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  #1  
Old 03-13-2014
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Default Discussion about NBME 6 question - dont enter if you plan to do nbme 6!

Hi,

There is a question in NBME 6 which i have no idea how to answer, i wasn't able to find any answers online so i wanted to discuss about it here. i changed the words.

Practically a women at her 40's presents with tenderness nausea and camps with jaundice. she underwent a cholecystectomy 2 months ago for acute cholecystitis without intraoperative choleangiography. on examination you find icterus with RUQ tenderness.
AST,ALT's are normal ALKphos in ~600,
US show dilated intrabilliary ducts.

they ask whats the next step
- CT
- HIDA
- IV ab's
- ERCP
- exploratory lapratomy

I chose a CT scan - i thought about malignancy (even though she didnt lose weight or so on) - anyhow it was wrong, what do you guys think?
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  #2  
Old 03-13-2014
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Default

I took it long time back so don't exactly remember if I got this correct. I answered ercp. Rational behind it was to diagnose and treat (decompress) any fluid remaining in biliary ducts which could be due to sphincter of oddi dysfunction, part of post cholecystectomy syndrome.

Required non interventional imaging with us has already been done and scenario not compatible with cancer so a CT scan Will be unyielding and unnecessary.

Quote:
Originally Posted by modesty View Post
Hi,

There is a question in NBME 6 which i have no idea how to answer, i wasn't able to find any answers online so i wanted to discuss about it here. i changed the words.

Practically a women at her 40's presents with tenderness nausea and camps with jaundice. she underwent a cholecystectomy 2 months ago for acute cholecystitis without intraoperative choleangiography. on examination you find icterus with RUQ tenderness.
AST,ALT's are normal ALKphos in ~600,
US show dilated intrabilliary ducts.

they ask whats the next step
- CT
- HIDA
- IV ab's
- ERCP
- exploratory lapratomy

I chose a CT scan - i thought about malignancy (even though she didnt lose weight or so on) - anyhow it was wrong, what do you guys think?
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The above post was thanked by:
modesty (03-13-2014)
  #3  
Old 07-09-2014
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Default

it's ERCP because he likely has choledocholithiasis (stone in the common bile duct)
the clue is she didn't have intraoperative choleangiography to look for obstruction (stones) in the ducts


Quote:
Originally Posted by modesty View Post
Hi,

There is a question in NBME 6 which i have no idea how to answer, i wasn't able to find any answers online so i wanted to discuss about it here. i changed the words.

Practically a women at her 40's presents with tenderness nausea and camps with jaundice. she underwent a cholecystectomy 2 months ago for acute cholecystitis without intraoperative choleangiography. on examination you find icterus with RUQ tenderness.
AST,ALT's are normal ALKphos in ~600,
US show dilated intrabilliary ducts.

they ask whats the next step
- CT
- HIDA
- IV ab's
- ERCP
- exploratory lapratomy

I chose a CT scan - i thought about malignancy (even though she didnt lose weight or so on) - anyhow it was wrong, what do you guys think?
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  #4  
Old 07-18-2015
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Default Nmbe 6

Quote:
Originally Posted by els224 View Post
it's ERCP because he likely has choledocholithiasis (stone in the common bile duct)
the clue is she didn't have intraoperative choleangiography to look for obstruction (stones) in the ducts
Hey,

Do you guys have any source of the NMBE 6 questions with answers? Would you mind sharing that with me?
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  #5  
Old 07-20-2015
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Default Healthy 18yo female on health maintenance visit

Hi guys, I have a question too:

healthy 18 yo female with regular periods, LMP 2 wks ago, sexually active with 1 partner, using condom inconsistently for contraception.
maternal grandmother with breast cancer age 65, paternal grandfather w colon cancer age 72, maternal grandfather died of MI age 66. Normal PE.
Q: Which of the following is the most appropriate screening test for this pt?
- CBC
- fasting serum lipids
- test stool for occult blood
- test for n. gonorrhoeae and chlamydia
- urinalysis

I answered CBC bc I dont see anything in her history that raised a flag for increased risk. She doesn't fit the definitions that I found about high risk groups for STDs... what do you think?
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