Abdominal Pain And Its Clinical Presentations.

Regarding patients presenting with abdominal pain select an option from the list given below:
A. Myocardial infarction
B. Colorectal cancer
C. Duodenal ulcer
D. Gastric ulcer
E. Biliary colic
F. Ruptured abdominal aortic aneurysm
G. Acute pancreatitis
H. Toxic megacolon
I. Diverticulitis
J. Intestinal obstruction

1. A 65-year-old man with a history of ischemic heart disease presents with sudden onset central abdominal pain radiating to his back. He is clammy and short of breath.

Answer: F. Ruptured abdominal aortic aneurysm

2. A 34-year-old man who drinks 21 units of alcohol per week presents with episodic epigastric pain that is relieved by eating.

Answer: C. Duodenal ulcer

3. A 40-year-old woman with a history of Crohn's disease presents with abdominal pain and distension. She describes constipation for the past 4 days.

Answer: J. Intestinal obstruction

Discussion:
Abdominal pain: 
Characteristic exam question features for conditions causing abdominal pain is briefly described below:

1. Peptic ulcer disease: 

• Duodenal ulcers: more common than gastric ulcers,  epigastric pain relieved by eating 
• Gastric ulcers: epigastric pain worsened by eating 
• Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)

Diagnosis Of UTI in A 12 Month Old Child.

Which of the following are diagnostic of urinary tract infection in a 12-month-old child?
A. A bag specimen that grows 50,000 bacterial colonies
B. Transurethral catheter specimen with 5,000 bacterial colonies
C. A suprapubic aspirate specimen with 1,000 bacterial colonies
D. A bag specimen with 10 to 15 WBCs per high-powered field
E. A bag specimen positive for nitrite and/or leukocyte esterase

Answer:  

Regarding Clinical Features In Parkinson's Disease

You review a 70-year-old who has developed a tremor in his right hand. Which of the following best describes the typical symptoms seen in Parkinson's disease?
A. Resting tremor + bradykinesia + fasciculation
B. Intention tremor + chorea + lead-pipe rigidity
C. Resting tremor + bradykinesia + rigidity
D. Resting tremor + chorea + cogwheel rigidity
E. Intention tremor + bradykinesia + rigidity

Answer:

Managing A 31 Year Old G2P1 At 41 Weeks Gestation (Case Study)

Case Scenario: You are seeing a 31-year-old G2 P1 at 41 weeks gestation by definite last menstrual period and 16-week ultrasound. She continues to note fetal movement and her examination is normal: BP 120/68, urine dipstick negative for protein and glucose, fundal height 42 cm, vertex, FHR 156. Her cervix is soft, anterior, 2–3 cm dilated, 50% effaced, and +1 station. She was induced with her first pregnancy, and this time she wants to have a “natural labor.”

Q 1. You decide to check a Bishop score. The Bishop score helps to determine:
A) The health of the fetus.
B) The likely success with induction.
C) The maturity of the fetal lungs.
D) The results of a Catholic Intramural Baseball game.

Answer And Discussion
The correct answer is “B.” The likely success with induction
The Bishop score, which takes into account cervical dilation, cervical effacement, station of the infant, and cervical consistency, can be used to predict the likelihood of a successful induction.

Q 2. The Bishop score is favorable.
Which of the following are the most appropriate recommendations at this point?
A) She should be induced at once; there is a high chance of fetal mortality after 41 weeks gestation.
B) Since her antepartum course has been uncomplicated to date, it is safe for her to await spontaneous labor until 43 weeks gestation.
C) She should undergo a nonstress test and ultrasound for amniotic fluid index.
D) She should plan for a cesarean section.

Answer And Discussion

Crohn's disease: Management (NICE guidelines)

A 30-year-old woman is admitted to hospital with abdominal pain and diarrhoea. She has no past medical history other than depression for which she takes citalopram. She smokes 20 cigarettes/day and drinks 20 units of alcohol per week. Ileocolonoscopy shows features consistent with Crohn's disease and she is treated successfully with glucocorticoid therapy. Which one of the following is the most important intervention to reduce the chance of further episodes?
A. Infliximab
B. Stop drinking
C. Stop smoking
D. Mesalazine
E. Budesonide

Answer:

A 63-year-old male with a known history of myocardial infarction, hypertension and peripheral vascular disease is admitted with breathlessness.

A 63-year-old male with a known history of myocardial infarction, hypertension and peripheral vascular disease is admitted with breathlessness. The blood pressure measured 158/96 mmHg. Blood results are shown.below:
Sodium 137 mmol/l, Potassium 4.5 mmol/l
Urea 11 mmol/l, Creatinine 130 mmol/l
Troponin T <0.1ng/l (NR <0.1 ng/l)
Arterial gases (room air): pH 7.31, PaCO2 6.4 kPa, PaO2 7.1 kPa, Bicarbonate 16 mmol/l
Chest X-ray Severe pulmonary oedema
ECG LBBB
Urinalysis Protein nil Blood nil

He was treated with diuretics and then commenced on an ACE inhibitor but after 72 hours the urea was 20 mmol/l and creatinine was 250 mmol/l. Echocardiography revealed mild impairment of left ventricular function.

What is the most probable cause for his presentation?
a. Myocardial infarction.
b. Hypertensive cardiomyopathy.
c. Renal artery stenosis.
d. Cardiac tachycarrhythmia.
e. Myocardial dysfunction secondary to acidosis.

Answer: