Ethiopians Public Health Officer

Ethiopian primary health care guideline updated

Giant cellulitis-like Sweet syndrome mimicking cellulitis: a case report

Selamawit T. Muche , Lishan D. Tefera, Nigatu A. Gerba, Kibrom M. Gebremedhin, Abdusamed A. Abdusamed, Melkamu K. Nidaw, Abenezer A. Kebede and Edom T. Degefa

Corresponding Author: Selamawit T. Muche

Share MedStar Internal Medicine 2nd Edition.pdf

# A 6wk child is very sick-looking. Bloods: Na+=124, K+=2.8. Dehydrated. What would you choose
to resuscitate?
a. 0.18% NS + 4% dextrose + 20mmol KCl
b. 0.9% NS
c. 0.45% NS
d. 0.45% NS + 5% dextrose
e. 0.45% NS + 5% dextrose + 20 mmol KCl
Ans. The given key is E. But it is wrong key! The correct key is B. 0.9% NS. Explanation: Rsuscitation is mostly done with 0.9% NS or ringers lactate, or hartmans solution. Here is hypokalemia. To treat hypokalaemia the cut off value is below 2.5 mmol/L and absence of anuria during resuscitation. Maintenance is with fluid E.
344. A 68yo man gets repeated attacks of LOC and TIA. What is the most likely cause for this?
a. Atrial fib
b. Mitral stenosis
c. Aortic stenosis
d. HOCM
e. Carotid artery stenosis
 
Ans. The key is E. Carotid artery stenosis.
 
# Pt presented with hemoptysis 7d post-tonsillectomy. What is the next step?
a. Packing
b. Oral antibiotics + discharge
c. Admit + IV antibiotics
d. Return to theatre and explore
e. Ice cream and cold fluids
 
Ans. The key is C. Admit + IV antibiotic. [infection is a common cause of secondary haemorrhage. Patient should be admitted to observe the course of bleeding and treatment is given with IV antibiotics].
 
# A child was admitted following a RTA with initial GCS=15. Then during the night the noticed GCS
reduced to 13. What is the management?
a. Refer to neuro-surgeon
b. IV fluids
c. Oxygen
d. CT brain
e. Skull XR
 
Ans. The key is D. CT brain. [probable intracranial haemorrhage].
 
# A 57yo woman who is suffering from HTN, presented to the hospital with complaints of
recurrent falls when trying to get out of bed or getting up from sitting. She is on some anti-HTN
therapy with no other med prbs. What is the cause of her fall?
a. CCB
b. Vertibrobasiliar insufficiency
c. Thiazide
d. Hypoglycemia
e. Infection
 
Ans. The key is C. Thiazide. [It causes postural hypotension by volume depletion].

 # A 56yo woman with MS presents with drooping of the left side of her lips. She also has loss of
sensation over her face, hearing impairment and some in-coordination of her movements. What
is the most likely anatomical site affected?
a. Cerebellum
b. Cerebrum
c. Spinal cord
d. Brain stem
e. Optic nerve
 
Ans. The key is D. Brain stem. Features of 5, 7, 8th cranial nerve and cerebellum involvement suggestive of brainstem lesion.

# A 68yo male presented with swelling in the lower pole of the parotid gland for the last 10yrs.
Exam: firm in consistency. What’s the most probable dx?
a. Pleomorphic adenoma
b. Adenolymphoma
c. Mikulicz’s disease
d. Parotiditis
e. Frey’s syndrome
 
Ans. The key is A. Pleomorphic adenoma. [Pleomorphic adenoma (most common) - also called benign mixed tumour: is the most common tumour of the parotid gland and causes over a third of submandibular tumours. They are slow-growing and asymptomatic, having a malignant potentiality].
 
# A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing
over the last 3m. There is no hx of HTN or DM but he is a smoker. Exam: loss of posterior tibial
and dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MTP joint.
What is the most probably dx?
a. Thromboangitis obliterans
b. Sciatica
c. DVT
d. Baker’s cyst
e. Embolus
 
Q. 1. What is the key?
Q. 2. What are the points in favour?
 
Ans. The key is A. Thromboangitis obliterans.
Ans. 2. i) young age ii) smoker iii) pain in cuff iv) loss of posterior tibial and dorsalis pedis pulsation v) non-healing ulcer at the base of the right 1st MTP joint all are suggestive of Buerger’s disease.

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Answer is B. To help flush the stones through the urinary tract.

Here's why:

• Nephrolithiasis: Kidney stones are formed when minerals and salts in the urine crystallize and form solid masses. These stones can vary in size, from tiny grains to large stones that can block the urinary tract.
• Fluid Intake: Increasing fluid intake helps to:
* Dilute Urine: More fluid in the urine makes it less concentrated, reducing the likelihood of stone formation and making it easier for existing stones to pass.
* Increase Urine Output: More urine production helps to flush out the urinary tract, increasing the chances of the stones being passed.

Let's look at why the other options are incorrect:

• To concentrate the urine: Concentrated urine increases the risk of stone formation, so increasing fluid intake actually dilutes the urine.
• To crystallize the struvite from the renal tubules: This is incorrect. Increasing fluid intake helps to prevent crystallization, not promote it.
• To break down the stones into smaller pieces that will more easily pass through the urinary tract: While increasing fluid intake can help to flush smaller stones, it doesn't break down larger stones.

D2.Q2. A-40- year old patient is brought to a Hospital with a diagnosis of nephrolithiasisand advised to increase fluid intake.What isthe importance of increasing fluid intake in this patient?
A. To concentrate the urine
B. To Help flush the stones through the urinary tract
C. Tocrystallize the struvite from the renal tubules
D. Tobreak down the stones into smaller pieces that will more easily passthrough the urinary tract.

The most important factor in preventing pressure ulcers in a comatose patient is D. Minimize pressure on the bony prominence of a bed-ridden patient.

Here's why:

• Pressure Ulcers: Pressure ulcers (also known as bedsores) are caused by prolonged pressure on the skin, particularly over bony prominences. This pressure restricts blood flow to the area, leading to tissue damage and ulceration.
• Minimizing Pressure: The primary focus for preventing pressure ulcers is to minimize the pressure exerted on the skin. This is achieved by:
* Frequent Position Changes: Changing the patient's position regularly, ideally every 2 hours, to relieve pressure from different areas.
* Pressure-Relieving Surfaces: Using specialized mattresses or cushions designed to distribute pressure evenly and reduce pressure points.
* Proper Positioning: Making sure the patient's body is properly aligned and supported to minimize pressure on bony areas.

Let's look at why the other options are incorrect:

• Positioning disturb patients in coma: This is incorrect. Frequent positioning changes are crucial to prevent pressure ulcers.
• Changing the position of a bed-ridden patient every 8 hours: While changing the position every 8 hours is better than nothing, it's not frequent enough to effectively prevent pressure ulcers. Frequent changes are essential, ideally every 2 hours.
• Rub the skin vigorously with alcohol: Rubbing the skin vigorously with alcohol can damage the skin and increase the risk of pressure ulcers. It should be avoided.