're at the STD clinic, and a young 30yo guy from Nigeria comes in with a "raw piece of skin on his penis"...kind of looks like an ulcer. What's your differential? Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 14, 2010 Administrator Share Posted December 14, 2010 Primary syphillis, granuloma inguinale... what does the lesion look like? What's the patient's HIV status? Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted December 14, 2010 Share Posted December 14, 2010 HIV negative. (just a theoretical case) Any others? Quote Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted December 14, 2010 Share Posted December 14, 2010 My DDx: HPV HSV CA Chlamydia Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted December 15, 2010 Share Posted December 15, 2010 Nice work Rev & chiaro... Common ulcers are: HSV and syphillis(primary) ...and rarely, chancroid. Uncommon/exotic ulcers include: LGV, Granuloma Inguinale ("Donovanosis"), TB, HIV Others include; trauma, Bowens, Crohns Disease, Lichen Planus (erosive) Here's a good ("quick") overview, representative of the CDC guidelines http://depts.washington.edu/nnptc/online_training/std_handbook/pdfs/ch9_ulcers.pdf Quote Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted December 15, 2010 Share Posted December 15, 2010 Nice one Mikey! Keep 'em coming. I love these pimp questions, even if I don't know most of the answers. Quote Link to comment Share on other sites More sharing options...
jsimps28 Posted May 17, 2011 Share Posted May 17, 2011 Portal HTN: esophageal, gastric, and rectal varices. Nevermind! Just realized this was on page one and there are 56 pages! Quote Link to comment Share on other sites More sharing options...
jsimps28 Posted May 17, 2011 Share Posted May 17, 2011 PIMP: What are Gohn and Ranke Complexes and what are they caused by? Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted May 17, 2011 Share Posted May 17, 2011 The cause is TB, I believe seen on cxr. not sure about the pathophysiology behind them though. Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted June 28, 2011 Share Posted June 28, 2011 What is the triad encompassing Churg Strauss syndrome (CSS)? What asthma medication has a "casual link" association to developing CSS? What is your DDX for eosinophillia? Quote Link to comment Share on other sites More sharing options...
xxbowiexx Posted June 28, 2011 Share Posted June 28, 2011 let see, the CSS includes vasculitis of the small vessels, asthma, and eosinophilia not sure about the asthma med.....theophyline maybe? DDX of eosinophilia encompass the mnemonic NAACP: neoplasm, addison, asthma, connective tissues, parasites Quote Link to comment Share on other sites More sharing options...
MikeyBoy Posted June 28, 2011 Share Posted June 28, 2011 Very nice Bowie. Leukotriene antagonists (montelukast[singulair]) have been linked.... http://thorax.bmj.com/content/63/10/883.full What are the 5 causes/classifications of hypoxemia? Quote Link to comment Share on other sites More sharing options...
deborah212 Posted October 25, 2011 Share Posted October 25, 2011 I got pimped on this a couple of weeks ago... What's the classic triad (think symptoms) of aortic stenosis? No peeking. Quote Link to comment Share on other sites More sharing options...
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