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  #1  
Old 06-13-2014
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A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.
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Old 06-13-2014
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Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.
Px has signs of increased ICP and focal neurologic findings. Do a CT first to look for Mass lesions or hemorrhage. If the CT comes out normal u can do a LP.
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Old 06-14-2014
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The thread is good and i like the information that has been shared with all of us.
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Default nbme7 answers

just seen this thread, i will post some qs at the evening
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S2
1. An asymptomatic 22-year-old nulligravid woman comes to the physician for a routine health maintenance examination. She feels well but is concerned about her risk for ovarian cancer because her mother received the diagnosis of the disease at the age of 42 years. She does not know of anyone else in her family who has had cancer. She has no history of serious illness and takes no medications. Menses occur at regular intervals and last 4 days. She does not smoke and occasionally drinks alcohol. She became sexually active at the age of 16 years but has not been sexually active for 6 months. She used condoms for contraception. She plays tennis two to three times weekly. She is 163 cm (5 ft 4 in) tall and weighs 54 kg (120 lb); BMI is 21 kg/m2.Her temperature is 37 degree, pulse is 60/min, respirations are 20/min, and blood pressure is 100/60 mm Hg. Physical examination shows no abnormalities. Which of the following is the most appropriate recommendation for this patient?
A) Annual assay for tumor markers
B) Annual pelvic ultrasonography
C) Annual CT scan of the abdomen and pelvis
D) Oral contraceptive therapy
E) Placement of an IUD

27. A 32-year-old man with major depressive disorder has had the sensation of insects crawling under his skin for 2 weeks. He was initially treated for scabies in the emergency department. When he went to the dermatology clinic for a follow-up examination, he was told he had herpes zoster. He has continued to use acyclovir and the topical scabies preparation prescribed, but his symptoms have worsened, and he now sees tiny worms crawling out from his skin. He appears anxious but healthy. He has scattered excoriations over his face, head, abdomen, and upper and lower extremities. The lesions are punched-out sores on a clean base. Toxicology screening is most likely to show which of the following?
A)Acetaminophen
B) Methamphetamine
C) Opiates
D) Organophosphates
E) Paraqua

32. Four days after undergoing a right hemicolectomy for cecalvolvulus, an obese 67-year-old woman has leakage of serosanguineous fluid between the incision staples; the dressing is soaked. Medications include corticosteroids for chronic obstructive pulmonary disease. Her temperature is 37.5。c (99.5。F),pulse is 73/min, and blood pressure is 140/90 mm Hg. Abdominal examination shows distention with minimal incisional tenderness and no erythema. Which of the following is the most likely diagnosis?
A) Anastomotic leak
B) Enterocutaneous fistula
C) Evisceration
D) Intra-abdominal abscess
E) Intra-abdominal bleeding
F) Mechanical small-bowel obstruction
G) Necrotizing fasciitis
H) Wound dehiscence
I) Wound infection

40. A 32-year-old man comes to the physician because of a 3-month history of episodes of burning substernal chest pain and a sour taste in his mouth. He sometimes awakens at night with an acidic liquid in his mouth. He has had a nonproductive cough for 2 months. He has smoked one pack of cigarettes daily for 14 years. He drinks approximately six beers every week. He
is 170 cm (5 ft 7 in)tall and weighs 90 kg (198 lb); BMI is 31 kg/m2.Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A) Barium swallow
B) Esophageal acid infusion test
C) Trial of omeprazole therapy
D) Esophageal manometry
E) Upper gastrointestinal endoscopy

44. A 37-year-old man comes to the physician because of a 6-month history of shortness of breath and fatigue. He now becomes short of breath after walking two blocks and has fatigue during the day. He typically sleeps 6 hours nightly but he does not feel well rested when he awakens in the morning. He does not smoke or drink alcohol. He has worked as a junior high school teacher for 15 years. He is 178 cm (5 ft 10 in) tall and weighs 186 kg (410 lb);BMI is 59 kg/m竺 His pulse is 86/min, respirations are 14/min, and blood pressure is 146/92 mm Hg. The lungs are clear to auscultation; breath sounds are decreased. Cardiac examination shows no abnormalities. Arterial blood gas analysis on room air shows:
pH 7.32
PC02 56 mm Hg
Po2 70 mm Hg

An x-ray of the chest shows no abnormalities. Which of the following is the most likely explanation for this patient’s hypoxemia?
A) Alveolar-capillary diffusion abnormalities
B) Alveolar hypoventilation
C) Arteriovenous shunting
D) Decreased Fio2
E) Ventilation-perfusion mismatch

S3
2. A 42-year-old man has had a pruritic rash on his back for 4 days. He is employed as a plumber and often has to move around on his back under houses. His temperature is 37。c (98.6。F). There are multiple, erythematous, serpiginous tracks on his back that are 2 to 10 cm in length. His leukocyte count is 10000/mm3 (45o/o segmented neutrophils,15% eosinophils,30%lymphocytes, and 10% monocytes).An x-ray of the chest shows no abnormalities. Examination of the stool for ova and parasites is negative. Which of the following is the most likely diagnosis?
A) Ascariasis
B) Cutaneous larva migrans
C) Fire ant bites
D) Hypereosinophilic syndrome
E) Scabies

8. A previously healthy 82-year-old woman comes to the physician because she is concerned that she has Parkinson disease. Over the past 6 months, she has had occasional difficulty finding the word that she wants to use, and her ability to distinguish smells has decreased. She repo同s that her reaction time to shifts in posture seems slow, and she needs to use a hand rail to steady herself while walking on stairs. She lives alone and is able to manage her own finances.T he pupils are 3 mm. There is mild reduction of upward gaze and brisk rotatory nystagmus on left lateral gaze. Audiometry shows mild high-frequency hearing loss. There are no tremors or rigidity. Her gait is normal. Her Mini-Mental State Examination score is 29/30.
Which of the following neurologic findings warrants further evaluation?
A) Brisk rotatory nystagmus on left lateral gaze
B) Decreased sense of smell
C) Decreased upward gaze
D) High-pitched tone hearing loss
E) Small symmetric pupils

A 72-year-old man has decreased ur川e output 2 days after admission to the hospital for treatment of cholecystitis. His urine output has been 15 ml/h over the past 3 hours. On admission, results of laboratory studies were consistent with gram-negative bacteremia and disseminated intravascular coagulation. He is currently receiving intravenous fluids, cefoxitin, and gentamicin. His temperature is 38.5C (101.3F), pulse is 11O/min, respirations are 24/min, and blood pressure is 90/64 mm Hg. Abdominal examination shows mild right upper quadrant tenderness. His serum creatinine concentration has increased from 1.5 mg/dl days ago to 3 mg/dl .This patient is most likely to have which of the following sets of urinalysis findings?

DIC’s urinary finding
Blood protein RBC WBC casts other microscopic findings
I guess
3+ 1+ >50 none RBC none (in the oreder)

14. A 14-year-old boy who has sickle cell trait is brought to the emergency department because of a 1-day history of severe pain in his left thigh and knee. He has been unable to bear weight on his left leg since the pain began. He has not had swelling, locking, or “catching" of his knee. Six days ago, he was evaluated in the emergency department after he twisted the knee during a basketball game. An x-ray of the knee taken at that time is shown. He was instructed to take a nonsteroidal anti* inflammatory drug and apply ice packs to the knee. He also was given crutches and told to bear weight as tolerated. His symptoms improved during the next 3 days, and he discontinued use of the crutches and medication at that time. On arrival, he is walking with the assistance of crutches. He is 173 cm (5 ft 8 in)tall and weighs 95 kg (210 lb);BMI is 32 kg/m2_ His temperature is 37c (98 6。F), and blood pressure is 110/70 mm Hg. Examination of the left lower extremity shows joint line tenderness of the knee; there is no effusion. Range of motion of the left hip is limited by pain. The remainder of the examination shows no abnormalities. His leukocyte count is 8000/mm3,and erythrocyte sedimentation rate is 10 mm/h. Which of the following is the most appropriate next step in management?
A)X-ray of the lumbar spine
B)X-ray of the left hip
C) Whole-body bone scan
D) MRI of the left knee
E) Aspiration of the left knee

16. A 21-year-old primigravid woman at 37 weeks' gestation has had mild epigastric pain and a moderate headache for 24 hours. The pregnancy has been otherwise uncomplicated. Her temperature is 37。c (98β。F), and blood pressure is 150/98 mm Hg. The fundus is nontender, and fundal height is 36 cm. Fetal heart rate is 130/min. Deep tendon reflexes are 3+
bilaterally. Urine protein is 3+. For each patient with a possible complication of pregnancy, select the most appropriate next step in management.

A) Culdocentesis
B) CT scan of the abdomen
C) Measurement of platelet count
D) Measurement of serum amylase activity
E) Paracentesis
F) Single-shot intravenous pyelography
G) Test of the stoolfor occult blood
H) Ultrasonography of the pelvis

31. A 62-year-old man comes to the physician because of intermittent painless rectal bleeding over the past 3 weeks. He has a history of angina pectoris and is currently taking inhaled corticosteroids for moderate chronic obstructive pulmonary disease. He has smoked one and a half packs of cigarettes daily for 45 years. Vital signs are within normal limits. Scattered crackles and wheezes are heard bilaterally. Heart sounds are normal. Abdominal examination shows no abnormalities. Rectal examination shows a palpable mass 2 to 3 cm inside the anal verge. Anoscopy shows a 5-cm ulcerated mass; a biopsy specimen of the mass shows adenocarcinoma. Which of the following is the most appropriate next step in management?
A) Colonoscopy to the cecum
B) Sigmoidoscopy
C) Radiation therapy to the rectum
D) Transanal excision of the tumor
E) Surgical resection of the rectum

33. An 18-year-old woman has had fever for 12 hours and obtundation for 4 hours. She had been attending a summer camp with 120 other students and was well until yesterday, when she developed a sore throat and nonproductive cough; this morning she could not be aroused. Her temperature is 38.6c (101.5。F), pulse is 120/min, respirations are 30/min, and blood pressure is 84/50 mm Hg. Her extremities are cold.The skin lesions shown are present over her extremities, chest, and abdomen. Hematocrit is 41%, and leukocyte count is 21,200/mm3with a shift to the left. Which of the following is the most likely diagnosis?
A) Acute Lyme disease
B) Cocaine overdose
C) Meningococcemia
D) Pseudomonal sepsis
E) Toxic shock syndrome

34. A 67-year-old man comes to the physician because of easy fatigability and generalized weakness for 3 months and left chest pain for 1 month. The chest pain is worse on deep inspiration. He appears slightly pale.T here is tenderness over the left 8th and 9th ribs laterally. Examination shows no other abnormalities. His hematocrit is 28o/o. Serum and urine protein electrophoresis shows a monoclonal spike. A biopsy specimen of bone marrow shows greater than 50% plasma cells.An x-ray of the chest shows 1- to 1.5-cm areas of radiolucency in both ribs corresponding to the sites of tenderness. This patient's condition makes him most susceptible to infection with which of the following organisms?
A)Aspergillus umigatus
B) Escherichia coli
C) Herpes zoster virus
D) Mycobacterium tuberculosis
E) Pneumocystis jiroveci (formerly P carinii)
F) Streptococcus pneumoniae

36. A 72-year-old woman comes to the physician because of an increase in abdominal girth over the past 2 months. She has had a 3.6-kg (8-lb) weight gain during this period despite being unable to finish any meal. She has one martini daily after her 3-mile walk. She underwent lumpectomy and radiation therapy for stage I breast cancer 4 years ago and has been treated with tamoxifen since then. Abdominal examination shows a fluid wave. Pelvic examination shows an 8-cm,fixed,nontender mass in the cul-de-sac. Laboratory studies show normal findings. Which of the following is the most appropriate next step in management?
A) Intravenous albumin therapy
B) Intravenous antibiotic therapy
C) Intravenous cisplatin and paclitaxel therapy
D) angiotensin-converting enzyme (ACE) inhibitor therapy
E) Oral spironolactone therapy
F) Therapeutic paracentesis
G) Exploratory laparotomy


41. A 23-year-old man is brought to the physician by his mother because of auditory hallucinations and confusion since his wife was killed in a motor vehicle collision 1week ago. His mother reports that he was unable to make any decisions regarding his wife's funeral and has been confused and disorganized since her death. Physical examination shows no abnormalities. He is oriented to person, place, and time. Mental status examination shows a sad affect. He appears preoccupied and has difficulty concentrating. He states that he hears his brother’S voice telling him that everything will be okay; his mother repo巾that her other son lives in another state. Which of the following is the most likely diagnosis?
A) Bereavement
B) Brief psychotic disorder
C) Post-traumatic stress disorder
D) Schizoaffective disorder
E) Schizophrenia
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S4
4.A previously healthy 67-year-old man has had an aching burning sensation in the distal lower extremities for 3 weeks; the symptoms are exacerbated by walking and relieved by elevation of the feet. The metatarsophalangeal joints and ankles are warm, swollen, tender, and erythematous. There is clubbing of the fingers and toes. Which of the following is the most likely diagnosis?

A)Bronchogenic carcinoma
B) Hyperparathyroidism
C) Hypoparathyroidism
D) Medullary thyroid carcinoma
E) Non-Hodgkin lymphoma

5.A 4 year-old boy develops chickenpox 8 hours after visiting his newborn sister in the nursery. Six other full-term newborns were also exposed; all of the mothers have a history of chickenpox prior to pregnancy. Which of the following is the most appropriate recommendation to prevent chickenpox in the newborns?
A) Acyclovir therapy for all exposed newborns
B) Administration of varicella vaccine to all exposed newborns
C) Administration of varicella vaccine to newborns with negative varicella titers
D) Isolation of the newborns from each other
E) No intervention is necessary

9.A previously healthy 18-year-old woman comes to the physician because of a lump in her neck that she first noticed 1 month ago. She is otherwise asymptomatic. Examination shows a 3- cm left supraclavicular lymph node that is firm and rubbery. The spleen is palpated 3 cm below the left costal margin. The remainder of the examination shows no abnormalities. Laboratory studies are most likely to show which of the followingつ
A)Decreased serum potassium concentration
B) Increased erythrocyte count
C) Increased serum calcium concentration
D) Increased serum lactate dehydrogenase activity
E) Increased serum thyroid-stimulating hormone concentration

21.A 27-year-old man is brought to the emergency department by paramedics 30 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained driver. He was unconscious at the scene, and he was extricated from his vehicle. On arrival, his Glasgow Coma Scale score is 10. His temperature is 37c (98.6F),pulse is 130/min, respirations are 36/min, and blood pressure is 90/60 mm Hg. Breath sounds are decreased on the right; there is crepitus to palpation over the right hemithorax. An x-ray of the chest shows a right hemopneumothorax. Abdominal ultrasonography for trauma (FAST) shows no abnormalities. An x-ray shows an unstable pelvic fracture. Placement of a right thoracostomy tube yields 300 ml of blood. After rapid infusion of 3 L of crystalloid ,the patient remains tachycardic and hypotensive. Which of the following is the most appropriate next step in
management?
A) Administration of epinephrine
B) Administration of hetastarch
C)Administration of recombinant factor VII
D) Transfusion of fresh frozen plasma
E)Transfusion of group ,Rh-negative packed red blood cells

28.A health status survey compares the clinical outcomes of patients treated for hip fracture at two hospitals. A total of 560 subjects are studied for 1 year after sustaining a hip fracture. After adjustment for age and gender, the level of physical functioning following treatment is found to be significantly lower among patients treated in one hospital (p=.02)Researchers conclude that treatment at this hospital was suboptimal. Which of the following raises the most concern about this conclusion?
A) The period of study is too short
B)The results are not adjusted for comorbidities
C) The results are not statistically significant
D) The statistical power is too low
E)The survey instrument does not include clinical measures

29. A 20-year-old man is brought to the physician by his parents because of auditory hallucinations and bizarre behavior over the past year. He recently dropped out of college and moved back home with his parents. He has not attempted to find a job. He says that he has been feeling strange, "like being in a dream,'and talks to his great-great-grandfather who died 50 years ago. He was diagnosed with hepatitis A 2 years ago after an episode of jaundice, and he has been treated with thyroxine for hypothyroidism for the past 6 months. His pulse is 68/min, respirations are 10/min, and blood pressure is 100/70 mm Hg. Physical examination shows hyperreflexia of the lower extremities and mild resting tremor of the upper extremities. On mental status examination, his voice is monotonous, his face is immobile, and he seems very anxious. He stares at the physician and barely answers questions. Serum studies show:
Total bilirubin1 mg/dl Thyroid-stimulating hormone 1 µU/ml AST 21 U/L, ALT 20 U/L
Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
A) Amyotrophic lateral sclerosis
B) Bipolar disorder
C) Hepatic encephalopathy
D) Major depressive disorder with psychotic features
E) Parkinson disease
F) Psychotic disorder due to a general medical condition
G) Schizophrenia
H) Substance-induced psychotic disorder

30. A study is proposed to assess the effectiveness of a new vaccine for the prevention of HIV transmission. The new vaccine has been tested on a number of animal models and has shown success for the prevention of HIV transmission. The study will include members of a prison population. T hose who agree to participate will be considered for early parole. Prisoners will be randomly assigned to receive the new vaccine or a placebo . Which of the following features of this study is of greatest potential concern?
A) Coercion of a vulnerable population
B) Conflict of interest
C) Failure to use an appropriate placebo
D) Inadequate informed consent
E) Lack of generalizability

32. A 2-month-old girl is brought for a routine health maintenance examination. She was born at 34 weeks' gestation and had temperature instability and slow feeding during the 2 weeks following birth. Her mother says that she recently had a runny nose and cough. Her growth and development are appropriate when corrected for gestational age. Her temperature is 37.c (100F) The remainder of her vital signs is within normal limits. Examination shows no abnormalities other than green rhinorrhea. Which of the following is the most appropriate plan for her immunizations?
A) Avoid live immunizations during illness
B) Delay the immunizations for 6 weeks to correct for prematurity
C) Delay all immunizations until her upper respiratory tract infection resolves
D) Give all recommended immunizations for age
E) Reduce the dose of immunizations according to her gestational age

35. A 67-year-old man has had an ulcer on the anterior surface of the leg just above the ankle for 2 weeks. He had mitral valve replacement 15 years ago because of rheumatic valvular disease. He takes furosemide for congestive heart failure and an oral hypoglycemic for type 2 diabetes mellitus. Examination shows a 5-cm ulcer with a 3-mm red border. There is moderate edema from the toes to midcalf bilaterally; his feet are warm, and pulses are weakly palpable. Scattered crackles are heard at the lung bases bilaterally. Which of the following is the most likely diagnosis?
A) Arterial insufficiency
B) Endocarditis with metastatic infection
C) Meleney ulcer
D) Mucormycosis
E) Stasis dermatitis with ulcer

Please give me the correct answers and explanations.
Thanks in advance.
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Old 06-14-2014
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Default NBME 7 answers

S2: 1D, 27B,32?, 40C it's GERD, 44B
S3: 2B, 8?, urinalysis : i picked the one with hyalin casts and i got it right because the pt is dehydrated, 14?, 16C, 31?, 33C, 34F encapsulated organisms, 36?, 41 C this choice wasn't in my exam, i had acute stress disorder instead
S4:4?, 5E, 9D, 21?, 30E, 32D
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[QUOTE=Gundam;371737]A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.[/QUOT

has neruo sx. ryte upper extremity weakness n optic disc not clear nystagmus so need to do CT scan to rule out.
So ans C
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[QUOTE=dr.baig22;372569]
Quote:
Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.[/QUOT

has neruo sx. ryte upper extremity weakness n optic disc not clear nystagmus so need to do CT scan to rule out.
So ans C
what's the answer of S4 4??? burning feet question
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[QUOTE=abeer;372729]
Quote:
Originally Posted by dr.baig22 View Post

what's the answer of S4 4??? burning feet question
ANSWER IS A( its called hyperhrophic pulmonary osteoarthropathy syndrome its athropathy coz oflung problem could be TB CR>>)
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[QUOTE=DrAGA;372801]
Quote:
Originally Posted by abeer View Post

ANSWER IS A( its called hyperhrophic pulmonary osteoarthropathy syndrome its athropathy coz oflung problem could be TB CR>>)
ohh yaa.. it was in step 1 UW man,.. so many step 1 things ....
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Smile NBME 7 answers

S4 28 29
Answer and explanation, please!
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Default Block 3

1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)
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Quote:
Originally Posted by dr.baig22 View Post
1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)

No 43 looks like one UW question in which there was 93 yr old lady with vaginal cancer... and the answer to her was radiation as she had multiple co-morbidities.. i think this question will also need radiation... but was your answer correct when you put tans-anal resection?
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Simply, the age in this question is 64 yo man. So, the answer is transanal excision,
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Default please help

there was a question about a 16 yo girl who was brought by the mother she wants contraception for her daughter and she is worried about her behavior. There was something about the dad being furious and does not know what's going on. The answer choices were:
behavior therapy for patient ( which I picked and got wrong)
family therapy
psychodynamic psychotherapy
tell the mother its just a phase
Triazolam

Please help me understand what the right answer is. Thanks
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Quote:
Originally Posted by tulip04 View Post
there was a question about a 16 yo girl who was brought by the mother she wants contraception for her daughter and she is worried about her behavior. There was something about the dad being furious and does not know what's going on. The answer choices were:
behavior therapy for patient ( which I picked and got wrong)
family therapy
psychodynamic psychotherapy
tell the mother its just a phase
Triazolam

Please help me understand what the right answer is. Thanks
I think its family therapy... My answer was behavior therapy fro pt and parents - its wrong..
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Originally Posted by DrAGA View Post
I think its family therapy... My answer was behavior therapy fro pt and parents - its wrong..
I thought that we are always supposed to find out what the patient thinks and then move onto the family. oh well. so hard to tell with these questions sometimes. thanks!
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A few other questions I have:

18.There was one where the patient had colon cancer and it was asking what kind of studies to use for developing a treatment strategy. Answer choices:
-case-controlled observational study
-case reports
-cohort study
-patient satisfaction surveys
-randomized clinical trial

27. trauma patient with neck pain and "slightly widened mediastinum" and C5 facet fracture. Question was asking what the most likely life threatening cardiovascular injury was.
I picked Carotid artery and got it wrong.

(Going through my questions now so pardon me for multiple posts) Really appreciate the help

Thank you.
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randomized controlled study sounds good for drugs.
for serious injury I would say aortic injury. what were the answer choices?
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Quote:
Originally Posted by druic View Post
randomized controlled study sounds good for drugs.
for serious injury I would say aortic injury. what were the answer choices?
the blood pressure was 120/80 and it said only a slightly widened mediastinum...so I did not pick aorta.

choices were:
abdominal aorta
carotid aorta ( wrong answer)
heart
IVC
innominate artery
innominate vein
jugular vein
pulmonary artery
pulmonary vein
subclavian artery
SVC
thoracic aorta
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I would go for thoracic aorta. I hope it`s right.
Anyone who got this q right, can u enlighten us?
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21.A 27-year-old man is brought to the emergency department by paramedics 30 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained driver. He was unconscious at the scene, and he was extricated from his vehicle. On arrival, his Glasgow Coma Scale score is 10. His temperature is 37c (98.6F),pulse is 130/min, respirations are 36/min, and blood pressure is 90/60 mm Hg. Breath sounds are decreased on the right; there is crepitus to palpation over the right hemithorax. An x-ray of the chest shows a right hemopneumothorax. Abdominal ultrasonography for trauma (FAST) shows no abnormalities. An x-ray shows an unstable pelvic fracture. Placement of a right thoracostomy tube yields 300 ml of blood. After rapid infusion of 3 L of crystalloid ,the patient remains tachycardic and hypotensive. Which of the following is the most appropriate next step in
management?
A) Administration of epinephrine
B) Administration of hetastarch
C)Administration of recombinant factor VII
D) Transfusion of fresh frozen plasma
E)Transfusion of group ,Rh-negative packed red blood cells *** he's bleeding somewhere
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29. A 20-year-old man is brought to the physician by his parents because of auditory hallucinations and bizarre behavior over the past year. He recently dropped out of college and moved back home with his parents. He has not attempted to find a job. He says that he has been feeling strange, "like being in a dream,'and talks to his great-great-grandfather who died 50 years ago. He was diagnosed with hepatitis A 2 years ago after an episode of jaundice, and he has been treated with thyroxine for hypothyroidism for the past 6 months. His pulse is 68/min, respirations are 10/min, and blood pressure is 100/70 mm Hg. Physical examination shows hyperreflexia of the lower extremities and mild resting tremor of the upper extremities. On mental status examination, his voice is monotonous, his face is immobile, and he seems very anxious. He stares at the physician and barely answers questions. Serum studies show:
Total bilirubin1 mg/dl Thyroid-stimulating hormone 1 µU/ml AST 21 U/L, ALT 20 U/L
Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
A) Amyotrophic lateral sclerosis
B) Bipolar disorder
C) Hepatic encephalopathy
D) Major depressive disorder with psychotic features
E) Parkinson disease
F) Psychotic disorder due to a general medical condition
G) Schizophrenia** he has enough of the positive and negative symptoms, he meets time criteria, the neuro findings could be 2/2 thyroid med (he has a low normal pulse and his bp is low) or drugs
H) Substance-induced psychotic disorder -> there is nothing that links his presentation in relation to any drug or alcohol use.
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35. A 67-year-old man has had an ulcer on the anterior surface of the leg just above the ankle for 2 weeks. He had mitral valve replacement 15 years ago because of rheumatic valvular disease. He takes furosemide for congestive heart failure and an oral hypoglycemic for type 2 diabetes mellitus. Examination shows a 5-cm ulcer with a 3-mm red border. There is moderate edema from the toes to midcalf bilaterally; his feet are warm, and pulses are weakly palpable. Scattered crackles are heard at the lung bases bilaterally. Which of the following is the most likely diagnosis?
A) Arterial insufficiency
B) Endocarditis with metastatic infection
C) Meleney ulcer -> cutaneous condition that is a postoperative, progressive bacterial gangrene.
D) Mucormycosis -> more in upper respiratory tract, black necrotic tissue in poorly controlled diabetic
E) Stasis dermatitis with ulcer** he has increased venous pressure in his leg 2/2 to his heart issues. the foot is WARM not cold..that differentiates it from arterial insufficiency (which is typically cool and pulseless)
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Quote:
Originally Posted by tulip04 View Post
the blood pressure was 120/80 and it said only a slightly widened mediastinum...so I did not pick aorta.

choices were:
abdominal aorta
carotid aorta ( wrong answer)
heart
IVC
innominate artery
innominate vein
jugular vein
pulmonary artery
pulmonary vein
subclavian artery
SVC
thoracic aorta
18-is randomised clinical study
27-thoracic aorta
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Default wrong qs from nbme 7

A 6 wk old boy is brought to doc for his first well child exam. He was born at 41 wks gestation following a prolonged labor and forceps delivery. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. He weighed 4111g at birth and now weighs 5200. His temp is 37.4 (99.3). The head is rotated to the left with the chin deviated to the right. The head can be moved to the midline only with difficulty. A 2 cm, hard nontender, oval mass is palpated in the right side of neck. Which of the following is the most likely cause of these findings?
Abscess of cervical lymph node (I don’t think)
Fibrosis of SCM muscle (probably)
Fracture of right clavicle (I don’t think)
Hemivertebra of the cervical spine
Malignant tumor (picked this as correct and got it wrong)


Three days after undergoing total hip replacement, a 50 year old man is unable to move his legs and has urinary incontinence. His symptoms began immediately following removal of an epidural catheter that was inserted for pain control. His medications include ketorolac, enoxaparin, and morphine. Which of the following is the most likely diagnosis?
Centrally herniated nucleus pulposus
Dural laceration
Epidural hematoma
Residual neurologic blockade from long acting anesthetic agents (picked this and was wrong)
Transverse myeltiis

67 year old man comes to doc b/c of aching in his calves for past 2 months. The pain is relieved with rest. Exam shows decreased pedal pulses .the most likely cause of the patient’s current symptoms is significant narrowing of which of the following vessels?
Abdominal aorta
Femoralpopliteral arteries
Iliac arteries
Peroneal arteries
Tibial and peroneal arteries (picked this and it was wrong)

32 year old man comes to the doc with his wife with changes in behavior during past 2 wks. Four weeks ago, he witnessed a close friend die in car accident. On the evening of collision, pt offered to drive friend home after they had a few beers but friend declined. As the friend walked away from pt’s car, he was struck by a truck.the pt doesn’t remember much about the incident. During the past 2 weeks the wife reports that he has been awakening nightly in sweat and shouting “watch out” he has become emotionally distance and doesn’t want to socialize with his friends.he hasn’t driven his car in 10 d.he has difficulty sleeping and concentrating and says “things don’t seem real at times.” He says he used to drinkalcohol only rarely but lately he has been drinking 2 beers nightly for 3 wks to help him calm his mind and sleep. His temp is normal, pulse, resp, but bp is 145/80. No abnormalities on physical exam. He has a flat affect but is also irritable.he has not been feeling much of anything lately. He has thought about death frequently in the last 2 wks but doesn’t want to kill himself. What is most likely diagnosis?
Acute stress disorder
Adjustment disorder
Bereavement (picked and I was wrong)
Dissociative identity disorder
MDD
Panic disorder
Substance induced mood disorder.

A 23 year old man is brought to doc by his mom because of auditory hallucinations and confusion since his wife was killed in a MVA 1 wk ago. He was unable to make any decisions regarding his wife’s funeral and has been confused and disorganized since her death. Physical examination shows no abnormalities. He is oriented to person, place and time. Mental status exam shows a sad affect. He appears preoccupied and has difficulty concentrating. He states that he hears his brother’s voice telling him everything will be ok; the mom says the brother is located in other state. Which is the most likely diagnosis?
Bereavement (wrong)
Brief psychotic disorder
PTSD (cant be b/c of the time frame needing to be >1 m)
Schizoaffective
Schizophrenia (cant be because of time frame needing to be >6m)

Five days after undergoing an open splenectomy for ITP, a 57 yr old woman has the onset of shortness of breath. During the operation, dissection of the splenic hilum was difficult. Her only med is morphine. Her temp is 99.2, BP 120/80, resps 20, pulse 80. The surgical wound appears normal. Breath sounds are decreased at the left lung base. White count 15,600, platelets 112k, serum amylase 90. Which of the following is most appropriate next best step in mgmt?
Xrays of chest
u/s of abdomen
iv antibiotics
iv immunoglobulin
systemic heparin (picked and was wrong)
pulm angiography
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67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I
no secretion of epinephrine from the adrenal medulla

a 12 month old boy is brought to the ED bc of a 4 hr hx of temps to 105 and irritability. He has had 2 previous infections during the past 8 months-pneumococcal bacteremia at age of 4 months and periorbital cellultis caused by type B H.inf at age of 7 m. all recommended immunizations were administered at the appropriate ages. An LP showed a leukocyte count of 500 with 95% neutrophils. Gram stain shows gram + diplococci.
Select the cell type most likely involved in the underlying condition:
B lymphocyte
Dendritic
Macrophage (picked and was wrong)
Mast
Monocyte
Neutrophil
T lymphocyte

There’s an xray of the spine. For each pt with low back pain, select the most likely diagnosis.
Ankylosing spondyltiis
Compression fracture
Dermatomyositis
Intervertebral disc herniation
Juvenile rheumatoid arthritis
Muscle strain
Psoriatic arthritis
Spondylolisthesis

15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL. ( I put muscle strain and was wrong now I am thinking compression fracture 2/2 oral steroid use )

6 hours after a CABG, a 62 year old man has a decrease in systolic blood p from 120/80 to 100/85. Urine output decreases from 60 ml/h to 10ml/h and cardiac output decreases from 6l/min to 3l/min. pulmonary artery diastolic pressure has increased. An xray of chest shows a widened mediastinum. Which of following is most appropriate next step in mgmt?
administration of 2 ampules of NAHCO3
administration of epinephrine
placement of an intraaortic balloon (thinking it could be this )
revision of coronary grafts ( was wrong)
surgical exploration of the mediastinum
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A 6 wk old boy is brought to doc for his first well child exam. He was born at 41 wks gestation following a prolonged labor and forceps delivery. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. He weighed 4111g at birth and now weighs 5200. His temp is 37.4 (99.3). The head is rotated to the left with the chin deviated to the right. The head can be moved to the midline only with difficulty. A 2 cm, hard nontender, oval mass is palpated in the right side of neck. Which of the following is the most likely cause of these findings?
Abscess of cervical lymph node
Fibrosis of SCM muscle <-----got this right, Congenital Muscular Torticollis
Fracture of right clavicle
Hemivertebra of the cervical spine
Malignant tumor

Three days after undergoing total hip replacement, a 50 year old man is unable to move his legs and has urinary incontinence. His symptoms began immediately following removal of an epidural catheter that was inserted for pain control. His medications include ketorolac, enoxaparin, and morphine. Which of the following is the most likely diagnosis?
Centrally herniated nucleus pulposus
Dural laceration
Epidural hematoma <---- got it right
Residual neurologic blockade from long acting anesthetic agents
Transverse myeltiis


67 year old man comes to doc b/c of aching in his calves for past 2 months. The pain is relieved with rest. Exam shows decreased pedal pulses .the most likely cause of the patient’s current symptoms is significant narrowing of which of the following vessels?
Abdominal aorta
Femoralpopliteral arteries <---got it right
Iliac arteries
Peroneal arteries
Tibial and peroneal arteries

32 year old man comes to the doc with his wife with changes in behavior during past 2 wks. Four weeks ago, he witnessed a close friend die in car accident. On the evening of collision, pt offered to drive friend home after they had a few beers but friend declined. As the friend walked away from pt’s car, he was struck by a truck.the pt doesn’t remember much about the incident. During the past 2 weeks the wife reports that he has been awakening nightly in sweat and shouting “watch out” he has become emotionally distance and doesn’t want to socialize with his friends.he hasn’t driven his car in 10 d.he has difficulty sleeping and concentrating and says “things don’t seem real at times.” He says he used to drinkalcohol only rarely but lately he has been drinking 2 beers nightly for 3 wks to help him calm his mind and sleep. His temp is normal, pulse, resp, but bp is 145/80. No abnormalities on physical exam. He has a flat affect but is also irritable.he has not been feeling much of anything lately. He has thought about death frequently in the last 2 wks but doesn’t want to kill himself. What is most likely diagnosis?
Acute stress disorder <----- he saw a traumatic event and the time frame is within a month so it fits the criteria
Adjustment disorder
Bereavement
Dissociative identity disorder
MDD
Panic disorder
Substance induced mood disorder.

A 23 year old man is brought to doc by his mom because of auditory hallucinations and confusion since his wife was killed in a MVA 1 wk ago. He was unable to make any decisions regarding his wife’s funeral and has been confused and disorganized since her death. Physical examination shows no abnormalities. He is oriented to person, place and time. Mental status exam shows a sad affect. He appears preoccupied and has difficulty concentrating. He states that he hears his brother’s voice telling him everything will be ok; the mom says the brother is located in other state. Which is the most likely diagnosis?
Bereavement --- got it wrong
Brief psychotic disorder ---i think this might be it because there are hallucinations and bereavement does not affect ability to function
PTSD (cant be b/c of the time frame needing to be >1 m)
Schizoaffective
Schizophrenia



Five days after undergoing an open splenectomy for ITP, a 57 yr old woman has the onset of shortness of breath. During the operation, dissection of the splenic hilum was difficult. Her only med is morphine. Her temp is 99.2, BP 120/80, resps 20, pulse 80. The surgical wound appears normal. Breath sounds are decreased at the left lung base. White count 15,600, platelets 112k, serum amylase 90. Which of the following is most appropriate next best step in mgmt?
Xrays of chest ---got it right
u/s of abdomen
iv antibiotics
iv immunoglobulin
systemic heparin
pulm angiography


67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I ---got it right
no secretion of epinephrine from the adrenal medulla

a 12 month old boy is brought to the ED bc of a 4 hr hx of temps to 105 and irritability. He has had 2 previous infections during the past 8 months-pneumococcal bacteremia at age of 4 months and periorbital cellultis caused by type B H.inf at age of 7 m. all recommended immunizations were administered at the appropriate ages. An LP showed a leukocyte count of 500 with 95% neutrophils. Gram stain shows gram + diplococci.
Select the cell type most likely involved in the underlying condition:
B lymphocyte
Dendritic
Macrophage
Mast
Monocyte
Neutrophil
T lymphocyte ---got it wrong

There’s an xray of the spine. For each pt with low back pain, select the most likely diagnosis.
Ankylosing spondyltiis ---almost certain that i picked this and got it right. it was a teenager and i was not very sure but it was the only one that fit the symptoms
Compression fracture
Dermatomyositis
Intervertebral disc herniation
Juvenile rheumatoid arthritis
Muscle strain
Psoriatic arthritis
Spondylolisthesis
15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL. ( I put muscle strain and was wrong now I am thinking compression fracture 2/2 oral steroid use )


6 hours after a CABG, a 62 year old man has a decrease in systolic blood p from 120/80 to 100/85. Urine output decreases from 60 ml/h to 10ml/h and cardiac output decreases from 6l/min to 3l/min. pulmonary artery diastolic pressure has increased. An xray of chest shows a widened mediastinum. Which of following is most appropriate next step in mgmt?
administration of 2 ampules of NAHCO3
administration of epinephrine
placement of an intraaortic balloon ----got it WRONG
revision of coronary grafts
surgical exploration of the mediastinum ---i was thinking this maybe?
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15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL.

----i think i put compression fracture and it wasn't in my wrong answers
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Quote:
Originally Posted by tulip04 View Post
A 6 wk old boy is brought to doc for his first well child exam. He was born at 41 wks gestation following a prolonged labor and forceps delivery. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. He weighed 4111g at birth and now weighs 5200. His temp is 37.4 (99.3). The head is rotated to the left with the chin deviated to the right. The head can be moved to the midline only with difficulty. A 2 cm, hard nontender, oval mass is palpated in the right side of neck. Which of the following is the most likely cause of these findings?
Abscess of cervical lymph node
Fibrosis of SCM muscle <-----got this right, Congenital Muscular Torticollis
Fracture of right clavicle
Hemivertebra of the cervical spine
Malignant tumor

Three days after undergoing total hip replacement, a 50 year old man is unable to move his legs and has urinary incontinence. His symptoms began immediately following removal of an epidural catheter that was inserted for pain control. His medications include ketorolac, enoxaparin, and morphine. Which of the following is the most likely diagnosis?
Centrally herniated nucleus pulposus
Dural laceration
Epidural hematoma <---- got it right
Residual neurologic blockade from long acting anesthetic agents
Transverse myeltiis


67 year old man comes to doc b/c of aching in his calves for past 2 months. The pain is relieved with rest. Exam shows decreased pedal pulses .the most likely cause of the patient’s current symptoms is significant narrowing of which of the following vessels?
Abdominal aorta
Femoralpopliteral arteries <---got it right
Iliac arteries
Peroneal arteries
Tibial and peroneal arteries

32 year old man comes to the doc with his wife with changes in behavior during past 2 wks. Four weeks ago, he witnessed a close friend die in car accident. On the evening of collision, pt offered to drive friend home after they had a few beers but friend declined. As the friend walked away from pt’s car, he was struck by a truck.the pt doesn’t remember much about the incident. During the past 2 weeks the wife reports that he has been awakening nightly in sweat and shouting “watch out” he has become emotionally distance and doesn’t want to socialize with his friends.he hasn’t driven his car in 10 d.he has difficulty sleeping and concentrating and says “things don’t seem real at times.” He says he used to drinkalcohol only rarely but lately he has been drinking 2 beers nightly for 3 wks to help him calm his mind and sleep. His temp is normal, pulse, resp, but bp is 145/80. No abnormalities on physical exam. He has a flat affect but is also irritable.he has not been feeling much of anything lately. He has thought about death frequently in the last 2 wks but doesn’t want to kill himself. What is most likely diagnosis?
Acute stress disorder <----- he saw a traumatic event and the time frame is within a month so it fits the criteria
Adjustment disorder
Bereavement
Dissociative identity disorder
MDD
Panic disorder
Substance induced mood disorder.

A 23 year old man is brought to doc by his mom because of auditory hallucinations and confusion since his wife was killed in a MVA 1 wk ago. He was unable to make any decisions regarding his wife’s funeral and has been confused and disorganized since her death. Physical examination shows no abnormalities. He is oriented to person, place and time. Mental status exam shows a sad affect. He appears preoccupied and has difficulty concentrating. He states that he hears his brother’s voice telling him everything will be ok; the mom says the brother is located in other state. Which is the most likely diagnosis?
Bereavement --- got it wrong
Brief psychotic disorder ---i think this might be it because there are hallucinations and bereavement does not affect ability to function
PTSD (cant be b/c of the time frame needing to be >1 m)
Schizoaffective
Schizophrenia



Five days after undergoing an open splenectomy for ITP, a 57 yr old woman has the onset of shortness of breath. During the operation, dissection of the splenic hilum was difficult. Her only med is morphine. Her temp is 99.2, BP 120/80, resps 20, pulse 80. The surgical wound appears normal. Breath sounds are decreased at the left lung base. White count 15,600, platelets 112k, serum amylase 90. Which of the following is most appropriate next best step in mgmt?
Xrays of chest ---got it right
u/s of abdomen
iv antibiotics
iv immunoglobulin
systemic heparin
pulm angiography


67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I ---got it right
no secretion of epinephrine from the adrenal medulla

a 12 month old boy is brought to the ED bc of a 4 hr hx of temps to 105 and irritability. He has had 2 previous infections during the past 8 months-pneumococcal bacteremia at age of 4 months and periorbital cellultis caused by type B H.inf at age of 7 m. all recommended immunizations were administered at the appropriate ages. An LP showed a leukocyte count of 500 with 95% neutrophils. Gram stain shows gram + diplococci.
Select the cell type most likely involved in the underlying condition:
B lymphocyte Encapsulated bacterial organism infection point towards B cell defect/opsonization defect
Dendritic
Macrophage
Mast
Monocyte
Neutrophil
T lymphocyte ---got it wrong

There’s an xray of the spine. For each pt with low back pain, select the most likely diagnosis.
Ankylosing spondyltiis ---almost certain that i picked this and got it right. it was a teenager and i was not very sure but it was the only one that fit the symptoms
Compression fracture
Dermatomyositis
Intervertebral disc herniation
Juvenile rheumatoid arthritis
Muscle strain
Psoriatic arthritis
Spondylolisthesis
15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL. ( I put muscle strain and was wrong now I am thinking compression fracture 2/2 oral steroid use )


6 hours after a CABG, a 62 year old man has a decrease in systolic blood p from 120/80 to 100/85. Urine output decreases from 60 ml/h to 10ml/h and cardiac output decreases from 6l/min to 3l/min. pulmonary artery diastolic pressure has increased. An xray of chest shows a widened mediastinum. Which of following is most appropriate next step in mgmt?
administration of 2 ampules of NAHCO3
administration of epinephrine
placement of an intraaortic balloon ----got it WRONG
revision of coronary grafts
surgical exploration of the mediastinum ---i was thinking this maybe?
Good work guys keep the discussion rolling.
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Old 06-17-2014
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Originally Posted by druic View Post
I would go for thoracic aorta. I hope it`s right.
Anyone who got this q right, can u enlighten us?
u r right, i got it right
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Default malignancy?

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Originally Posted by tulip04 View Post
15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL.

----i think i put compression fracture and it wasn't in my wrong answers
how about malignancy? The fact that the pain is night and day makes me suspicious. do u remember the answer choices?
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Default nbme7 answers

can someone explain to me why this answer is correct

67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I ---got it right
no secretion of epinephrine from the adrenal medulla
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Default to druic

Ankylosing spondyltiis
Compression fracture
Dermatomyositis
Intervertebral disc herniation
Juvenile rheumatoid arthritis
Muscle strain
Psoriatic arthritis
Spondylolisthesis
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  #36  
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Default ACE inhibitor mechanism of action

Quote:
Originally Posted by usmleck View Post
can someone explain to me why this answer is correct

67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I ---got it right
no secretion of epinephrine from the adrenal medulla
"One mechanism for maintaining the blood pressure is the release of a protein called renin from cells in the kidney (to be specific, the juxtaglomerular apparatus). This produces another protein, angiotensin, which signals the adrenal gland to produce a hormone called aldosterone. This system is activated in response to a fall in blood pressure (hypotension) and markers of problems with the salt-water balance of the body, such as decreased sodium concentration in the distal tubule of the kidney, decreased blood volume, and stimulation of the kidney by the sympathetic nervous system. In such situations, the kidneys release renin, which acts as an enzyme and cuts off all but the first 10 amino acid residues of angiotensinogen (a protein made in the liver, and which circulates in the blood). These 10 residues are then known as angiotensin I. Angiotensin converting enzyme (ACE) then removes a further two residues, converting angiotensin I into angiotensin II. Angiotensin II is found in the pulmonary circulation and in the endothelium of many blood vessels.[24] The system increases blood pressure by increasing the amount of salt and water the body retains, although angiotensin is also very good at causing the blood vessels to tighten (a potent vasoconstrictor)."

(taken from wikipedia)

ACE cuts of the peptides on AngiotensinI, converting it to AngiotensinII. And an ACE inhibitor prevents this action to activate the hormone.

Hope that helps!
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Quote:
Originally Posted by usmleck View Post
can someone explain to me why this answer is correct

67 year old man comes to the ED because of an uncontrollable nosebleed for 6 h. he has no history of HTN and takes no meds. He has smoked 1 to 2 packs of cigarettes daily for 45 years. His BP is 220/120. Examination shows a small lesion in the left naris that is controlled with cauterization. There are bilateral bruits over the flank. Renal arteriography shows the kidneys to be 13 cm in length with single renal arteries. There are ostial lesions over both kidneys that occlude approximately 85% of the orifice of the vessels. After treatment with an ACE I, his bp decreases to 140/80. Which of the following is the most likely explanations for this pt’s response to the ACE I?

capping of receptors sites on the macula densa of the juxtaglomerular apparatus
inhibition of mineralocorticoid production in the adrenal cortex
no aldosterone secretion from the adrenal cortex
no cleaving of c terminal peptides on angiotensin I ---got it right
no secretion of epinephrine from the adrenal medulla

i want to ask r u sure about a answer? i checked it and answer supposed to be macula densa...coz ACEi inhibit AGII production form AGI in macula densa...AGI synthesis in lung..
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Quote:
Originally Posted by DrAGA View Post
i want to ask r u sure about a answer? i checked it and answer supposed to be macula densa...coz ACEi inhibit AGII production form AGI in macula densa...AGI synthesis in lung..
just went through all my wrong answers and its not in there. and I am pretty sure I picked "no cleaving of c terminal peptides on angiotensin I"

capping of receptors sites on the macula densa of the juxtaglomerular apparatus would be right answer if they used an ARB instead of an ACE inhibitor.

Am I wrong?
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Quote:
Originally Posted by tulip04 View Post
just went through all my wrong answers and its not in there. and I am pretty sure I picked "no cleaving of c terminal peptides on angiotensin I"

capping of receptors sites on the macula densa of the juxtaglomerular apparatus would be right answer if they used an ARB instead of an ACE inhibitor.

Am I wrong?
yes ur right..i didnt noticed that they give receptors capping..so its for ARB...
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Default more ques - block4

woman in labor at 28 weeks, with contractions for 4 hours. past history of premature delivery at 28 and a spontaneous abortion at 16 weeks. cervix is effaced and contractions every 5 mins. question is asking for the therapy:
desmopressin
ergonovine
mag sulfate --- is it this? to prevent cerebral palsy?
mifeprestone
misoprostol
oxytocin --this is wrong

17 yo with pain with swallowing. he takes ibuprofen for pain, 4 pack years of smoking!. no heartburn, weight loss, chest pain, vomiting or blood in stool. diagnosis?
esophageal motility disorder
GERD
IBS
peptic ulcer disease - wrong answer
zenker diverticulum
pill induced esophagitis

18 yo woman with lump in neck. supraclavicular lymph node 3cm that is firm and rubbery. splenomegaly. labs would show:
decreased serum potassium
increased erythrocyte
increased serum calcium -- wrong answer
increased serum LDH
increased TSH

Hiatal hernia question in an asymptomatic patient with a previous history of salicylate related ulcer+ GI bleed. She is here for a follow up visit and healed ulcer and hiatal hernia found.
observation
perscription of antacids
H2 blocker
Nissen
hernia repair

woman with graves disease. it was asking for the appropriate initial step in management:
radioactive iodide ---wrong answer
is it PTU?

21yo female with sudden chest pain - pleuritic, SOB and trouble taking breaths. recent trip to andes mountains. rash on cheecks and trunk. inspiratory rub with no crackles or wheezes.
Pulmonary embolus - wrong answer
I think it might be viral pleurisy
did anyone get this right?

Thank you
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Quote:
Originally Posted by tulip04 View Post
woman in labor at 28 weeks, with contractions for 4 hours. Past history of premature delivery at 28 and a spontaneous abortion at 16 weeks. Cervix is effaced and contractions every 5 mins. Question is asking for the therapy:
Desmopressin
ergonovine
mag sulfate --- is it this? To prevent cerebral palsy?give tocolytic to prevent preterm labour
mifeprestone
misoprostol
oxytocin --this is wrong

17 yo with pain with swallowing. He takes ibuprofen for pain, 4 pack years of smoking!. No heartburn, weight loss, chest pain, vomiting or blood in stool. Diagnosis?
Esophageal motility disorder
gerd
ibs
peptic ulcer disease - wrong answer
zenker diverticulum
pill induced esophagitis (odynophagia, nsaids are one of the culprits)

18 yo woman with lump in neck. Supraclavicular lymph node 3cm that is firm and rubbery. Splenomegaly. Labs would show:
Decreased serum potassium
increased erythrocyte
increased serum calcium -- wrong answer
increased serum ldh (looks like lymphoma in which ldh correlates with worse severity)
increased tsh

hiatal hernia question in an asymptomatic patient with a previous history of salicylate related ulcer+ gi bleed. She is here for a follow up visit and healed ulcer and hiatal hernia found.
Observation
perscription of antacids
h2 blocker
nissen
hernia repair
(dying to know about this shitty mcq). May be observation or nissen but again i am not sure

woman with graves disease. It was asking for the appropriate initial step in management:
Radioactive iodide ---wrong answer
is it ptu? (antithyroid drugs as best "initial" therapy)

21yo female with sudden chest pain - pleuritic, sob and trouble taking breaths. Recent trip to andes mountains. Rash on cheecks and trunk. Inspiratory rub with no crackles or wheezes.
Pulmonary embolus - wrong answer
i think it might be viral pleurisy (chest pain with relation to breath and inspiratory rub point towards pleuritis)
did anyone get this right?

Thank you
Can someone please fill up reasoning behind hiatal hernia question
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Quote:
Originally Posted by offpiste View Post
Can someone please fill up reasoning behind hiatal hernia question
I got nissen wrong. So i think its observation most probably. Since she is not having any active problems
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Quote:
Originally Posted by tulip04 View Post
I got nissen wrong. So i think its observation most probably. Since she is not having any active problems
My first instinct was" observation " since we don't do surgery in sliding type hernia and person has healed ulcer and is asymptomatic ...... but again if someone can post correct answer then it would be helpful
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Default hiatal hernia q

i answered observation and it was correct
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its observation hence she doesnt have any symptoms....

rule of tratment...if asymptomatic no treatment..if symptoms + then H2 or PPI AND LAST OPTION if medication does not help -surgery(nissen)but not recomended
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Hi
I sat 2ck yesterday. I felt the length of questions were as long as those of nbme 7. Stick to nbme7 and free 150. That is what I want to say.
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  #47  
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Quote:
Originally Posted by Gundam View Post
Hi
I sat 2ck yesterday. I felt the length of questions were as long as those of nbme 7. Stick to nbme7 and free 150. That is what I want to say.
how helpful did you find UW???
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Quote:
Originally Posted by Gundam View Post
Hi
I sat 2ck yesterday. I felt the length of questions were as long as those of nbme 7. Stick to nbme7 and free 150. That is what I want to say.

Thanks for sharing. My exam is on sunday. Any suggestions on what to do during the last few days? would you say that the free 150 is an assessment of how much you know. because I only did one block so far (plan on doing the rest before exam) and i scored about 74%...got me a little worried.
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Default answer keys

plz can any one send me the answer key for nbme7
my exam is next week
thnx or ur help
dr_4renaissance@yahoo.com
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I found the questions' concepts were quite close to nbme7's and free150. It helped me a lot during the exam.
Quote:
Originally Posted by tulip04 View Post
Thanksfor sharing. My exam is on sunday. Any suggestions on what to do during the last few days? would you say that the free 150 is an assessment of how much you know. because I only did one block so far (plan on doing the rest before exam) and i scored about 74%...got me a little worried.
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Quote:
Originally Posted by dr ashour View Post
plz can any one send me the answer key for nbme7
my exam is next week
thnx or ur help
dr_4renaissance@yahoo.com
see here nbme 7
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great!! i really appreciate it
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Papiledema and focal deficit first ct probably sah
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Quote:
Originally Posted by tulip04 View Post
15 yo girl with low back pain for 2 months.she described the pain as a dul ache that is present all day and night, often making it difficult for her to find a comfortable sleeping position. She has been treated for severe asthma since 2 years of age, including prolonged courses of oral prednisone. She has a cushingoid and hirsuit appearance. There is tenderness from t11 to l2 and paravertebral muscle spasm. Her CK and ESR is WNL.

----i think i put compression fracture and it wasn't in my wrong answers
Yeah, that's what i'm thinking too cuz they say she gotta ccushingoid appearance

i put spondylolisthesis can't read x-ray lol
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Quote:
Originally Posted by microshara88 View Post
Yeah, that's what i'm thinking too cuz they say she gotta ccushingoid appearance

i put spondylolisthesis can't read x-ray lol
spondylolisthesis has urinary incontinence...and yeah compression fracture due to the continuous use of the glucocorticoids.
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A 32-year-old woman is brought to the emergency department because of abdominal pain and nausea and vomiting for 6 hours She underwent a cholecystectomy 2 years ago. Menses occur at regular 28-day intervals: her last menstrual period was 2 weeks ago She does not smoke or dnnk alcohol She appears acutely ill Her temperature is 37 4*C (99.3‘F), and respirations are 14/min. Her pulse is 110/minand blood pressure is 130/70 mm Hg while supine, and pulse is 135/min and blood pressure is 90/60 mm Hg while standing Abdominal examination shows guarding with rebound over the epigastrium, bowel sounds are decreased. The remainder of the examination shows no abnormalities. Serum studies show

Na* 146mEq/L

K* 3 3 mEq/L

Ca2- 8 9 mg/dL

Total bilirubin 1 mg/dL

Alkaline phosphatase 120 U/L

AST 64 U/L

Amylase 1022 U/L

The most appropriate next step in determining the underlying cause is measurement of which of the following serum concentrations?

A)Apolipoprotein A
B)Apolipoprotein B
C)HDL-cholesterol
D)LDL-cholesterol
E)Triglycerides


I'm leaning towards E. triglycerides... anybody knows the correct answer? my second guess would be B.
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it is Triglycerides- elevation can lead to pancreatitis
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Answer is CT scan b/c of focal Neuro finding. You first have to rule out a mass or abscess. Plus you can't do a LP b/c they specifically said fundoscopy is not done...so you don't know if there is increased intracranial pressure. Actually, the first step would be antibiotics empirically and then send to CT.
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Default indian doctor ( step 1 to be given on 25 sugust 2014)

Quote:
Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.

answer could not be lumber puncture. that is sure.
you can see increased ICP by looking at the fact that fundi could not be visualized.
SO NOT TO TAKE RISK OF HERNIATION BY DOING LP.
you can do CT SCAN.
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[QUOTE=Gundam;371737]A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.[/QUOTE Answer in my opinion should be C, the woman is showing symptoms and signs of raised intracranial pressure and a LP is contraindicated in this scenario, the CT Scan of head will show signs of raised ICP to confirm your diagnosis and possibly the cause of the raised ICP. ]
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[QUOTE=Iradat;422409]
Quote:
Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.[/QUOTE Answer in my opinion should be C, the woman is showing symptoms and signs of raised intracranial pressure and a LP is contraindicated in this scenario, the CT Scan of head will show signs of raised ICP to confirm your diagnosis and possibly the cause of the raised ICP. ]
yeh, D would be wrong because you never do lumber puncture when there are neurological defects present on physical exam... esp increased intracranial pressure is a major contraindication of lumbar puncture. So CT scan would be the logical option in this case.
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  #62  
Old 08-03-2014
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28.A health status survey compares the clinical outcomes of patients treated for hip fracture at two hospitals. A total of 560 subjects are studied for 1 year after sustaining a hip fracture. After adjustment for age and gender, the level of physical functioning following treatment is found to be significantly lower among patients treated in one hospital (p=.02)Researchers conclude that treatment at this hospital was suboptimal. Which of the following raises the most concern about this conclusion?
A) The period of study is too short
B)The results are not adjusted for comorbidities
C) The results are not statistically significant
D) The statistical power is too low
E)The survey instrument does not include clinical measures- Wrong


Any thoughts on this one? whats the best way of thinking through this?
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  #63  
Old 08-08-2014
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Default to which form of the offline nbme are these answers to?

can someone please send me a link to the questions/complete answer keys? thank you
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  #64  
Old 08-13-2014
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Quote:
Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.
C is correct-this pt has weakness of the rt upper ext, that is a focal sign. You need to do a ct before you can do a tap. If ther Raised ICP, Lp is contraindicated
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  #65  
Old 09-14-2014
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Stop 45. I got nasogastric and I failled. I think is Elevation of the head of the bed

Quote:
Originally Posted by dr.baig22 View Post
1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)
I got this and failed
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  #66  
Old 10-07-2014
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What's the right answer in this one...

32 yo male sudden confusion and agitation. PMH of schizoaffective disorder, depressed type. 5 days ago new drug added because hallucinations. temp 103.5, pulse 110, BP 160/100, muscle rigidity. CK 950. What neurotransmitter is responsible?

GABa
dopamine
glutamate
Histamine
NE
Serotonin ---got this one wrong THANKS!
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  #67  
Old 10-12-2014
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Is correct answer C?? explanation is also needed.
Thanks in advance.


the Patient with signs of increased ICP .. so LP in not a choice b/c of Herniatin possibility ..
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  #68  
Old 12-26-2014
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[QUOTE=dr.baig22;372569]
Quote:
Originally Posted by Gundam View Post
A 47 yo woman comes to the physician because of fever, nausea, vomittng and severe headache for 24 hrs. Temp is 39 degree. Exam shows weakness of the right upper extremity and nystagmus; optic fundi cannot be visualized. Which of the following is the most appropriate next step in diagnosis?

A Ice-water caloric testing
B EEG
C CT scan of head
D lumbar puncture
E cerebral arteriography

I chose D, which was wrong.

Is correct answer C?? explanation is also needed.
Thanks in advance.[/QUOT

has neruo sx. ryte upper extremity weakness n optic disc not clear nystagmus so need to do CT scan to rule out.
So ans C
These symptoms can be due to either ischemic or hemorrhagic lesion of the brain. The first step is to determine which lesion it is and for that non-contrast CT scan is the best option. As optic fundi were not clear, increased intra-cranial pressure (ICP) can not be ruled out. Lumber puncture is contraindicated in pt with increased ICP, so it should be avoided as initial test. Cerebral arteriography can be done as Tx after hemorrhagic lesion is made to block the bleeding artery, or to remove the clot in ischemic lesion.
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  #69  
Old 12-26-2014
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Quote:
Originally Posted by DrAGA View Post
i want to ask r u sure about a answer? i checked it and answer supposed to be macula densa...coz ACEi inhibit AGII production form AGI in macula densa...AGI synthesis in lung..
No His answer was right. Ang-II is most potent vasoconstrictor. Ang-I is converted into Ang-II in lung not macula densa.

Last edited by asthula; 12-26-2014 at 12:38 PM.
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  #70  
Old 12-26-2014
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Quote:
Originally Posted by tulip04 View Post
just went through all my wrong answers and its not in there. and I am pretty sure I picked "no cleaving of c terminal peptides on angiotensin I"

capping of receptors sites on the macula densa of the juxtaglomerular apparatus would be right answer if they used an ARB instead of an ACE inhibitor.

Am I wrong?
Rule of thumb ! Don't assume what is not told in the question. ACE-I means ACE-I not ARB. Tulip is right. Moreover, macula densa does not have receptors for ang-II. It is sensitive to only NaCl concentrations.

Last edited by asthula; 12-26-2014 at 12:39 PM.
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  #71  
Old 12-26-2014
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Quote:
Originally Posted by Silvis2013 View Post
What's the right answer in this one...

32 yo male sudden confusion and agitation. PMH of schizoaffective disorder, depressed type. 5 days ago new drug added because hallucinations. temp 103.5, pulse 110, BP 160/100, muscle rigidity. CK 950. What neurotransmitter is responsible?

GABa
dopamine
glutamate
Histamine
NE
Serotonin ---got this one wrong THANKS!
All antipsychotic drugs especially Typical ones block dopamine receptor D2. So the right answer is dopamine.
Mnemonic: Felling Crazy Take Halloparidol double Dose (D2). Letters in red stand for 4 typical antipsychotic drugs and Double dose for dopamine D2 receptor.

Last edited by asthula; 12-26-2014 at 12:43 PM.
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  #72  
Old 01-15-2015
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S3: Q36 the correct answer is (G) Exploratory Laparotomy as Tamoxifen increases risk of endometrial cancer. Peritoneal effusion is due to malignancy.
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  #73  
Old 01-24-2015
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21yo female with sudden chest pain - pleuritic, sob and trouble taking breaths. Recent trip to andes mountains. Rash on cheecks and trunk. Inspiratory rub with no crackles or wheezes.
Pulmonary embolus - wrong answer
i think it might be viral pleurisy (chest pain with relation to breath and inspiratory rub point towards pleuritis)
did anyone get this right?

????? any body got it right?
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  #74  
Old 01-24-2015
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Arrow

Quote:
Originally Posted by Grimlock View Post
28.A health status survey compares the clinical outcomes of patients treated for hip fracture at two hospitals. A total of 560 subjects are studied for 1 year after sustaining a hip fracture. After adjustment for age and gender, the level of physical functioning following treatment is found to be significantly lower among patients treated in one hospital (p=.02)Researchers conclude that treatment at this hospital was suboptimal. Which of the following raises the most concern about this conclusion?
A) The period of study is too short
B)The results are not adjusted for comorbidities
C) The results are not statistically significant
D) The statistical power is too low
E)The survey instrument does not include clinical measures- Wrong


Any thoughts on this one? whats the best way of thinking through this?
It can be found by excluding wrong answers. 1 year period is enough to measure parameters required, P=.02 is significant, as sample size is large, so statistical power is high. Observation does not require any survey instrument. So the right answer is ""Results not adjusted for comorbidities" e.i., B
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  #75  
Old 01-31-2015
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Default Cholecystitis pt with G- bacteremia and DIC

A 72-year-old man has decreased ur川e output 2 days after admission to the hospital for treatment of cholecystitis. His urine output has been 15 ml/h over the past 3 hours. On admission, results of laboratory studies were consistent with gram-negative bacteremia and disseminated intravascular coagulation. He is currently receiving intravenous fluids, cefoxitin, and gentamicin. His temperature is 38.5C (101.3F), pulse is 11O/min, respirations are 24/min, and blood pressure is 90/64 mm Hg. Abdominal examination shows mild right upper quadrant tenderness. His serum creatinine concentration has increased from 1.5 mg/dl days ago to 3 mg/dl .This patient is most likely to have which of the following sets of urinalysis findings?

DIC’s urinary finding
Blood protein RBC WBC casts other microscopic findings
I guess
3+ 1+ >50 none RBC none (in the oreder)

I guess the right answer will be the one with schistiocytes (dysmorphic cells) as DIC is microagniopathic hemolytic condition. So the last choice will be the right answer.

Any body any suggestion?
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  #76  
Old 03-16-2015
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I agree help

9.A previously healthy 18-year-old woman comes to the physician because of a lump in her neck that she first noticed 1 month ago. She is otherwise asymptomatic. Examination shows a 3- cm left supraclavicular lymph node that is firm and rubbery. The spleen is palpated 3 cm below the left costal margin. The remainder of the examination shows no abnormalities. Laboratory studies are most likely to show which of the following:

A)Decreased serum potassium concentration
B) Increased erythrocyte count
C) Increased serum calcium concentration
D) Increased serum lactate dehydrogenase activity
E) Increased serum thyroid-stimulating hormone concentration

the answer for this one with the explanation please help me out
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  #77  
Old 03-20-2015
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can anyone plz tell me its answer
Attached Thumbnails
NBME7 anwers-ck.jpg  
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  #78  
Old 03-20-2015
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I agree

Quote:
Originally Posted by DocVirgo View Post
can anyone plz tell me its answer
Hey there, is this a screen capture of a offline nbme or is it your actual wrong question from expanded feedback?

I did it offline, picked the same answer E, and the answer sheet I have say it was correct, to be honest that is what is stated in uworld and mtbs, any time a fetus is undergoing late decelerations not even delivery is an option, you MUST do C-section ASAP.

maybe Im wrong, who knows maybe the answer is not even E, but I wont see why not E be the answer since the fetus is too high (-1) to use forceps, to further accelerate the labor with oxytocyn might waste some valuable time and the fetus might suffer even more, and you cannot simply observate while fetus is undergoing acidosis and amnioinfusion doesnt make sense.
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  #79  
Old 03-22-2015
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Quote:
Originally Posted by DocVirgo View Post
can anyone plz tell me its answer
I put continued observation and it didn't come up as a wrong answer. I guess she is dilating fine and initially recurrent decels wouldn't need a C-section, as you would do other things like placing her in the left lateral positing or giving oxygen.
But I'm confused as the books say a second stage arrest would be no decent change for 3h .. anyway think its safe to observe her for a while longer.

Can someone please answer this one for me.
18yo with a 3cm lymph node in the neck for 1 month and 3cm splenomegaly. what would you find on labs?
1. decreased potassium
2. increased erythrocyte
3. increased calcium
4. increased LDH
5. increased TSH
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  #80  
Old 03-22-2015
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Quote:
Originally Posted by drpisho View Post
9.A previously healthy 18-year-old woman comes to the physician because of a lump in her neck that she first noticed 1 month ago. She is otherwise asymptomatic. Examination shows a 3- cm left supraclavicular lymph node that is firm and rubbery. The spleen is palpated 3 cm below the left costal margin. The remainder of the examination shows no abnormalities. Laboratory studies are most likely to show which of the following:

A)Decreased serum potassium concentration
B) Increased erythrocyte count
C) Increased serum calcium concentration
D) Increased serum lactate dehydrogenase activity
E) Increased serum thyroid-stimulating hormone concentration

the answer for this one with the explanation please help me out
oops Ive just seen that you have posted the same question. I went for increased erythrocyte count which was obviously wrong. I was thinking could it be lymphoma/leukemia but couldn't match up any of the answers. I think splenomegaly after mono can stay for ~3m but lymph node shouldn't.. Anyway hope someones got some bright ideas.
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  #81  
Old 03-22-2015
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Smile

Quote:
Originally Posted by ir308 View Post
I put continued observation and it didn't come up as a wrong answer. I guess she is dilating fine and initially recurrent decels wouldn't need a C-section, as you would do other things like placing her in the left lateral positing or giving oxygen.
But I'm confused as the books say a second stage arrest would be no decent change for 3h .. anyway think its safe to observe her for a while longer.

Can someone please answer this one for me.
18yo with a 3cm lymph node in the neck for 1 month and 3cm splenomegaly. what would you find on labs?
1. decreased potassium
2. increased erythrocyte
3. increased calcium
4. increased LDH
5. increased TSH
ITS D. Increased LDH, its NONhodgkin lymphoma.
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  #82  
Old 05-12-2015
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a previously healthy 57 year old man comes to the emergency department because of mild left flank pain and intermittent blood in his urine for 3 days. he takes no medications. he appears to be in mild distress. his temperature is 37.2, pulse is 88/min, respirations are 12/min, and blood pressure is 146/94 mmhg. examination shows mild left costovertebral angle tenderness. his serum calcium concentration is 10.9 mg/dL, serum phosphorus concentration is 2.3 mg/dL, and serum intact parathyroid hormone concentration is 1020 pg/mL (N=10-65). a CT scan of the abdomen shows renal calculi bilaterally. which of the following is the most likely cause of the calculi.
a. decreased urinary excretion of citrate
b. decreased urinary excretion of uric acid
c. increase gastrointestinal absorption of oxalate---wrong
d. increased urinary excretion of calcium---is this one right?
e. increased urine pH
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  #83  
Old 05-12-2015
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can anyone please send me nbme7 offline to my mail sparashuram29@gmail.com.. i got my exam next week
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