Regarding Dermatomes.....

A 55-year-old woman complains of neck and right arm pain for the past two months. The pain is often triggered by flexing her neck. Her past medical history includes osteoarthritis of her knee, obesity and depression.
On examination there is no obvious muscle atrophy or weakness of the right arm. There is however some sensory loss over the middle finger and palm of the hand.
Which nerve root is most likely to be affected by the impingement?
A. C4
B. C5
C. C6
D. C7
E. C8

Answer:

Normal Physiologic Changes With Aging

An anxious 80-year-old woman presents with multiple complaints. You perform a thorough evaluation of this patient, including laboratory work, stress testing with echocardiography, and pulmonary function testing. When evaluating this woman and her test results, which of the following is considered a normal finding for her age?

A. Decrease in creatinine clearance
B. Blood pressure of 160/80
C. Elevated FEV1 value on pulmonary function tests
D. Low-frequency hearing loss
E. Maximum stress test heart rate of 90

Answer :

Case Study Of A 20-year-old woman with no significant past medical history presents with a 2-month history of episodic shortness of breath.

A 20-year-old woman with no significant past medical history presents with a 2-month history of episodic shortness of breath. These symptoms began with an upper respiratory tract infection. She has fits of coughing and trouble catching her breath with exertion. She states that her breath “sounds like whistles” at times. She tried a friend’s albuterol inhaler with some improvement and wonders if she has asthma. On exam, she is breathing comfortably at 16 times per minute and her oxygen saturation is 96% on room air. Her lungs are clear to auscultation, and the remainder of her exam is unremarkable. You want to better categorize, this patient’s disease.

Which of the following tests is most appropriate to order now?
A) Spirometry.
B) Chest x-ray.
C) Arterial blood gas (ABG).
D) Methacholine challenge.
E) Chest CT.

Answer And Discussion
The correct answer is “A.” Spirometry.

Since this patient has symptoms of bronchospasm, spirometry will be essential in determining if there is objective evidence of obstructive lung disease. However, spirometry results are often normal in mild cases of asthma, especially when the patient is asymptomatic. Bronchoprovocation testing, with methacholine or histamine, may be useful in such cases, but should follow basic spirometry. Although chest radiography (x-ray or CT) may reveal an unsuspected process, it is not indicated in
otherwise healthy patients with symptoms of bronchospasm.
Bacterial pneumonia is a potential precipitant of bronchospasm that may be diagnosed on chest x-ray, but this patient has no constitutional symptoms (like fever) associated with serious bacterial infection. ABG levels may be helpful when a patient presents with respiratory distress but certainly not in the office setting.

If this patient has mild asthma, which of the following pulmonary function test results would you expect to find?
A) Forced vital capacity (FVC) 50% of predicted.
B) Forced expiratory volume in 1 second (FEV1)
100% of predicted.
C) FEV1/FVC ratio <0.7.
D) Total lung capacity (TLC) 50% of predicted.
E) FEV1/TLC <0.7.

Answer And Discussion

Tests Done In The Diagnosis Of Helicobacter pylori Infection

A 54-year-old man is investigated for dyspepsia. An endoscopy shows a gastric ulcer and a CLO test (rapid urease test) done during the procedure demonstrates H. pylori infection. A course of H. pylori eradication therapy is given. Six weeks after completing treatment the patients comes for review. Unfortunately his symptoms have not improved. What is the most appropriate test to confirm H. pylori eradication?

A. Culture of gastric biopsy
B. H. pylori serology
C. Hydrogen breath test
D. Urea breath test
E. Stool culture

Answer:

Sarcoidosis- Diagnosis

A 35-yr -old woman complains of a painful rash on her legs. She also gives a three-mth history
of dyspnoea on exertion. Her doctor arranged for her to have a CXR and this shows bilateral hilar
prominence. Examination of her legs reveals a purplish-red, nodular tender rash on her shins.
Apart from few bi-basal crepitations on auscultation, systemic examination is normal. A
pulmonary function test shows a mildly impaired DLCO. Which one of the following is the best
investigation to confirm the Dx?
A. Sputum microscopy and culture
B. High-resolution CT scan of the thorax
C. Open lung biopsy
D. Kveim test
E. Serum ACE level


Answer: B)  High-resolution CT scan of the thorax

Discussion: This woman has erythema nodosum and bilateral hilar lymphadenopathy. This suggests that she has sarcoidosis. This has a good prognosis.

A 42 Year Old Woman with History Of Diabetes Presents With Chest Pain - Case Study

A 42-year-old registered nurse is seen because of pain in the chest. She describes a “pain in my heart” and points to a 1-cm area above the left breast. The pain is intensified by deep breathing, coughing, recumbency, and twisting motions. It has lasted continuously for 2 days. Three days ago, she noted extreme fatigue and shortness of breath lasting for 24 hours. Findings from a complete physical examination are normal.
1. What is the most likely diagnosis in this patient, and why?

As you are about to discharge this patient, her husband tells you he is concerned about his wife because her sister underwent coronary bypass surgery at 44 years and her brother at 34 years. Because the pain has some features of pericarditis, you decide to do an ECG. It shows normal sinus rhythm with Q waves in the inferior leads and diffuse ST-segment elevation.

2. What is your diagnosis, and w hat would you do?

Answers: