This is a tricky case. The CT PE option sounds good, but with this history, a CT is not going to alter your management, you will be anti-coagulating this patient. The patient is not hemodynamically unstable at this point, therefore, thrombolysis is not an immediate consideration. However, the patient does have the potential to become hemodynamically unstable, which is an indication for thrombolysis. This is why UFH is the better choice than LMWH for this patient. It can be turned off, whereas you cannot reverse LMWH.

This question is based off a real case which occurred recently. It was discussed with several staff physicians and a radiologist before deciding that CT PE was not the next step. Personally, I thought CT PE was appropriate, but given her instability, a bedside U/S to assess for both the DVT and right ventricular dysfunction was performed.

This is the ECG of a classic TCA overdose. Hypertension is an early finding, while hypotension occurs late, secondary to alpha-1 blockade. Remember that all of the intervals lengthen in TCA toxicity (PR, QRS, QT). This is because of both fast sodium channel inhibition as well as potassium efflux inhibition.

Plastic surgeons are often called upon to repair soft tissue defects from open ankle fractures.

The Gustilo classification stratifies open tibia fractures based on the size of the wound, contamination, vascular injury and comminution.

Briefly, the classification is as follows:
- Grade I: wound < 1 cm, clean bed
- Grade II: wound > 1 cm, moderate contamination
- Grade IIIa: wound < 10 cm with crush and contamination
- Grade IIIb: wound > 10 cm with crush and contamination, inadequate soft tissue for primary closure
- Grade IIIc: major vascular compromise

For more detailed criteria see the following link:
http://www.wheelessonline.com/ortho/gustillo_classification_of_open_tibial_frxs

This injury, the mallet finger, results when the extensor mechanism is disrupted, either by avulsion from the distal phalanx or tendon rupture. If untreated it may lead to a swan-neck deformity in susceptible individuals (those who have hyperextensible PIP joints). Splinting the DIP joint in full extension is the treatment of choice, although K-wire fixation may also be used. Tendinous injuries require 6-8 weeks of continuous immobilization, and bony avulsion injuries (evident on X-ray) require 4-5 weeks of immobilization.

http://emedicine.medscape.com/article/1242305-overview

The ideal answer for treatment of mallet finger is spling the DIP joint in extension for 6 WEEKS. The duration of splinting is the most important and is not included in the answer.

A long term complaint of migraine is less likely to be due to an intracranial mass lesion. Other reasons that may prompt a CT before the LP are any solid organ cancers and recent history of transplant (immunosupression).

Anterior chamber reaction (cells floating inside the eye) can be found in conditions such as uveitis, scleritis, etc but not usually in ACG.

This is a Canadian CT head rule question. The criteria for doing a CT head in a patient with minor head injury are: Age > 65, Signs of basal skull fracture, Suspected open or depressed skull fracture, 2 or more episodes of vomiting since the time of injury, GCS < 15 2 hours after injury, high-risk mechanism and amnesia before impact greater than or equal to 30 mins.

Cushing's triad is reflex hypertension, bradycardia, respiratory irregularity due to increased intracranial pressure.

Common manifestations of compromised vascular supply to the anterior cerebral artery includes contralateral extremity weakness (lower>upper), altered mentation and reasoning, and bladder incontinence.

Infection (eg. from PROM, C/S, internal fetal monitoring) is a complication post-partum, but tubo-ovarian abscess is more commonly associated with PID than delivery. PPH, eclamptic seizures, AFE and DVT are all post partum complications.