32. A 77-year-old woman comes to the physician because of a 2-day history of cramping abdominal pain and distention accompanied by nausea and vomiting. She is otherwise healthy and has no history of abdominal operations. Her temperature is 37.4 C (99.4 F), blood pressure is 110/86 mm Hg, pulse is 112/min, and respirations are 24/min. Cardiopulmonary examination shows no abnormalities. Examination of the abdomen shows distention and mild diffuse tenderness; bowel sounds are high-pitched. An x-ray film of the abdomen shows air-fluid levels throughout the small bowel and air in the liver; there is no gas in the colon or free air. Which of the following is the most likely diagnosis?
A
) Adhesive small-bowel obstruction
B
) Cecal cancer
C
) Gallstone ileus
D
) Intussusception
E
) Mesenteric infarction
F
) Ruptured appendicitis
G
) Small bowel lymphoma
can not be A no history of surgery before. small bowell obs, maybe C
33. Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient-controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes?
A
) Epidural-related hypotension
B
) Insufficient intraoperative fluid replacement
C
) Postoperative intra-abdominal hemorrhage
D
) Supine hypotensive syndrome
E
) Underestimated intraoperative blood loss
SLIP LIGTURE ............CC
35. A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?
A
) Acetaminophen with codeine therapy
B
) Arthrocentesis
C
) Bone marrow aspiration
D
) Bone scan
E
) Immobilization and traction
F
) Lyme titer
G
) MRI of the spine
H
) Physical therapy
I
) Reassurance
J
) Serum rheumatoid factor assay
K
) Systemic antibiotic therapy
BB........treatment and diagnosis
what is this? septic arthitis or osteomyelitis?
what about k? r we going for invasive arthrocentesis for 4 yr old first? can we just go for antibiotic as it could be simple septic arthitis caused by staph aureus? i am confused.
not invasive it is just like IM injection with fine sedation or easier than canula fixation for pediatric ..... it is ....septic arthritis