Clinical mastery series medicine form 1 discussion
I recently did the clinical mastery medicine form 1 and there were some questions that i got wrong which i wanted to discuss since they dont provide any answers.
A 25-year-old man who is HIV positive comes to the physician because of a 3-week history of cough and wheezing. He stopped taking his antiretroviral therapy 6 months ago because of
adverse effects, and he has had an increasing plasma HIV viral load since then. He has required treatment with prednisone for immune thrombocytopenia over the past 2 months with
improvement of his platelet count from 25,000/mm3to 1 OO,OOO/mm3. His temperature is 38.9•c (1 02.F), pulse is 95/min, respirations are 30/min, and blood pressure is 100/60 mm Hg.
Examination shows shotty bilateral cervical adenopathy. There is dullness to percussion over the left upper posterior thorax, and rhonchi are heard over the same area. Laboratory studies
leukocyte count 10,000
segmented neutrophils 70%
An x-ray of the chest shows a nodular density in the left upper lung field posteriorly. Which of the following is most likely to confirm the diagnosis?
A) Examination of duodenal aspirate
B) Examination of the stool for ova and parasites
C) Toxoplasmosis titers
D) Blood cultures
E) Biopsy and culture of the lung mass
F) Lymph node biopsy
The answer is not F. could it be C?
18. A 67-year-old woman comes to the physician because of a 2-day history of passing 12 watery stools daily. She has no other history of abnormal bowel function. Two weeks ago, she was
treated in the hospital with antibiotic therapy for right lower lobe pneumonia. She had a myocardial infarction 5 years ago. She underwent a total abdominal hysterectomy 18 years ago for
bleeding leiomyomata uteri. She has a 20-year history of rheumatoid arthritis. Current medications include prednisone and aspirin. She appears lethargic. Her temperature is
39.1•c (102.4.F), pulse is 120/min, respirations are 18/min, and blood pressure is 98/68 mm Hg. Examination shows decreased skin turgor. Abdominal examination shows distention
and right lower quadrant tenderness with voluntary guarding. Laboratory studies show:
Flexible sigmoidoscopy shows pseudomembranes. Which of the following is the most likely cause of this patient's current symptoms?
B) Bowel ischemia
C) Electrolyte imbalance
D) Inflammatory bowel disease
E) Ingested spores
F) Perforation of the colon
Is it B?
A 52 year old man with alcoholism is brought to the emergency department because he has been unable to move his lower extremities for the past 4 hours. He is awake and alert. Examination shows slight swelling of the lower extremities. He has oliguria. Bladder catheterization yields only small quantity of urine that is positive for blood by dipstick. which of the following is most likely diagnosis?
B) Cerebral infarction
C) Conversion disorder
D) Familial periodic paralysis
E) Guillan Barré syndrome
G) Myasthenia gravis
I) Spinal cord compression
An unconscious 25-year-old man is brought to the emergency department 15 minutes after his neighbor found him lying in the street. The neighbor reports that the patient was jogging before falling to the ground. The patient is wearing a medic alert bracelet that states that he has type 1 diabetes mellitus. No other history can be obtained. There is no evidence of trauma. He does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. His temperature is 37C (98.6F), pulse is 90/min, respirations are 12/min, and blood pressure is 122/70 mmHg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A) Urine toxicology screening
B) MRI of the brain
C) Administration of a bolus of insulin
D) Administration of 50% dextrose in water
E) Rapid infusion of 1 L of 0.9% saline
F) Lumbar puncture
I got all of the above correct so I know these are the right answers.
yes i think they are correct
*the qs set "confirm", so E (biopsy)
*toxic megacolon due C. difficile-->perforation, so F
*rule in/out hypoglicemia: replace w/dextrose, so D
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