Page 1 of 1: mccee 2Q

masawa · Credits: 4537 My Scrapbook

72-year-old man with history of recently diagnosed small cell cancer of the lung, presents to the emergency room with increasing fatigue and unsteadiness on his feet. His serum sodium is 115 mmol/L. Which one of the following is the best approach to the management of his electrolyte disturbance?

1) fluid restriction

2) intravenous normal saline at 25 mL/hr

3) intravenous normal saline at 100 mL/hr

4) intravenous 3% saline at 25 mL/hr

5) intravenous 3% saline at 100 mL/hr

A 62-year-old man presents with a 4-week history of pruritus and steadily deepening jaundice. He has taken no drugs. The only significant positive findings are jaundice, dark urine and clay-colored stools on rectal examination. Preliminary biochemical test results include: alkaline phosphatase four times normal; aspartate aminotransferase slightly elevated. Which one of the following tests should you do next?

1) upper gastrointestinal barium contrast x-ray

2) ultrasound examination of the upper abdomen

3) endoscopic retrograde cholangiopancreatography

4) measurement of serum HBs-antigen, anti-HBc and anti-HAV

5) percutaneous transhepatic cholangiography

maryana · Credits: 15476 My Scrapbook

72-year-old man with history of recently diagnosed small cell cancer of the lung, presents to the emergency room with increasing fatigue and unsteadiness on his feet. His serum sodium is 115 mmol/L. Which one of the following is the best approach to the management of his electrolyte disturbance?

1) fluid restriction////////////////

2) intravenous normal saline at 25 mL/hr

3) intravenous normal saline at 100 mL/hr

4) intravenous 3% saline at 25 mL/hr

5) intravenous 3% saline at 100 mL/hr

A 62-year-old man presents with a 4-week history of pruritus and steadily deepening jaundice. He has taken no drugs. The only significant positive findings are jaundice, dark urine and clay-colored stools on rectal examination. Preliminary biochemical test results include: alkaline phosphatase four times normal; aspartate aminotransferase slightly elevated. Which one of the following tests should you do next?

1) upper gastrointestinal barium contrast x-ray

2) ultrasound examination of the upper abdomen

3) endoscopic retrograde cholangiopancreatography//////////

4) measurement of serum HBs-antigen, anti-HBc and anti-HAV

5) percutaneous transhepatic cholangiography

2Pandai · Credits: 21419 My Scrapbook

5) intravenous 3% saline at 100 mL/hr

3) endoscopic retrograde cholangiopancreatography

rmc · Credits: 6647 My Scrapbook

agree with 2pandai

arloushi · Credits: 13692 My Scrapbook

agree with RMC and 2pandaii

saimamanzoor · Credits: 814 My Scrapbook

why not usg for second one

arloushi · Credits: 13692 My Scrapbook

CORRECTION

in the second question ultrasound, we need to start with least invasive procedures, therefor ultrasound in this case.
it looks like choledocholithiasis
acholi stools, dark urine, fluctuating jaundice, so first ultrasound, then then ERCP.

docnoor · Credits: 3871 My Scrapbook

why not fluid restriction in first question?

maryana · Credits: 15476 My Scrapbook

you have to choose fluid restriction because it is paraneoplastic syndrome-SIADS

smartyroy · Credits: 13861 My Scrapbook

fluid restriction

u/s of upper abdomen

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