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MedicalCareer版 - step3 Archer 3题求助 谢谢!
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A ck nbme form3 question请问step1 UW Q bank 的一个道题
相关话题的讨论汇总
话题: wound话题: her话题: blood话题: she话题: patient
进入MedicalCareer版参与讨论
1 (共1页)
d******u
发帖数: 47
1
1, Your patient is a gravida 2 para 2 female with a complaint of a vaginal
discharge, vulvar irritation, and dysuria. Her symptoms have recurred 4
times within the past year. She had a recent urinary tract infection that
was treated with ciprofloxacin, but is in otherwise good health. She is
afebrile with normal vital signs, and pelvic examination reveals vulvar and
vaginal erythema with a thick white discharge in the vaginal vault. KOH prep
reveals pseudo hyphae. Which of the following treatments is most
appropriate for this patient?
a. Oral fluconazole 150 mg x 1
b. Probiotic lactobacilli
c. No treatment is necessary
d. Oral Fluconozole induction followed by maintenance.
e. Topical miconazole x 7 days
2, A 65-year-old woman with a previous medical history of diabetes and
rheumatoid arthritis underdoes an exploratory laparotomy for perforated
sigmoid diverticulitis. Her postoperative stay is prolonged because of
pneumonia, but is extubated on the fifth postoperative day and the next day
discharged from the ICU to the floor. You are called by the nurse to check
her wound as she noticed a new serous discharge. Her temperature is 37.0 C (
98.6 F), pulse 100 beats/min, blood pressure 140/80 mm Hg, and blood glucose
by finger stick 240 mg/dl. Abdomen is soft and non-tender. There is no
induration, erythema, or crepitus of the wound. Copious amounts of serous
brownish liquid are expressed from the wound on gentle pressure. Fluid is
expressed spontaneously on coughing from both upper and lower parts of the
wound. Which of the following is the most appropriate next step?
A. Start the patient on an insulin drip
B. Stop anticoagulation with subcutaneous heparin
C. Order dry dressings to be continued
D. Prescribe a 1-week course of antibiotics
E. Schedule the patient for wound exploration in the operating room
3, A 25 year old woman is seen by you today due to an abnormal blood count.
Three weeks ago, she volunteered for blood donation and a complete blood
count that was drawn at that time showed abnormal values. She has regular
menstrual periods with normal flow. Her last menstrual period was one week
ago. Her previous blood count was done several years ago and she is unaware
of being told they were abnormal. A complete blood count is as follows :
WBC 5.5k/µl
HGB: 12.1 gm%
MCV 84 fl
Platelets : 800k/µl ( Normal 140k to 340k/ul)
Differential count : Neutrophils : 64% Lymphocytes 30% Monocytes 4%
Which of the following is the most important next step?
A) Obtain Bone Marrow Biopsy
B) Order Transferrin Saturation
C) Obtain Jak-2 Mutation Analysis
D) Obtain Arterial Blood Gases
E) Start her on Aspirin
T****g
发帖数: 705
2
共同讨论, [so fun to discuss cases]
1. E
Patient has candida vaginitis, needs treatment. Typical starting with local
antifungal.
2. E
Unsatisfied wound healing is common for DM patient, especially when his
blood glucose is not very well maintain. Even thought there is no sign of
wound infection, the copious amount of fluid expressing from wound warrant a
good look at the wound. A proper drainage might help the wound healing.
3.A
This is a hard one. I had to do a little research.
Patient has thrombocytosis, most likely Essential Thrombocytosis, however
she is too young for it. Since prognosis is not so great for Essential
Thrombocytosis, I would like to be more aggressive, to make the diagnosis
first.
Ref:
http://emedicine.medscape.com/article/206697-differential
British guidelines propose the following five criteria for diagnosis of
essential thrombocytosis[21] :
1.Sustained platelet count ≥450 × 109/L
2.Presence of an acquired pathogenetic mutation (eg, in the JAK2, CALR or
MPL genes)
3.No other myeloid malignancy, especially polycythemia vera, primary
myelofibrosis, chronic myeloid leukemia, or myelodysplastic syndrome
4.No reactive cause for thrombocytosis and normal iron stores
5.Bone marrow aspirate and trephine biopsy showing increased megakaryocyte
numbers displaying a spectrum of morphology with predominant large
megakaryocytes with hyperlobated nuclei and abundant cytoplasm; reticulin is
generally not increased (grades 0–2/4 or grade 0/3)
Diagnosis requires the presence of criteria 1–3 or criterion 1 plus
criteria 3–5.[21]
d******u
发帖数: 47
3
Thanks TJxing!
I have several questions:
#1, since it's recurrent candida vaginitis, should we consider oral
fluconazole (A)?
#2, I thought insulin should be initial tx to control blood glucose and then
wound exploration;
#3, someone suggested Aspirin as initial tx...

local
a

【在 T****g 的大作中提到】
: 共同讨论, [so fun to discuss cases]
: 1. E
: Patient has candida vaginitis, needs treatment. Typical starting with local
: antifungal.
: 2. E
: Unsatisfied wound healing is common for DM patient, especially when his
: blood glucose is not very well maintain. Even thought there is no sign of
: wound infection, the copious amount of fluid expressing from wound warrant a
: good look at the wound. A proper drainage might help the wound healing.
: 3.A

T****g
发帖数: 705
4
1. Pt has recurrent UTI, not vaginitis. The history of antibiotic
precipitates her vaginitis. Also, oral antifungal is not a prophylaxis
manner of preventing candida infection.
2.A better control of glucose level will be the next step. The acute problem
is wound healing. Glucose level of 240, is not that severe. Insulin drip
would be first line for DKA.
3.Pt is asymptomatic. The immediate use of Aspirin would be aim at avoiding
clotting, like in ACS. I still think it is reasonable to have a diagnostic
test first. No indication for a need of treatment now or even during the
time waiting for diagnosis.
T****g
发帖数: 705
5
I reviewed the Qs. I was wrong for #1
Pt does have recurrent candida vaginitis.
D should be correct answer.
see the following:
http://www.aafp.org/afp/2000/0601/p3306.html
Has Dr. Red released the key?
Which Q# are those?
Thanks
R**D
发帖数: 30
6
1. Fluconozole one dose enough, no need maintenance.
J*********4
发帖数: 1274
7
3. C first need diagnosis
T****g
发帖数: 705
8
Jenny
3. C
你是对的
刚做了一道UW Step 3 类似这一道
楼主, Archer出答案了吗?
1 (共1页)
进入MedicalCareer版参与讨论
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ECFMG的ROD service开始了请教一个解剖学问题
相关话题的讨论汇总
话题: wound话题: her话题: blood话题: she话题: patient