Еще одна пилюлька Hескучина

[riltsov]

Травматолог из моей поликлиники поставил бы диагноз - «плече-лопаточный периартрит». В англоязычной медицине - Impingement Syndrome.
Начнем с A. advise patient that he should rest and ice the shoulder

[Delsol]

The correct answer is D. Rotator cuff tears are chronic use injuries most common in throwing athletes. The clinical symptoms are weakness and instability of the shoulder. An x-ray may show a subacromial spurring, a high-riding shoulder, or calcific tendonitis. Diagnosis is made by MRI of the shoulder. This is a non-emergent diagnosis and the imaging can be performed on an outpatient basis. Repair is made arthroscopically.

Advising the patient to rest and ice the shoulder (choice A) will help alleviate the immediate symptoms of pain. It will not, however, treat the underlying condition of a rotator cuff tear. Rest and ice are good for muscle sprains, but will not help torn tendons.

A CT scan of the shoulder (choice B) is not indicated in suspected cases of rotator cuff tears. A CT is good for evaluating the bones of the shoulder, but does not provide the resolution to evaluate the muscles and tendons of the shoulder.

An emergent MRI of the shoulder (choice C) is not indicated. Rotator cuff tears are chronic overuse injuries and do not require emergent diagnosis or repair. The MRI should be ordered on an outpatient basis.

Prescribing nonsteroidal antiinflammatory drugs (choice E) will help alleviate the immediate symptoms of pain. It will not, however, treat the underlying condition of a rotator cuff tear.

[Delsol]

1) A 35-year-old man comes to the emergency department with a 2-day history of sharp chest pain that has been getting progressively worse. The pain increases when he is supine and improves when he sits upright. He has never had pain like this before and he denies dyspnea, diaphoresis, nausea, or presyncope. He does not smoke, has no chronic medical conditions, and has no family history of coronary artery disease. He is an avid jogger and was running 3-5 miles every day up until the pain began 2 days ago. Upon further questioning, you discover that he had a recent upper respiratory tract infection that resolved approximately 5 days ago. His temperature is 37.6 C (99.7 F), blood pressure is 120/82 mm Hg, pulse is 95/min, and respirations are 14/min. Physical examination shows a triphasic cardiac rub. A chest x-ray is normal and an electrocardiogram shows diffuse ST segment elevation with ST segment depression in aVR. The most appropriate next step in management is to
A. administer nonsteroidal antiinflammatory agents
B. obtain an echocardiogram
C. obtain serial cardiac enzymes
D. order serologies for coxsackie B virus
E. treat the patient with a second-generation cephalosporin


2) A 32-year-old woman who has been a patient of yours since childhood underwent a total thyroidectomy for a 4-cm papillary adenocarcinoma. There were no intraoperative complications. During the surgery all 4 parathyroid glands were identified and preserved, and both recurrent laryngeal nerves were identified and were intact. You go to visit her in the recovery room after 1 hour, and while you are there, she develops progressive laryngeal stridor and becomes cyanotic. The most appropriate immediate management is
A. administration of epinephrine
B. endotracheal intubation with a laryngoscope
C. intravenous administration of calcium
D. nasotracheal suction
E. to open the entire wound

[Aladdyn]

1) D. Хотя в России была бы эхо-кг сначала наверняка.
2) C.

[riltsov]

1.Миокардит. A. administer nonsteroidal antiinflammatory agents
Потом можно выполнить ЭХО-КГ, определить уровень кардиоспецифичных энзимов. serologies for coxsackie B virus – это разве что в научно-исследовательских целях может быть применено.
2. Я боюсь, что пациентка может задохнуться. B. endotracheal intubation with a laryngoscope

[Rodionov]

Не понял, каким образом, но оказалось, что я подписан на рассылку клинических случаев для студентов: [Ссылки доступны только зарегистрированным пользователям ]

Простенько и со вкусом...

[Alexey2301]

Уважаемые коллеги! Есть ли изменения сегмента ST в данной электрокардиограмме или кажется мне?