Welcome to machetebettyโs page.
Contributor score: 4
Comments ...
Subcomments ...
machetebetty
Tamsulosin, too, can definitely cause orthostatic hypotension.
+
study_dude_guy
Had the same reaction as you and then I learned that AA is a buzz word for lactose intolerance
"African American and Asian ethnicities see a 75% - 95% lactose intolerance rate, while northern Europeans have a lower rate at 18% - 26% lactose intolerance"
+1
seagull
I also choose Celiac's. "BuT RaCe AnD mEdICiNe DoN't Go ToGeThEr".
+3
hayayah
I think a key part to differentiate between celiac's and lactose intolerance in this question isn't race, it's because of the part that says "he occasionally had diarrhea after meals since 12 years old and then it got worse since starting college".
If he had celiac's he'd have GI symptoms (i.e. diarrhea) any time he ate something containing gluten (which would be every single time he had a meal) since he was 12. You'd also see signs of fat or vitamin malabsorption in celiac's patients and other autoimmune symptoms.
Whereas in lactose intolerance, it's much more likely he'd once in a while eat a lot of dairy and have his symptoms triggered, and then he starts college and has even less of a well rounded diet and so his symptoms get worse.
+4
sahusema
I agree with above, but it could just as easily of been CD and people here would have been like "JuSt cAUse He aFricaN AmErICaN DoNT MaEN he CanT haVe CEliaC."
+
imtheman
I dont understand how the whole college part adds into this? I thought IBD to be honest. Complete BS question. Are we to assume he eats more milk products in college?
+
machetebetty
My best guess re: college is the primary currency of (pre-Covid) college gatherings: FREE PIZZA.
+1
jj375
Also lactose intolerant commonly begins around puberty, so that may be a buzzword. Most people can digest lactose when theyre young and then grow out of that ability and stop making enough lactase!
+
dreamyyn
per uptodate, you should still give them prophylaxis:
Women with GBS bacteriuria any time in pregnancy (Grade 2B) or an infant with early-onset GBS infection in a previous pregnancy (Grade 2C) should routinely receive intrapartum antibiotic prophylaxis
+
machetebetty
I wonder if there was confusion about who is receiving the penicillin? The patient in the stem is the woman, not the newborn; the laboring patient is receiving the (indicated) penicillin.
+
saffronshawty
They mentioned that the uterus is 3 cm above the umbilicus which is an indication that it's enlarged and hasn't returned to the normal post-partum size it should be, which is at the level of the umbilicus +/- 2 cm.
+4
derpymd
So that +1cm is the distinction here? They misdirect to suggest there may be retained placental tissue, but tell us nothing truly valuable about the state of the uterus. I think this is a poor question.
+1
cinnapie
@derpymd i get what you are saying but they said that the placenta is torn but complete. I guess we need to take their word for it if they say the placenta is complete and there is absolutely NOTHING left behind to cause the symptoms
+1
jmorga75
You could make an argument for a benzo, but that benzo def wouldn't be diazepam that has a half life of 1-3 days. If you were going to give a benzo you'd have to give a short-medium acting one (midazolam, Alprazolam, or lorazepam). Also, atropine, unlike benzoes, slows down the aging process of organophosphates, so it's probably better to give atropine ASAP.
+
jmorga75
You could make an argument for a benzo, but that benzo def wouldn't be diazepam that has a half life of 1-3 days. If you were going to give a benzo you'd have to give a short-medium acting one (midazolam, Alprazolam, or lorazepam). Also, atropine, unlike benzoes, slows down the aging process of organophosphates, so it's probably better to give atropine ASAP.
+
lindasmith462
diazepam is the specific benzodiazepine indicated in the treatment of organophosphate poisoning associated seizures and was noted to work faster than atropine in animal models. in this case you would give both at the same time. thus the crappyness of this question
+
machetebetty
I wonder if actually their point (...in that darling NBME way...) is to differentiate between "next best step" (which could be either, and realistically, in the ED it's all just happening ASAP) vs "most appropriate pharmacotherapy"- i.e., what's the antidote for the core problem (as opposed to, benzos as symptomatic/supportive care in this case).
[Kinda like that Q w/ the pregnant person who also has an SBO >> pregnancy was a diagnosis but not THE diagnosis... darned NBME punks XD ]
+
bluebul
I didn't even get that far. Only way to prevent long term complications is with abx and we know metro isn't an option. Leaves only Amox.
+4
machetebetty
I know that both Sketchy and Divine agree with doxy-except-when-pregnant-or-pediatric, but fwiw, to the extent the CDC is a "source of truth" for the USMLEs, they seem to regard them as equivalent (for this scenario). https://www.cdc.gov/lyme/treatment/index.html
...This also helps me feel less perturbed about the possible [ridiculous] assume-she's-pregnant thing, to @derpymd's point!!
+
lilmonkey
Shouldn't we stabilize her neck with a collar (maybe not too soft:)) to prevent further damage before taking her to the OR?
+
machetebetty
Yes to a collar before she heads to urgent/emergent surgery- but a rigid collar. Tricksy buggars ;)
+1
sassy_vulpix
As per UWorld :
Adults : Centor Criteria : 0-1 : viral,No test reqd; 2-3 : RSAT, if positive antibiotics, if negative, we assume it to be viral so nothing; 4 : penicillin/amoxiciliin
whereas for kids, we always need to follow up a negative RSAT with a throat culture. In adults, there is no need.
+1
machetebetty
She doesn't meet criteria for empiric treatment (4 or 5 points); if she had, they wouldn't have performed the RST. She has 3 points- age, temp, no cough. Also, helpful for remembering (not mine but I don't remember where I got this) -
Cough [trick is remembering, lack thereof]
Exudates
Nodes
Temp
Old
r [or, "RST if 2-3"]
+
Bacterial vaginosis is also very common in women/people with vaginas who have sex with women/people with vaginas, and more common in that population vs gen pop.
One 2005 study of 12K vagina-owners found 45% prevalence in folx who'd had at least one partner with a vagina, vs 29% rest of study population.
(Sorry no link, just sharing from "Lesbian Health" by Dibble & Robertson.)