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Old 08-15-2014
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Default nbme 6

discussion of nbme 6 anyone?
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A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

57 year old cigg smoker with BP of 180/112 pule 82. Bruit at the right upper quardrant hct 42% what is the cause of bruit
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Quote:
Originally Posted by doc007 View Post
A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

57 year old cigg smoker with BP of 180/112 pule 82. Bruit at the right upper quardrant hct 42% what is the cause of bruit
You left out the choices.
The first one looks like asthma.
The second one has risk factors for atherosclerosis of the renal artery.
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for the first one
A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer

well she has a smoking history, why wont it be COPD?
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Quote:
Originally Posted by Ergo Proxy View Post
You left out the choices.
The first one looks like asthma.
The second one has risk factors for atherosclerosis of the renal artery.
The second options are
accumilation of lipids
hypertrphy of arterial wall
giant cell invasion
round cell invasion
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[QUOTE=doc007;443650]

Q. A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic
B) antihistaminic
C) antibiotic
D) b blocker
E) mast cell stablizer
Anticholinergics for COPD

Q. 57 year old cigg smoker with BP of 180/112 pule 82. Bruit at the right upper quardrant hct 42% what is the cause of bruit

A) accumulation of lipids
B) hypertrphy of arterial wall
C) giant cell invasion
D) round cell invasion
Renal Artery atherosclerosis
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[QUOTE=cardiovasculaire;443738]
Quote:
Originally Posted by doc007 View Post

Q. A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic
B) antihistaminic
C) antibiotic
D) b blocker
E) mast cell stablizer
Anticholinergics for COPD

Q. 57 year old cigg smoker with BP of 180/112 pule 82. Bruit at the right upper quardrant hct 42% what is the cause of bruit

A) accumulation of lipids
B) hypertrphy of arterial wall
C) giant cell invasion
D) round cell invasion
Renal Artery atherosclerosis
antichol was the wrong answer
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Q) Visiting egypt what prophylaxis?

CEftriaxone, Acyclovir, Isoniazid, Albendazole, Mefloquine, Metronidazole, Penicillin

Q) 67 year old person with abd pain, copious vomiting 24 hours. 2 week ago syncronized for afib and started on warfarin. Yesterday stopped warfarin after checking that INR was 6. BP 100/48, 98.6F, 120/min, 20/min. Distended abdomen moderately tender, voluntary gaurding in epigastrium, occult blood in stool negative. HB dropped from 13 to 7.8 since yesterday

Ischemia d.t embolus, hematoma, intussception, malrotation

Q) A 58 year old female with dec libido 8 months ago had TAH, BSO. Is on HRT with estrogen. Moist rugated vagina due to

dec androgen, dec estrogen, dec FSh, dec LH, Dec prog, dec prolactin, inc anfrogen, inc estrogen, Inc LH, inc prolactin, inc progesterone

Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?
observe, im.naloxone, 5%dextrose, lorazepam, chlorpromazine

Q) 4 hours after undergoing C section the lady complain of dizziness and confusion. Blood loos of 800 reported. B.P falls to 80/40 and was 120/70 intra operatively. pule is 152/min as compared to 96/min. breath sounds dec bilaterally. Abld distended and tender, bowel sounds absent. incison intact with no drainage
HCT 23% as compared to 35% What is all of this due to?
Epidural hypotension
miscalculated intra op fluid loss
underestimated fluid replacement
post op hemolysis
supine hypotension
supine hypotension

Q)A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?
A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer
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That is weird. It looks like an exacerbation of COPD, is there any info on vital signs? If it is an infection then probably give antibiotics...
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Quote:
Originally Posted by cardiovasculaire View Post
That is weird. It looks like an exacerbation of COPD, is there any info on vital signs? If it is an infection then probably give antibiotics...
temp 37.4 and bp 130/80 rest everything normal
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Quote:
Originally Posted by doc007 View Post
Q) Visiting egypt what prophylaxis?

CEftriaxone, Acyclovir, Isoniazid, Albendazole, Mefloquine, Metronidazole, Penicillin
prophylaxis against malaria

Q) 67 year old person with abd pain, copious vomiting 24 hours. 2 week ago syncronized for afib and started on warfarin. Yesterday stopped warfarin after checking that INR was 6. BP 100/48, 98.6F, 120/min, 20/min. Distended abdomen moderately tender, voluntary gaurding in epigastrium, occult blood in stool negative. HB dropped from 13 to 7.8 since yesterday

Ischemia d.t embolus, hematoma, intussception, malrotation
looks like this patient has a gastric bleed...not so sure...

Q) A 58 year old female with dec libido 8 months ago had TAH, BSO. Is on HRT with estrogen. Moist rugated vagina due to

dec androgen, dec estrogen, dec FSh, dec LH, Dec prog, dec prolactin, inc anfrogen, inc estrogen, Inc LH, inc prolactin, inc progesterone...idk...

Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?
observe, im.naloxone, 5%dextrose, lorazepam, chlorpromazine ...idk...

Q) 4 hours after undergoing C section the lady complain of dizziness and confusion. Blood loos of 800 reported. B.P falls to 80/40 and was 120/70 intra operatively. pule is 152/min as compared to 96/min. breath sounds dec bilaterally. Abld distended and tender, bowel sounds absent. incison intact with no drainage
HCT 23% as compared to 35% What is all of this due to?
Epidural hypotension
miscalculated intra op fluid loss
underestimated fluid replacement
post op hemolysis
supine hypotension
supine hypotension

Q)A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer
we should consider asthma especially since cough is nocturnal, worse wit activity and early morning...recent URTI may have precipitated present episode...consider mast cell stabilizer...what do you guys think?
That is what I think...

Last edited by cardiovasculaire; 08-15-2014 at 01:47 PM.
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Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?

observe (this looks like canabis intoxication - conjunctival injection and paranoia), im.naloxone, 5%dextrose, lorazepam, chlorpromazine
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Q)A previous healthy 32 y old person with persistent cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer
we should consider asthma especially since cough is nocturnal, worse wit activity and early morning...recent URTI may have precipitated present episode...consider mast cell stabilizer...what do you guys think?
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Quote:
Originally Posted by cardiovasculaire View Post
Q)A previous healthy 32 y old person with persistent cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer
we should consider asthma especially since cough is nocturnal, worse wit activity and early morning...recent URTI may have precipitated present episode...consider mast cell stabilizer...what do you guys think?
well it has to be asthma because it is not COPD. But, then why not bronchodilator?
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Quote:
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well it has to be asthma because it is not COPD. But, then why not bronchodilator?
I don't see bronchodilator in the answer choices...and anticholinergics do not help in asthma...this question is weird like every other question on the CK
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Quote:
Originally Posted by cardiovasculaire View Post
I don't see bronchodilator in the answer choices...and anticholinergics do not help in asthma...this question is weird like every other question on the CK
The answer is the beta-agonist. For treatment of asthma you start with beta-agonist. (Albuterol/Salmeterol)
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Quote:
Originally Posted by doc007 View Post
Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?
observe, im.naloxone, 5%dextrose, lorazepam, chlorpromazine
Obviously this guy went to colorado and smoked some Ganja, hence his statement for food. For ppl like this, you give them a snicker bar and observe.
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3 month old baby with poor head control and hypotonia. point of max impulse is in the left mid axillary line liver is palpated 4m below the right costal margin. Spleen not palpated.What is the diagnosis
Muscular dystrophy, Pompe's, GM1, botulism, VSD

A pt complain of mid lumbar back pain. anxious and pale and diaphoretic. 98.8F, 105/65, 120/min Xray shows degenerative disease of the spine. Ant to vertebral bodies there are calcifications. Diag?
Aorticoiliac dis, herniated nucleus pulposus, lumbar discitis, strain, pyelonephritis, ruptured aneurysm, spinal stenosis

Pt wants to share the result of her test only with her husband and doesn't want to be told. what to do nexT?
share only with her husband
share it with her
psych eval
inform the hospital

72 year old man with HTN and severe back pain for 2 months. Had an MI 4 years ago. Tenderness on T11, T12, L1 and L2. OSteoblastic spine on xray. most likely
MM, Prostatic ca, ostosarcoma, fibrosarcoma, AA

47 yr old man with fever and chills for a day. H/o alcoholic cirrhosis. 1 month back had evacution of sub dural hematoma. Post op had tonic clonic seizure.
Carbamazepine for treatment. still drinks 12 drinks/day, tem 102 and BP- 120/80/ Icterus, ascites, spleenomegaly. Hct 39%, MCV 102, leucocytes 1200
seg 6%, eosinophils 1%, basi 1%, lym 80%, mono 12%, Platelets 210,000 what is the cause of dec in leuco count
Carbamazepine, folic, hyperspleen, Sepsis, dec of marrow due to alcohol
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a 6 mth old was treated for myelomeninhocele when she was 2 days old. right now her ant font are 6X8 cm bulging and post font are 3*4 bulging. Severe sensory and motor deficits lowe ext.
age and head circm are as follows
birth 34.2
1 36.6
2 38
4 44
6 47

cause of inc ICP?
cerebral edema, dec CSF absorption, Dilataion of cerebral arteries, Mass lesion, Obst of lat sinus, SVC obst, obst of CSF, over production CSF

Q) for coarctation of arota do we do surgery only or is there pharmacological treatment also?

Q) A kid comes to regualr checkup for participation of sports. his maternal and paternal Grandfathers had DM2 and HTN. he is in the 95%for ht and wt, BMI. 98.1F, 84/min, 16/minRR, BP is 130/84 What to do next?
no pharmacotherapy, ACE, BBlocker, Ca channel blockers, thiazide

Q) 6 year old visual loss for past year. since the past 2 years there had been dec in hearing speech and writing. uncle had similar complaints. Visual acuity 20/200 optic atrophy. HEaring impaired. all the extremities are spastic and weak. DTR are hyperactive. Babisnski sign is + bilateral. Cannot remember place, month, year, sibling. MRI shows symm white matter destruction of all lobes, what is seen in this pt?
ab normal inc in cholesterol?
acanthocytes
long chain fatty acids
normal nerver
vit E def
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please share you explanation also!
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what about the one which was 70 y o M with urinary hesitancy and frequency. He had an enlarged rubbery prostate, nontender. temp-99.5, no urethral discharge. UA-leukocytes, no erythrocytes. Gram stain shows-gram -ve rods.
Which of the following is the cause of the pt's findings?

ans: outflow obstruction...

Q: why is it not an infection of the prostate/epididymus or urethra?
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Quote:
Originally Posted by doc007 View Post
3 month old baby with poor head control and hypotonia. point of max impulse is in the left mid axillary line liver is palpated 4m below the right costal margin. Spleen not palpated.What is the diagnosis
Muscular dystrophy, Pompe's, GM1, botulism, VSD

A pt complain of mid lumbar back pain. anxious and pale and diaphoretic. 98.8F, 105/65, 120/min Xray shows degenerative disease of the spine. Ant to vertebral bodies there are calcifications. Diag?
Dissection

Pt wants to share the result of her test only with her husband and doesn't want to be told. what to do nexT?
share only with her husband
share it with her
psych eval
inform the hospital

72 year old man with HTN and severe back pain for 2 months. Had an MI 4 years ago. Tenderness on T11, T12, L1 and L2. OSteoblastic spine on xray. most likely
MM, Prostatic ca, ostosarcoma, fibrosarcoma, AA

47 yr old man with fever and chills for a day. H/o alcoholic cirrhosis. 1 month back had evacution of sub dural hematoma. Post op had tonic clonic seizure.
Carbamazepine for treatment. still drinks 12 drinks/day, tem 102 and BP- 120/80/ Icterus, ascites, spleenomegaly. Hct 39%, MCV 102, leucocytes 1200
seg 6%, eosinophils 1%, basi 1%, lym 80%, mono 12%, Platelets 210,000 what is the cause of dec in leuco count
Carbamazepine, folic, hyperspleen, Sepsis, dec of marrow due to alcohol
I'd give an explanation but I googled all of them. The last one is a weird one.
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Quote:
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what about the one which was 70 y o M with urinary hesitancy and frequency. He had an enlarged rubbery prostate, nontender. temp-99.5, no urethral discharge. UA-leukocytes, no erythrocytes. Gram stain shows-gram -ve rods.
Which of the following is the cause of the pt's findings?

ans: outflow obstruction...

Q: why is it not an infection of the prostate/epididymus or urethra?
What were the other choices? Outflow obstruction sounds correct to be. One of the symptoms of urinary hesitancy and frequency stems from a rubbery prostate.
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Quote:
Originally Posted by doc007 View Post
a 6 mth old was treated for myelomeninhocele when she was 2 days old. right now her ant font are 6X8 cm bulging and post font are 3*4 bulging. Severe sensory and motor deficits lowe ext.
age and head circm are as follows
birth 34.2
1 36.6
2 38
4 44
6 47

cause of inc ICP?
cerebral edema, dec CSF absorption, Dilataion of cerebral arteries, Mass lesion, Obst of lat sinus, SVC obst, obst of CSF, over production CSF

Q) for coarctation of arota do we do surgery only or is there pharmacological treatment also? Surgery

Q) A kid comes to regualr checkup for participation of sports. his maternal and paternal Grandfathers had DM2 and HTN. he is in the 95%for ht and wt, BMI. 98.1F, 84/min, 16/minRR, BP is 130/84 What to do next?
no pharmacotherapy - this is a preventative medicine question, remember you need at least 3 readings to call it hypertension. Imagine if this was a real life scenario would you start treatment on a kid just because his BP was high that one time?, ACE, BBlocker, Ca channel blockers, thiazide

Q) 6 year old visual loss for past year. since the past 2 years there had been dec in hearing speech and writing. uncle had similar complaints. Visual acuity 20/200 optic atrophy. HEaring impaired. all the extremities are spastic and weak. DTR are hyperactive. Babisnski sign is + bilateral. Cannot remember place, month, year, sibling. MRI shows symm white matter destruction of all lobes, what is seen in this pt?
ab normal inc in cholesterol?
acanthocytes
long chain fatty acids
normal nerver
vit E def
Did the best I could here.
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Originally Posted by Ergo Proxy View Post
Did the best I could here.
why is it pompe"s? I thought the person needed to have other anomalies.

what is the reason for long chain fatty acids?

isn't metastatic cancer lytic lesion?
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Quote:
Originally Posted by lithium View Post
what about the one which was 70 y o M with urinary hesitancy and frequency. He had an enlarged rubbery prostate, nontender. temp-99.5, no urethral discharge. UA-leukocytes, no erythrocytes. Gram stain shows-gram -ve rods.
Which of the following is the cause of the pt's findings?

ans: outflow obstruction...

Q: why is it not an infection of the prostate/epididymus or urethra?
well, if they say a prostrate is enlarged and rubbery it is generally BPH with the age and if it is BPH then it is obstructive.
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[QUOTE=cardiovasculaire;443738]
Quote:
Originally Posted by doc007 View Post

Q. A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?

A) antcholinergic
B) antihistaminic
C) antibiotic
D) b blocker
E) mast cell stablizer
Anticholinergics for COPD

Q. 57 year old cigg smoker with BP of 180/112 pule 82. Bruit at the right upper quardrant hct 42% what is the cause of bruit

A) accumulation of lipids
B) hypertrphy of arterial wall
C) giant cell invasion
D) round cell invasion
Renal Artery atherosclerosis
also for arteriosclerosis I read online that it is round cell invasion and lipid is for abdominal aneurysm. and for hypertension it is hypertrophy. So, now I am not sure what the answer is
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choice b--hypertrophy would be for fibromuscular dysplasia
A- is right, for renal artery stenosis....considering his age and all.
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Q) A 58 year old female with dec libido 8 months ago had TAH, BSO. Is on HRT with estrogen. Moist rugated vagina due to

dec androgen, dec estrogen, dec FSh, dec LH, Dec prog, dec prolactin, inc anfrogen, inc estrogen, Inc LH, inc prolactin, inc progesterone...idk...Answer may be decreased androgens as methytestodsterone is given to women to increase libido


Q) 4 hours after undergoing C section the lady complain of dizziness and confusion. Blood loos of 800 reported. B.P falls to 80/40 and was 120/70 intra operatively. pule is 152/min as compared to 96/min. breath sounds dec bilaterally. Abld distended and tender, bowel sounds absent. incison intact with no drainage
HCT 23% as compared to 35% What is all of this due to?
Epidural hypotension
miscalculated intra op fluid loss
underestimated fluid replacement I put this and it was wrong, it may be postop hemolysis
post op hemolysis
supine hypotension
supine hypotension
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