JenGintheED Posted December 20, 2004 Share Posted December 20, 2004 Merseur, I think that you are thinking of B anthracis. At least that is the one we were presented with as being associated with wool. Good call, neuro! "ulceroglandular tularemia - treat with streptomycin. 2nd line are chloramphenicol & tetracycline [higher rate of relapse]." But don't feel bad mersuer - we had ID last semester, and I still had to look up both wool and rabbit. Ugh - I feel so lost! {not giving up, though :o } Quote Link to comment Share on other sites More sharing options...
Monica Posted December 20, 2004 Share Posted December 20, 2004 Thanks for firing this thread back up Angel.... You have an older male patient who comes in to see you c/o acute urinary retention. You start thinking of all the important questions to ask based on your differentials. Why is the "recent illness" question important to ask in this case? :) M Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted December 20, 2004 Share Posted December 20, 2004 Thanks for firing this thread back up Angel....M My pleasure! I love this thread :) As for your question, I am stumped... anyone else? Any hints? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 20, 2004 Moderator Share Posted December 20, 2004 hint: has he had a runny nose recently? Quote Link to comment Share on other sites More sharing options...
merseur Posted December 20, 2004 Share Posted December 20, 2004 UTI or Kidney stone? Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted December 20, 2004 Share Posted December 20, 2004 Hmmm... for a runny nose, one may take Benadryl, an antihistamine with anticholinergic properties - which can lead to urinary retention in the elderly, especially in older males. Am I right? Which antihistamine would be a better choice for this man's rhinorrhea? Quote Link to comment Share on other sites More sharing options...
Monica Posted December 20, 2004 Share Posted December 20, 2004 Hmmm... for a runny nose, one may take Benadryl, an antihistamine with anticholinergic properties - which can lead to urinary retention in the elderly, especially in older male. :D Ding..Ding.. Ding! You are correct! He may have taken an OTC anticholinergic med(s) & that could easily cause the urinary retention. As far as the best antihistamine...good question maybe one of the vets will let us know. M Quote Link to comment Share on other sites More sharing options...
Guest recycle Posted December 20, 2004 Share Posted December 20, 2004 Question will a nasonex type rx do for this guy???? Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted December 21, 2004 Share Posted December 21, 2004 :D As far as the best antihistamine...good question maybe one of the vets will let us know. M When I was looking up an answer, I read that loratidine (a 2nd generation antihistamine) lacks anticholinergic properties and thus was better for the older population - but the next sentence said that since it lacked anticholinergic properties, it also lacked effectiveness at treating histamine-related sxs??? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2004 Moderator Share Posted December 21, 2004 Saline Nasal Spray Is Always A Safe Bet In The Htn/bph/elderly Folks.... Quote Link to comment Share on other sites More sharing options...
Joe1968 Posted December 22, 2004 Share Posted December 22, 2004 Thanks for firing this thread back up Angel.... You have an older male patient who comes in to see you c/o acute urinary retention. You start thinking of all the important questions to ask based on your differentials. Why is the "recent illness" question important to ask in this case? :) M oh cool I'm new to the forum (joined today), can I take a guess? you wanna ask him for hx of URI specifically Strep infection, you wanna r/o PSGN specially if pt has s/s of oiliguria <500cc of UO. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 22, 2004 Moderator Share Posted December 22, 2004 decongestants like sudafed can also cause urinary retention in older folks with pre-existing bph sudafed essentially acts as an alpha 1 agonist to cause vasoconstriction( and indirectly decreases nasal congestion). meds to treat bph( for example hytrin) are often alpha antagonists. Quote Link to comment Share on other sites More sharing options...
Marlene G Posted January 9, 2005 Share Posted January 9, 2005 This thread scares me. Too many smarties. LOL! Truth be told, I am becoming more comfortable with rotations and time will start to cement ideas in my mind. At 45, I still have a good 25 years in me to learn on the job. (Who is reallly going to retire anymore at 65 in 20 years, anyway!) :p Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted January 10, 2005 Share Posted January 10, 2005 Aw, Marlene, don't let it scare you! The purpose of this thread, at least as I see it, isn't to show off knowledge and look down on those who don't have it yet. Instead, it is an opportunity to learn! And that should fit in nicely with your admirable attitude towards continuing to learn throughout your career ;) Why don't you share a few questions that you've been asked on rotations? Studying for midterms, one comes to mind... A man goes out for a few beers after work. He ends up not eating dinner and has more than a few beers, but makes it home safely to sleep it off. The next morning at work his coworkers notice that he is pale, sweaty and shaky. Soon, he passes out. 1. If this man were brought to your ED and you could only order one test, what would it be? 2. What would you expect to find? 3. What is the pathology of this man's condition? Prognosis? Quote Link to comment Share on other sites More sharing options...
v_chicky Posted January 10, 2005 Share Posted January 10, 2005 angel - 1. blood glucose level 2. very low, potentially ketones 3. etoh-induced hypoglycemia, didn't eat dinner or breakfast, etoh inhibits gluconeogenesis in liver, leading to hypoglycemia and potentially ketosis. i have to guess on the prognosis, i'd say good, hydrate and give him some glucose. Quote Link to comment Share on other sites More sharing options...
doboy Posted January 11, 2005 Share Posted January 11, 2005 I agree on the ETOH induced hypoglyciemia, smell their breath. Remember to give the Bannana bag to along with some d5. fluids up, sugars up, discharge home with local AA meetings. Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted January 11, 2005 Share Posted January 11, 2005 Yea, V and Do! Who has the next question? Quote Link to comment Share on other sites More sharing options...
doboy Posted January 11, 2005 Share Posted January 11, 2005 Case: A 22 yo f presents to your clinic, CC intermittent fever as high as 101, with chills, Symptoms occured on alternating days X7 days, begining in the early afternoon and lasting several hours. A day after her symptoms developed she began to feel pain in her L side, and 2 days later developed dysuria, no urgency/frequency. Pt stated she did return from India a few months ago. Vitals temp 97F HR 80 BPM BP 110/65 Remarkable physical findings- abdomen- spleen tip could be felt 3 cm below l costal margin at end of inspiration Labs HB 10.9 mg/dL WBC 5200 platelets 103000 blood smear reveals P. Vivax What is the dx? What is the tx? Quote Link to comment Share on other sites More sharing options...
v_chicky Posted January 11, 2005 Share Posted January 11, 2005 malaria, tx w/ chloroquine any other complications? here's a question i was asked while shadowing a pa recently. what pathogen do you need to be concerned about when a pt. steps on a rusty that penetrates his rubber shoe before piercing his foot? what drug do you use? Quote Link to comment Share on other sites More sharing options...
Marlene G Posted January 12, 2005 Share Posted January 12, 2005 Pseudomonas aeruginosa oral ciprofloxacin Ask when patient had last tetanus injection - give injection if > 5 yrs. Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted January 12, 2005 Share Posted January 12, 2005 Pseudomonas aeruginosa oral ciprofloxacin Ask when patient had last tetanus injection - give injection if > 5 yrs. I knew you could do it, too ;) Quote Link to comment Share on other sites More sharing options...
Marlene G Posted January 13, 2005 Share Posted January 13, 2005 Thanks, much appreciated. This one I saw in ER rotation. ;) Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 14, 2005 Moderator Share Posted January 14, 2005 Pseudomonas aeruginosa oral ciprofloxacin Ask when patient had last tetanus injection - give injection if > 5 yrs. REMEMBER THAT YOU CAN'T GIVE QUINOLONES TO FOLKS UNDER 18, THEY INTERFERE WITH DEVELOPING GROWTH PLATES. USE A 3RD GENERATION CEPHALOSPORIN INSTEAD IN THESE FOLKS( LIKE VANTIN). also a small punch biopsy( 2mm) of the apparent track of the nail (after anesthesia) may help removed a retained fb(shoe piece) and speed healing. Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted January 14, 2005 Share Posted January 14, 2005 Thanks, E! It's great to know that some practicing PAs are monitoring our fun here, keeping us fledglings straight :p "The EMedHome Question of the Day is: Appendicitis is the most common surgical emergency in pregnancy and the presentation of these patients may not be classic. What is the misdiagnosis rate in pregnancy? What is the most common condition that is confused with appendicitis?" Quote Link to comment Share on other sites More sharing options...
isomerization Posted January 14, 2005 Share Posted January 14, 2005 What is the most common condition that is confused with appendicitis?" Ectopic pregnancy? As for misdiagnosis I have no idea. Quote Link to comment Share on other sites More sharing options...
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