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Old 07-14-2015
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Default NBME clinical mastery series neuro form 2 question

Please help me out with these questions
1)A previously healthy 25-year-old woman is brought to the emergency department 30 minutes after being struck by a motor vehicle. On arrival, she is alert and oriented and reports leg pain. Her vital signs are within normal limits. Examination shows normal sensory and motor function in the foot. Posterior tibial and dorsalis pedis pulses are normal. X-rays show a minimally displaced comminuted midshaft fracture of the tibia. The lower extremity is splinted in the emergency department, and the patient is admitted for observation. Three hours later, she has numbness in her foot and increasing pain in her lower extremity. Examination now shows decreased sensation to light touch over the foot and pain with passive extension of the toes. Which of the following is the most appropriate next step in management?
A) Elevation of the extremity
B) Measurement of compartment pressures
C)Anticoagulant therapy
D) Angiography
E) Closed reduction
F) Nerve exploration
G Open reduction only
H) Open reduction and internal fixation


2 An 87-year-old woman is brought to the physician by her son because of a 7-month history of decreasing ability to function independently. She is no longer able to write checks and often gets lost while driving. She has hypertension and hyperlipidemia. Current medications include chlorothiazide and pravastatin. Her temperature is 37°C (98.6°F), pulse is 84/min, respirations are 12/min, and blood pressure is 170/100 mm Hg. Physical examination shows no other abnormalities. Mental status examination shows poor concentration. She is oriented to person and place but not to time. She is able to recall zero out of three objects after 5 minutes. Cognition and constructional ability are decreased. Laboratory findings are within the reference range. Which of the following is the most appropriate next step in diagnosis?
A.Measurement of serum ammonia concentration
B. Neuropsychological testing
C.PET scan
D. MRI of the brain
E. EEG

3 A 47-year-old woman comes to the physician because of a 4-month history of difficulty walking, constant headache, and urinary incontinence. Her symptoms have worsened over the past month. Treatment with acetaminophen and ibuprofen has not relieved her headache. She has had mild memory impairment since a motor vehicle collision 5 years ago in which she lost consciousness. She has had two generalized tonic-clonic seizures over the past year. Her sister has multiple sclerosis. The patient's vital signs are within normal limits. Examination shows normal strength in the upper and lower extremities and increased muscle tone in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Her gait is broad-based and spastic. Sensation is intact. Which of the following is the most likely location of this patient's lesion?
A Cauda equina
B Cervical spinal cord
C Parasagittal cerebral cortex
D Pons
E Thoracic spinal cord


4 An 18-year-old man comes to the physician because of difficulty walking for 1 week. Examination shows visual fields that are constricted equally in both eyes on close and distant testing. He has collapsing effort on muscle strength testing in the left extremities. He staggers from side to side when walking but does not fall. On Romberg testing, he abruptly falls to the left. There is hemisensory loss to light touch, pinprick, vibration, and proprioception on the left that stops exactly at the midline. Which of the following is the most likely diagnosis?

A Cerebellar degeneration
B Cervical spinal cord compression
C Conversion disorder
D Guillain-Barré syndrome
E Multiple sclerosis
F Sensory neuropathy
G Tabes dorsalis
H Vitamin B12 (cobalamin) deficiency

5 An 82-year-old woman with dementia, Alzheimer type, is brought to the physician by her husband because he has had progressive difficulty feeding her over the past 4 weeks. He says she no longer swallows food that he puts in her mouth, even with prompting. She no longer says his name, and he believes that she does not recognize him. He has been her primary caregiver for 4 years. She does not have an advance directive. He says he does not want to hasten her death. He wants to continue to take care of her at home but is concerned about his ability to do so. He declines placement of a gastrostomy tube. She is 163 cm (5 ft 4 in) tall and weighs 44 kg (98 lb); BMI is 17 kg/m2. She appears well groomed but malnourished. She is not oriented to person, place, or time. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate recommendation?

A Oral multivitamin supplementation at home
B Oral nutritional supplementation at home
C Hospice care at home
D Admission to the hospital for total parenteral nutrition
E Transfer to a skilled nursing care facility for tube feeding
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  #2  
Old 07-14-2015
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Quote:
Originally Posted by Dr.Noe View Post
Please help me out with these questions
1)A previously healthy 25-year-old woman is brought to the emergency department 30 minutes after being struck by a motor vehicle. On arrival, she is alert and oriented and reports leg pain. Her vital signs are within normal limits. Examination shows normal sensory and motor function in the foot. Posterior tibial and dorsalis pedis pulses are normal. X-rays show a minimally displaced comminuted midshaft fracture of the tibia. The lower extremity is splinted in the emergency department, and the patient is admitted for observation. Three hours later, she has numbness in her foot and increasing pain in her lower extremity. Examination now shows decreased sensation to light touch over the foot and pain with passive extension of the toes. Which of the following is the most appropriate next step in management?
A) Elevation of the extremity
B) Measurement of compartment pressures
C)Anticoagulant therapy
D) Angiography
E) Closed reduction
F) Nerve exploration
G Open reduction only
H) Open reduction and internal fixation


2 An 87-year-old woman is brought to the physician by her son because of a 7-month history of decreasing ability to function independently. She is no longer able to write checks and often gets lost while driving. She has hypertension and hyperlipidemia. Current medications include chlorothiazide and pravastatin. Her temperature is 37°C (98.6°F), pulse is 84/min, respirations are 12/min, and blood pressure is 170/100 mm Hg. Physical examination shows no other abnormalities. Mental status examination shows poor concentration. She is oriented to person and place but not to time. She is able to recall zero out of three objects after 5 minutes. Cognition and constructional ability are decreased. Laboratory findings are within the reference range. Which of the following is the most appropriate next step in diagnosis?
A.Measurement of serum ammonia concentration
B. Neuropsychological testing
C.PET scan
D. MRI of the brain
E. EEG

3 A 47-year-old woman comes to the physician because of a 4-month history of difficulty walking, constant headache, and urinary incontinence. Her symptoms have worsened over the past month. Treatment with acetaminophen and ibuprofen has not relieved her headache. She has had mild memory impairment since a motor vehicle collision 5 years ago in which she lost consciousness. She has had two generalized tonic-clonic seizures over the past year. Her sister has multiple sclerosis. The patient's vital signs are within normal limits. Examination shows normal strength in the upper and lower extremities and increased muscle tone in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Her gait is broad-based and spastic. Sensation is intact. Which of the following is the most likely location of this patient's lesion?
A Cauda equina
B Cervical spinal cord
C Parasagittal cerebral cortex
D Pons
E Thoracic spinal cord


4 An 18-year-old man comes to the physician because of difficulty walking for 1 week. Examination shows visual fields that are constricted equally in both eyes on close and distant testing. He has collapsing effort on muscle strength testing in the left extremities. He staggers from side to side when walking but does not fall. On Romberg testing, he abruptly falls to the left. There is hemisensory loss to light touch, pinprick, vibration, and proprioception on the left that stops exactly at the midline. Which of the following is the most likely diagnosis?

A Cerebellar degeneration
B Cervical spinal cord compression
C Conversion disorder
D Guillain-Barré syndrome
E Multiple sclerosis
F Sensory neuropathy
G Tabes dorsalis
H Vitamin B12 (cobalamin) deficiency

5 An 82-year-old woman with dementia, Alzheimer type, is brought to the physician by her husband because he has had progressive difficulty feeding her over the past 4 weeks. He says she no longer swallows food that he puts in her mouth, even with prompting. She no longer says his name, and he believes that she does not recognize him. He has been her primary caregiver for 4 years. She does not have an advance directive. He says he does not want to hasten her death. He wants to continue to take care of her at home but is concerned about his ability to do so. He declines placement of a gastrostomy tube. She is 163 cm (5 ft 4 in) tall and weighs 44 kg (98 lb); BMI is 17 kg/m2. She appears well groomed but malnourished. She is not oriented to person, place, or time. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate recommendation?

A Oral multivitamin supplementation at home
B Oral nutritional supplementation at home
C Hospice care at home
D Admission to the hospital for total parenteral nutrition
E Transfer to a skilled nursing care facility for tube feeding
1)h
2)b?
3)e?
4)h?
5)c

Difficult questions ..failing here
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  #3  
Old 07-14-2015
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HBEH is wrong
not sure about c.
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  #4  
Old 07-14-2015
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[QUOTE=Dr.Noe;811673]HBEH is wrong
not sure about c.[/QUOTE

Kindly share the answers
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  #5  
Old 07-14-2015
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I am asking for help cos I am the one looking for the rt answers. HBEHD was my wrong answers.
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  #6  
Old 07-15-2015
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hey ,i solved them online and got most of these Q's wrong as well,but i guess we can rule out the options i put down.

1. B - I got this right
2. C is wrong, maybe D?
3. E is wrong, maybe A?
4. A is wrong, maybe G?
5. D is wrong, maybe C?

i know i haven't been much help,but this is all ive got man,good luck.
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Dr.Noe (07-15-2015)
  #7  
Old 07-15-2015
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Thanks samren17 I am planning to do all of mastery series have you finished all already? I have finished only Psych and Neuro. We can rule out answers. Actually the more the better. Anybody who knew the answers or are looking for answers please post questions here. I am looking forward to solve these problems altogether. it's a bummer to spend the whole day browsing for answers while we can help each other out.
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  #8  
Old 07-15-2015
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Quote:
Originally Posted by samren17 View Post
hey ,i solved them online and got most of these Q's wrong as well,but i guess we can rule out the options i put down.

1. B - I got this right
2. C is wrong, maybe D?
3. E is wrong, maybe A?
4. A is wrong, maybe G?
5. D is wrong, maybe C?

i know i haven't been much help,but this is all ive got man,good luck.
Hey I think answer for 3rd question is parasaggital cerebral cortex. The diagnosis is NPH-Normal Pressure Hydrocephalus.In NPH ventricles are dilated. How is the cauda equina correct? can u plz explain.
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  #9  
Old 07-15-2015
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Quote:
Originally Posted by Dr.Noe View Post
Please help me out with these questions
1)A previously healthy 25-year-old woman is brought to the emergency department 30 minutes after being struck by a motor vehicle. On arrival, she is alert and oriented and reports leg pain. Her vital signs are within normal limits. Examination shows normal sensory and motor function in the foot. Posterior tibial and dorsalis pedis pulses are normal. X-rays show a minimally displaced comminuted midshaft fracture of the tibia. The lower extremity is splinted in the emergency department, and the patient is admitted for observation. Three hours later, she has numbness in her foot and increasing pain in her lower extremity. Examination now shows decreased sensation to light touch over the foot and pain with passive extension of the toes. Which of the following is the most appropriate next step in management?
A) Elevation of the extremity
B) Measurement of compartment pressures
C)Anticoagulant therapy
D) Angiography
E) Closed reduction
F) Nerve exploration
G Open reduction only
H) Open reduction and internal fixation


2 An 87-year-old woman is brought to the physician by her son because of a 7-month history of decreasing ability to function independently. She is no longer able to write checks and often gets lost while driving. She has hypertension and hyperlipidemia. Current medications include chlorothiazide and pravastatin. Her temperature is 37°C (98.6°F), pulse is 84/min, respirations are 12/min, and blood pressure is 170/100 mm Hg. Physical examination shows no other abnormalities. Mental status examination shows poor concentration. She is oriented to person and place but not to time. She is able to recall zero out of three objects after 5 minutes. Cognition and constructional ability are decreased. Laboratory findings are within the reference range. Which of the following is the most appropriate next step in diagnosis?
A.Measurement of serum ammonia concentration
B. Neuropsychological testing
C.PET scan
D. MRI of the brain
E. EEG

3 A 47-year-old woman comes to the physician because of a 4-month history of difficulty walking, constant headache, and urinary incontinence. Her symptoms have worsened over the past month. Treatment with acetaminophen and ibuprofen has not relieved her headache. She has had mild memory impairment since a motor vehicle collision 5 years ago in which she lost consciousness. She has had two generalized tonic-clonic seizures over the past year. Her sister has multiple sclerosis. The patient's vital signs are within normal limits. Examination shows normal strength in the upper and lower extremities and increased muscle tone in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Her gait is broad-based and spastic. Sensation is intact. Which of the following is the most likely location of this patient's lesion?
A Cauda equina
B Cervical spinal cord
C Parasagittal cerebral cortex
D Pons
E Thoracic spinal cord


4 An 18-year-old man comes to the physician because of difficulty walking for 1 week. Examination shows visual fields that are constricted equally in both eyes on close and distant testing. He has collapsing effort on muscle strength testing in the left extremities. He staggers from side to side when walking but does not fall. On Romberg testing, he abruptly falls to the left. There is hemisensory loss to light touch, pinprick, vibration, and proprioception on the left that stops exactly at the midline. Which of the following is the most likely diagnosis?

A Cerebellar degeneration
B Cervical spinal cord compression
C Conversion disorder
D Guillain-Barré syndrome
E Multiple sclerosis
F Sensory neuropathy
G Tabes dorsalis
H Vitamin B12 (cobalamin) deficiency

5 An 82-year-old woman with dementia, Alzheimer type, is brought to the physician by her husband because he has had progressive difficulty feeding her over the past 4 weeks. He says she no longer swallows food that he puts in her mouth, even with prompting. She no longer says his name, and he believes that she does not recognize him. He has been her primary caregiver for 4 years. She does not have an advance directive. He says he does not want to hasten her death. He wants to continue to take care of her at home but is concerned about his ability to do so. He declines placement of a gastrostomy tube. She is 163 cm (5 ft 4 in) tall and weighs 44 kg (98 lb); BMI is 17 kg/m2. She appears well groomed but malnourished. She is not oriented to person, place, or time. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate recommendation?

A Oral multivitamin supplementation at home
B Oral nutritional supplementation at home
C Hospice care at home
D Admission to the hospital for total parenteral nutrition
E Transfer to a skilled nursing care facility for tube feeding
1. B - THIS COMParmtnet sydrome, get the pressures and do fasciotomy
2. d do an MRI to distinguish between multi infarct dementia which will show and other causes of dementia,
3 C
4 g
5 d she is way underweight and needs feeeding NOW.

got these right using this logic, hope that helps!
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  #10  
Old 07-15-2015
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Thanks alittlebitmore.
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  #11  
Old 07-15-2015
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#alittlebitmore
5. D is wrong. i got it wrong. it may b c.
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  #12  
Old 08-05-2015
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Correct Answer

[QUOTE=alittlebitmore;812945]1. B - THIS COMParmtnet sydrome, get the pressures and do fasciotomy
2. d do an MRI to distinguish between multi infarct dementia which will show and other causes of dementia,
3 C
4 g Its not tabes dorsalis i picked that and got it wrong may be its B12 Def
5 d she is way underweight and needs feeeding NOW. Its Hospice care at home - i got this question RIGHT..."her husband is been taking care of her for 4 years and the patient doesn't have any signed directive. He said he doesnt want any TUBE involvement
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  #13  
Old 11-15-2015
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I disagree Neurology CLINICAL MASTERY QUESTIONS

Does anyone have the answers to these?

The marked ones are WRONG!
Attached Thumbnails
NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.23.34-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.23.16-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.22.49-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.23.25-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.23.07-pm.png  

NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.22.42-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.22.58-pm.png   NBME clinical mastery series neuro form 2 question-screen-shot-2015-11-15-7.22.28-pm.png  
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  #14  
Old 08-17-2016
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4 is c.
Determining a conversion disorder is tricky but you can "split the midline" by placing a tuning fork on the xyphoid or frontal bone and ask which side does the patient feel it. A conversion may have a sharp demarcating line but these bones conduct equally across sides and it should be felt on both. This patient doesn't have that. A rapidly positive romberg is also quite odd. Lastly, tunnel vision is not a neurological phenomenon and if the field defect is the same on near and far this points to a psychological diagnosis.
-also I didn't get that one wrong so that must count for something.
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