Scribd
Upload
123 views189 pages

(Medicalstudyzone - Com) Block 9

Uploaded by

DEEJK
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
123 views189 pages

(Medicalstudyzone - Com) Block 9

Uploaded by

DEEJK
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
Ons al < 1 72-year-old woman comes othe emergency depart wecase of vps abdomal pul and nausea othe pst : hour. the patent rates the pana an sto aon 3 Topo cla. she has had an epnae of monblondy worn ice the Da sated. she has aso of ype 2 dlabtes melts, hypertension, ad osteporesis, The patent has smoked pac opt ay a Arle ik eit Seer cfay Carers clahe atch, Isinepi na orl var O supplements Her temperstres 385°C (1017, pls 10min, and ood pressures 138/66 mma, Lamination stows seete eign endermes to palpation wih gunn bu ro rebound. Llratonogrpi of he abdomen shows ffs enlargement ofthe paneast. no qaltoner ate inulze. The patent ‘ited othe hospi for pan consol and wtaveneus hytavon Which ofthe allowing ithe most appropiate nxt Sepin the management f tha pater' pai? a ‘ral yarocodone an aquest eae eiarcan eae “Transermal bupivacaine on request ‘Cominuous intravenous keane ‘ra acetaminonhen every § hows (ral gabapentin erry 24 hours Trane ean every 72 ers hone Oma s wl 1 72-year-old woman comes othe emergency depart vecase of vps abdoral pul and nausea othe past eal ce, es eat ie tec eg ba pasate. she has a sory of ype 2 dlabtes melts, hypertension, and osteporess, The patent has smoked pac opt ay a Arle ik eit Seer cfay Carers clahe atch, Isinepi na orl var O supplements Her temperstres 385°C (1017, pls 10min, and ood pressures 138/66 mma, Lamination stows seete eign endermes to palpation wih gunn bu ro rebound. Llratonogrpi of he abdomen shows ffs enlargement ofthe paneast. no qaltoner ate inulze. The patent ‘sanited othe hospital fr pan conrol and navenos yan Which ofthe allowing i the moss appropiate next Sepin the management f tha pater' pai? 6s aes ce 2a ‘ra hydrocodone potent analgesic hat appropriate for Weubg ater pa. Patents with cate ances ap ‘vomting are offen kept NFO ard hey nave an ereased ns of eeveloina dlaes gest erwin and an eus Theefre, Insavenos analgesia woud be more appropiate or inal pain management ‘anant- 1 26-year-old man's brought the emergency deparmert 35 mirwes ae e sustaed agunsber wound tothevignt — S thigh hs hae ype tabetor melt. On aval ls pale 112/minrxpatons are 20min and ood presse i 115/68 mig Flse oxy on ror a shows an oxygen saturation of SB Theres an anvace wound cr the smeromecial surface of te ight hgh 2 er belo the inguinal igument. There so brut orl. There sp ‘sun Te Bal uses mised on the night side compared to tele. The absomen 5 softandnentande. The Femainer of ie xannaion sons no abnomaie, Laboratory studies she res mogen 2419 a Chacose 120mg Which of fling isthe most apropnie nxt step m management? “This man kay has avascular jury dmanshed pedal pss) tht requves further ulation Hower the raed “eau! ony ptmis carta iesigaons. 2a ‘in pavets wan unnoum or nsufcet tetanus and cphthra mmunizater,approprte tetanus propyl wth tetanus {oid shuld be samimsteed as son as possibe allowing a au ty o wound Tetanus imrunogiobu shuld aso be [minitred in underserated ptt whe have sstaed wun that might be det contaminated Wounds seule “ane roroughly and ner sue should be debided. hough ths pte shoud be asted about is tears eal eyes eee a dee eee Pavant ir ace compartment syaarome regu gent fascocony wo feleve the pressure an preven sue reco Although gurshot wounds may rtm compartment sypome to nflemmation edema of homo fmt, Ie ‘att doesnt complain of ightness or swingin his lowe’ exe Signs of comparmentsyarome, such Sze ‘Sapanty beeen the no ler entrees paenteia, te la otealed in the phyla OM Baal <2 + 1400 ‘pus ooes at compa or agains or sueningn us ower Sem) Sars of Compare sytem, suena Sze ‘Sepanty beach the olor entre or pathol, te loot ead i the piel aam ‘CT angogaphys one of the bes agnostic method for evaluating vase nury hemodynamically tbl patents wthout ‘ear gps of escuarijry auch an leesing or xtemty hea omer th patents renal reufiseney ad Mtr oF “taets meus merease ms sk for conrast-nauced nephron, whch means tat angioataah snot he Petes ‘ig! subrrcton angiography is method for mvesigatng areal vse injury lowing for elie visualization ofthe ‘aie’ ates. However. the pens rel instficeny and eabetes live pt im at isk of eontast-induced Iepiropaty and terefre mak him aes tan ie cana fragman of conras. ‘Paent exhib "ard sigs of rte imury require urgent surgical ep. Har sigs of ari yy Inca cine neem pa rac ler cel ceed tl palette ‘This pate meets none ofthe cre, ads hedynamicly table enough to undego further eegrost esr, hemodynamically table pales wth suspected vascular uy, eppropte agnosie stues should be performed to lute the vascular uy. Tis cou be aheved by means of agiography. whit canbe performed by te pysdan ne ‘mergency roam rte opsrang room, and dupes ukrasonograpy, whch should be performed by aramed vatult {echnologist or radiologist. Ths pate undering Siabecs mets ard fa insuicency teases iad of eveopngconrastindued nephropathy ding arteriography. For ths reason, he should ntesd ueego duplex ‘uivasonearapm which das not equ const BB. Festinger Ons al <3 +im> fa stse yaad ign tan 429 wd gon ae esc fa lenip amin a ( {ge 0f1 yexs it sions are win normal its, Examination shows a3.0-cm,non-mobe, frm, ahd ronendet ass Inthe upper outer quan of the le ress. There sn palpble sil Iymphadenopay. Pvc examination shows & ‘ers consistent sz wth 2 20-week gestation Mammography nd core neal psy confi an nitag lobular ‘atcnoma. The patolgil specimen i postive or estogen and human eps growth factor receptor 2 HERS) ‘eeepors and negate fr pragevtran eeaptte. Staging shows na tant metastatic eh of he allowing ‘he most appropiate management? (@) aednerapy ony (©) socal resection and radiotherapy (© sural resecion and chemomneapy ‘ormona erany ©) Hormonal heany and wascezuma aaoterapy and chemotherapy Omns al <2+> a ae A obese 24-year o pumiranid woman at BOWS" GET comes tome pica fr afolen-up examinaion tra {age of 11 years Vital sins are within noc limits Examination shows a3.0-cm, nonemobil, frm, and nonender mass _ Inthe upper outer quan ofthe let rest. There sn palpable ily Iymphadenopay. Pvc examination shows a ters consistent sz wth 2 20-weegestator Mammography and cor nese biopsy cot ‘The paola specimen i ositve for euegen and human epemal growth aco feept® 2 HER) pots and negate for pragestrane ecptos Staging shows na data tata deare, Whe ofthe fling eee a as ee a ee eT ee ase ae area ene cm < « 2a oss although aooherapy suse forthe exe of rest cance in nonpregnant combination wth her Uherareutesategis sch chemotherapy, sugey and bemonal erp souls nt be used nthe treatment of rast ste ‘cancer dung pregnancy Because ofthe isk of fetal Gamage. ‘ula resections associated with imal sho the fetus equals of gestational ae, bu adimatapy should nt be ‘eed during prognaney Because of he ink of etal arege ven after test mest ivan the pavenS Umer size ef 3: em, he als tothe category of MOM-rsk BAUM aN shou, meteor, undergo adjuvant chemotherapy 9g eee eaee OUD s al <> “Tramturumab can be consderedinnoprepnant patent tht have an HER2-pontive tamer. Curing pregnancy, Howes t shoul be avoided ecase ofthe rskof fetal damage “Although surgi erection recommended for he westmant af gotaorl beat canst Beaute of the low rik of fetal ‘damage, his imerveron shel be combined wth a syster therapy satay in hs Mrs east cance patent Abe pat it tpn ets pes eA el et ae etl er ‘amon ts trestmentsconramlcteé nal patents wth pregraneyasSocted rest cancer because oF ek a tl anaes, “The combination of hormonal therapy a rastuznab ia rconsnanded advan exten ar surgical ection for ‘etrogenrecestor ponte, HERZ-postve bear cancer, However, blk ete! apna ar cortadested ig rearacy because ofthe vk of tal damage ‘aloough cheney maybe Stely anita. this patent adleterapy i convainaeaea dung pregnancy a may “Termination of pregnancy not ecmmended ia ths pater cau heres Westment alae thats aaocated with only ‘minimal nk of fetal damage Furermere pregnancy Yrminaten sro assed Wi Beer DEAS Cancer SUNN. Ons « <++m> ‘48-year-old man's rough 1a the emergency deparment ater he was founda suporous sta wha smal cut on Ie feraead on aot night n Rot ef he apartment: Nom conrat hed Cental nd he mentored nthe megencydeperment. Twelve hows ae, he yells fo help bcase he heats the wallpaper heatening hs far. He also hana headache The patient stared rng regulary 10 years ag abd consumed ito eda pit 0 amnion. He coccsionaly smokes maniuana and uses cane. Ms tl sgn are whi normal imi. On metal satus examatn, ‘he pants alert andorra, He appears markeay dessa and is aphareic Ale digital vem on Ms Hg aed Ienoted: The emai’ of he raufclopielsxam shows no abnormaies nn tocclagie searing poning Which of the fllowing ith mos ay diagnosis? a > Phencycdneinoxtcaton @ ») ol 12} ter psyenene asorae 4 BO Omns al <1 +> a a s-yacttman soups me arin pret ares oa stp sate wh asl cob a ° Ptah oe sat ght nfo fh spate hanson fender haan ew mene ne igen Septinet eee hows it, eet hp se ese a cee mots marine ns es cea Somer sis a Shep ae pas rareah assed aa shred ea osha ‘tho te emanate hale tam sow 0 sna tne ncaa en png of thetatonig tbe mse eg Pn rt 8 oe he ptt’ esr mac (SAE SRE EST 2a « oss J > ‘he presence of alacnaions ang he walipape pes hac sensor Gey ala and ented a eas | hous sne ths pate ot alcaole beverage sugges leaholiHalucnas Ths patient dl labo onsumtion places him a sk er alecel weaves auteromie hyperactivity ea any, apres, Mo?) supports this ~ ‘Sagres lahol halacnsts usual resohes win 241048 hors an aval stam an be manages xh Bensoiaepnes. i B Acanot use asc Fence (FOP toxin can cause hallucinations, 2 seen this pati. However, phencyclidine intoxication csc ‘aune agtesveness eptaton and iceated pun aerance, whieh i ot consent wth ths patent ator. Father, oP inenteaten usualy ast 1-8 outs. is hereore uly te this paves stl oxeted test 12 Rous ater ospuatzauor. ‘Cocaine intonation can cause autonomic Mera. awit, Slaphoresi temen andhallacnations Hower Om Ds al < + 10> ‘Pencyeine PC, toneton can auze hallucinations a eaen nhs Flot Howatr, phuncyeliine mrolaton larly “causes aggressiveness sation, and incase pn teerance which ot consistent wth ths part Mtr. Furthermore, (cP imoneanon sual ase 1-4 hous es nerfre ual hat his patrol nested at ast 12 or afer ‘osprateaton. ‘Cocansitontatin can cause autonomic hypsratty (2 amet phoresis, temen and hallucinations. Mone, physical exam pial shows wl sign aborraltes (acca. hypertension and pupa ation whch hs patient lack. Furthermore, since ths patent has bers the hepa for ver 12 Nous, cantando unl “This pent’ alcoel use places hm a sk for tarme decency and Wericke encephalopathy, Homever, hes ot confuses and aks ophiaric or atic naigs on nersogal exam, malin sags unl. ‘elitum vemens can cause halucrations, a5 Sean ths patent However, OT usualy occurs benween 48 0 9B hous ae Inst ina pats wl have tl ign abnormalities eg tachyaria, hypertension) witha droped senscim (ack oF ‘reaver eorfusion. since ts patents Val ins end orletton ae normal adi st mwas Waly wn 24 Rous, note augtoss i more May. {nat peychoti decrder rotor payehoi corer an cause audory hallucmatons eee in ths patent. Homer the ‘diagnosis can ony be made in the absence of any substance 3, ards patent consumed ach vry rece. Futemore, Dates uth ie pechotiedaorder wl ves normal physical exam whichis ht consent ith ha pate utanomic Inperaouey antes, daphoess reron Ons al * preusty meaty 10-year Boys brought othe emergency ceparent 15 mints after he had a sezut. Hs = rather report hate complained of sudden nausea an ating shiny light” aru he corer of mouth abd ‘her Wife began ttching, Next he et eu aloud Scream, d/opped othe fcr unconscious, and began to ek MS sr and legs a wel for abut to minutes, the wat he hosp he Boy reguned conscious, bt as Confused and coud not speak cer fr about he minutes, He Rada eran Sve tet one week ap0 which Improved ser weatment wh sata ophen. He appears Ena an caro fecal wha happened Gute epsode is wal ‘gn are within normal rts nated to ume, plats and person. Cea tendon aft a2 tater, Thee ‘asclar pin at amp oe deep endon rales, Physical and neurologic exarnaions show no other normals, Which of th flowing the most ety aprons a ae) Focal seizure with dyscogntie features 1 Conuine scone ® Syenam chores Generated myociont Stee 4 Omns al ‘A preusty meaty 10-year Boys brought ote emeigncycesarent 15 mints after he hada sezut. Hs = ‘maths report he complained of fr wc Next he q He hd a fever and sore host one Week a0 whch Improves ster veatment wh acetaminophen. He appears nae a caro! fecal wha happened Gu the epsode His wal ‘gn are within normal its senate to ume, plats and person. Cea tendon aft ae 2+ tateraly, Thee ‘muscle pa at aemots oe deep tendon reflees. Prysiclandrewolgi examinations Show no other normals, Which of th flowing the most ety aprons 8 : at ©) Westnet mts anes ei a 2 - soos 2a ae) te cee ashy a ria ar ay een se Wn aaa see {3 ied are of one nemispare the bra a progresses wo mvlve bom hemseres. oe, these sezues beg wh 2 “ura nat may incu elings of nausea of seen shy ght. Ts paves nal acl Wehing a muscle convactors| “tere charrette of fecal tizre(epettne mowers on ore) The itera tone-clonle parton ofthe rizute ‘ccd when eos consciousness and beg eng all exeris, ae toic-cone sears, consciousness usualy ‘ett ly anda postal aha i th care, thrgy an cof) Beg. Bs Faoents who have focal stare wth dscognn features (previous termed complex paral swe se conscousness ‘ting ee course of me sizure,Alough ts patent facil tschng and os of consous ate suggestive of ths diagnos, Ihe biateral jerking meverants operand ower stems ae not charctaruti of foal azure In aan, thi pate remained conscious ring te ning of his zur and only lost conscuses he. Omns al <> ‘Convlsve syncope can have avery simi presentaton to tha of szares, icing a prodrome and convulsions iu to ‘ecieased cereal pesfsion As a eu, te apss MSL sometimes be made based upon stuatonal acts such as Drslonged standing, dhydrston, fs, and pam ich ae all suggestive of eomlive syoeope, nanan, pont conten In this pacen would make conwishe syncope an une agnosis. ‘enna chorea type mans a a symptom of sheumati fever 1-8 month fer group A streptococcal inecion ara 4 ommon form of aque chorea childhos. Therap, Mega and non-stereoyped movement of syentam chores ‘2 usualy generalized mbang ie hea, nec, a ibs) ad cornueus whe the pte is ava, worsening over Nous te day Motrsymproms may be stoned wth mated metor conto muse wasknes, nor hypotonia Whe he ‘ates story of e ore toat week ago Should rise spin of = oup A sueptococalnfecion, the ining the Appearance ofthe motor dutrbane nd the ak of athe teria suggestive of heumatic leer Uae era make he ‘tanosts of joerhams core nike ‘Cenralzed myoclonic raze ae alo attsciated wth jerking moverents ofthe ene body, which ese ii cae ‘Usual the szues beg Sue uthontprodiomes) and wee only brief impatient of conscusness. Though is ‘ates motor symptoms ae similar t the of macaresezres, he presence of «prostre, ha til ymptoms nd ‘osu confusion make ths apres uel ‘Cenerazed tonic-clonic seas usualy Bepin witha vague procrome eg ep Sstubunces, ghtessedness, mons ‘hanger, ane imably, pared cacarrato hour before the satur,faloned by = xe of eonsouses ith Distr! muscle convections (one) a musce etching clono. Though ths patent’ pe ad lover extent eiching s suggestive ofa generatzed tonelome seizure, the rial sure al ehaniges) and arise fac tartching witht lost oF consciousness woul net be Seen hs pe oF sez, o a gs 83 hone Omns al <5 +> ‘10-year-old its bought wo the phys because ofhgh-arae fever, mall nd gneraized tage for 3 dy. She retuned rom aaeetton to arcana Ran ¢ day go She tok the appropiate madistons snd mmeruraon peat {0 het vst Theres no family istry of serious ess. he apes il Her temperatures 38°C (1037) pulses Tt) ae crane) rn fg et hee tea ac rgd Tce 2) Soft ana nonender: the spleen speed 21 cm el the ft costal margin, Laboratory studless Hemoglobin 101 ga estore count 4.650 men? Pate court 200,000? renting 2.8 mg Toul rma Direct oa mga lactate debyiogenats 212 UL Which ofthe allowing the most kay to conf the diagnosis? 4a ® metro att st (©) Thick and hin lod meee (© owecrantobon ws (@ tesme es (©) Se cat ex (| wlestund ofthe abdomen . BO Omns al <5 +> o oe sto-yur-ot it aug sn bce of malar genazed gorda Bri | Somat revo spops meron snd nase oe toe vt Terao Nerf seus ess She ape et enperne 3-7 83 pubes a soft and romende:the elon he eh costal mara Laberatory tls shaw mee eo farrcone 200000"? os ae ge ‘clucose so mg/d ot Crenne cami 2 ydrgonste 2120) hone Which ofthe allowing the most kay to conf the diagnosis? - “he presence of hemo anes jaune, an plenoregay an dual who ha retuned from Baris indctve . ‘of mala even ifthe have aken adequate prophvacte measures & 2a ES et ee eee nes Ferree el Epstan-tr ras (5 While te nfecon I ofen aymptomane Younger chen, adelescers and acts ply eset io Yever male, splenomegah, ary, and pronounced tonsils epatomegay and unde ay Oca! a eS of Ipatie nthe abence of pharyngitis an toni, an infernal. Om ns al <5 (> “Thlek nd th Sloe smesrs are used to danrose malar. Tick lod smears are sed as ial ests detec the parastes, Uae tin lod smears conte te cages ano determine te oe of Pesmodum pecs, alana esspecea cde a sry of reer rae eee teas opel Aes Asa at South Ameri) ke symptoms, Gnd ecrtert fever spies. Fura etures clude gestures Symptoms Woking nausea} heptosplenomesal, [undic, and detection of rahe anemia in Hood tes. Bo “Tha dec amgobutn ts et Coons tei uted wo detrmine heme ami rere: melted ete by ‘gglthaon of RCS). The autoimmune reaction cap be wiggered by numberof conto, nding nections ‘erycoplasna, EV), aignancis (eg. CLL Non-Hodg ymphora), and systemic lupus mythematoss. Sine the patients ‘bresemton snot consistent with an EV or mcplasa infection, and CL nd Nor-odgin phoma cur ery peopl, annmmune-medited hemol anemia ui ‘Enzyme testing canbe usd o dee nambe fdas. nnd ih hemo anei, janie, nd splenomegaly, _guanttave ana ofthe GEPO enzye can be set rule out glcore-6-phongate dehydrogenase defen. hough “ntmalaral cua act as mane fr nemelv crises npabents wie GSP cereny, he conden does ne presen WHR Symptoms or feve, malas and mila, a is atetoeunthaly. “Th ule alte detects harooobin fom a Slod sample and ured to tran foal call ese feted indole reser nith nemo area a eadency wo infcons,andvaso~occlisie ses hat ae chatacerized by Sve pas of he Peres Coen) © Wi a al <6 0 > “The deer amigobun ts (et Coons tei uted o determine Fhemehe ami i svune- meted eat by _agglnaon of Rs) The autoimmune reaction canbe wiggered by a numberof condoning infections (eryoplasm. EN), malignancies (eg. CLL Non-Hodgn Iyphoma), an systemic lupus mythematoss. Sine te patie’ preseraton snot consistent wth an EBV or mycoplasma nection, and CLL end Non-HedakImphoras occur ty people an krevune-meaated enol enemas nla, _Enayne resting canbe usd oder number fdas. n india with hemo anemi, jade, ad pleromegaly, uantativ analy of he CEFD enzyne canbe ued to ue out lucane-6-phorphatedehyrogenave decency. Although “numalaral ous at as nape for nemovt crises pabents wie GSP deny, he conden Goes Noe BreseR WH ‘Shmptoms of fee, malase and mala ans Wereore uy. resent nth hamolytie ner tendency wo infctons,andvato-cclusive cise that ae characeaed by severe pa ofthe Dons, chest and abdomen ‘Stee dease onset unal ces a ery chon 6 years fae] and symptoms Nat ‘Notaly nade high eer, ths claaness une Wl anaemia vasound can be ested oases the ver and pen tha paint nth plenomegay asus, “anno determine te underaig aus of both these condone eer, ad the eMON enema, eet peeetnors ee oe) pected ge 8 Ons al <7 -0> ‘2 so-year-olt woman comes 0 te phys othe esludion of aque over te pas 6 mons. Dung ths tog the Patent has ako hada 3k 11-1) weight love she hat asary of Ratha [Link] we setuly ctne with her husband onl She does nt smoke. She inks one ass of wine pe day. Se dows no usc digs et ony redcaton i evthyonne. Tanperstres 27°C (8867, pulse 9 70/min and Sood rest 110) 70 mm He ‘Aedomiral exarnaton shows tndemess nent upper quadrant wth no reound or guaréng Laboratory studies ‘Stow aseium aanie aminouatsterase level of 190 Uy, eum aspartate amtansTase eal of 250 U/L and Serum ‘otal lub oul of maa ter bop sons lazma cal inflaton and sear of periportal pecemed recone Further evaluation of ts pater mos kly 0 Show which af the llowing ndings? 2a '@| ‘Seale serum apna tesoproten © ‘Posveam-soth muscle abies BE Ponty ami-mteenonarantbosie Oe ‘Decrees rem ceuopann concern Postve HBV suis antigen |e) Post perinuclear ant-neuopileplsmc anodes =) Pony amv amooces 4 BO me Omns al <7 +> 2 so-year-olt WOR comes othe physician ote elution of eugue over te past months. During hs seticg, the Patent ha alo Nad 23 kg (1-1) welgh love. she hat aston of Ratha thrash ir etuly actve wth ht husband onl She does nt smoke. She inks one ass of wine pe day. Se dows no usc digs et ony redcaton i evthyonne. Tanperstres 27° (88.67, pulse 9 70/min and Sood rest 110) 70 mm He ‘Aedomiral exarnaton shows tis n igh BBE QUST wth ro resound or uaréna Laboratory studies ‘Stow aseium aanie aminouatsterase vel of 190 U/L, elu aspartate amtansfase eval of 250 UL and Serum Further evaluation of tis pater most ly 0 Show whch af he llowing hnings? (9 LECCE NRCS TE EEC 2a Alhough not speci, the presence ofan elevated serum alphe-ftopotin (AF) nhs patient would be suggestive of hepetoclarcarcinome (HC. We Re synptors cul! la be ent HCC, she es na ink ats conc hepa ‘us infection, ero lesho se non-lcohole faty ver sess) and Me 005) esUs ae met OMS Wh BS agnosis, “The parece of erm a-smosth muscle antibodies (ASMA) ha peciey of SON forthe agnons of pe aatimmune hepsi Aioal sboratory dbormalties in autcinerune hepa’ ten nde postive animale andy (ANA and ieee eran gs ssc th oer rte omicna; ute rete Roi is aie BE Aseereetcheeet “The presence ofant-mitechondral aoubodis (MA) aS aSSocltes wi primary Belay cross (PBC. Whe er symptoms sh bopy celts ould tobe ree wth oC, she ack he symptoms and ndings ofa chlete procse (5 lei, ours) hat re Wok or Pc om te af <7 i> 2G semtmmminnneme her symptoms could als be sen wth Wison sas, se aks adconl findings f spor ths agnossneuoiaie ‘Symptoms, ayser-Flesene ings). ver Mstology may aso show recon as Seen ths pat ut ese cop “The presence of hepatitis surface antigen suggests acter chrome infection with hepatitis @ rus HEV Whe he aymptoms ‘ould aso be Sen th HB rector she hes rok ars for HEV infection ea IV 7 se, mull sexual Parmer nor ieveassocated wan Hashimoto hres, “The pretence of an love ranaforin stration i hi pata would be sugesthe of hrochromatoni anf Saturation» SON s~808 speci fois lags Wile her symptoms could als be sean wih hemochvonaioss, she aks ‘eon! ning to suppot ths cagnons hyperpigmentes sn, diabetes, aha ander htaagy Iemochromatosis would mestffn stow pronounced siderosis wth Fon depots In hepatoates. “The precacs of pANCA ators wh several aucune condion and mts rca contest wold be euppestive ofa ‘47-year-old woman comes othe emergency departot 4 nour tr the onset of abdominal and gh howd on 257 out of 10m mens. she has hd multe sina eplsodes over the past 4 months that rsohedsporaneous she ‘ks 2 pints of veda daly Se appears il Her trperstre a 28°C (D1) pulse 11min tesratons te 20/mun and los pressures 155/90 rm sh Is ake an fully ores Examination shows laphoresi an mule ‘elngucasia verte wunk ana back Tne abdomen ie dstenGe, there tenderness to paoaon in che nghe upoer Tne the patent winces ad het beath ates. Vou guarding and shiig dns ae preset The ve palpated Levoca count 16300/mm? Chore 185 moval roi Go) 2.1 may Abunin 31g ‘An abdominal lasound shows muti smal stones nthe gabled and id nthe gallate wal wth wall 2a rattan and acon (8) neovencue vain (© Abserial pracentae © ‘Open chlegysecomy BO a oats Omns al <5 > ‘47-year-old woman comes tthe emergency epariert hours ter the ose of abgomina ard rat stoucer gun. (Ey {57 out of 10 in ncensity. she has had multiple similar episodes over the past 4 months tht resohed spontaneously, she ae She appar ll Her erperature 38-4 (1011 pues 110/ma,resprations ate 20/ma and loa pressures 155/90 rm. sh I ae an uly ore Examination shows laprores' an UE ve the uunk and back, Te ebdomen i danced thet ls tenderness to palpation te igh upoer [undrant wen te pata = sned tne wth he eran and blot conta marin the ie mile Tne the patent wnces ad het breath ates. Voluntary guarding and Siig lS oe peset, The ver palpated Levoca count 16300/mm? Prothrombin time. 20 sec NR=13) Chore 185 moval roi Go) 2.1 may Abunin 31g ‘An abdominal lasound shows muti smal stones nthe gabled and id nthe gallate wal wth wall ‘This patient resem th cue chests acute RUC pan, fever poste Murphys Sn, and alld nflarmtion G)enuttesound canal dedsion-making is especialy ciel nhs ase hen hs patents 9s of ross Shing Snes ndetng sets, tlangertene, hopstomagay, Ch Tarcote-Fugh clas 2a « ‘ra rein an aculse ae oth s-tne testmerts for hepatic encepalopatny for whch ths pants at Sk aNen her ‘ones Because this pats mental stats appeas notmal she sot encepralopemhe, Om Ds al < sia > borderine-levaed INR, vitamin Ksuplemenaton i neflctive in patents wth clos, Varin i spy asst ‘ied by the net make cating factors Hanever the ners ante futon is cmpomaned asi choi) hen ‘amin K supplememton wil net have ay Sanficant effect on coagulation oagulpathie pans Wh cwThoss, eT Tagats membenes le, FFP) must be prowdea. [Abdominal paracentesis oth hagostic nd therapeu n patente wth ater Fabien wth nhote are 2 much ghar "sk peroperatve merbity nd morality, especally compaction of her dysfuncion ate present, Sees, ‘coagulopathy, encephalopathy) Feroperatine morality wcremes win CTP azar (grade 410% 8-208, C-C0all u the most emergent surges, emote patents shou have such compheations cece before proceeding to surgery In rdefo Iriniaze te vsk of suri morb,I Nscse, ddominal araceress woul all for aotatey ara of he sce ‘ud, ada, mould alo flp eve he gh intron! posure sented with ac, us deren te ck of sige! wound dehiscence Bo Laparoscopic cholecystectomy she standard weaorent option for noc good operate candidates, Whe ths patience chlectus shes ae evidence of ver deaace whch sgncay increas her peiperaie ck. ote Irtrvertionsar nesta before safe to proceee with celeyteony ‘open cholecystectomy is nda fr pains with colecystis #lapaoscopc approach alls ompcations ae Special ig deere Wh ts pte sheers’ aoe el meeps core ewer rot iseaes ge 8 Ons al <3 n> 1 22-year-old man comes tthe physica because of ght Sco Syeting fore past 2 weeks. He has ad ld ower stoma comfort forthe ptt 2 week. Thee fenapesonal a amy story ferou lest. He appeat healthy ‘ial signs are within normal bts, Examination shows gyecomasta Tere ro iguinal phaderopaty. Theres @ Davent asked 9 cough, the nagle does ot causes Bune The abdomen i sf ans nates. he iver Plpsee om pst te ight costal margin. Digital eal examinations uirenrtabe, Serum pha eogroten, LOM, and CC ‘mass wa variable echogeiy.& C1 ofthe abdomen shows rutile hyostenusig lesions on he hr ad Which of flowing isthe mest aporepnte net step n management? asain apy ‘cplann, topside, ana bleomyen theraoy BO teacoarn 3-fucrauac acl oral teapy ‘tam a wane oats Omns al shqucckimvematiaeprrlininmettiflerintactay athena cette: ee eae oem nee ea ee | CoE a a pone ep eroy eer ee corr eee eieereeeel Pearaiar gs teu leat ee eee eerie ee ee ene lymph ne dsechon performed. ‘A nonchereoenous, cyte tester mass wth a negate trnsitlmnation et and mulepehepste and mate ‘eslons sgh suggest of metas esl cafcinoma Cxvanod ata metastases A the Une of presentation ges ineresad FP lvls makes nof-remnomstous gum eal for (SCT the most aly type ofr me ptt) 2a ‘ ternal beam radiation 1 used to clear the reopertonel moh nodes of of micro-macrometstases in ery tage Uh tA 1a seminoratous gem cel tumors (SCT) whic ar ence asosnstve Ragan therapy sot Used inthe reakment. ‘of non-reminomatous gm cl tor |NSCCTs) becaute NSCETs ate comparthay racoresian. 9 ‘Adjuvant chemotheany with cisplatin, posi, and em (EF age) the standard of cate or weting tumor markers tage NC Maden to he adel ngualoretomy, he woul kay Teg 4 ces of Es regimen ve By Festal mors oun s al <3 +0 > 1 seminomatous gern cel tumrs (SECTS) which ae extemeyraiosensitve, Radiation therapy fot Usd nthe earment ‘of nonseminomatous germ cll tors NSCCTS) because NSCCTs af comparateyracorsstat ‘Adant chemotherapy wih csp etoposide, and leomycm (BEF regimes the standard of care for weatng ‘non-samiomas al sags. The patent has ies of avanced Non-Feminoma win metastases (ois heen rte tumor mater tage Il). addon fo heal ingunleehetomy, he woul Maly requ eyelet regimen at tothe aorancad ate of is cance, ‘Te combnanon of ucovon,S-Fuorourac and oxalplan FOLFOX) 5 used fr the test of corel ance. not [Afar an inguinal relctomy, athe suvalancecontting of regula low-up exams etal montarng of umer mater, “ad maging adorn ad pvc, chest 1a) maybe ncaa sles patents wth ay stage ‘ron seminomatous ger call tumors NSCCTS) thou levated tum markers. Any NSGCT of tape and above ony [SGT rh elevated timor markers requis spec orm of ajwant therapy afer ochecomy. ‘peripheral lod stam call wasplnttn ented for paints ho raqu igh-dore charoterapy, ich hat 2 Imylobiave eet Howeve, high-dose chemotherapy prefered in etcular ancer ove convene chemodterapy only pets el wr cept tesperse oe rcuen docs Song Hr fet ee ona eng Seca ‘Menspleeatien sno requre folowing the convenoonals-ne advan tery. ge 8 a Ons al <1 ‘a year-old ts brought wo te physica because oa progtessve selng of er nek Tr te past 6 months. Se as ‘opan,dremmes of ephaga She he CO perro gin ud he 5° perce for wot. Wl ear ‘ihn normal bts: Examination shows 2 3-em est, romende seting i the mine ofthe neck. Te weling moves Upeards on protrusion ofthe tongue There no eral ymphdenopathy. Her erm hyod-sbmlating hormere eel 1521 ime whch of folowing is the mst sopropnte nxt step In management? a Fie neele aspiration biopsy ‘xesion ofthe cst wack and mold Bone ‘ratonegapy ofthe nck @@|O| (©) CTacan ofthe neck ® (©) Sccson of est and pad one |G @) Secon ofthe at “Thyroid semoaraphy 4 |@\c BO Omns al <0 > sa yd i ovghr e aatnctn ofa progeine sang of terack rie pasts ments snes ES ‘no pain, dyspnea, or dysphagia. she ts at the 60M percentile for height and the 35° parcentle for weight. Vital signs a Sin noma ii uamoaton how “This patient should frat underge ulrsonograpy to canfrm the diagnsis of a threosal duc cyt, the oat common case ‘of mlatne neck mass {cpl nya tissu Is resent m many ptets wh the ciel features of 2 hyogossl ct cs ‘Since tus cc ssue maybe te puts ony Tunctonal hold sue, uasoncgraphy shuld rst be erovmed 6 confirm te presence of anormal hrld gland and aeeer he cat tchecure, a nll ato confi that rng! xeon of ‘the st would rot eu In postoperative hypthyoksm. Tyo function esting maybe normal even Hf ctopi ty id Assur teeny uncioning tate, butt may be el # he yo lan hs at abnorel appearance ots tot vues ‘ona, By. Congenital neck masses ‘ACT scan woul detect he est ara provide valuable ntormaton fer planing Suge ut K would aa expose te che {oration Tere are cher sense Imaging Moca that slow exporute to asain tobe soled Wn surgi resectn of the yroglosal cc pts sual noes encaon ofthe cat andthe hyd bone, mare estensne ‘resection required to prever rearence. However, oro 0 any surgi iterveton, te eagrests soul be conte and the presence of ectopic Byroid tsve exduses ‘imple even ofthe tytalona duct cyt i at he prefered sppoach removal dt he gh nik of ecarenc. Homer, por any sugKal nervenion the agnosis Shel beconimed and the presence of ectopic thd sue ‘nie yd srngrapny can used 1 fle ou cope yo Sues unecessary to perlorm ithe maging method of hoe evel oral had afectare and hyo facto etng ena Adon, apoxing chide 9 oats & Omns al ‘a &-yar-old boy brought the pysicar by hs pares for shor stature, Nee is Coting or is shoe sie have ‘hanged our the pat yer a aqualy bump nto abeacle sucha furtre 2nd hes Hedaches a igh in ‘hays ist for cold water ad has ben nating more equ The ears agp ead at asa eack nat Was uber. Hs mothers height 147 em (4 10 In and is fathers Regs 160 cm fm He ate 5 pererl for neigh and 5 percent for weigh. as tmpeature 2798.9, uses SB, fespuatons ae 15a, ane Tanne tage 1, ily ire absent. Pcl elses ate 1= lata, Laborato sues show nae 145 meg © hme o 12 meni Hoos 2mtgt at 9.8 mat Gust am Nomgia ‘Thvoure Shot lesuln-ke gow Facer 1 24 ng (51-255 mg/d Insult grown facto ining poten 3.2.1 mem (1.56.5 09m) a eseaton ss tect ©|@| Oe Autoimmune pelendoeinesycrome BO Oe nil shor sare ala) 12} ‘ranepheratoma Mul doc ope G fornelant and 5" pecere for wegh. as temperatures 37°C 96.57% pulse 5 98min respeations ae 15mm ane ood gressute is 10/54 mm Hg. Gamat shows af anc nomtnder abdomen. The genals 20d pu Ma fe ooh Insulin growth face binding protein 32.1 meg (5-65 g/l) wtih of ne rooning se mosey agnosis? Feeback 4a « ears oieantaeed Ca eee Ceara Cleese Chas (@ rary aoa B snow enner a oats & Omns al ‘an $-yearold bys brovgh to he pyscan yh pare fr sor sau, Nether Ms coving nos soe sche (IE hanged ovr the pat yea He sch fer od os RE hls for cold war ad Nas been “hve yeas go, he hd an asta atack at was {rete wih altel anda one-week course of trod. He mothe hs Hacker’ tyre and had precocious uber. Hs moter hegh 147 em (4 10 In and is fathers Regs 160 cm fm He ate 5 perere forneight and 5 pecente for weigh. as temperature 2798.59, uses 9m, respeations ae 15a, ane Tanne tage 1, ily ire absent. Pcl elses ate 1= lata, Laborato sues show nae 145 meg © hme o 12 meni Hoos 2mtgt at 9.8 mat hucoee Nemgia Tyvoane Sang ot (61-255 ngim) nding poten 3 21 meg ML (.6-65 wim) “Th boy har symptoms ad laboratory finding sggertne of mul hormonal deflcsencie aber nee, Secondary hpotiytidism, and growth hormone deficsency. Theft at the chi requeny Bumps ite cbstaces Oe ese tat Wc cislb crted es?ecr toe tee ceo 2a tong-tarm cmostrld therapy (for chlan wh nephrote syndrome) known to cause short stature. Homer, Iypopitunterism. However, symptoms usualy occur beiween the ages of 30 and 50 years and acifferent agnosis is move lyin ths your oy ‘chm’ syndrome, te most common form of avommunepovendoeriesynreme, may presen with ees thyonne lev (eto nypoctyedmy as well as polyra and pvp de coype 1 dabetes melts). However, sms rates rer comes orca mene etme 20 hd yea wat cman wah teal Tal ro ey hypotnoiim). cH deficiency sugested by deceased Ft vels) nd shot stature woud be unexpected Moreover, sel ers pico oes pth becak el adel ects aa prot ed pss pee ‘caused oy cnallabetes nsipius ther tan iabees mel “erent cause Tor shot statue's moe key on acount ofthe presence of mule hormone ceficences, headache, and ‘Arough alow mid-parerta height might does suanst amill shor stature, whch son ofthe most corimon causes of ‘Sort sau, presence of mute Normone dcerces, Neda, and visual el tes Suggest afer agnosis. ‘ranopharngiomas ae the most cormon cause of cir Iypopiarsm among chien Thc prasens with {eauresofhypopttaram such ss growth hormone defciecy an ndeated by lo \F-1 ard shat tate ete Insp as matated by potune and potapsa and secondary hypothrak'm as nokta by portion, low TSH and tom myonine eel Headache caused by compression ofthe accent brat parenchyma andor tihng ote dra truer na iat Rl tect ar th eno compression of the apt sem, © Ul eat: 1 + ean ‘isl ld deters. though ow mid-parenta eight might does suggest familar stature, hich sone ofthe most common aus of shor stare, te presence of mute hoemone celoencies, esdache, and wsvl Fld defects suogest a ferent gnosis. altar a int ct ee of cle Feri my che dp {eatres of ypopttarism such as growth hormone deficiency as nates by low 1-1 ard shot ttre, bees insipidus an cheated by pour and plein and secondary hypethracm as neta by portion, low TSH, a ‘ow tyrosine lvls. Headache! caused by cmorssion ofthe alacent bra parenchyma aor seeing of he dra tae hie visual el detec ar the eso ompesson othe op cae, Bo ‘Pavone ith multi endocrine Popla tps 1 (HEN 1) may develop ptr adenomas, hich can cei headache, wl ‘eld defects, nd multiple hormone defences (Gu te destruction ofthe neal pay and However, pity ‘sderomasin puters th MEN I sully deel rng acthod, an, by the time ptutary adenomes becom symptoms ater amostavays hae creased serum lum lvls to Grima yperarahyowm, which usualy the eres ‘large, non-secretoy patty adenoma may result n headaches, visual fi defects, and multiple hormone defiencs de {te hypontutaram However symptoms tually aca between the ages of 0 and 6D Yura ciffernt agnosis mare key tmase-yea-ols boy. Ons al < 20> ‘A 21-month-oi boys broug 1 the physica or a wel-cis amination. Hs mater nevced detormtes eather fas loge scab started woking topo He hasbeen bly apart om an oper etn ct fection ‘months ao. Hewes devered at 38 wees gestation. is Syeaol sister wes ese for development! spas of ae up-to-date Hes atte 4 percent for hla ana 50 percent for weg. Vil sigs are wth normal ims. ‘taminaon stows dosed ane aa posto fontanees. The kes dono stay gett when bo the Tat and Following i the most appropiate nex Step mmanageren ge 8 2a '@| amin D supplementation R © exssurance and follow-up OC He abductor brace Oe eo) emieionyaaes “Tia eseoromy =) ( sone 0D 4 Omns al <2 > BIBER) sbrougne 1 the physica or a wel-cis amination. Hs mater neuced deforms mw eomer fhe lege ses busted woking topo He hasbeen bly apart oan oper eatery ct fection | ‘months ao, He was davered ot 38 weeks’ gestation is &yeot-ol iter wes ened fr development! dspasia of the hip. He can kb and saya 2-nord phrase. Me plays well wth ther cdren at his ay eae. Kis mmuniations| ae up-to-date Hes atte 4 percent for hla ana 50 percent for weg. vil sigs are thin normal is. Examination tows cased sero ad pst tonnes, ‘RRIBERBERIIREER. the go crerertale. Te ratarseoncarod tha be Pasa growth rd. Wh ofthe folowing ithe most appropiate nex Step mmanageren Se ‘Yamin © supolmans ar vedo Wee ickes, Wile ck can cavs he gen vrum defor, as een inthis pain 8 sella the gen alum deformity the underiying tami D deficiency ents a atening of al bones, presenting th ‘elyed sing ofthe fontanelis,impared growth usualy < 10" perce fer heh, and further one ferme Ths ‘has closed fomanles an aepays normal gromth ana develope. “Th gen vara deformty Sow lge) enor i ehdren 52 yeas and rypealy caret tthe infant ears to walk an beat move weight on the lowe exemies. knee algnmee becomes petal a about 18-24 moh of age anus mo a gens ‘gum deformtyfrock-tnesh which should ere by age 5. Ths 2-month-ls development has een normal th land ne has met all the ge-approorte milestones, He has 2 arma gat nd stows no ins or smproms ofan underng| putholgialCondton 2, unlatral deformity, abirmally shor saute, ee, o nb Sueling. Regul TOW Up ‘harntaion ar recommended to mcstfe the nteteandyar tans art document the expected spatanen elon, By. cotton of rttopececomtons Om Ds al <> Aig tracing of he hip acini an appropriate stent fer chlren< mnths with developmental deposi of the np (OO. West cases of D0" ar detected orig newborn ereerng or well-chld examinations. eR untese, ayia of ‘he ipesus in severe gas abermales (e.., Tandeerburg gut and/or ceasing adduction contain of te pena ‘ars deforma, wth comenstry gen valgum deform), However, thx by has sm ayrpeomate gen vara deformity. [Additonal evan ihe had ODA, chan» 18 onthe sch this pate, surgical eset, and ot hip bracing, would tn patents wh gens yarum deform, an x-ray of th ower ntremites sony obtined samoiogKal vrs I suspected. ‘ar npr determine the undeshing disease, soning evidence of Bout dsease chats, Sela foes ‘Sevcopmana yelai ofhe Np) or 2 np of he eg. However, the 27-monthold ha shown normal signs of ‘Seveloprant ths far hes no get abroraies, and shows sins or symptoms ofan undetying patholgkl Condon, (25, unlteral deformity, abnormally shor stature, 25" pete fever, orm ling tracing of the lone extremities the apropitevestnen fx chden mth slour disease. Whe Blount disease can aso ‘resent wth bogs that become apparent ene the hl starts walling can usualy be differentiated from ysl ‘ars eformty uring physical examination, as tmanfests na trl using ak he the hee of the feted leg Ss ‘uiward ea time weight paced ond iceral oan tthe prxial al metaphys aoale prominence. The {hd doesnot have = prs bial defor and he as anormal gat making lout reser. Tc} Omns al present ith bow legs ha bacome apparent nce the cid sats alin, can usualy be aifrenaed fom psiloc ss defnyddio ries rl Mtg po Oh ace ct tas ‘outward ean me welgh spaced on and eral rotation athe pronal bial metephs palpele prominence. Ths ‘ea aoes not havea pra iia deformity are as anormal gat, making oun esese wrk. emepphysoden sug! westmant opon reserve for chen wth 2 patent pthalage gens vam deformity ‘espe appropriate medical management (eater vitamin D supplementation n= Ci wth ikem enables guided ‘rom by seletvelyitrrupting the grow plate ultra. However, th 21~mont-a ed has no ign symetors Irecang a patcogie ger varum deformity, ulate deformity bnormaly Stor stature, fever, rm sven) “Tl osteotomy isa eaten option erred for crn wih peste pathological gna varum defor expt ‘appropiate medics management, afer amin Dsipplermenttion n= Ci wth kes. Howes this 21-month-ld {hls no sgn or oympomsnacatingspaholgel gen varum dere ister fam normal shor statue fever rim sweling). ‘bop ofthe bore mignt be nated in patents with cnc Textures and/or maging suggesting a bone turer ie Gang sarcoma, ortesarcoms arly 2 mapas can cause asymmetric bone growth resin 2 unlsteral ather than Datta ars or vals deform, Usually, magnet bone tumors ate assoctetes with localized bone pa sling, 2860 sere cat eee right swat Hower tha hd hasan asymptomate lateral gen var deform, Aol. I abone rumor were suspected an x-ray wuld ete mt tes of cole and would be performes prior t 105 Ons al ‘2 2owoeklé newborns bought 1 te physica by hi patents because of poo esding, enka, and equent : hours: bur the pan often sp up or eases o eat. Hepat nas bom a a aha 8 Fs bows overeat Sohours of ie has snc had one bowel moveren day He a he SO™ percentile forlength, 10 perantle for a selon ana #0" peeenie for nea cremfrene. He doesnot appenre be nasi eres Fl tmpersire a 38S Guest c 140m, respons ar 40m, an loss pressures 90/60 rm Hg. Pysical examination - ‘Shows that pate axel ese cad ae at rca toe aed ge space bxaree he Brat re Second toe [Link] abdomen stand When the ge removed folowing afta exam, teres . epost lene of tal om the patient rectum. An aay of the absome shows aecion of te clon ole by | teoment of son wou tol ora Which oF ne fllowing et ikey to conten me nanos” (CF sean ofthe acon “Trantabdomina lrasoneaaphy # Sas (©) Guanutaveplocareineimroprress F)secalsucvon biopsy sy © tops hase e ont me Omns al <> ‘2 2owoeklé newborns bought 1 te physica by hi patents because of poo esding, enka, and equent = 5 houts, bu the patent cen sp up or eases oe. Te patient nas bom a aha of fe Hear scx had one bowel mover! dy Hes athe SO perce or lng, 10 perce or ‘elo ard 40" pecentie for hea crumfrence He doesnt appear to be m acute ress temperatures 38S Guest c 140m, respons ar 40m, an loss pressures 90/60 rm Hg. Pysical examination how thatthe potor hasta low-ret care, z broad and fat naa ig, at 2 age space bute the fst and Second te biter. The abdomen sdtended. When the ge removed following afta exam, tere an PEt os iors nora cnt cae “This newborn has festrs of Coun symdrome ard was noted st bth to have late passage of meconium Which res conceof Hisesprungs aseas, The cent sympios f poor Teading an ious vriing, exam ess of Shiomialdsteton and explore soa late upon rectal examination and cry ning of late clone xgrent ‘ronal tan empty segment further crease is Suspicion “ eke fo let nero apace ala ede cinweal peal aoc co “eteton, however, n chen n genera aps even mae on enters sich atti oy at 3 wee of 296 CT sean chou be avoided wnancier possible because of the exposue fo olan asain and i inca ik of ng complications (Gg, ralaton- related cancers) Aare maging techniques such a ltatonoraphy 2a ME ae sor aye Detered. Abdominal CT Scars ae ot nated To the agrostic workup of Haschspungés asase “ieabel eaapy eeepc ls pol ae ose ea oe malformations ofthe abdominal cay (ea, duodenal eves Whe fredinas on abdominal ultrasonography my Suppor the ‘agnosie (gn alata colonic segment) gen spor postive pede vale utrasound doe not pay an mgortan ole Inthe agnosie of irechprang dacare oul arta ot bean appropiate confit tat neh patent Om ns al <-> “exermine te lena ofthe azanlionc segment proto sugey may show a change m cae along te feted clonic {sament a coneticted dst bowel ana prolonged baum etenvon Gaim enema useful for excluding Hsehspungs ‘the diagnosis of hitschsprng’seseas, Furthermore, false negatives are not uncommon with barium enemas, e4), because of free ee ec eran eeteycietia | areata ar ae “Areca ranometr useful srening etn chen > 1 mort of ae wth suspected Hirschsprng’s ese. 2 pave ih schsprun’s disease, he et woul show a abseateaxauon fe ofthe eal aa spine. HomeNe, {Trorctl maorety fet perfor inneuborn bcaureadequme coperaton event for thc procedie, Ts ‘ou not be the appropiate et or is nebo a9 wack of age ‘avaneratveplocerpine iontophoresis the gold standard test for alaanesing cst Hoss About 108 of children wth ste ‘joss have meconium seus, bh prasers wh delays passage of meconium, abdominal sterton, and possibly blows ting, Asbo ory ght la shew eidencr of led wl lop, sc van hr, no analy the ral bowel is atected ater tan the colon Wie the cia presentation wou be simi te that een inthis pater the fangs oF ser elec eel eer ed re el Dr ree emt eee ‘esse etl blops the gol sancard conrmatry et for uspactes Hschsrung’s dsease canbe permed ae 8 {al-thcknessbopey cared out under general anes ora areca sutontapay, dey athe bead, spring the Ome a <> “Quancaieplocapinelontophrei te gold tandara west for agnsing ost Tose AbOUE LON of chien wih Ete ‘bons have moron leur beh provers wth aelayed pasrage of merontm, abdominal tention, a psa laut ‘oming,An abdominal ory ight lo show evidence of ltd Howe! loops as sean her, hough val th sal bowel ir atecte ater tan the colon Whe thecal preertaton woul be smd fo that een nth pater he fangs oF ‘explosive tal release yon etl examinvon andthe asocton wih Down syrorome i mare suggestive of Hscsprung’s Rectal bop the gold stanard confirmatory tet for suspected Hirchaprang’sdacse canbe peformed ether a ful-meess bop, cared out under general anestresa, ora areca sucten aps, dec atte ease, sparma the paver the aed to undergo gnarl anesiest, the biopsy Shows ah absence of ganglion cls at adequate usu Sree, {areheprongs devas [Link] py rera ten fom acrec Qs, 2 prorat tat) ‘rally re ue Hrachsprng’s sete er . 9 LB trschsprang’s ence Se eu eon ge 8 Ons al ‘42-year-old man rough ta the emergency department 40 miewes fe fling fa 10-fot at He has severe Fe apes’ uncomforabie Ms emperatie 8 371 BREN, pls 98 rin respraions ate 16, and ood presure {5 110/80mm ig. He alert and arented to person, place ard tm, Examination shows multiple arson over bath lower enemies, Theres sweling aa tenderness ofthe right ankle: ange of adn Is Ite by ol The render of ‘in ofthe ont ane BO ong eg ast ‘Ope ection and internal aon Xray ofthe sone Omns al <> sere cian compen seiegme torment no te ONE mes CE a Fer anpen ie eoee oy tities cee ipctecee ta cemcne ree Se SS 49 « Abhough ai might provide more formation aout he ctr ahi maybe wef fordeciing on 2 Westman ppcoarh ‘special th case fanart ace) and any associated sot sue damage, tere aire aceon hat hull take precedence. ‘Anough aT sean might prow mere information about he Fracture Nhien may Be useful for deccng on a esorent ‘opronn, especialy ine case oan iar Factre) See a erent ntrvenin hat Should ake precedence ‘This pave sustained a high-energy rau nury, which warants Further study and etme ‘Along eg cst my be ncaa for sre facies, particu of he dtl ema, atl, bi, andor la none of wich fret casein cis patent Om Be al Although 4 CT an might poue morenformtion about he racer ach maybe wf for deg on 2 essere “oprah, especialy the case ofan inzarculat Fracture) ere ferent nerenion tht shold ake precedence “This vent sustained a high-energy rau mun, hich warants Further study and retment. ‘Along eg cst may Be cated or Some Nace, parca of he tl emus, atl ia, and/or Tua none of wich Sethe caa ete patent ‘Open rection and tera fiat are ciated in aves of placed pen, pathologie ctr, rcturesimaing ‘neurovascular compromise, ne of which ae the cas ths pada Pavan sustaing clareas aus duet fal om a eight ae a SK of high-energy anal oading yrs, 540) as ‘mprestonfatre afte nec ro the femur and lamba vrata, othe easy xray af tetera spe troas-specram ato therapy sequen th case fan open acre, WhIh his patent doesnt have ge 8 Ons al ve weeks ater cry, 2 1250-9 (2-1 0-22) male nenbor as respratry sues. He was bora at 26 weeks gest ‘ovieton fr 5 days. Hs temperature is 38° (9827), pulse i 148/min resptaons ae 63min, and lod pressure i 50/22 mm Hg Pare oximetry on 408 onygen shows among stration ofS Examination shows moderate Invercomtal ans subcoml erations Setees cree re nest inte thor. An cra fhe chest ows ee (ranula denies and acl elects, Wich ofthe fllong fete most iy Gagnon? @) Techeormtace (© wenchopamonsry dysplasia merit emphysema (©) Borehole cera 4 oats Omns al <> esctisate aeya ise gia tad means nse ares ‘ventilation for 5 days. His temperature is 36.8°C (98.27), pulse 1s 148/min, respirations are 63/min, and blood pressure is 1 ee ee es cee lcs cci cee ase an pero eee eee eae ret of prolonged incubation and te developmen of conc ung dase, Wine racheamalare ean alts case rexpatry dates, he petetng symptoms hee ae ot consistent th the wheezing land sido pic sean wih ahaoralacia, Moreover, the reported oxygen saturation of S18 on 408 onyge represens woul not elim hs patents cra finding. “This monat as Several sk atts forthe development of pueumona fusing prematuty ana prolonged iubatn. Aalsough apes fis imi prerenation ar conta wth protons (hypoxemia and tachypnel key asin! {eatres are cbsent, such as feet, cough especialy = prouctve cough oF yal 2-ay findings of lobar proces. Ths ‘ronchopuimonary depisa dv to beroueuma and oxyoen tency «complication of poanged mechanic velo io {echypnea labore breathing (itercosta and subcostal reactions), FiO: > 30 wo maintain peripheral saturation > 90%, end oe OUT s al although arpects fhis cima presenation are orate wth preumora(yposeri and tchypnel ky asi features are csen, suchas fer, cough sce 2 produce cough oF yl ¥-ay fangs of lobar proces. THs patents ray traegs ae more naive of ten cordon ‘ronchopimeonay dysplasia ce wo baretvauma and oxygen tx 2 complication of prolonged mechanical vention (eer et cee itis erie rents the Gace rescreatoe o BP ach cces prc {acrypne,aboredoreathing (nercosal and subcostal reractons 10 > 30 9 marman penpieal aturaton > 90% and ‘mug ganar denstes with basal atelectasis on X-ray. Lae nthe ease Course, espesed GSU areas ana Tse ype ofthe tng can [Link] of EPD primary focuas on lmting oxygen oy and preventing complications pectiealypreurthora,ctdiovasclr clase, nd poral ep). Bo Tectia eihacen poemiy el pds Pot ‘of whch ae prsant her. The cic presenation | entreraly arable and can range From asymgtomate 0 severe hypoxemia secondary to compression of wal catlapumorary sv ucts In hese seete cases, complains such a5 rerum asating fom the ung hi ater than he cise nul Sensis arid basal telecasts sean this patent, making tis agrosis nley. froncholsobtetars (2) scassaly Seen npedatc paves wih 2 history o Seer ung nfecton, especially adenowus proumonis ties postble cure of xprtory dats a ld and cry ndings eof norapecfe: Most often, however, he peseation of 6015 vag, consisting of coughing, wheezing, and shortness of brethaithough che putophysniogy snot ene understond, symptoms commonly delay ove Yeats SO woud be unl ins S-week-old Daler rh no nstor of sancant infecton. ge 8 Ons al < 10> | S-yar-old man comes tothe physica because of terment throbbing Metdacres Over te payer The nesdaches sraveorssuen he wakes up ad sano accompanied by ther synpoms ha pat ao repere rouble caneenetng tn datas a wor, His wife has beer complaining aly abouts String ding lp, wich he abuts ois ‘ron unin Hehas a hatry of pertain and an allergy to dt mites. He has aked a peck of igure day for layers ie pugs 72min and oo pressure 150/95 mm gH 175.0m (#19 tal and wean 12049 (265 BE is 37.9 kg/m, Neurological and cutaneous amination shows No abnormal mich 6 the Folng he moet lialy ease of atin hypertension? Law eating free tyrxine eves 1} 3|@|@|@ ypopyse neoplasm ypersecretion of edosteone le 4 BO Omns al <5 > o a ‘A se-yer-id man comes othe psc Decase of REINER AAAS oer he pst yet. Me nesoanes (Oy ° ES and sent acompaned by ata septa. Th pata als report Gn daly sts at work Hie hasbeen complaining atl about Ns BR ring sep hich he ates CON {tronic san, He has sory of hyperenmin and an aergy fo dot ie He es ached a pack of gees daly a for 1s years Hs puss 72/min and bod pressures 150/95 MMH He 175 cm (Fe 10 tal and wens 12049 (265 BEMIS 7.9 KAMP. Newroiogial ans cutaneous ination shows no abnormales mich 6 the = folong he moe tay ease of patients peter? 6 “avert with this condition ae ypellyobess and sf fom dally headaches ad signcant daytime Fatigue, often ont {ating asleep for sor parods of ine, Foysomnograpy wl confirm se dagross ow excusing foe thyroxine lvl 56h hypothyroid oul expla th ypatensin, pans pated cancenrston, “and obesity, Howaver, lacks other characte estes of ypey rim, sch et cold imleranc, constipation, ¥ hyporelea tradyeari and stn changes ng cl yor. myxedema, at os) efferent pthogy amare key Stee ‘aus ofthis patents hypertension. fecmet “The calupse of pharygea muscles ding leap latng to rocuna upper away obstucoe Is the mala mechanism tary haute sony apes (SA). Typed fstares cf hr samen porter eorog, ras tarda and oor concnaton, a een in span. Noctura apneic episodes In eis With OSA esuitin hypercapnia, whch recente Selene at a creer pert ley oes ate sleniness, fate and depression. Obesity, expecta around the nec, se most Imprtat nk acter fr developing OSA, “and neght es wl fen improve syotort By onerrucve step apnea ‘vooohseal or iui adenomas can cause amass ff edna to headaches, a seen in his eatin Secondary OM Peat leon ‘bor Concensaton, as Seen wis pavent Nocturna spre e005 Malus WA Usa FeSut i WEIN Ue, eee set cere at aes Vesey bral ibe reds atin slepines, fatigue, and depression. Obesity, especialy around the rec, se Most prt’ Wk facto fr developing OSA, fest bee cy meer By Oieetie secre ‘eypoptysea cr puta adenomas can cause 2 mass Tec easing vo eadaches, 2 Seen ths sat Secondary hypecorialam dus to mereated ATH secretion fom 2 funetond putty adenama (curing rete) coud asa explain ‘his paves hypertension, poor concentaton, and obesity However patty adenomas usually cause visual fil dec (ed pebble seen! Ur aid byes ae ‘utaneousFestrs of cusingSyarome eth sh, te, bale hump! woud be expected patents wh Cushing ‘Apheceomeeyom 3 benign tumor of the cromafi cals nthe aonal lan, could expan spats hyprarston| ‘od itertant headaches. Hever, te headaches associated wih heoch/omocytome apically paonal ad {rcompaned by sgnicant seating, tachyarcia an palo Eaty moring Meadache, oben. etd snonng nugget afer! ‘aus forthe pavens mperension. Fem peadovttonam ean manor wh ypertnson and headaches, However, hypetalostraniem woul ot explain ‘is paves soning or obey, The presence of Wes Testes suggests = fren diagnos ‘Low syrup serotonin eels are asociated with deprestion, which can manfest with weight gana o concentrate and ‘ovo headache ec grain) ut wes not cause hypertension. ge 8 Ome al ‘A 56-year-old man comes tothe physica because of owe back pin for the pat 2 weeks, Te pln tabbing and ‘Sheg ney rl inn eth aco slag tpar te waeMg bfcamen wor Th pa hasbeen geting worse, and haha stared Yo nce occasional numbness and clumsiness whe waking He has ppt ae pera iy ce! cerns kc: aetna wenger 37 (58.9) pulses 82/m, an blood pressures 133/92 mm Mg Perper pulses ae palpable nl four excemies. Neutlogcal examination shows 5/5 suength inthe upper etemtes and 3/5 svenoth in Batra foot drseion, of eithar the ight or lta causes pain eating down the plate leg Which ofthe flowing fhe mos appropiate Za BO B) Etro sesimenation (©) Maer amar sine (©) cr scan ofthe abdomen (©) Treepeune exes eamen (©) berote mtnseaton and wip 2 wth 4 oats Omns al ‘.56-yer-old man comes oe pcan bees ot foc th past? wets ne pan tng and = ie tis wens ed shea aie aetna et ome ee Sve omer, pale ez rian od pesre' 139/92 mm heroes we al owes. Newroapcal xamason sows 5/5 sngth the upper eames and Steer ene crs punta owe he pal ach he loge Mo appoptte “uader-onset back pin accompa by radar pain shooting down the leg onthe trait eg rave eta Sensormetor stanton n specif spinal nerve strbuton Igy sbagetve of key.) mbar dc herition 2a Ai ry she ete eto pets i ese bak preven a pete Cg sin of ‘osteoporens) Ths paint does ne neve ary san cant nk factors fr esteopeross ea ede, conic gucocrecid use ‘port mencpausal emai) a does re have ast of igficant Wau fal Hor hagho, making vertebral acre Lnyhvcye stdmenratin ates nonspaciic maker of fenmation. An epidural abscess or bone matsases wou cause {elomted Etta could preset wih wat ck pan and LA vdalopaty, Hower the association betwee hem ing ‘nd re onset of syngas nts pater suggests an aut mechan mechanism of lu Aatealy, Ms patent lack ‘ofrsk aces eg, sory of cancer oF immurosuppession) fever, or oer constutonal symptoms makes wrecuon ot Frlignany nay Fnaly an lvated ESR would on sugoertannfsmmtory proces an weil not spar any specie ‘iagnoss, Sole would be utely to sigticanty att acute pte management. OM sa 7 10> tunis a frs-tine west for laansia isc herniation wt sseoated aclopathyn patents wh progressive or severe rotor ders, sade anesthe, way fete, o uae! symptoms (een spa, a MA recommended 2 ‘confirm te agnosie. Frogrestiva eutfagi efit should fae conern, ah they may rq erergeey sue ‘oneton ape assessment of he lesion required g fei begeeentreer eae ine 15 to detect waa, whch spel causes cacy, ular Man pin has ee, and uals woul 0 ot apa it [eroated wth eur andor hematuna Ths patent har none oF aewolge mpm. aN “arapeatc errs, pla hry) at of conservative therapy or cesta oF warp abet. “This patent's progesive neurologic symptons and moor weakness should ase concen ofa complied ds erin, Enercine could woten ths conden oo orpcated disease shoul be ruled out at i th tient 9 OM Da al Abdominal CT scans 2 sting et wo detect wlth’, which ypc causes clk iat nk pain hats Ssronates wth run and/or hematuca, Ths patent has none of hese ng, and uathass woul a aot explain it reuroioge siretoms. Sc eae epi fecal te at Vere each seni iat ee “Ts patent progresie neurologic symptoms and mor weakness shou rae concen of acampliaea dsc hemito, [eres auld worsen tus conden s0 complicated disease shou beled out Sti ths patent Feces eran sel 1 vst rrr Fae tr ‘his patents progesive lateral euolgie symptoms and motor weakness shoul, Roweve, rie concn of competed Fsameasuemert maybe part ofthe nual workup of a pant with suspeces prostate cance. although prostate cance Can rPetataiz tthe verabrae and czue ace back par, 25 enone and would nor confirm 3 agnor of prota Cancer THs patie’ ak of 5k ators eh, HSL of prostate cacer uit symptoms) an the consttutons! Sr pote cere edly Merce, oc Eeseccs tony Wire comet ten paler ages an acute mecarcal mechanism of. Ons al Fv dys ater uncergoing gh knee atopy for ostesartits, 2 66-year-old man has severe pan inthis ghtknee prevarting i rom partlpsing im pysial hrepy. On th hid postop dy when the desing was change, the Surgical wound appeared to be tc, sgh swollen, ad had a lear eceton He has ison of abetes, pps cat bgps et’ Cart seater emer repel ern Fs tmp 37 517 pute 94 min aha loos prestie i 130/88 mm Hp Hs Nah ene swale, enemstous he ‘ender wo palpation. Tate pain on maerant of te it The medial papell skin nein appears superically Incision, Which fe Filing the next es steph the management ofthis paten?t ge 8 ont 2a ) sucpealsepndement @) naan serpy (© sh arating (© | seo o onan (©) ves ares (F) Arepic axzeng Omns al <> am Fe dys er unerglng ght kage atopy for osteoanhis &6E-year-olg man nes severe pan ins igteaaee (Ey prevarting i rom partlpsing im pysial hrepy. On th hid postop dy when the desing was change, the Surgical wound appeared to be tc, sgh swollen, ad had a lear eceton He has ison of abetes, Epps catlfps tet’ Cart eset eck mera repel ern Fs traps a 37-7 9.17 pues mm. ana blood pes 130/68 mm Ho eae kee a “mee pein on vere of eo. The medal ptaptli skin cian eppears superisay pened ns ronal and al part wh ‘ten Ines wich fe flour is th wx Dae sep ne anager of th acer aa aaa 2 = 4a “ sis a “ences, aneling, yea, hlack sin, and wound dhicnce age sin pcos a he non se The fra ep in See Ineton sn iene oun cehseee By. Wound weatment ‘ates common sed to vee memicla-snsiveStaphyococusaueus wens (ecu, espe, ‘rdocandii, ot) that 2 ary aro spectrum of cy a lacks MRSA coverage. Though kroner spear anes {He ineated fr ths patent, Kis imperative 0 Femovecetazed, neice hat My inp wound Mel ‘snorting useful mcses of extensne shin fs riage ass of necrosis. This patents necrosis is curenticonfned {othe incision st. hn gratig maybe cced inte cue the wound eae poor or the paint develops & © Wh essere eter oe iecon Soa tuterwouna sence By. Wound testment ‘afc is amon used to West memclin-snaiveStph/ococut aureus wees (a. clue, erspes, ndocandii, ete) that 2 ary aro spectrum of cy a ake MRSA coverage. Though broader spear anes {ncaa fr ths patent, is mprate 0 Femovedetazed, neice that My inp wound Mela, ‘on artong useful n cases of xtensneshn 155 marge areas of necrosis. Ts patents necrosis is curenticonfed {othe inci ste. hn grat maybe cced inte cue the wound eae poor or the paint deveoos & ‘asec infection onignating from the nes sn ‘Removal ofthe postess may be ndicated depending on the depth of ness, but would ot be appropiate ithe necrosis upericaly onined othe shin ‘vacuum essing ingatine-pessure wound desing) acaerates wound healing by nctasing Blood How a reducing Me “rount of nflammatey mediators Howser ft des not etre Sood owt necrotze shim nd shoul nat Bete onan Infected wound “Anise desings are common aren the eaten of sal ty wound (2, mires, “This Woe of sessing Is msufcent fr age necong infected wounds ge 8 Ons al < sri > ‘21-year-old colege student comes to te emergency department becase of wo-day history of vomiting dd ‘patne pan that ante tote back He hat ahitory of stp dermatis an nacho thre He ony ‘medication i levthyfoxine He has not eehved any oie vacations He mks 1-2 bers onthe weekends and cesonally sme: marjuana. The patent appears distressed ands aphotte hie tmperatren 379 (100.27. pulses 105m, resprations ae 16m and lod pressures 130/78 mm tq Physkal examination Shows abdominal {stron wih eaderness to pation ate epgas um. Tete sno Qua otfeaound enderness hn examination Sere celal vl eed eis bead eet eed eer oncenration 815.2 and erm acum concenatan 87 hg Which of he following is th ost appropri La @)| Messe rae mops BA (©) fever an espnagogastoduocenescopy | bean an upright xray of te abdomen ‘esse serum pe levels (P) Mesure ool lear oe Omns al <> o ce, | Aisles den cones een apm ei fn yo oming a fear soy ope dermatoses) eden eveyone eshte nnn, ks? bee oh heh Cecnonly mck matuna The ie spa dived nd pee sempre 371007 a Buses 0s, orators we 1 mn saben reo 30 Tema sel xian shows a a “heen rang er curacy on amnion Ceram an rer oceans 797 /OeMBER fe lawn ee POE on ea Ry 2 si Za « e ‘A pilocorine-induced sweat et canbe used to diagnos esti brs, which can caus cate pancreas: However. e¥3e See tress mre en eer scene paneer many an sane te ane oF re ‘ots woud bean epiodeof cue panes ge 21 tn adn, te pale’ cutaneous nannorse make aot esse of mamps lM antibody levels can be sed ro dee aca mums infection, a ae (< TS) nus of acute panceatin Ths patents ak of aidhod vaccination nlacing the MR vaccine) puts a sk of catacng ump bitthe peak incidences 5-14 years of ages Moreover, he has no other Symptoms 0 SoQgeS ace MUMS IneCEEN uous, on-atade eve, mals, headache, For) "sophagogstvoduodenoscopy (GD) san ivasve et hat can be wef in he evaluation of patients with dysphagia, ‘samophaci,hematemeas,Remstocheri, alot milena. An ECD can be sed to haoaepebi alcer atae, Wc can Om me at "sophagogstvoduodenoscopy (GD) san ivasve et hat can be wef in he evaluation of patients with dysphagia, ‘saynophagi,hematemeas,Remsacheri, alot mele. An ECD can be sed to hagoae pep sce orae, wich cat ‘so presen wen acute eplgesec pain adatg fo the back, However, hs pallens mpocalceml and erupt xanthomas 22 rote consistent won acute pancreas, or which ECD woul tbe Mega. ‘ophthalmic eed fetes for perforation of the trator t lz pancreatic ‘lieaton associated wit conic pancreas. aud ot be help in agnosing or deeming th cause of ce Pancreat The patent here doe at hee signs of an acute abeamn sich a domly, rebound, a guaeing an odominal 12 wou ertore st expose fo Umecessry rasan “Thi patent cutansour erupts nanthomas ae hala fining of ypertigystidemi, which can cue ate pares then hyde vl exceed 1000 rnd Ode aes of acute pancreas incudebiary pathology (eg, glstons, {onsncion ofthe apa of Vat, alcool un, and mediation (eg sufonamdes, apr ac,erceline, trods) The ‘ntl lagnoste workup n parts suspected of having pancests should incu pase andor ames ev epat Panel, andsome form of adomia aging (ea, abdominal uttasound of CD By Acme pancreas ‘tool elmtas levels ate utd to anes for xoerine pancreatic insfficeny patent wth ympoms of era pancreatitis Ie would wot help olen te cause of acate pancreas eee aes oun s a ophagogesueduodanoscopy ECD an invites that can be seul in the valuation of pases wh dsohapa, ‘saynophagi,hematemess,Rersocheti, aot mele. An ECD can be sed to hagose pep sce atte, wich cat ‘so presen wen acute eplgasorc pan adatg fo he back, However, his patents mpocalcema nd erupt xanthomas 22 Imote conser won acute pancreas, oF whch ECD would at Be Mega. ‘fe ephte-ayft satrmen scaly wed a ste for petition of he rt rt lz pcre “lticatons associated wit conic pancreas aud pot be Rl fn iagnosing or determining the cause of ace Pnceain The patent here doe hat hee sighs of an aruteabcomn sucha domly, retour uae an domi! ray woul ertore jst expose fo umecessary alate. “Thi patent cutarsout erupts nanthomas ae halla fing of perverse, which can cute acute paren “then ely lvl exceed 1000 rnd Ota causes of acute pacreatis incudebiary pathology (eg, glstons, {omtncion ofthe anpl ofVate, sleoel ue, and mediation (eg sufonamdes, apr ac,terceline, terad) The Intl eapnoste workup n puters suspected of having pncreatss should nctde pase anor amylase evel, heat ane, and some form of abdominal aging (e., abdominal uttasound or By Aewe panes ‘tool elatan nels ate uted to anes for exocrine paces nsficeny i patent wth symptoms of eran pancreatitis Ie would wot help olen te cause of acute pancreas Ons al < 410 > “nis question spat o «sequnce ot quests. Answering tis qustion wil unlock he follow-up ausstons. Hower, you won't be 1 22-year-old woman gravida 2, pra 2, comes tome pica fr the evaluaion of palpable mass in er ght breast ‘ype eabees metus estes with mar she has no family story of beast cancer. She has smoked al «pak of {igen day for 15 yeas Hes trperatre e 37°C (98.57), ple 78/min respratons re 14m, and Hood gs Dresures 125/75 mmHg xamnaton shows at, onosinfu,nonmabie nae the rant usr ausarant ot a breast Tere sno ple scare. Examnation ote sin and lymph nods shows no sbnormalies, No mses Ae ‘ua sean one beset ‘Mammostaby (©) core neat psy (EBA pene esting ‘ont se-beast exams ‘lratonogaphy ofthe best Which fhe allowing isthe mon appropriate next aepin management? 4a |) sese-conterng tere ns hmph rose opey @|Tawoniten heey (© essed meray (© worn FeCT (©) sizer masecomy wth moh node dssecon ors Om Ds al < n> a “nis question spat o «sequnce ot quests. Answering tis qustion wil unlock he follow-up ausstons. Hower, you won't be a bite change te anewar a soon at you have iewed the fllow-up asin. & ‘Spel MOR, orev 2, pra 2, comes ome psc forte evaubton of apapale mass ner ghtbrsst— ( Matabets mts ete wth form. She bas amy stay of reas cance- Se hs Her temperatures 37°C GBP, pues 7am resp are 14 and od A pressure 125/75 mm. farimaton sho fr, nenssinfl, RORble aes the AAMEBBEE UAE of he breast Tere sno ple scare. Examation ote sin and Iymghnodse shows no abnormalities, No mses ae bart Papatd inthe aft bear hich of he flowing i the most appropiate nxt tap inthe Management ofthis patent? 2a < 8 we {ss srening cl whan the pate hasan increased ik fr breast acre, BRCA main care) ower, one of a (edemeieced ary & ‘Mammography is the recommended imaging modality for the evaluation of a breast lump im women older than 30 years of age. ‘Along wih cna aetezsnen, cite na tpn rest cancer agnosis and allows deciding wheter a bop) further By tremteancer omns a < m0 > By treet cancer ‘ne-neelesypraton x he recormended daprortc moc freaking nonsutpcou best mass (9 y00ng pater oft movable mass but performed ater imaging, THis pair also already hs signs conceming for malignancy. although ore mele biopsy is part of he werkup of bess limps when here suspicion of malgnancy ti performed ater mana. S8CA ger eto s eronrerced for malting tras cavern patonts wth family tory of bres, vain tal or etnoresl cance, Fn Some patients ler ies cancer is Gagnosd eg ple agate of Datel bess cance), Homeye “Amonthysef-beas exam snot a recommended Sratey mths patent since she has abreast mp concerning for breast “arcr utie aquest work uo. ‘Uvascund isthe recommended intial maging testo a Slipped beast mp in women younger then 30 yes of age ‘because fer higher tena than marmagram Young worn ave higher ensty Great aave, whch makes he ‘etecon of bess abrormaltes i mammogram mae ie a | mie ORT al < 10> a ‘ne patent wndegees 2 mancoram whch sows an see mass wih an a ‘subsequence ees ope fea hows Mang Gul ecnara stop nae ney ae ea ae eae ca ae Sea coe eal ee aeer ee eee pases ‘ enogtoo vsga ant = 140 mea o 103 meat . feo Som es Uren open Tengist ‘ane rospaase aut fini amncrustease ur) 13 UL ey Aspartate amnotrancferase (AST) 12 U/L & oa ee ee scot ‘nour ter Sunn and wena a> ecast-conering therapy ae snl nace bop are hagosti and therapeutic procedures used aa fiat-ne nteveton| in paters wen newly agnoseaimasive auc carcinoma, Al peters wre UndErg® lumpectomy regueposteperstne ‘ado ote wole beat o mime te vik of recurrence Senumel ode ope ls pceiar to tage the cae, ich benef fom adnan systemic cemetery nthe form of wastzumad i were om ns al ‘Tamoxifen is selene estrogen eeotor modulator that primary ued in patents wth estogen recetor-posve Beast, ‘arcr but thi pate ui eaogen receptor negate. “ratuzumab wo tava chemotherapy apart wth operable, HEE receplorposthe beat canara the care ‘ete. though his patent Should eventually undergo wastuzumab therapy, athe Step of management since at his ‘Avole-ody PET/CT sc is requre inal patents with stage Ao higher disease to asses for mesastses, Adio, ‘ates wo present a signs of ata ners sur a ional pom elated LFTs, pape sore ease fray bent fom a wholeboay PET/CT scan. However, he stage of ths pate’ cance hs ot et ben Jetemined ard She (doesnot have any igh of metastatic deste, 29 hle-bogyPET-CT would no be aceated a hi tne ‘Abiatera matecomy wth mph noe isectonscommenly arformed in patents wih ltr asso patents who the a GRCA gene mutator laugh & HRCA mutation fas not expiy been led out ts poet, RCA mutton Cees _enerly have x pteonal apr famly ory of reas, variant er patton! cancer, nd may seo have mote ‘tevenced disease at presetation(ple-egatve beer breast cance TS pate doesnot have ay of these ‘onaiton, whieh makes # RCA mutation le Imada, a HER? mutation Nas aendy bem ented a the ely ‘rt "Atbone sani commonly obtained patents who preven with one or elevated alle potter in the satin of eu iagnosed eas cance, which maybe nda of metastatic seas. Tis patent does nt have ether ofthese Om Ds al < aria > “Tamouten is selective estrogen eceator modulates tats primary used i pants wth estogen rector postive Beast ant bu ths pte tf stone apr rept. ‘Trasuzumab s sed 3s adjuvant chemotherapy in pater wihopeable, HERZ receporpostve beast cance, 2 the case ere although ths patent should eventual undetg Wartcura therapy, anther sep of management incised a th ‘A ol-body PET/CT sean requredn all patents ih stage Aor higher date vo assis for merastses, Adina, (tenes ho present with signs of metastases, Such a abdominal pan, elevated LFTs, oF palpable abdonal mass, fay benefe fom a whole-body PET/CT scan. However, he sage ofthis patent's cancer hs ot yet ben determined and she ‘ees not nave any signs of metastatic sees, sa whle-bogyPET-CT would net be nceatea atts me. ‘A aera msceciomy wth mph nae sections commonly tore in pavens with lateral disease on patents who ave 288A gone mutaton. though 4 BCA mutton Nar ot expt ben led aut i tl alent, BREA Msn cei ‘general haves personal anor famiy story of rest, vain, tubal o peor cance, a may aso have mote ‘Seed ses terse reece eel nest emer Ths pice esa ee ono tse “onatons, Which makes 8 BRCA mutation unin adsbon, 2 HERZ matavon Ras aes) been ere a th kely ‘pa “Abe sani commonly cbained inpatients who presen with Done pan or elevaad alkaline phosphatase in the sing of ely iagnosed tras cancer, which may beindeatve f metantate deave. This patent dats nt have ether ofthese fatnas Ons al < 20> ‘16-year-old no comes to te pysian becuse of pass enlargement of Ne est fr te past 2 weeks. The stant report tht he enlargement worse nthe evnings, specifi lang soccer. has not ad any trauma 0 the testes Ther no personal or far istry a ete nes. ital sigs ar thin norval Kis, Exainaton shows Structures asappear the sine postion. The estes are normal on palpation, The pavers a greatest rk of developing win fe flowing complications? ge 2a 8 Testicle trion “erelartumor ‘ei ce yturcon BO Omns al < 21> ‘year-old by comes tte phystclan because [Link] Pst report tht he elargemon ie uorse nthe evenings, pel fer laying acer. ahs not Pas any aus the teste Theres tees ee ee “The testes are normal on papa, Tne paDert at rates Mk of developing wich of me folowing complexions? 1 peg alec alpag lipo tne) ‘tanaing orth a Vales manewer suggests a vaneaale hen mat commonly ser uring adleranc, “The isk o bowel angular sncteased patents wlth eras. nec ngural efi Would PEAY present as 2 Corda suture above he estes Suggest that te pair has avarice and ota ei ° ‘setotelhematoma can acca flung the rupture of vance but ths compleation extremely tre and ony a few ‘cases ave been reported date. Fubeny iar fare for testa trio ue the sudden eesti eet volume) Sut vareoel does aot increas he is of testicular worsion, Rsk factors forest tron Mle testcase wth orzo Spermat cod tbel-apper anatomical van Om De at < 20> “cyporhiiom which manifests san empy Scots a brown Sk actor fra esc [Link] lp may Be “estes ae palpated within the serotal sa. ltermitenthemiscrval sweing wih corde suuctres above the tests indicates “The isk of areulty among men wih a vancocele 2-4 umes gate tan thse winout a vaniocele. Gay how avancocae ‘cautery ent fly nde, bu the most probable mechan simpaed sprmatagenei ae 2 ot of increased tesa temperature ad tesicua ischenie ve merase nastics presse venoWs Sa, oF ‘isocostction secondary fo etectoamine rfl rom the astenal glee). Te daprons fa variccte scone By ‘ivasoneaapm which sould eel lata pampinform ves. n yuna men, Semen ana shou be perormed regulary te asses sperm number ard quay atin veatmart wh wourscopc varcacaecomy o percutaneous emBoIZazon recerany for hore ith erate discomfort andor abnoaltes on rman ay By. scott apnormates ‘testicular abscess yplallydeeops m patents with utesteseptayno-ochits, which can also presen wth elagement tthe testes, Homever the an oe he testes oul be ec arm, an si, and eer a nll a seat ui wold ypc ‘so be present am te scrotum would decrease wen the Memisrtum Is SUPpOreG(posve Prem SGN na the eof ‘he sctalseling would not eens wit est Tis ectrs fo teu sfncion inde peripheral ater disease, autonomic newopatiy fe, diabetes melas, Perkins’ ace) spinal cord damage (2 aust spinal cord injury, mull cerous damage to poe meres (sc surgery, ee Bauma, endocrine dserers ea, hyBogonadsm, hyperplane ypothrOlsm, a the use of cera ‘madiatons (ag, beta Bickers, anuaepressan, Averiocle does rot cease tek of ree ystuncon Ons al < 20> ‘a 8¢-yar-olé woman i brought tothe pysican by he Son ear he our ne tying 2 ang hese om the cena tncaue ste fat thats wana family. Har any ay tht er the pst 2 oth sh Ra ado sero leave arom, hs buon slesping mast of he dy, as lost 10g (21), and ces eary day She was agnosed wih after cagress she tly underwent chemoterap but asconimued the tretment when the metastases Spread to a the spine and bran es Ite expectancy ls -2 ees and se carer reshingRome-Rospc cae tony caret é ‘aseaton 3 eran! patch Shee 160 cf) all and weigh 4 eg (10181) il i 1 gm Har tl gn ein normal hts. Examination shows slow speech, at affect, ard depessed mood. Wich ofthe flowing tremments is ntl most et prove the greatest Senet for tha paint ge 8 La BO ©] Metviphenats (© meses (© Fhowine (©) coonevebehaweral tery F) Berrepee * oats Omns al <2 10> sasesoratevonate regio oe py yt etre ene I aoe coy Laie Reine aac ereret te cas oe pare een eos sear Oe er es ee ee ter saat ceed erst eri asec Ersese eed os Becmesa nas or oe meso ets ee eee “Ths patient meet the eter for he dagnon of MOD ade attempt, depressed mond, anhedona, hypetsomris ‘bsjchomotor etardation, and feelings of worthesnes ora paid of ove 2 weeks). Hr Sho Ife expecancy end ONC ey shou be considered nner wesimet par. 2a « Methylphenidate and othe pychostmulans, deopte adverse fects. anoreia nies and weight lor), shoul be ‘consgered fr terminal il patents wh Sever cite depression anda ery rede expecany 0. dys Weeks) and OF ‘ase tsk of sulci Because he augs ae fast-acting (esponse often win 1-2 dys. m mary cases, poyhostmuars er ofan 38 Bi tar dope Hleszoconvlive therapy (ET) an efectne treatment modality for depression with paychoti fetues or severe depesion resistant to pharmacologic westmert simptoms usually prove within 1 week of nt tretart Wiles terminal paver wou bere om ET, meustsis 1 e bras arelaive convaaicaton ors Wena. nation ts part

You might also like