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+--- Thread: sugesstion needed - dr_usmle2012 (/showthread.php?tid=796072)
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0 - ArchivalUser - 07-26-2015
that is the correct answer.
0 - ArchivalUser - 07-27-2015
A 68-year-old white man, who is recovering in the acute rehabilitation unit 4 weeks following coronary artery bypass grafting, continues to report numbness in his hands and feet and weakness of his arms and legs since transfer from the intensive care unit 1 week ago. The patient required another operation 8 hours after the coronary artery bypass grafting to correct a bleeding problem. He then acquired pneumonia that required prolonged intubation. He cannot ambulate without assistance. Medical history is remarkable for type 2 diabetes mellitus that was well controlled with metformin and chronic lymphocytic leukemia diagnosed 2 years ago. Additional medications include atorvastatin, ramipril, and folic acid. Vital signs are temperature 37.0°C (98.6°F), pulse 90/min, respirations 15/min, and blood pressure 126/78 mm Hg. He is alert and oriented. Cranial nerves are intact. Muscle strength is 4/5 in the distal aspects of all extremities. Deep tendon reflexes are diminished in the biceps, triceps, and quadriceps and absent in the Achilles. There is reduced sensation to pinprick and light touch in the distal aspects of all extremities. Which of the following is the most likely diagnosis?
A) Amyloid neuropathy
B) Critical illness polyneuropathy
C) Diabetic neuropathy
D) Guillain-Barré syndrome
E) Paraneoplastic neuropathy
0 - ArchivalUser - 07-27-2015
E?
3 - ArchivalUser - 07-27-2015
B...
0 - ArchivalUser - 07-28-2015
B ,
0 - ArchivalUser - 07-28-2015
can you explain the answer
0 - ArchivalUser - 07-28-2015
Ans: B) Critical illness polyneuropathy
Critical illness polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality.
Most patients have generalized flaccid weakness with distal prominence and depressed tendon reflexes. Muscle wasting is absent in a third of patients. It is rare to see facial weakness or other cranial nerve involvement. Pain or paresthesias are not features of critical illness neuropathy. When prospectively investigated, at least 50% of critically ill patients with sepsis and multiple organ failure who were resident in ICUs for at least 2 weeks have EDX features indicative of an axonal polyneuropathy.
0 - ArchivalUser - 07-29-2015
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0 - ArchivalUser - 07-29-2015
Thanks
0 - ArchivalUser - 07-29-2015
You are called to the neonatal unit of the hospital to evaluate a male neonate who is not breast-feeding well. The neonate was born 12 hours ago to a 27-year-old woman. He is the mother's first child. He was born at term via uncomplicated vaginal delivery; he was vigorous at the time of delivery. The mother received appropriate prenatal care throughout her pregnancy. She says that the neonate appears hungry, but soon after he latches onto the breast he gags and becomes uninterested in feeding. Vital signs now are temperature 37.0°C (98.6°F), pulse 150/min, and respirations 40/min. On physical examination, the neonate is alert and active. Lungs are clear. Chest and abdomen are normal. Anus is patent. The neonate has passed only a small smear of stool since birth.
On day 2 of life, the neonate continues to have problems with feeding. On physical examination now, he appears alert and vigorous. Abdominal girth is increased 3 cm (1.2 in) since birth. The abdomen is distended, but it remains soft to palpation. The neonate has not passed any stool today. A nasogastric tube is inserted and less than 10 mL of clear, nonbilious secretions with small flecks of brown blood are disclosed. Which of the following is the most appropriate next step?
A) Administer ranitidine
B) Administer sucralfate therapy
C) Do lower gastrointestinal barium study
D) Obtain plain x-ray of the abdomen
E) Order upper endoscopy