A 21 year old presents to the office two weeks after a sore throat. The rapid strep test came back positive as well as cultures showing group A beta-hemolytic strepococcus. He finished his course of antibiotics and came back to the office two weeks later with the main complaint of swelling in his feet. He also noticed he's not urinating as frequently and the urine he does make is smoky-brown. His vital signs were significant for an elevated blood pressure of 150/80. What is the most likely diagnosis?
A) Wegener's granulomatosis
B) Goodpasture's syndrome
C) Alport's syndrome
D) IgA Nephropathy
E) Postinfectious glomerulonephritis
What additional lab tests can be ordered?
A) c-ANCA
B) serum C3
C) ASO titer
D) fat pad biopsy
Answer: This patient most likely has postinfectious glomerulonephritis, an immune complex nephritic syndrome. A serum C3 would be decreased and an ASO titer would be positive.
Source:
1. Le, Tao. First Aid for the USMLE Step 2 CK. 5th. New York: McGraw-Hill, 2006.
First Aid for the USMLE Step 2 CK (First Aid for the USMLE Step 2: Clinical Knowledge)
Tuesday, December 25, 2007
Wednesday, December 19, 2007
poison signs and symptoms
Mercury - stomatitis, abdominal pain, nausea and vomiting, and explosive, bloody diarrhea.
Iron - vomitting, hematemesis, diarrhea, hypotension, and metabolic acidosis
Arsenic - skeletal muscle cramps, abdominal pain, watery diarrhea, vomiting
Lead - headache, abdominal pain, constipation, coma, convulsions
Selenium - garlic breath, hair loss, skin depigmentation, abnormal nail growth, fatigue
Source: NMS review for USMLE Step 2 Ck
Iron - vomitting, hematemesis, diarrhea, hypotension, and metabolic acidosis
Arsenic - skeletal muscle cramps, abdominal pain, watery diarrhea, vomiting
Lead - headache, abdominal pain, constipation, coma, convulsions
Selenium - garlic breath, hair loss, skin depigmentation, abnormal nail growth, fatigue
Source: NMS review for USMLE Step 2 Ck
Expensive efficiency in medicine
This NY Times article looks at the cost of promoting efficiency in medicine. An office of four doctors had to spend $140,000 to install electronic medical records.
Who Pays for Efficiency?
Who Pays for Efficiency?
Regional differences in Medicare
The NY Times compiled an interactive graphic about regional differences in Medicare looking at reimbursements, surgery rates, and enrollees.
http://www.nytimes.com/ref/business/20070611_GAP_GRAPHIC.html
http://www.nytimes.com/ref/business/20070611_GAP_GRAPHIC.html
California debating universal health care
California Moves Toward Universal Health Care
The program would be funded by several sources including a cigarette tax and a 4% tax on hospital revenues.
The program would be funded by several sources including a cigarette tax and a 4% tax on hospital revenues.
Saturday, December 08, 2007
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