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Old 01-10-2013
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Question NBME form 2 Block 1, 2....need few answers

BLOCK 1

3.) A 5-year-old girl is brought to the physician 30 minutes after being bitten on the forearm by her cat. Examination shows a small puncture wound covered with dried blood. She is at increased risk of infection for which of the following reasons?
A) Arm wounds are more susceptible to infection
B) Salivary enzymes in cats augment infection
C) It is difficult to cleanse pathogens from this wound
D) The Staphylococcus species involved is particularly virulent
E) Young children are less able to resist infection than adults

BLOCK 2


9. A 57-year-old man has been hospitalized for 2 days for treatment of unstable angina pectoris. He is currently receiving intravenous heparin and undergoing evaluation for coronary artery bypass grafting. His blood pressure is 160/90 mm Hg, pulse is 88/min, and respirations are 16/min. Laboratory studies show: Platelet count 90,000/mm3 Prothrombin time 12 sec (INR=1.1) Partial thromboplastin time 35 sec Which of the following is the most likely cause of these findings?
A) Excessive platelet destruction
B) Factor VIII deficiency
C) Inadequate platelet production
D) Uncontrolled activation of coagulation and fibrinolytic cascades
E) Vitamin K deficiency

14. An otherwise healthy 19-year-old woman comes to the physician because of a 3-year history of intermittent facial blemishes. She drinks wine occasionally on weekends. She takes no medications. Examination shows multiple 1- to 2-mm red and white papules and larger red nodules on the forehead and cheeks. Which of the following is the most appropriate initial pharmacotherapy?
A) Oral isotretinoin
B) Systemic corticosteroids
C) Topical benzoyl peroxide
D) Topical corticosteroids
E) Topical metronidazole
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Old 01-10-2013
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I might be wrong on all three but here goes:
C) It is difficult to cleanse pathogens from this wound
edit: looks like the answer is D. Explanation's on wikipedia and medscape
C) Topical benzoyl peroxide

Last edited by smanthrav; 01-10-2013 at 08:54 AM.
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3Q)...yeah C is the correct option given online.....

9Q)..by looking at option D- i was thinking of DIC..so got this one wrong.....i choose option A bcoz i thought IgG antibodies would kill the platelets.....

14Q)...nodular lesions on face, thot oral tretinoin would be best. But i read somewhere that oral tretinoin is started only after topical medications are tried.....
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Q:3) C) It is difficult to cleanse pathogens from this wound.

Q:9) D) Uncontrolled activation of coagulation and fibrinolytic cascades

Q:14) A) Oral isotretinoin
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not sure. i might be wrong.
1) E ( remember hearing it in poisoning cases of ID kaplan from the smiley guy)
2) D.
3) C ( topical benzoyl peroxide initially and if unresponsive use topical isotretinoin and still doesnt work, oral isotretinoin after Urinary Bhcg.i said it coz the question is initial therapy)
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Quote:
Originally Posted by slamdunk View Post
not sure. i might be wrong.
1) E ( remember hearing it in poisoning cases of ID kaplan from the smiley guy)
2) D.
3) C ( topical benzoyl peroxide initially and if unresponsive use topical isotretinoin and still doesnt work, oral isotretinoin after Urinary Bhcg.i said it coz the question is initial therapy)
i think i am wrong with the first answer. it should be C. E would be the answer for possible snake bite in children.
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Quote:
Originally Posted by slamdunk View Post
i think i am wrong with the first answer. it should be C. E would be the answer for possible snake bite in children.
Yup...C is the right option.....
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How much did you score btw? This your second nbme?

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Old 01-11-2013
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Quote:
Originally Posted by smanthrav View Post
How much did you score btw? This your second nbme?

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I did it offline dude......
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Old 05-11-2013
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Why isn't the answer to Q9 ---a ? I thought it could be Heparin induced thrombocytopenia..
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  #11  
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Default Acne Mx

For Q no 14, I think it will be Oral Isotretinoin
I think in Uworld it says

Mild acne , non-inflammatory comedomes: topical retinoids
Mild to moderate inflammatory acne: topical antibiotics
Moderate to severe inflammatory acne and papules: Oral antibiotics
Nodulocystic and scarring acne: Oral Isotretinoin


Question here describes large nodules
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Quote:
Originally Posted by anomali View Post
block 1

3.) a 5-year-old girl is brought to the physician 30 minutes after being bitten on the forearm by her cat. Examination shows a small puncture wound covered with dried blood. She is at increased risk of infection for which of the following reasons?
A) arm wounds are more susceptible to infection
b) salivary enzymes in cats augment infection
c) it is difficult to cleanse pathogens from this wound
d) the staphylococcus species involved is particularly virulent
e) young children are less able to resist infection than adults

block 2


9. a 57-year-old man has been hospitalized for 2 days for treatment of unstable angina pectoris. He is currently receiving intravenous heparin and undergoing evaluation for coronary artery bypass grafting. His blood pressure is 160/90 mm hg, pulse is 88/min, and respirations are 16/min. Laboratory studies show: Platelet count 90,000/mm3 prothrombin time 12 sec (inr=1.1) partial thromboplastin time 35 sec which of the following is the most likely cause of these findings?
A) excessive platelet destruction
b) factor viii deficiency
c) inadequate platelet production
d) uncontrolled activation of coagulation and fibrinolytic cascades
e) vitamin k deficiency

14. An otherwise healthy 19-year-old woman comes to the physician because of a 3-year history of intermittent facial blemishes. She drinks wine occasionally on weekends. She takes no medications. Examination shows multiple 1- to 2-mm red and white papules and larger red nodules on the forehead and cheeks. Which of the following is the most appropriate initial pharmacotherapy?
A) oral isotretinoin
b) systemic corticosteroids
c) topical benzoyl peroxide
d) topical corticosteroids
e) topical metronidazole


1. B
2. D
3. C
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  #13  
Old 08-04-2013
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Quote:
Originally Posted by smanthrav View Post
I might be wrong on all three but here goes:
C) It is difficult to cleanse pathogens from this wound
edit: looks like the answer is D. Explanation's on wikipedia and medscape
C) Topical benzoyl peroxide
Q3: the link to medscape doesn't seem to work. I would go for C, as deep wound is a RF for infection in cat bite.
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Old 08-05-2013
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Why is the answer D for question 9? is it Dic?
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Can we start isotretinoin directly? In step up its given that retinoids should be ADDED in nodular acne but you should give it after previous therapies have failed.
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I like how NBME questions cause so much discussion and arguments!
This is the true reason that we should do online ones!!!

I believe the answers are like this:

C. (like a puncture wound)
A. (HIT) though for hit plateletts are usually below 50,000 mark, but this might be just the beginning.
C. Asking about initial treatment! To start Oral isotretinoin we must make sure she is not prego first...
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Quote:
Originally Posted by DocSikorski View Post
I like how NBME questions cause so much discussion and arguments!
This is the true reason that we should do online ones!!!

I believe the answers are like this:

C. (like a puncture wound)
A. (HIT) though for hit plateletts are usually below 50,000 mark, but this might be just the beginning.
C. Asking about initial treatment! To start Oral isotretinoin we must make sure she is not prego first...
HIT occurs atleast 4-5.days after starting heparin...unless you are talking about HIT 1 which can occur within 2 days.
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Quote:
Originally Posted by made4usmle View Post
HIT occurs atleast 4-5.days after starting heparin...unless you are talking about HIT 1 which can occur within 2 days.
Ok, from all other available options what would you choose? All can be excluded easily except for D. but why in the world with this presentation would he have DIC?
From all the options given and the fact of receiving heparin he most likely has HIT.
And if you particularly like, let it be HIT 1...
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Quote:
Originally Posted by DocSikorski View Post
Ok, from all other available options what would you choose? All can be excluded easily except for D. but why in the world with this presentation would he have DIC?
From all the options given and the fact of receiving heparin he most likely has HIT.
And if you particularly like, let it be HIT 1...
It's not what I like or what you like, its about facts..
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Quote:
Originally Posted by made4usmle View Post
It's not what I like or what you like, its about facts..
exactly, so what answer do you suggest?
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  #21  
Old 04-21-2014
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for the 5 year old child who was bit by a cat..

is it not salivary enzymes?
Pasteurella known to be in saliva of animals?

http://www.ncbi.nlm.nih.gov/pubmed/2587958
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Old 04-21-2014
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How can it be DIC in the second question if the INR is normal?

http://en.wikipedia.org/wiki/Dissemi...tion#Diagnosis

It is most definitely HIT
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@drivenby its most def HIT..


coagulation studies normal and platelet counts decreased
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Quote:
Originally Posted by SOBE223 View Post
@drivenby its most def HIT..


coagulation studies normal and platelet counts decreased

im sorry, are you agreeing with me?

im confused cause you used the same wording as i did, don't know if you are mocking me lol
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lol no! I'm agreeing with u!
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  #26  
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its my english
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Quote:
Originally Posted by SOBE223 View Post
its my english
hahaha its okay


As for the 3rd question, i would choose a topical treatment before starting Oral Isoretinoin.

To even START oral isoretinoin you have to sign a waiver in the United States, it has far too many side effects to be used as initial treatment IMHO.

PLus this is a female, and like someone else mentioned, they can't just prescribe it to her without a pregnancy test. Also no mentions of scarring either on the question.
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