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* Question from USMLE Sample questions?
 #854959  
  aricept123 - 10/11/18 13:34
 
  A 35-year-old man is brought to the emergency department because of altered mental status. He is disoriented and reports problems with his vision. You have been his physician for the past 3 years. He has type 1 diabetes mellitus and a known history of intravenous drug use. You last saw him 2 weeks ago; at that visit his serum glucose concentration was 150 mg/dL 3 hours after eating. Today, vital signs are temperature 38.1°C (100.5°F), pulse 110/min, and blood pressure 190/70 mm Hg. On physical examination pupils are constricted; funduscopic examination of the left eye following dilation is shown. Which of the following is the most appropriate test at this time?

(A) Blood cultures (B) Chest x-ray (C) Hemoglobin A1c level (D) HIV antibody titer (E) Plasma renin activity
 
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* Re:Question from USMLE Sample questions?
#3373497
  cardio69 - 10/11/18 19:01
 
  Pat DM1 & known "IVDU"^ (There is no reliable marker available to exclude serious illness in the febrile IV drug user) -> YOU obtain specimens for Blood culture & adm* pat 4 observation while culture/results are awaited… even if your pat “clinically well” pat for whom follow up can be ensured/outpat evaluation is reasonable ALA appropriate culture specimen are obtained.

Pat^ here clearly painted with infection (most probably related to IVDU history) standard care-> blood cultures must be obtained in case pat didn’t respond to the antibiotic in order-> *for pat adm with septic or possible meningitis ...

 
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* Re:Question from USMLE Sample questions?
#3373500
  cetamool - 10/11/18 20:39
 
  Will, this guy clearly had cocaine, the pulse pressure is very high! I would go with cxr to rule out widening of the mediastinum.  
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* Re:Question from USMLE Sample questions?
#3373502
  cardio69 - 10/11/18 22:19
 
  Let's review step 1@cetamool

On pat who took sympathetic NS agonist or amphetamine/coca/LSD -> Q4 you, Do you see Bilateral constricted pupils???:) on your PE...
("On PE pupils are constricted") ask yourself :) can cocaine cause that?
 
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* Re:Question from USMLE Sample questions?
#3373837
  aricept123 - 10/19/18 12:23
 
  This question is not asking you diagnosis. Just is asking you what to do first.
This is a picture of infection related to IV Drug users, next step will be Blood cultures.
:)
 
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* Re:Question from USMLE Sample questions?
#3373860
  cardio69 - 10/19/18 16:42
 
  lol
@arice no1 said what they asking:) As I just dissect for you but one should be able to dissect the Qs in point of view into the center of clinical medicine.
That's how you learn.
Pat here clearly at the time presentation not taking coca:)
 
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* Re:Question from USMLE Sample questions?
#3373871
  aricept123 - 10/19/18 17:13
 
  I said that because when I read the question I try to focus in the context and put all together and get to the dx and then I know what to do. But in these question I said to myself no matter what diagnosis is. What matter is these is a picture of infectious process and next step is culture.
I was no correcting anybody just in case. I apologize.
 
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* Re:Question from USMLE Sample questions?
#3373884
  cardio69 - 10/19/18 23:28
 
  No apology necessary:) @ari..
I was just clearing confusion for our friend @cetamool who got it wrong.
 
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