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Discussion in 'Medical Exams' started by Esramed, Dec 6, 2015.

  1. Esramed

    Esramed New Member

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    i have couple questions dont understand it can anybody help me

    1) 32 years old man, complaining of fatigue and jaundice, in the physical examination, the conjunctiva is pale, sclera is yelow, spleen 4 cm palbable below the ribs, in fbc hg:11g/dl, mchc:38g/sdl, leucytes:4400/mm3 , thrombocytes 214.000/mm3, reticulocytes %7, periphral smear the erythrocytes are hypochromic, in the osmotic fragility test theres hemolysis.
    Whats is the proper treatment for this patient?
    A) steroid
    B) splenectomy
    C) immunosuppressive drugs
    D) intravenous immunoglobulin
    E) anti-d immunoglobulin


    2) 25 years old women, brought to the emergency department for sudden onset of severe dyspnea. Before 24 hrs ago the same patient came to the emergency department for uti, phenazopiridin & sulfamethaxazole given to her, the patient is obese and smoker 2 packet/day. In physical examination, theres signs of dyspnea and pseudo cyanosis. In Arterial blood gas theres no hypoxemia. Complete blood count is normal.
    Whats the next approach to this patient??
    A) by repeating ABG analysis to see if theres increase in hypoxia
    B) pulmonery arteriography
    C) giving methylene blue
    D) giving 2 units of erythrocyte suspension

    Can anyone answer these questions with explanations please ..
     
  2. cake or death?

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    Guessing you no longer need the answer to these - but since no-one has replied? These were fairly fun to ponder- they're tough

    The second one I think is methaemagobinemia. It can occur with certain drugs including sulphonureas and other antibiotics. Its the only thing I know that gives cyanosis plus with no apparent hypoxemia? It's treated with Methylene blue so the answer would be C

    The first one? I have to admit haematology is not my strong suit. haemolytic anaemia plus hypochromic cells and osmotic fragility says thalassemia to me? He has splenomegaly which will be causing increased break-down of erythrocytes - so I would say splenectomy, B

    Not sure if anyone else has a more educated (corrrect?) opinion?
     

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