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You are evaluating a 72-year-old man brought to the emergency department in an altered mental status. He lives alone, but his neighbors informed paramedics that the patient was complaining of abdominal discomfort earlier in the day. Paramedics noted that there is evidence of vomiting at the bedside at the patient's home. The patient is wearing a wristband identifying him as an insulin-dependent diabetic. His temperature is 38.3 C (101 F), blood pressure is 106/60 mm Hg, pulse is 86/min, and oxygen saturation is 94% on room air. He is moaning in pain and is flexing his hips. His mucous membranes appear dry, and chest auscultation reveals coarse crepitations. Abdominal examination shows a distended, tender abdomen with guarding and hyperactive bowel sounds. His extremities are warm with diminished distal pulses. During the physical examination, particular attention should be given to his
A. chest
B. groin
C. hips
D. neurological status
E. peripheral vasculature
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Answer is A. chest,
this is a case of diabetic ketoacidosis (DK), although there will be other signs like decrease in the capillary filling( choice E) but it would be none specific. rapid, deep, and labored breathing
(Kussmaul respiration); and fruity breath odor are common physical findings in DK
altered mental status is none specific to DK.
abdominal pain helps, blood and urine ketones as well as blood sugar level.
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The correct answer is B. Hernial sites must be examined to complete any acute abdomen evaluation. Incarcerated or strangulated hernias in an elderly patient can cause acute abdomen, dehydration, and altered mental status. Failure to diagnose an incarcerated hernia at an early stage can lead to strangulation.
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but they already mentioned the abdominal exam and didn't mention the hernia,that means the hernia is not there. abdominal exam is never complete without examining the hernia sites.
who made this question.?
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Read the question:
During the physical examination, particular attention should be given to his?
The patient has severe abdominal pain and you want to focus your PE on the chest?!....
