![]() Physical examination shows several petechiae on her forearms, muscle twitching in her upper and lower extremities, expiratory wheezes on lung auscultation, decreased S1 and S2 and the presence of an S3 on cardiac auscultation, and positive Trousseau and Chvostek signs. ![]() The vital signs include blood pressure 102/65 mm Hg, heart rate 93/min, respiratory rate 17/min, and temperature 36.1℃ (97.0℉). On day 2 postoperatively, she developed irritability, dysphagia, difficulty breathing, and spasms in different muscle groups in her upper and lower extremities. Which of the following is most likely to be the underlying cause for the fracture in this patient?Ī 48-year-old woman underwent a thyroidectomy with central neck dissection due to papillary thyroid carcinoma. On abdominal imaging of the left hip joint, a transcervical fracture is noted in the left hip with surrounding bony sclerosis. A DEXA scan shows a T-score of -2.5 at the hips and -1.5 at the lumbar spine (normal T-score ≥ -1.0). The rest of the examination, including a complete neurological examination, is unremarkable. On physical examination, there is limited flexion and extension at the left hip. His past medical history is significant for Crohn’s disease, managed with a combination of prednisone and mesalamine and presently in remission. The patient denies any history of injury, weight loss, change in appetite, or recent travel. However, it worsened over time to its present 8/10 intensity and does not respond to Tylenol anymore. He initially attributed it to heavy work and took a few days off work, but he did not seek medical attention. Initially, it improved with rest and Tylenol. He says the pain has rendered him unable to report to work for the last 2 weeks. The pain was initially 4/10 in intensity, dull with no radiation and was aggravated to 5/10 in intensity upon weight-bearing. He says that symptoms started a month ago and have progressively worsened. Which of the following drugs is 1st-line for chronic therapy of gout?Ī 40-year-old man presents with left hip pain. He is also put on chronic therapy to prevent the recurrence of future attacks. Ibuprofen is prescribed for the acute treatment of this patient’s symptoms. HDL: high-density lipoprotein LDL: low-density lipoprotein Laboratory studies show: Serum glucose (random) Joint arthrocentesis of the inflamed toe reveals urate crystals. A plain radiograph of the right foot reveals no abnormalities. ![]() The remainder of the examination is unremarkable. On physical examination, there is significant erythema, swelling, warmth, and moderate pain on palpation of the right 1st toe. The patient is afebrile and the vital signs are within normal limits. He reports similar symptoms in the past and this is his 2nd visit to the emergency department this year with the same complaint. Which of the following would be the most appropriate next step in management?Ī 59-year-old man presents with intense, sharp pain in his toe for the past hour. Arthrocentesis of the 1st left metatarsophalangeal joint reveals sodium urate crystals. The 1st metatarsophalangeal joint of the left foot is erythematous, severely tender to touch, and swollen. On physical examination, the patient is slightly overweight and in obvious distress. The vital signs include: pulse 86/min, respiratory rate 14/min, and blood pressure 130/80 mm Hg. He reports regular drinking and the occasional binge on weekends, but denies any smoking history or recreational drug use. Family history is significant for a mother who has type 2 diabetes mellitus and a father who has hypertension. There is no significant past medical history and he takes no medications. He denies any recent history of trauma or fever. He says he had similar pain a few weeks ago after an evening of heavy drinking with his friends.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |