Cardiac Muscle Physiology - Usmle Quick review
Pyruvate kinase deficiency - Extremely High-yield Usmle Lecture
Pyruvate kinase deficiency - Extremely High-yield Usmle LectureDetailed Board lecture will be coming soon guyzz ......MEDVIZZ - USMLE , PLAB , AMC , MCCQE , COMLEX , SLE , MRCP INSTITUTE FOR MEDICAL EDUCATIONLive and online Training for all licensing Exams with Qbanks and study material .
Diaphragm Quick review - Usmle respiratory physiology
Hi Dr Mullens, The prevalence up to 90% is now historic data.The significantly high prevalence was related to the multiple blood product transfusions given to these patients. This prevalence has now significantly decreased with the implantation of recombinant factor VIII. (as this has mostly eliminated the risk of HIV and hepatitis virus transmission associated with plasma-derived coagulation factor).
J Bone Joint Surg Am. 2013 Oct 02;95(19):1801-11.
Embryology - Limb Development
Great work, thank you.
A 50-year-old male sustains a closed head injury and closed femur fracture after falling off of a ladder. His GCS is currently 15, and he only speaks Spanish; he has several family members in the waiting room of the hospital. Which of the following is true regarding informed consent for fixation of his femur fracture?
Patient must be able to read the consent form
Patient must be able to sign the consent form
Patient does not need to be able to communicate in any manner to give his or her own informed consent
Patient must not be on any antidepressant medication prior to verbal or written informed consent
Patient should give verbal informed consent prior to narcotic administration
Dr. Anonymous - verbal consent can be obtained in circumstances such as what you list, but there should be written documentation of this; this generally consists of the surgeon signing as well as a witness for the patient. In addition, many institutions require that the witness is not a participant in the surgery to minimize conflict of interest. I've modified this answer choice to minimize confusion as well as modified the GCS issue. Hope that helps.
A 25-year-old man sustains a Grade III-A open tibial shaft fracture secondary to a motorcycle accident. The patient is unconscious and has no family members who can be reached for consent. What is the most appropriate course of action?
Document the necessity for treatment and proceed immediately with definitive fracture care
Proceed with a preliminary irrigation and debridement in the emergency department, apply a splint, and wait for him to regain consciousness before proceeding with definitive treatment
Contact a hospital administrator for approval of care
Confirm and document the necessity of care with a colleague with similar expertise and knowledge prior to proceeding with surgery
Proceed immediately to the operating room for definitive treatment without further documentation
Dr. AS - in general, waiting for consciousness to recover has an unknown time period, and they may or may not recover in the early period. Unless restoration of consciousness is imminent, I would still recommend proceeding with treatment in a timely manner. Additionally, the patient may recover some consciousness but may not be fully alert or consentable in the early phases of this, especially with a closed head injury.
I'm confused about the need for the patient to sign the consent form. I don't think this answer choice was adequately addressed in the explanation. Is it not necessary at all (i.e. verbal consent will suffice to take the patient to the O.R.), or just not necessary if the form is not available? Sometimes patients are in a collar or both hands are injured, and maybe they could scribble their name on the consent form, but it's very difficult or perhaps very painful. Is verbal consent adequate under those circumstances, even if the form is available?
17F with Multiple Bone Marrow Edema Lesions (C2680)
17 / F - 16F presents in January of 2015 with Left Ankle pain. No history of trauma/injury. Xrays are normal. MRI showed Bone Marrow Edema (BME). Non-weight bearing is advised.
In October of 2015, she presents with right hip pain/limited movement of her right hip because of pain. No history of trauma/injury. MRI’s (Right hip & Left ankle) show BME in her right hip and improved BME in her left ankle. Non-weight bearing and rest in advised.
In January of 2016 screening MRI’s (Right hip & Left ankle) are performed. They show an improvement of her previous BME in her right hip and eradication of the BME in her left ankle. Clinically, she is getting better.
In May of 2016 she presents with Right ankle pain with limited movement due to the pain. No history of trauma/injury. MRI is performed and it again shows BME of her Right ankle and Right calcaneus.
Lab tests (lupus, ACA, β2 GPI, thyroid hormones, protein electrophoresis, CRP, RA-test, C3, C4, Anti-CCP, ANA, FBC,ESR, PT/APTT, INR, D-dimers) are all normal.
Her symptoms were getting better until today. We have already planned MRIs of both her ankles and Right hip.
Xrays & MRI pics are attached.
What is the likely diagnosis in this patient?
Chronic Recurrent Multifocal OsteomyelitisAn Update on the Pathogenesis and Treatment of Chronic Recurrent Multifocal Osteomyelitis in Children.Taddio A, Zennaro F, Pastore S, Cimaz RPaediatr Drugs. 2017 Apr 11. doi: 10.1007/s40272-017-0226-4. pii: 10.1007/s40272-017-0226-4PMID: 28401420 (Link to Abstract)
Level 1 evidence has shown Low-intensity Pulsed Ultrasound Stimulation (LIPUS) decreased the time to fracture union in all of the the following injuries EXCEPT?
Radius shaft fracture
Distal radius fracture
Tibia shaft fracture treated with casting
Tibia shaft fracture treated with reamed intramedullary nailing
Anonymous-I don't think there would be any harm in using a bone stimulator in the scenario you present, however there is not specific level 1 evidence to support it. In general, most people do not prescribe bone stimulator use after acute fixation of primary fractures and insurance is always an issue. Thanks for your comment.
so if you have a patient with a tibia fracture you plated, that is high risk of nonunion, you shouldn't bother using a bone stimulator? I know the insurance companies have a time frame after which they will pay for these devices.
DNA replication occurs during which phase of the cell cycle?
Dr. Howell-This website does not select the exact learning points for each question. Rather, they are based on prior OITE and SAE/AAOS question topics. This particular question is based on prior OTIE tested material.
Thanks for your comment.
Dr Richard,NO DNA REPLICATION ,NO BONE FORMATION.
In the topic on tibia fractures,the recommendation is that open fractures need a debridement within 24 hrs and not within 6 hrs..if this patient is unconscious because of shock and may recover consciousness within 24 hrs,then option 2 is also valid.maybe his gcs score or some other information could be included in the stem....
I think in the discussion above, Indomethacin should be removed from the cyclooxygenase inhibitor group and mentioned as a separate category-lipooxygenase inhibitor..
Which of the following is true regarding the cell seen in Figure A?
Originates from hematopoietic cells from a macrophage lineage
Derived from undifferentiated mesenchymal cells
They are former osteoblasts trapped in the matrix they produced
They become cartilage under intermediate strain and low oxygen tension
They form bone by producing non-mineralized matrix
cool theme song for bone video
An 80 year-old female undergoes ORIF of her hip fracture without any complications. A hospitalist consult was obtained for medical clearance pre-operatively, and she was diagnosed with osteoporosis. Which of the following treatment scenarios will lead to the best management of the patient's osteoporosis?
Schedule a follow-up appointment with the patients primary care physician to initiate therapy
Order a physical therapy consult and initiate an exercise plan
Have the patient meet with a nutritionist to increase her calcium and vitamin D intake
Start bisphosphonates, and have the patient follow-up with her primary care physician
Perform a metabolic work-up as an inpatient, and set-up an appointment in an osteoporosis clinic
Dr. Taylor,Thank you for your response.
A patient undergoes closed reduction of a bimalleolar ankle fracture dislocation by the ER physician and is sent to your clinic for evaluation. You evaluate the patient and schedule him for surgery. According to the 2009 guidelines, which of the following scenarios would meet criteria for coding the encounter as a new patient?
You injected his knee in the office almost 3 years ago for osteoarthritis, and have not seen him since
He had an arthroscopic operation by your partner 4 years ago
You were consulted 1 year ago for shoulder pain when he was hospitalized for chronic renal failure
He was seen by your partner in clinic for a herniated disk 2 years ago, but had no procedures performed
You performed a hip replacement on him 12 years ago, and his last follow-up was 18 months ago at which time he was doing well
Dr. Taylor,Thank you for your response