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Default Nbme-2


A previously healthy 67-year-old woman is brought to the emergency department by paramedics 40 minutes after the sudden
onset of shortness of breath while shopping. She is unable to provide additional medical history. She is in severe respiratory distress. Her temperature is 37 C (98.6 F), blood pressure is 90/60 mm Hg, pulse is 120/min and regular, and respirations are 24/min. Examination shows marked jugular venous distention. Diffuse crackles are heard throughout all lung fields. Cardiac examination shows an enlarged point of maximal impulse and normal S1 and S2; there is an S3. Abdominal examination shows no abnormalities. There is no edema of the lower extremities. Laboratory studies show: Hematocrit 38% Leukocyte count 12,000/mm3 Platelet count 350,000/mm3 Arterial blood gas analysis on 5 L/min of oxygen: pH 7.5 PCO2 16 mm Hg PO2 64 mm Hg
A ) Aortic valve rupture
B ) Cardiac tamponade
C ) Congestive heart failure
D ) Pulmonary embolism

nbme-2 ques-12

A 72-year-old man comes to the physician because of generalized weakness and night sweats for 6 months. During this period he has had a 5-kg (11-lb) weight loss. He has had polycythemia vera for 12 years treated with hydroxyurea and multiple phlebotomies. Examination shows cachexia. The liver is enlarged and nontender with a
span of 13 cm; the spleen is enlarged. Hematocrit is 27%, leukocyte count is 3200/mm3, and platelet count is 150,000/mm3. A blood smear is shown. Which of the following is the most likely diagnosis?
A ) Acute myelogenous leukemia
B) Hodgkin's disease
C ) Miliary tuberculosis
D ) Myelofibrosis


A 75-year-old man with a 3-year history of progressive cognitive impairment due to dementia, Alzheimer's type, has had nocturnal disorientation for 2 weeks. He lives at home with his wife. He is otherwise healthy and takes no medications. Physical examination shows normal findings. He is disoriented to time and place, has poor short-term memory, is unable to do simple arithmetic, and has a poor understanding of general information. Which of the following is the most appropriate initial step in management?
A ) Increase in home nighttime lighting
B ) Prescription for chloral hydrate
C ) Prescription for diazepam
D ) Prescription for haloperidol
E ) Use of nighttime mechanical restraints

Nbme-2 Ques-14

A 76-year-old man has had fatigue and loss of interest in daily activities over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight loss during this period. He states that he has probably lived long enough. His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a slow return of deep tendon reflexes. Measurement of which of the following serum levels is the most appropriate next step in management?
A ) Calcium
B ) Creatinine
C ) Glucose
D ) Testosterone
E ) Thyroid-stimulating hormone

Seriously, what's this question asking about?? :-(

One week after undergoing an uncomplicated liver transplant for biliary atresia, a 3-year-old boy appears jaundiced. Examination shows scleral icterus. His serum aspartate aminotransferase (AST, GOT) activity has increased to 1300 U/L, and serum alanine aminotransferase (ALT, GPT) activity has increased to 2500 U/L. His serum bilirubin level is 3.5 mg/dL, and serum alkaline phosphatase activity is 100 U/L. Which of the following is the most likely artery responsible for this patient's gastrointestinal symptoms?
A ) Hepatic
B ) Ileocolic
C ) Inferior mesenteric
D ) Left gastric
E ) Left gastroepiploic
F ) Middle colic
G ) Posterior penetrating H ) Right colic
I ) Right gastroepiploic
J ) Splenic
K ) Superior hemorrhoidal
L ) Superior mesenteric

nbme-2 ques-16

A 2-year-old girl has had fever and bloody diarrhea for 10 days. A stool culture obtained 7 days ago grew Salmonella species sensitive to amoxicillin. A blood culture was negative. Despite beginning oral amoxicillin therapy 4 days ago, her diarrhea has persisted. Current examination shows no other abnormalities except for a temperature of 38.6 C (101.5 F). Which of the following is the most likely explanation for the failure of amoxicillin to improve her symptoms?
A ) Amoxicillin does not alter the course of Salmonella enteritidis
B ) Amoxicillin has caused pseudomembranous colitis
C ) Amoxicillin is absorbed at the level of the jejunum, leaving no drug to be delivered to the colon
D ) Oral amoxicillin is not absorbed into the systemic circulation in the presence of diarrhea
E ) Salmonella has expressed an inducible -lactamase that inactivates amoxicillin
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