Forwarded from Medical Mnemonics
๐งฉ Medical Mnemonics
Learn Fish-vertebra sign in Osteoporosis by #visual_mnemonics.
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๐ฅ IMAGING Explanation
The โfish-vertebraโ sign is a smooth deformity of the vertebral bodies, with a characteristic biconcave body occurring due to a squared-off depression of the vertebral end-plates and compression by adjacent intervertebral discs. This radiologic sign can be seen in osteoporosis, osteomalacia, hyperparathyroidism, Paget disease, sickle cell disease, multiple myeloma and systemic lupus erythematosus.
๐ป Join us in the official Instagram page: Online Medical School
#radiology
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ยฉMedical Mnemonics
Learn Fish-vertebra sign in Osteoporosis by #visual_mnemonics.
โโโโโโโโโโโโโโโโ
๐ฅ IMAGING Explanation
The โfish-vertebraโ sign is a smooth deformity of the vertebral bodies, with a characteristic biconcave body occurring due to a squared-off depression of the vertebral end-plates and compression by adjacent intervertebral discs. This radiologic sign can be seen in osteoporosis, osteomalacia, hyperparathyroidism, Paget disease, sickle cell disease, multiple myeloma and systemic lupus erythematosus.
๐ป Join us in the official Instagram page: Online Medical School
#radiology
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ยฉMedical Mnemonics
๐14
โณ Case-based MCQ | #Case_431
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A 13-year-old white female reports a 6 month history of intermittent abdominal cramping, with each episode becoming progressively worse. Based on her history, there is no obvious relationship to eating, voiding, or defecating. She report that she has not yet begun menstruating and is not sexually active. Her weight has been stable. She appears to be in mild emotional distress about being the โlast girl in her class to have a periodโ. She is in no physical discomfort and her vital signs are normal. Secondary sexual characteristics appear to be developing normally. She is in the 57th percentile for height and the 65th percentile for weight. A complete physical examination confirms your presumptive diagnosis.
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A 13-year-old white female reports a 6 month history of intermittent abdominal cramping, with each episode becoming progressively worse. Based on her history, there is no obvious relationship to eating, voiding, or defecating. She report that she has not yet begun menstruating and is not sexually active. Her weight has been stable. She appears to be in mild emotional distress about being the โlast girl in her class to have a periodโ. She is in no physical discomfort and her vital signs are normal. Secondary sexual characteristics appear to be developing normally. She is in the 57th percentile for height and the 65th percentile for weight. A complete physical examination confirms your presumptive diagnosis.
The therapeutic procedure of choice would be:
Anonymous Poll
11%
A. Appendectomy
12%
B. Colonoscopy
61%
C. Hymenotomy
11%
D. Cystoscopy
5%
E. Paracentesis
๐13
โณ Case-based MCQ | #Case_431 | #answer
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โ C
The key to making a diagnosis of imperforate hymen, aside from the obvious finding on physical examination, lies in the systematic drawing of inferences. One can speculate that this patientโs recurrent crescendo abdominal cramping represents six menstrual sheddings, with no egress from the body. Her delay in menarche, despite normal growth parameters, offers another clue that the structural amenorrhea is present. Amounts of retained blood vary among patients; up to 3000 mL have been reported. A large volume can accumulate without causing any permanent damage, and subsequent fertility is usually normal. Hymenotomy will relieve the pressure, and normal menses should ensue.
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โ C
The key to making a diagnosis of imperforate hymen, aside from the obvious finding on physical examination, lies in the systematic drawing of inferences. One can speculate that this patientโs recurrent crescendo abdominal cramping represents six menstrual sheddings, with no egress from the body. Her delay in menarche, despite normal growth parameters, offers another clue that the structural amenorrhea is present. Amounts of retained blood vary among patients; up to 3000 mL have been reported. A large volume can accumulate without causing any permanent damage, and subsequent fertility is usually normal. Hymenotomy will relieve the pressure, and normal menses should ensue.
๐9๐5
โณ Case-based MCQ | #Case_432
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A 58-year-old male presents with nausea and vomiting for two days. He had noticed that he lost 7 kg over the last two months but he did not think too much about it, as he was overweight. Past medical history is significant for smoking 20 packs of cigarettes a year.
Physical examination reveals an enlarged, hard, painless left-sided supraclavicular lymph node.
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A 58-year-old male presents with nausea and vomiting for two days. He had noticed that he lost 7 kg over the last two months but he did not think too much about it, as he was overweight. Past medical history is significant for smoking 20 packs of cigarettes a year.
Physical examination reveals an enlarged, hard, painless left-sided supraclavicular lymph node.
๐3
Which of the following is the most likely diagnosis?
Anonymous Poll
8%
A. Esophageal cancer
45%
B. Gastric cancer
19%
C. Hodgkin lymphoma
22%
D. Lung cancer
5%
E. Thyroid cancer
๐23๐2
โณ Case-based MCQ | #Case_432 | #answer
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โ B
There are approximately 300 lymph nodes in the neck region. A regional lymphatic system is composed of the first, second, third and even fourth or much more intercalated nodes along the lymphatic route from the periphery to the venous angle or the thoracic duct. The third or fourth node is usually termed the last-intercalated node or end node along the route.
One of the supraclavicular nodes is known to correspond to the end node along the thoracic duct. It is generally called Virchow's node. It is the site of Virchowโs metastases of gastric cancer (choice B). It is also called the sentinel node. Virchowโs node is where the lymphatic drainage from the thoracic duct enters the venous circulation via the left subclavian vein. By the time gastric cancer presents with a Virchowโs node it is already in its advanced stage. Various intra-abdominal malignancies besides gastric cancer could present with the Virchowโs node (e.g. gallbladder, pancreas, kidneys, testicles, ovaries, or prostate).
โ Esophageal cancer (choice A), Hodgkin lymphoma (choice C), and Lung cancer (choice D) can present with an enlarged right supraclavicular lymph node, which tends to drain thoracic malignancies. Out of the choices given only gastric cancer is most likely to present with the Virchowโs node.
โ Thyroid cancer (choice E) can usually be found relatively early because of its location. When it metastasizes to lymph nodes, the pretracheal, paratracheal and prelaryngeal nodes are affected.
๐ Key point:
The left supraclavicular adenopathy (Virchow's node) suggests abdominal malignancy (e.g. stomach, gallbladder, pancreas, kidneys, testicles, ovaries, or prostate).
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โ B
There are approximately 300 lymph nodes in the neck region. A regional lymphatic system is composed of the first, second, third and even fourth or much more intercalated nodes along the lymphatic route from the periphery to the venous angle or the thoracic duct. The third or fourth node is usually termed the last-intercalated node or end node along the route.
One of the supraclavicular nodes is known to correspond to the end node along the thoracic duct. It is generally called Virchow's node. It is the site of Virchowโs metastases of gastric cancer (choice B). It is also called the sentinel node. Virchowโs node is where the lymphatic drainage from the thoracic duct enters the venous circulation via the left subclavian vein. By the time gastric cancer presents with a Virchowโs node it is already in its advanced stage. Various intra-abdominal malignancies besides gastric cancer could present with the Virchowโs node (e.g. gallbladder, pancreas, kidneys, testicles, ovaries, or prostate).
โ Esophageal cancer (choice A), Hodgkin lymphoma (choice C), and Lung cancer (choice D) can present with an enlarged right supraclavicular lymph node, which tends to drain thoracic malignancies. Out of the choices given only gastric cancer is most likely to present with the Virchowโs node.
โ Thyroid cancer (choice E) can usually be found relatively early because of its location. When it metastasizes to lymph nodes, the pretracheal, paratracheal and prelaryngeal nodes are affected.
๐ Key point:
The left supraclavicular adenopathy (Virchow's node) suggests abdominal malignancy (e.g. stomach, gallbladder, pancreas, kidneys, testicles, ovaries, or prostate).
๐6
โณ Case-based MCQ | #Case_433
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A 53-year-old man presented to his family physician with episodic retrosternal chest pain that radiates to the left shoulder. During the last four months, he experienced this pain three times, the last of which was two weeks ago and all were while exercising on treadmill and while running for a few minutes. In all three occasions pain subsided within about 5 minutes of rest. He does not smoke and rarely drinks alcohol.
Physical examination is normal. Urine analysis, complete blood count, fasting blood sugar, lipid profile, serum urea and electrolytes, chest X-ray and 12-lead ECG are all normal. Chronic stable angina is suspected.
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A 53-year-old man presented to his family physician with episodic retrosternal chest pain that radiates to the left shoulder. During the last four months, he experienced this pain three times, the last of which was two weeks ago and all were while exercising on treadmill and while running for a few minutes. In all three occasions pain subsided within about 5 minutes of rest. He does not smoke and rarely drinks alcohol.
Physical examination is normal. Urine analysis, complete blood count, fasting blood sugar, lipid profile, serum urea and electrolytes, chest X-ray and 12-lead ECG are all normal. Chronic stable angina is suspected.
๐4
Which of the following investigations should be done next?
Anonymous Poll
13%
A. Measurement of cardiac enzymes
45%
B. ECG exercise testing
10%
C. Cardiac imaging
22%
D. Coronary angiography
10%
E. Echocardiography
๐ฅฐ2
โณ Case-based MCQ | #Case_434 | #answer
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โ C
Exercise ECG testing (choice B) should be done next to verify or refute the diagnosis of angina. A 12-lead ECG is done just before, during and after standardized exercise protocol with increasing work load. Flat or down sloping of ST segment during exercise confirms diagnosis of ischemia. These ECG changes together with the typical symptoms of angina confirm the diagnosis of chronic stable angina.
โ There is no indication for measurement of cardiac enzymes (choice A) in this patient. These cardiac biomarkers are measured if the diagnosis of unstable angina or ST elevation myocardial infarction is suspected. Unstable angina is suspected if frequency and duration of pain attacks is increasing; pain is not responding to treatment with nitroglycerine, pain occurs at rest or angina following myocardial infarction.
โ Cardiac imaging (choice C) is done only if ECG exercise testing is abnormal to evaluate the extent and site of ischemia.
โ Coronary angiography (choice D), an invasive procedure, is indicated only if: diagnosis of disabling chronic stable angina is confirmed; the patient is at high risk of coronary artery disease; diagnosis or prognoses are uncertain; the patient cannot undergo non-invasive testing.
โ Echocardiography (choice E) is not indicated in this patient at this point. The initial test in patients able to exercise should be exercise ECG.
๐ Key point:
In patients with typical episodic chest pain provoked by physical activity, diagnosis of chronic stable angina should be confirmed or refuted by ECG exercise testing
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โ C
Exercise ECG testing (choice B) should be done next to verify or refute the diagnosis of angina. A 12-lead ECG is done just before, during and after standardized exercise protocol with increasing work load. Flat or down sloping of ST segment during exercise confirms diagnosis of ischemia. These ECG changes together with the typical symptoms of angina confirm the diagnosis of chronic stable angina.
โ There is no indication for measurement of cardiac enzymes (choice A) in this patient. These cardiac biomarkers are measured if the diagnosis of unstable angina or ST elevation myocardial infarction is suspected. Unstable angina is suspected if frequency and duration of pain attacks is increasing; pain is not responding to treatment with nitroglycerine, pain occurs at rest or angina following myocardial infarction.
โ Cardiac imaging (choice C) is done only if ECG exercise testing is abnormal to evaluate the extent and site of ischemia.
โ Coronary angiography (choice D), an invasive procedure, is indicated only if: diagnosis of disabling chronic stable angina is confirmed; the patient is at high risk of coronary artery disease; diagnosis or prognoses are uncertain; the patient cannot undergo non-invasive testing.
โ Echocardiography (choice E) is not indicated in this patient at this point. The initial test in patients able to exercise should be exercise ECG.
๐ Key point:
In patients with typical episodic chest pain provoked by physical activity, diagnosis of chronic stable angina should be confirmed or refuted by ECG exercise testing
๐9โค2
โณ Case-based MCQ | #Case_434
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A 23-year-old female G1P0 at the 34th week of gestation presents to your department with eclampsia. She had last seen her ObGyn at the 20th week of gestation, and the pregnancy was developing normally.
On physical examination, her BP is 190/115 mmHg, temperature 37.7ยฐC, pulse 110 bpm, and respirations 20 bpm. After appropriate initial therapy is given and stabilization achieved, the patient delivers vaginally a 3000g boy. The immediate postpartum period at the hospital is uneventful. You visit the patient few days later for counseling before she is discharged from the hospital. Her BP is 145/100 mmHg.
BP remains elevated in the following 4 weeks, 160/110 mmHg on average. The patient has been breastfeeding the baby.
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A 23-year-old female G1P0 at the 34th week of gestation presents to your department with eclampsia. She had last seen her ObGyn at the 20th week of gestation, and the pregnancy was developing normally.
On physical examination, her BP is 190/115 mmHg, temperature 37.7ยฐC, pulse 110 bpm, and respirations 20 bpm. After appropriate initial therapy is given and stabilization achieved, the patient delivers vaginally a 3000g boy. The immediate postpartum period at the hospital is uneventful. You visit the patient few days later for counseling before she is discharged from the hospital. Her BP is 145/100 mmHg.
BP remains elevated in the following 4 weeks, 160/110 mmHg on average. The patient has been breastfeeding the baby.
๐4
Which of the following is the most suitable treatment?
Anonymous Poll
33%
A. Methyldopa 250 mg every 12 hours
34%
B. Nifedipine 10 mg every 6 hours
16%
C. Metoprolol 50 mg every 12 hours
11%
D. Hydrochlorothiazide 25 mg every 12 hours
5%
E. Furosemide 40 mg every 8 hours
๐9๐3
โณ Case-based MCQ | #Case_434 | #answer
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โ B
Hypertension may develop for the first time postpartum, and in 50% of women who had hypertension during pregnancy, it may continue after delivery. If BP is mildly elevated, treatment is usually not required, but close monitoring is advised. In patients with systolic BP > 155 mmHg or diastolic BP > 105 mmHg, antihypertensive medications should be given. Labetalol and nifedipine are the most commonly used. For women who used ACE inhibitors before pregnancy, they can resume taking them. The recommended dose for nifedipine is 10 mg orally every 6 hours (choice B) and a maximum dose of 120 mg/day.
โ Some guidelines suggest avoiding methyldopa (choice A) postpartum because of the risk of postnatal depression.
โ Metoprolol 50 mg every 12 hours (choice C) is incorrect. Metoprolol, nadolol, and atenolol are excreted in breast milk in high concentration and would not be the best choice of treatment for this patient.
โ Hydrochlorothiazide 25 mg every 12 hours (choice D) and Furosemide 40 mg every 8 hours (choice E) are incorrect. Diuretics should generally be avoided in breastfeeding mothers because they significantly reduce milk production.
โ Key point:
In postpartum patients with systolic BP > 155 mmHg or diastolic BP > 105 mmHg, antihypertensive medications should be given. Labetalol and nifedipine are the most commonly used
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โ B
Hypertension may develop for the first time postpartum, and in 50% of women who had hypertension during pregnancy, it may continue after delivery. If BP is mildly elevated, treatment is usually not required, but close monitoring is advised. In patients with systolic BP > 155 mmHg or diastolic BP > 105 mmHg, antihypertensive medications should be given. Labetalol and nifedipine are the most commonly used. For women who used ACE inhibitors before pregnancy, they can resume taking them. The recommended dose for nifedipine is 10 mg orally every 6 hours (choice B) and a maximum dose of 120 mg/day.
โ Some guidelines suggest avoiding methyldopa (choice A) postpartum because of the risk of postnatal depression.
โ Metoprolol 50 mg every 12 hours (choice C) is incorrect. Metoprolol, nadolol, and atenolol are excreted in breast milk in high concentration and would not be the best choice of treatment for this patient.
โ Hydrochlorothiazide 25 mg every 12 hours (choice D) and Furosemide 40 mg every 8 hours (choice E) are incorrect. Diuretics should generally be avoided in breastfeeding mothers because they significantly reduce milk production.
โ Key point:
In postpartum patients with systolic BP > 155 mmHg or diastolic BP > 105 mmHg, antihypertensive medications should be given. Labetalol and nifedipine are the most commonly used
๐9โค6
โณ Case-based MCQ | #Case_435
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A 64-year-old man presents with several months of progressive weakness of the upper and lower extremities, along with ongoing pain in the affected areas. Physical examination shows difficulty standing up from a chair and tenderness over the affected areas. He is also found to have a violaceous erythematous rash over his eyes. A working diagnosis of dermatomyositis is made.
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A 64-year-old man presents with several months of progressive weakness of the upper and lower extremities, along with ongoing pain in the affected areas. Physical examination shows difficulty standing up from a chair and tenderness over the affected areas. He is also found to have a violaceous erythematous rash over his eyes. A working diagnosis of dermatomyositis is made.
๐3
Which of the following features, on history, would be more suggestive of dermatomyositis than polymyositis?
Anonymous Poll
31%
A. Autoimmune disorder
25%
B. Cancer
30%
C. Connective tissue disorder
9%
D. Human immunodeficiency virus infection
6%
E. Parasitic infection
๐10โค6
โณ Case-based MCQ | #Case_434 | #answer
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โ B
Dermatomyositis is an inflammatory myopathy, which bears many clinical similarities to entities such as polymyositis and autoimmune myositis. It is characterized by muscle weakness, tenderness, and a "heliotrope rash" around the eyes. Bloodwork will show inflammation (elevated leukocytes and ESR/CRP) in addition to an elevated CK. It may be confirmed with muscle biopsy. Treatment modalities include glucocorticoids, immunosuppressants or immune modulation.
Malignancies (choice B) may be associated with dermatomyositis in up to 15% of cases. The most common associations are ovary, breast, melanoma, GI, and lymphoma.
โ Autoimmune disorders (choice A) such as inflammatory bowel disease, vasculitis or celiac disease, are more likely to be associated with polymyositis than dermatomyositis.
โ Connective tissue disorders (choice C) can be associated with both dermatomyositis and polymyositis.
โ HIV (choice D) or parasitic infection (choice E) are more commonly associated with polymyositis.
๐ Key point:
Dermatomyositis is one of a number of inflammatory myopathies which can cause muscle weakness, pain, and tenderness. It is usually accompanied by a heliotrope rash and may be associated with malignancy in up to 15% of cases
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โ B
Dermatomyositis is an inflammatory myopathy, which bears many clinical similarities to entities such as polymyositis and autoimmune myositis. It is characterized by muscle weakness, tenderness, and a "heliotrope rash" around the eyes. Bloodwork will show inflammation (elevated leukocytes and ESR/CRP) in addition to an elevated CK. It may be confirmed with muscle biopsy. Treatment modalities include glucocorticoids, immunosuppressants or immune modulation.
Malignancies (choice B) may be associated with dermatomyositis in up to 15% of cases. The most common associations are ovary, breast, melanoma, GI, and lymphoma.
โ Autoimmune disorders (choice A) such as inflammatory bowel disease, vasculitis or celiac disease, are more likely to be associated with polymyositis than dermatomyositis.
โ Connective tissue disorders (choice C) can be associated with both dermatomyositis and polymyositis.
โ HIV (choice D) or parasitic infection (choice E) are more commonly associated with polymyositis.
๐ Key point:
Dermatomyositis is one of a number of inflammatory myopathies which can cause muscle weakness, pain, and tenderness. It is usually accompanied by a heliotrope rash and may be associated with malignancy in up to 15% of cases
๐7โค1
Forwarded from Medical Mnemonics
๐งฉ Medical Mnemonics
Black named disorders
โ๐ Black death (plague): black areas from bleeding into skin
โ๐โ๐ฆบ Black dog: major depression disorder
โ๐งโโ Black sickness (Kala azarโleishmaniasis): dark skin on extremities
โ๐ซ Black lung: coal dust pneumoconiosis
โ๐ฝ Blackwater fever: severe plasmodium falciparum malaria (dark urine)
#confusing_terms
ใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐ
ยฉMedical Mnemonics
Black named disorders
โ๐ Black death (plague): black areas from bleeding into skin
โ๐โ๐ฆบ Black dog: major depression disorder
โ๐งโโ Black sickness (Kala azarโleishmaniasis): dark skin on extremities
โ๐ซ Black lung: coal dust pneumoconiosis
โ๐ฝ Blackwater fever: severe plasmodium falciparum malaria (dark urine)
#confusing_terms
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ยฉMedical Mnemonics
๐10๐ฅฐ4
Forwarded from EDL Backup Channel
โ ๐ ๐๐๐๐ ๐๐๐๐ ๐๐๐๐ ๐
๐๐ ๐ ๐๐๐๐๐ ๐๐๐ ! โคต
1. ๐ ๐๐๐๐๐๐ ๐๐ ๐๐ญ๐ข๐ก ๐
2. ๐๐๐ฆ๐ - ๐๐๐ฆ๐๐ ๐ ๐๐ค๐ฆ ๐ฏ
3. ๐จ๐ฆ ๐ ๐๐๐ค๐ ๐ฃ๐ฅ๐๐ฃ๐๐ฅ๐๐ง๐๐ข๐ก
4. ๐ฉบ ๐๐๐ ๐ ๐๐๐๐๐ข๐ฆ (๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐๐ก๐ ๐๐๐ก๐๐ฆ)
5. ๐ ๐๐๐ ๐ฃ๐๐๐ฅ๐
6. ๐ ๐ข๐ก๐๐๐ก๐ ๐ ๐๐๐๐๐๐ ๐ฆ๐๐๐ข๐ข๐
7. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐๐ฅ๐ ๐๐ก๐ฌ ๐ฉ๐ช
8. ๐ฃ๐ฅ๐๐๐ง๐๐๐ ๐๐ก ๐๐จ๐ฆ๐ง๐ฅ๐๐๐๐ ๐ฆ๐บ
9. ๐ ๐๐๐ฆ & ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐ง๐๐๐ฌ ๐ฎ๐น
10. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐จ๐ ๐ฌ๐ง
11. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐จ๐ฆ ๐บ๐ธ
12. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐๐ก๐๐๐ ๐จ๐ฆ
13. ๐๐ฅ๐๐ก๐๐ ๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐ซ๐ท
14. ๐๐๐ฅ๐ ๐๐ก ๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐ฉ๐ช
15. ๐ ๐๐๐๐๐๐ ๐ฅ๐๐ฆ๐๐๐ฅ๐๐ ๐
16. ๐ธ ๐๐๐ฅ๐ ๐๐ง๐ข๐๐ข๐๐ฌ ๐๐ง๐๐๐ฆ
17. ๐งฉ ๐ ๐๐๐๐๐๐ ๐ ๐ก๐๐ ๐ข๐ก๐๐๐ฆ (๐๐๐๐ฅ๐ก ๐๐๐ฆ๐๐๐ฌ)
1. ๐ ๐๐๐๐๐๐ ๐๐ ๐๐ญ๐ข๐ก ๐
2. ๐๐๐ฆ๐ - ๐๐๐ฆ๐๐ ๐ ๐๐ค๐ฆ ๐ฏ
3. ๐จ๐ฆ ๐ ๐๐๐ค๐ ๐ฃ๐ฅ๐๐ฃ๐๐ฅ๐๐ง๐๐ข๐ก
4. ๐ฉบ ๐๐๐ ๐ ๐๐๐๐๐ข๐ฆ (๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐๐ก๐ ๐๐๐ก๐๐ฆ)
5. ๐ ๐๐๐ ๐ฃ๐๐๐ฅ๐
6. ๐ ๐ข๐ก๐๐๐ก๐ ๐ ๐๐๐๐๐๐ ๐ฆ๐๐๐ข๐ข๐
7. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐๐ฅ๐ ๐๐ก๐ฌ ๐ฉ๐ช
8. ๐ฃ๐ฅ๐๐๐ง๐๐๐ ๐๐ก ๐๐จ๐ฆ๐ง๐ฅ๐๐๐๐ ๐ฆ๐บ
9. ๐ ๐๐๐ฆ & ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐ง๐๐๐ฌ ๐ฎ๐น
10. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐จ๐ ๐ฌ๐ง
11. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐จ๐ฆ ๐บ๐ธ
12. ๐ฅ๐๐ฆ๐๐๐๐ก๐๐ฌ ๐๐ก ๐๐๐ก๐๐๐ ๐จ๐ฆ
13. ๐๐ฅ๐๐ก๐๐ ๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐ซ๐ท
14. ๐๐๐ฅ๐ ๐๐ก ๐ ๐๐๐๐๐๐ ๐๐ข๐ข๐๐ฆ ๐ฉ๐ช
15. ๐ ๐๐๐๐๐๐ ๐ฅ๐๐ฆ๐๐๐ฅ๐๐ ๐
16. ๐ธ ๐๐๐ฅ๐ ๐๐ง๐ข๐๐ข๐๐ฌ ๐๐ง๐๐๐ฆ
17. ๐งฉ ๐ ๐๐๐๐๐๐ ๐ ๐ก๐๐ ๐ข๐ก๐๐๐ฆ (๐๐๐๐ฅ๐ก ๐๐๐ฆ๐๐๐ฌ)
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โณ Case-based MCQ | #Case_435
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A 39-year-old multigravida at 36 weeks gestation presents with a temperature of 40.0ยฐC (104.0ยฐF), chills, backache, and vomiting. On physical examination, the uterus is noted to be nontender, but there is slight bilateral costovertebral angle tenderness. A urinalysis reveals many leukocytes, some in clumps, as well as numerous bacteria.
ใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐ
A 39-year-old multigravida at 36 weeks gestation presents with a temperature of 40.0ยฐC (104.0ยฐF), chills, backache, and vomiting. On physical examination, the uterus is noted to be nontender, but there is slight bilateral costovertebral angle tenderness. A urinalysis reveals many leukocytes, some in clumps, as well as numerous bacteria.
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What would be the most appropriate therapy at this time?
Anonymous Poll
7%
A. Oral levofloxacin
13%
B. Oral nitrofurantoin
16%
C. Oral trimethoprim/sulfamethoxazole
57%
D. Intravenous ceftriaxone
6%
E. Intravenous doxycycline
โค1๐1
โณ Case-based MCQ | #Case_435 | #answer
ใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐใฐ
โ D
Pyelonephritis is the most common medical complication of pregnancy. The diagnosis is usually straightforward, as in this case. Since the patient is quite ill, treatment is best undertaken in the hospital with parenteral agents, at least until the patient is stabilized and cultures are available. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteremic.
Ampicillin plus gentamicin or a cephalosporin (choice D) (e.g., Ceftriaxone, Cefepime) is typically used.
โ The safety of levofloxacin (choice A) in pregnancy has not been established, and it should not be used unless the potential benefit outweighs the risk.
โ Oral nitrofurantoin (choice B) may induce hemolysis in patients who are deficient in G6PD, which includes approximately 2% of women.
โ Oral trimethoprim/sulfamethoxazole (choice C) is contraindicated late in pregnancy because they may increase the incidence of kernicterus.
โ Intravenous doxycycline (choice E) is contraindicated because administration late in pregnancy may lead to discoloration of the childโs deciduous teeth.
๐ Key point:
Acute pyelonephritis in pregnancy is treated in hospital with intravenous antibiotics (e.g., Ampicillin plus gentamicin, or Ceftriaxone, or Cefepime) until the patient is afebrile for 24 to 48 hours and symptomatically improved.
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โ D
Pyelonephritis is the most common medical complication of pregnancy. The diagnosis is usually straightforward, as in this case. Since the patient is quite ill, treatment is best undertaken in the hospital with parenteral agents, at least until the patient is stabilized and cultures are available. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteremic.
Ampicillin plus gentamicin or a cephalosporin (choice D) (e.g., Ceftriaxone, Cefepime) is typically used.
โ The safety of levofloxacin (choice A) in pregnancy has not been established, and it should not be used unless the potential benefit outweighs the risk.
โ Oral nitrofurantoin (choice B) may induce hemolysis in patients who are deficient in G6PD, which includes approximately 2% of women.
โ Oral trimethoprim/sulfamethoxazole (choice C) is contraindicated late in pregnancy because they may increase the incidence of kernicterus.
โ Intravenous doxycycline (choice E) is contraindicated because administration late in pregnancy may lead to discoloration of the childโs deciduous teeth.
๐ Key point:
Acute pyelonephritis in pregnancy is treated in hospital with intravenous antibiotics (e.g., Ampicillin plus gentamicin, or Ceftriaxone, or Cefepime) until the patient is afebrile for 24 to 48 hours and symptomatically improved.
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