(MCQS 316-318) :A 36 year old woman presents with severe flank pain radiating to the ipsilateral labia and accompanied by nausea and vomiting

Correct Answer: A
Females often have no symptoms of Gonorrhea at all (up to 80% don't). For females some common symptoms include: burning during urination ,thick green/yellow discharge , little or no fever , pain and tenderness during sexual intercourse , rectal discomfort , joint pain ,rash on palms ,mild sore throat ,pain in bowels. The symptoms can appear anywhere from 2-10 days up to 1 month If gonorrhea is at an advanced stages, some of the symptoms include : abdominal pain and bleeding between menstrual periods.

Correct Answer: I
Patients typically present with colicky flank pain. The pain may radiate to the ipsilateral groin, testis, or labia and it may be associated with nausea, vomiting, and gross hematuria. Colic can be severe and is characterized by writhing as the patient tries to find a comfortable position, in contrast to intraperitoneal processes, in which the patient tends to lie still. Irritative voiding symptoms are frequent when a stone is lodged in the distal ureter. The stone may cause dysuria and marked urinary frequency and urgency. Clinical presentations can vary, ranging from asymptomatic, incidentally noted calculi to frank urosepsis

Correct Answer: F
Occlusion of the central retinal artery is a condition that usually affects older patients. It typically results from a small emboli originating from the atherosclerotic carotid artery or from the heart. Occasionally, it may be related to temporal arteritis. In younger patient, other conditions that can induce thrombosis and vasculitis should be investigated. • Symptoms: Patients usually present with acute severe painless vision loss in one eye. Patients may report previous episodes of transient visual loss that lasted minutes then resolved. Symptoms of temporal arteritis usually need to be probed since patients rarely volunteer them. • Signs: Visual acuity is severely decreased to the level of 20/400 or light perception except in the presence of a cilio-retinal artery. A central retinal artery occlusion will not cause vision to be no light perception (NLP) unless the occlusion is at the level of the ophthalmic artery. The retina looks white and edematous. This allows for the underlying choroidal circulation to stand out more in the foveal center where the retina is very thin giving the classic cherry-red spot appearance. • Diagnosis: The typical presentation along with the characteristic fundus findings are sufficient to make the diagnosis. Fluorescein angiogram may demonstrate delayed filling of the retinal arterioles. The test may be normal by the time the patient presents for evaluation. • Treatment: is aimed at minimizing the damage of the retina in the acute phase and preventing late complications. Attempts at dislodging the embolus include lowering the introcular pressure by performing an anterior chamber paracentesis or ocular massage; or dilating the retinal arterioles by asking the patient to breath in a paper bag or carbogen. Results of these treatment options are variable but probably worth doing given the low side effect rate. If neovascularization of the iris or angle are noted, PRP should be initiated immediately. Medical treatment of any underlying system disease is also indicated. • Work-up: Elderly patients with CRAO should be always asked about symptoms suggestive of temporal arteritis and an ESR obtained if the index of suspension is high. A carotid Doppler and an echocardiogram should be performed if a retinal embolus is seen. Younger patients presenting with this condition should be evaluated for systemic conditions that result in hypercoagulable state and also collagen vascular diseases.


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