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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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  #101  
Old 06-29-2014
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Someone please clarify. I am confused about these two:

1) 19 y man found by police standing in neighbours living room in middle of nyte. he is conscious but remains mute. pt has 37C pulse98 bp160/95. PE bilateral nystagmus. constricted pupils.hypertonia.decreased sensation to pinprick. which of following substance taken?

A. alcohol
B. amphetamine
C. hallucinogen
D. inhalant
E. opiod
F. PCP

I get that horizontal nystagmus is specific to PCP, but constricted pupil is very specific to opiods plus the "decreased sensation to pinprick" due to opoid numbness. Also if the patient was on PCP won't he be aggressive and belligerent? But q mentions that he is "mute".

2) The question about the 37 wk preggo in labor, with a previous (treated) herpes outbreak 6 weeks prior. She is currently asymptomatic. Whats the next intervention? She is 5cm dilated, 80% effaced and 1 station.

Quite a few people chose Amniotomy and vaginal delivery. I was also going to pick vaginal delivery but why amniotomy? The only indication for amniotomy is usually for fetal bradycardia, maternal distress. I dont get why you'd rupture her membrane at this point especially when the question didn't state how long she was in labor for, and the baby's head is still at 1 station.

I ended up choosing IV acyclovir because it is recommended to give acyclovir at 36 weeks or more to preggos with recurrent outbreaks or primary infection during pregnancy (which she had 6 weeks prior), to suppress recurrence of outbreaks.
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  #102  
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Quote:
Originally Posted by Nixy View Post
Can you type the question?
1. 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

2. A 43 y/o man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa
E. Strep pneumonia.

3.A 72 y/o man is hospitalized because of dyspnea for 6 weeks. He has a history of type 1 diabetes and angina pectoris. Medications include insulin and warfarin. During the past 4 months, he was hospitalized once for deep venous thrombosis and another time for pulmonary emboli. Examination shows jugular venous distention, ascites, and pitting pretibial edema of both lower extremities. An chest X-ray shows mild cardiomegaly and no evidence of pulmonary edema. Which of the following is the most likely casue of this patient's worsening condition?

A. aortic stenosis
B. Cor pulmonale
C. ischemic heart disease
D. Mitral regurgitation
E. viral cardiomyopathy

4. A 72-year-old man has decreased urine 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?


Blood, protein, RBC, WBC, casts, other microscopic findings

A. none, none, none, none, hyaline, none
B. none, 4+, none, none, none, oval fat bodies
C. trace, 1+, 0-5,> 50, none, WBC clumps
D. 1+, 1+, 0-5, 0-5, pigmented granular, renal tubular epithelial cells
E. 1+, 1+, 5-10, 10-20, none, eosinophils
F. 3+, 1+, >50, none, RBC, none
G. 4+, 1+, none, none, pigmented granular, squamous epithelial cells
H. 4+, 1+, 10-20 dysmorphic, none, none, none.

Would you please let me know the correct answers to these 4 questions. I am very confused. Thank you so much.
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  #103  
Old 06-30-2014
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Quote:
Originally Posted by Andante View Post
1. 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
E because moms had a history this passed the immunoglobulins to the babies.

2. A 43 y/o man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa
E. Strep pneumonia.
I think it was A because he had not much risk factors for any other.

3.A 72 y/o man is hospitalized because of dyspnea for 6 weeks. He has a history of type 1 diabetes and angina pectoris. Medications include insulin and warfarin. During the past 4 months, he was hospitalized once for deep venous thrombosis and another time for pulmonary emboli. Examination shows jugular venous distention, ascites, and pitting pretibial edema of both lower extremities. An chest X-ray shows mild cardiomegaly and no evidence of pulmonary edema. Which of the following is the most likely casue of this patient's worsening condition?

A. aortic stenosis
B. Cor pulmonale
C. ischemic heart disease
D. Mitral regurgitation
E. viral cardiomyopathy

B because of massive pulmonary emboli causing right sides cardiac failure hence symptoms.

4. A 72-year-old man has decreased urine 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?


Blood, protein, RBC, WBC, casts, other microscopic findings

A. none, none, none, none, hyaline, none
B. none, 4+, none, none, none, oval fat bodies
C. trace, 1+, 0-5,> 50, none, WBC clumps
D. 1+, 1+, 0-5, 0-5, pigmented granular, renal tubular epithelial cells
E. 1+, 1+, 5-10, 10-20, none, eosinophils
F. 3+, 1+, >50, none, RBC, none
G. 4+, 1+, none, none, pigmented granular, squamous epithelial cells
H. 4+, 1+, 10-20 dysmorphic, none, none, none.
I think D because of gr negative bacteremia and ATN.
Would you please let me know the correct answers to these 4 questions. I am very confused. Thank you so much.
I have written the answers with the questions in the box above.
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  #104  
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Quote:
Originally Posted by Nixy View Post
I have written the answers with the questions in the box above.
Thank you so much, Nixy, for your answers and clear explanation. All the best to you and will keep you in my prayers.
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  #105  
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Quote:
Originally Posted by Nixy View Post
I have written the answers with the questions in the box above.
In question 1, if all mothers are negative for antibodies of chickenpox, should the correct answer be: Acyclovir or isolation each other, it seems more reasonable to give Acyclovir to each baby. What do you think?

In question 4, what disease would be for G?

Thanks again.
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  #106  
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Quote:
Originally Posted by Andante View Post
In question 1, if all mothers are negative for antibodies of chickenpox, should the correct answer be: Acyclovir or isolation each other, it seems more reasonable to give Acyclovir to each baby. What do you think

In question 4, what disease would be for G?

Thanks again.
If exposed to chicken pox, and mothers have no history, babies should be given immunoglobulins since vaccine is given usually at 12 months of age. Acyclovir to shorten duration if illness. I don't know if it's ok to give acyclovir for prophylaxis. And isolation might be a good idea to prevent chicken pox in the babies that have not already caught the virus.
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  #107  
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Quote:
Originally Posted by Andante View Post
In question 1, if all mothers are negative for antibodies of chickenpox, should the correct answer be: Acyclovir or isolation each other, it seems more reasonable to give Acyclovir to each baby. What do you think?

In question 4, what disease would be for G?

Thanks again.
G Might be myoglobinuria but I m not sure.
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  #108  
Old 06-30-2014
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Default Block 1 #37

Curious, what the 18 year old female with jaundice, splenomegaly, negative Coombs test, cervical lymph nodes has? If answer to Form 1 #37 is splenectomy, I just can figure out why she should have gotten one! Thanks
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  #109  
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PAtient undergoing MRI c/o tunnel vision.


can someone answer this please ?

Last edited by a_usmle; 06-30-2014 at 06:19 PM.
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  #110  
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Correct Answer Lorazepam

Quote:
Originally Posted by a_usmle View Post
PAtient undergoing MRI c/o tunnel vision.


can someone answer this please ?
The Answer is give Lorazepam. I was considering this and breathing into a bag(anxiety) and I got the second wrong. So pretty sure its Lorazepam
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  #111  
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Quote:
Originally Posted by dr.baig22 View Post
1. MDD
2. viridians step. (dental cleaning + prostatic valve)
3. amoxicillin (lyme)
4. Nursemaid elbow - suppination of forearm with elbow slight flexed
5. determine if pt. wants to discuss his decision with anyone else
6. wound dehiscence(rupture along suture,obesity, serosanguinous discharge)
7. Heat stroke
8. TTP
9. OCP ( protective for ovarian ,endometrial and colorectal cancer)
10. Osteoarthritis (20degree flexion hip contracture)
11. ERCP (cholangitis RUQpain, jaundice, fever)
12. Atropine ( organophosphate poisoning)
13. methamphetamine (tactile hallucination with cocaine n amphetamine)
14. intramuscular betamethasone
15. uterine atony
16. atrophic gastritis
17. B lymphocytes
18. neutrophils (CGD)
19. inc. GI absorption of oxalate
20. EColi - gram neg. bacilli
21. genital herpes
22. cricothyrotomy
23. HOCM
24. ALS emg:fibrillation potentials in multiple muscles of multiple extremities
25. education abt puberty for child and parents (normal puberty)
26. alveolar hypoventilation
27. trial of omeprazole (GERD)
28. Rh incompatibility
29. anaphylactic transfusion reaction
30. pneumococal vaccine
31. analgesic therapy
32. hypoglycemia
33. capping of receptor sites on macula dense of JG apparatus- I am assuming its the fourth option, not sure
34. renal ultrasound
35. naloxone
36. botulism
37. urethral diverticulum
38. heparin treatment- Its Diruetics (CHF)
39. enterotoxicgenic EColi - watery diarrhea
40. clomiphene
41. no treatment
42. HYPOkalemia
43. HYPOnatremia (cancer patients have electrolyte imbalance decNa) I think I marked Hypercalcemia and got it correct.
44. carotid endarterectomy
45. abstinence from alcohol
46. CHF ( CXR perihilar densities and hazy with cephalization of pulmonary vasculature)

I just took the NBME 7 and did a bit of research from my correct answers and yours. And there are a few I got correct and do not match with yours so I will change them here and post them.
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  #112  
Old 06-30-2014
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Default Achalasia vs. Zenker's

62 year old woman with 2 month history of difficulty swallowing solids and liquids. She states she occasionally regurgitates undigested food. Exam shows no abnormalities except foul-smelling breath. Initial step?
Answer: Barium swallow

I'm wondering if anyone has a trick differentiating between Zenkers (barium) and achalasia (manometry) on symptoms from this stem alone?

Both present with difficulty swallowing solids and liquids, with regurgitation of undigested food and bad breath. How do you know it was Zenkers and not achalasia?
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  #113  
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Correct Answer Block 3

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 - Its physiological(got it correct)
28. methanol ( inc aniongap with met acidosis 140-110 = 30) Its salicylates. Met acidosis with anion gap with resp alkalosis
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. ??ATN tubular casts
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum) - Probably colonoscopy. Got this one wrong marking this answer.
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)
This is block 3 corrected
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  #114  
Old 06-30-2014
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Quote:
Originally Posted by Midwesternblot View Post
62 year old woman with 2 month history of difficulty swallowing solids and liquids. She states she occasionally regurgitates undigested food. Exam shows no abnormalities except foul-smelling breath. Initial step?
Answer: Barium swallow

I'm wondering if anyone has a trick differentiating between Zenkers (barium) and achalasia (manometry) on symptoms from this stem alone?

Both present with difficulty swallowing solids and liquids, with regurgitation of undigested food and bad breath. How do you know it was Zenkers and not achalasia?
Zenker has bad breath but it's not common in achalasia. Anyway you do barium swallow for both of them
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  #115  
Old 06-30-2014
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Correct Answer Block 4

Quote:
Originally Posted by dr.baig22 View Post
1. zinc
2. destruction and dilatation distal airways (emphysema)
3. colposcopy
4. stasis dermatitis with ulcer
5. schizophrenia
6. hypovolemia
7. INC. LDH (?)
8. ?
9. Dopamine
10. oral PTU (graves)
11. transfuse FFP
12. external carotid artery - ICA
13. abruptio placenta
14. compression fracture
15. spinal dysraphism (clubfoot n loss of motor/sensory)
16. wiskott-aldrich syndrome
17. IV 0.9 saline
18. acute MI ( st elevation in v2 v3 v4)
19. V-TACH
20. vancomycin
21. Mg sulfate (tocolysis)
22. organophosphate
23. Viral pluirisy(got it right)
24. laparoscopic nissen fundoplication
25. fibrosis of sternocledomastoid muscle (torticollis)
26. brochogenic ca
27. olanzapine therapy
28. PID
29. Interferon Alfa (hep c - cryroglubinemia)
30. give all recommended immunization for age
31. no intervention necessary
32. dec. renal blood flow
33. add lisinopril
34. pill-induced esophagitis (ibuprofen)
35. inappropriate ADH secretion (dec serum, osm Inc. urine osm)
36. Mitral valve incompetence (Rheumatic fever)
37. surreptitious administration of thyroxine
38. viral infection (tender thyroid)
39. right lower lobe pneumonia
40. riluzole rx for (ALS)
41. optic neuritis (affrent puppillary defect + central scotoma)
42. no Rx indicated at this time
43. appendicitis
44. finasteride (enlarge prostate oldy with obstructive sx-doxazosin wrong)
45. ?
46. CT scan of the chest

For this block, Q.12 I marked internal carotid and got it right. Anyone else gave a different take on that?

Also for block 2, Q32- its vasovagal attack, not hyopglycemia.
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  #116  
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Default Question I didn't find the answer to

18 y/o woman had fever for 12 hours and obtundation for 4 hours. Summer camp- developed cough and ry cough. Febrile, HR-120, RR- 30 and hypotensive. Cool extremities. Erythematous lesions on her hand, chest and abdomen. WBCs- 21000 with left shift. What is it?
a. lymes
b. cocaine
c.meningococcemia
d. pseudomonal sepsis
e. toxic shock syndrome
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  #117  
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Quote:
Originally Posted by TheSsm View Post
18 y/o woman had fever for 12 hours and obtundation for 4 hours. Summer camp- developed cough and ry cough. Febrile, HR-120, RR- 30 and hypotensive. Cool extremities. Erythematous lesions on her hand, chest and abdomen. WBCs- 21000 with left shift. What is it?
a. lymes
b. cocaine
c.meningococcemia
d. pseudomonal sepsis
e. toxic shock syndrome
It's C meningococcemia
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  #118  
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Quote:
Originally Posted by Nixy View Post
G Might be myoglobinuria but I m not sure.
Thank you, myoglobinuria might be the most possible one if there is any disease matches G.
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  #119  
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Quote:
Originally Posted by Nixy View Post
If exposed to chicken pox, and mothers have no history, babies should be given immunoglobulins since vaccine is given usually at 12 months of age. Acyclovir to shorten duration if illness. I don't know if it's ok to give acyclovir for prophylaxis. And isolation might be a good idea to prevent chicken pox in the babies that have not already caught the virus.
THANK YOU! I almost forget about the immunoglubins.
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Quote:
Originally Posted by Nixy View Post
It's C meningococcemia
Thank you. Really appreciate you taking time out and answering the question.
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  #121  
Old 07-01-2014
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Quote:
Originally Posted by TheSsm View Post
For this block, Q.12 I marked internal carotid and got it right. Anyone else gave a different take on that?

Also for block 2, Q32- its vasovagal attack, not hyopglycemia.
Thank you for correcting some of the answers to block 4 questions. But I remember that I got following questions right which I chose different answers from you. I post the questions here, would anyone please correct me if I remember them wrong.

1. A 47 y/o man comes to the emergency department because of a 3-day history of nausea and vomiting and burning nonradiating epigastric pain. He notes that the vomitus was initially yellowish, but the last two episodes were darker. He consumed 1 pint of whiskey 4 days ago. He takes no medications. On arrival, he is awake and confused. His T 37.4'C, P 128 /min, R 12 /min, and Bp 90/50 mmHg. The skin is cool and clammy. Cardiopulmonary exam shows no abnormalities. Abdominal exam shows diffuse tenderness without rebound. Neurologic exam shows no focal or sensorimotor abormalities. Test of the stool for occult blood is negative. An x-ray of the chest shows no abnormalities. An ECG shows sinus tachycardia. Which of the following is the most likely cause of this patient's abnormal vital signs?

A. Cardiogenic shock
B. esophageal rupture
C. hypovolemia
D. Pulmonary embolism
E. septic shock

It is E, high temperature, low blood pressure, diffuse tenderness on abdominal exam.

2. An otherwise healthy 37 y/o man comes to the physician because of a 3-month history of low back pain. Use of NSAID has provided moderate relief. Forward flexion of the spine is normal and does not produce pain, hyperextension of the spine increase the pain. Muscle strength in the lower extremities is 5/5; sensation and reflexes are normal. A lateral X-ray of the lumbar spine is hsown. Which of the following is most likely diagnosis?

A. Compression fracture
B. intervertebral disc space infection
C osteitis deformans (Paget disease)
D. Osteoporosis
E. spondylolisthesis

It is B. No pain on forward flexion, pain on hyperextension of spine indicates spinal canal stenosis due to intervertebral disc space infection. Compression fracture only gives severe back pain, more commonly seen in patients with osteroporosis or lytic lesions from metastatic or primary tumors, but this patient is healthy and young.


3. A 52 y/o woman comes to the physician because of a two-week history of progressive shortness of breath with exertion. She becomes short of breath when walking across a room.Eight year ago, she was diagnosed with breast cancer and underwent mastectomy followed by chemotherapy. Annual exminations hav shown no evidence of recurrence. Her vitals are normal. No Jugular venous distention. There is dullness to percussion over the lower half of the right lung, the left lung is clear to ascultation. Heart sound are normal.There is no peripheral edema. Which of the following is the most likely casue of this patient's dyspnea?

A. Hypothyroidism
B. Left ventricular dysfunction
C. pericardial tamponade
D pleural metastases
E. right lower lobe pneumonia.

It is D, pleural metastases from breast cancer, dullness to percussion over the lower half of the right lung, it is not E, because temperature is normal, no coughing.

4. A 62 y/o woman is brought to the ER because of a 4-day history of increasingly severe upper back pain, progressive weakness of both legs, and tingling in her legs and feet. She has had episodes of urinary incontinence during this period. Six months ago she underwent a mastectomy for treatment of breast cancer, which was lymph node positive. Normal cranial nerves and normal strength in the upper extremities. Muscle strength in the lower extremities is 3/5 bilaterally with increased tone. Sensation to pinprick is mildly decreased over the midtrunk. And sensation to vibrations is decreased in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Which of the following is the most appropriated next step in managment?

A. Azathrioprine therapy
B. Chemotherapy
C. interferon therapy
D. Pyridostigmine therapy
E. Radiation therapy
F. riluzole therapy

It is E, spinal cord compression from metastatic breast cancer.

5. A 51 y/o woman had a 15-minute episode of acute right-sided chest pain and shortness of breath following insertion of a right subclavian catheter for hemodialysis. She is hospitalized for treatment of renal failure. P 92/min, R 16/min, Bp 114/72 mmHg with no orthostatic changes. Hemoglobin is 9g/L. Pulse oximetry shows an oxygen saturation of 94%. An x-ray of the chest shows a 10% apical pneumothorax. The subclavian catherter is in good position. Which of the following is the most appropriate next step in managemen?

A. observation
B. CT scan of the chest
C removal of the subclavian catheter
D. placement of a chest tube
E . Ppleurodesis

It is A. The subclavian catherter is in good position. A 10% apical pneumothorax can be absorbed spontaneously.

Please correct me if you know the correct answers for sure. Thank you so much.
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  #122  
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Originally Posted by Andante View Post
Thank you for correcting some of the answers to block 4 questions. But I remember that I got following questions right which I chose different answers from you. I post the questions here, would anyone please correct me if I remember them wrong.

1. A 47 y/o man comes to the emergency department because of a 3-day history of nausea and vomiting and burning nonradiating epigastric pain. He notes that the vomitus was initially yellowish, but the last two episodes were darker. He consumed 1 pint of whiskey 4 days ago. He takes no medications. On arrival, he is awake and confused. His T 37.4'C, P 128 /min, R 12 /min, and Bp 90/50 mmHg. The skin is cool and clammy. Cardiopulmonary exam shows no abnormalities. Abdominal exam shows diffuse tenderness without rebound. Neurologic exam shows no focal or sensorimotor abormalities. Test of the stool for occult blood is negative. An x-ray of the chest shows no abnormalities. An ECG shows sinus tachycardia. Which of the following is the most likely cause of this patient's abnormal vital signs?

A. Cardiogenic shock
B. esophageal rupture
C. hypovolemia
D. Pulmonary embolism
E. septic shock

It is E, high temperature, low blood pressure, diffuse tenderness on abdominal exam.

2. An otherwise healthy 37 y/o man comes to the physician because of a 3-month history of low back pain. Use of NSAID has provided moderate relief. Forward flexion of the spine is normal and does not produce pain, hyperextension of the spine increase the pain. Muscle strength in the lower extremities is 5/5; sensation and reflexes are normal. A lateral X-ray of the lumbar spine is hsown. Which of the following is most likely diagnosis?

A. Compression fracture
B. intervertebral disc space infection
C osteitis deformans (Paget disease)
D. Osteoporosis
E. spondylolisthesis

It is B. No pain on forward flexion, pain on hyperextension of spine indicates spinal canal stenosis due to intervertebral disc space infection. Compression fracture only gives severe back pain, more commonly seen in patients with osteroporosis or lytic lesions from metastatic or primary tumors, but this patient is healthy and young.


3. A 52 y/o woman comes to the physician because of a two-week history of progressive shortness of breath with exertion. She becomes short of breath when walking across a room.Eight year ago, she was diagnosed with breast cancer and underwent mastectomy followed by chemotherapy. Annual exminations hav shown no evidence of recurrence. Her vitals are normal. No Jugular venous distention. There is dullness to percussion over the lower half of the right lung, the left lung is clear to ascultation. Heart sound are normal.There is no peripheral edema. Which of the following is the most likely casue of this patient's dyspnea?

A. Hypothyroidism
B. Left ventricular dysfunction
C. pericardial tamponade
D pleural metastases
E. right lower lobe pneumonia.

It is D, pleural metastases from breast cancer, dullness to percussion over the lower half of the right lung, it is not E, because temperature is normal, no coughing.

4. A 62 y/o woman is brought to the ER because of a 4-day history of increasingly severe upper back pain, progressive weakness of both legs, and tingling in her legs and feet. She has had episodes of urinary incontinence during this period. Six months ago she underwent a mastectomy for treatment of breast cancer, which was lymph node positive. Normal cranial nerves and normal strength in the upper extremities. Muscle strength in the lower extremities is 3/5 bilaterally with increased tone. Sensation to pinprick is mildly decreased over the midtrunk. And sensation to vibrations is decreased in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Which of the following is the most appropriated next step in managment?

A. Azathrioprine therapy
B. Chemotherapy
C. interferon therapy
D. Pyridostigmine therapy
E. Radiation therapy
F. riluzole therapy

It is E, spinal cord compression from metastatic breast cancer.

5. A 51 y/o woman had a 15-minute episode of acute right-sided chest pain and shortness of breath following insertion of a right subclavian catheter for hemodialysis. She is hospitalized for treatment of renal failure. P 92/min, R 16/min, Bp 114/72 mmHg with no orthostatic changes. Hemoglobin is 9g/L. Pulse oximetry shows an oxygen saturation of 94%. An x-ray of the chest shows a 10% apical pneumothorax. The subclavian catherter is in good position. Which of the following is the most appropriate next step in managemen?

A. observation
B. CT scan of the chest
C removal of the subclavian catheter
D. placement of a chest tube
E . Ppleurodesis

It is A. The subclavian catherter is in good position. A 10% apical pneumothorax can be absorbed spontaneously.

Please correct me if you know the correct answers for sure. Thank you so much.

2. An otherwise healthy 37 y/o man comes to the physician because of a 3-month history of low back pain. Use of NSAID has provided moderate relief. Forward flexion of the spine is normal and does not produce pain, hyperextension of the spine increase the pain. Muscle strength in the lower extremities is 5/5; sensation and reflexes are normal. A lateral X-ray of the lumbar spine is hsown. Which of the following is most likely diagnosis?

A. Compression fracture
B. intervertebral disc space infection
C osteitis deformans (Paget disease)
D. Osteoporosis
E. spondylolisthesis

It is B. No pain on forward flexion, pain on hyperextension of spine indicates spinal canal stenosis due to intervertebral disc space infection. Compression fracture only gives severe back pain, more commonly seen in patients with osteroporosis or lytic lesions from metastatic or primary tumors, but this patient is healthy and young.

It's a chronic condition of three months can't be disc space infection. Also infection should cause cord compression and not spinal stenosis. It is E spondylolisthesis E.

About the question number one I don't remember the answer but it seems hypovolumia to me because of peptic ulcer perforation and now diffuse abdominal pain which was only on epigastriun before that. Doesn't sepsis but I could be wrong I don't remember my answer here. Rest of your answers match mine.
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  #123  
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Default yea

Its spondylolisthesis for sure.next that qs of shock it need to be hypovolemic,once i thought septic but no temp rise and x-ray was normal so no perforation by h/x suggesting little bit of bloody emesis (darker)
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Default hey

To all doc who answered PCP for above qs, guys yea at first it goes for pcp like nystagmus,htn, but OPIOID clinch the dx only by pupil constriction and to all dr pcp dilates it ...
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  #125  
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Originally Posted by Pearljam View Post
To all doc who answered PCP for above qs, guys yea at first it goes for pcp like nystagmus,htn, but OPIOID clinch the dx only by pupil constriction and to all dr pcp dilates it ...
It's PcP not opioid. Opioid does cause confused state but not hallucinations or going astray like this man is in not knowing where he is. Opioid causes respiratory depression unlike this man. In pcp pupils are neither dilated nor constricted so constricted pupil was only a distractor. Hallucinogens cause dilated pupils. Also yes the man is not belligerent but mute which is again a non classic thing but inhalants are associated with agressiveness. Pcp too causes belligerence but it's still seemed more of the answer and I got it right.
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Quote:
Originally Posted by Nixy View Post
2. An otherwise healthy 37 y/o man comes to the physician because of a 3-month history of low back pain. Use of NSAID has provided moderate relief. Forward flexion of the spine is normal and does not produce pain, hyperextension of the spine increase the pain. Muscle strength in the lower extremities is 5/5; sensation and reflexes are normal. A lateral X-ray of the lumbar spine is hsown. Which of the following is most likely diagnosis?

A. Compression fracture
B. intervertebral disc space infection
C osteitis deformans (Paget disease)
D. Osteoporosis
E. spondylolisthesis

It is B. No pain on forward flexion, pain on hyperextension of spine indicates spinal canal stenosis due to intervertebral disc space infection. Compression fracture only gives severe back pain, more commonly seen in patients with osteroporosis or lytic lesions from metastatic or primary tumors, but this patient is healthy and young.

It's a chronic condition of three months can't be disc space infection. Also infection should cause cord compression and not spinal stenosis. It is E spondylolisthesis E.

About the question number one I don't remember the answer but it seems hypovolumia to me because of peptic ulcer perforation and now diffuse abdominal pain which was only on epigastriun before that. Doesn't sepsis but I could be wrong I don't remember my answer here. Rest of your answers match mine.
THANK YOU SO MUCH for correcting me and your clear explanation, Nixy! I agree with you about Q 1 and 2 in this post. THANK YOU!
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Originally Posted by Pearljam View Post
Its spondylolisthesis for sure.next that qs of shock it need to be hypovolemic,once i thought septic but no temp rise and x-ray was normal so no perforation by h/x suggesting little bit of bloody emesis (darker)
Thank you for correcting me!
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Originally Posted by Andante View Post
THANK YOU SO MUCH for correcting me and your clear explanation, Nixy! I agree with you about Q 1 and 2 in this post. THANK YOU!
You're welcome!
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  #129  
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Default How to post here?

Hi, I am doing medicine first year I am going for exams this july end. I want to know about usmle. anyone please explain me
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  #130  
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can someone inbox me the url for nbme 7? thanx
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Default Asymptomatic Hiatal Hernia

60 year old man f/u 2 months after episode of UGI bleed from salicylate-induced ulcer. UGI series sows healed ulcer and type 1 sliding hiatal hernia. Which is most appropriate step in management?

I always thought asymptomatic hiatal hernias get medical management and observation. His previous ulcer seems resolved. If answer is Nissen, this seems a little drastic. What am I missing? Thanks!
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  #132  
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Quote:
Originally Posted by Midwesternblot View Post
60 year old man f/u 2 months after episode of UGI bleed from salicylate-induced ulcer. UGI series sows healed ulcer and type 1 sliding hiatal hernia. Which is most appropriate step in management?

I always thought asymptomatic hiatal hernias get medical management and observation. His previous ulcer seems resolved. If answer is Nissen, this seems a little drastic. What am I missing? Thanks!
I think it's plain observation because I did nissen and it was wrong
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  #133  
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Quote:
Originally Posted by Andante View Post
Thank you for correcting some of the answers to block 4 questions. But I remember that I got following questions right which I chose different answers from you. I post the questions here, would anyone please correct me if I remember them wrong.

1. A 47 y/o man comes to the emergency department because of a 3-day history of nausea and vomiting and burning nonradiating epigastric pain. He notes that the vomitus was initially yellowish, but the last two episodes were darker. He consumed 1 pint of whiskey 4 days ago. He takes no medications. On arrival, he is awake and confused. His T 37.4'C, P 128 /min, R 12 /min, and Bp 90/50 mmHg. The skin is cool and clammy. Cardiopulmonary exam shows no abnormalities. Abdominal exam shows diffuse tenderness without rebound. Neurologic exam shows no focal or sensorimotor abormalities. Test of the stool for occult blood is negative. An x-ray of the chest shows no abnormalities. An ECG shows sinus tachycardia. Which of the following is the most likely cause of this patient's abnormal vital signs?

A. Cardiogenic shock
B. esophageal rupture
C. hypovolemia
D. Pulmonary embolism
E. septic shock

It is E, high temperature, low blood pressure, diffuse tenderness on abdominal exam. Its C . I got it right. 37.4 is not >100F which is a criteria for sepsis. For sepsis we need 2 out of 4 things, T<36 or >38, RR>20, HR>90 and WBCs <4000 or >12000 or >10% bands. This meets only one criteria. So the only other possibility is C. Tenderness is due to rupture of esophagus

2. An otherwise healthy 37 y/o man comes to the physician because of a 3-month history of low back pain. Use of NSAID has provided moderate relief. Forward flexion of the spine is normal and does not produce pain, hyperextension of the spine increase the pain. Muscle strength in the lower extremities is 5/5; sensation and reflexes are normal. A lateral X-ray of the lumbar spine is hsown. Which of the following is most likely diagnosis?

A. Compression fracture
B. intervertebral disc space infection
C osteitis deformans (Paget disease)
D. Osteoporosis
E. spondylolisthesis

It is B. No pain on forward flexion, pain on hyperextension of spine indicates spinal canal stenosis due to intervertebral disc space infection. Compression fracture only gives severe back pain, more commonly seen in patients with osteroporosis or lytic lesions from metastatic or primary tumors, but this patient is healthy and young.

Its E. Someone already explained it


3. A 52 y/o woman comes to the physician because of a two-week history of progressive shortness of breath with exertion. She becomes short of breath when walking across a room.Eight year ago, she was diagnosed with breast cancer and underwent mastectomy followed by chemotherapy. Annual exminations hav shown no evidence of recurrence. Her vitals are normal. No Jugular venous distention. There is dullness to percussion over the lower half of the right lung, the left lung is clear to ascultation. Heart sound are normal.There is no peripheral edema. Which of the following is the most likely casue of this patient's dyspnea?

A. Hypothyroidism
B. Left ventricular dysfunction
C. pericardial tamponade
D pleural metastases
E. right lower lobe pneumonia.

It is D, pleural metastases from breast cancer, dullness to percussion over the lower half of the right lung, it is not E, because temperature is normal, no coughing.

I think I did mark it as D. And got it right. I may have missed that which correcting the answers.

4. A 62 y/o woman is brought to the ER because of a 4-day history of increasingly severe upper back pain, progressive weakness of both legs, and tingling in her legs and feet. She has had episodes of urinary incontinence during this period. Six months ago she underwent a mastectomy for treatment of breast cancer, which was lymph node positive. Normal cranial nerves and normal strength in the upper extremities. Muscle strength in the lower extremities is 3/5 bilaterally with increased tone. Sensation to pinprick is mildly decreased over the midtrunk. And sensation to vibrations is decreased in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Which of the following is the most appropriated next step in managment?

A. Azathrioprine therapy
B. Chemotherapy
C. interferon therapy
D. Pyridostigmine therapy
E. Radiation therapy
F. riluzole therapy

It is E, spinal cord compression from metastatic breast cancer.
E is also right. I saw it in other forums. My bad

5. A 51 y/o woman had a 15-minute episode of acute right-sided chest pain and shortness of breath following insertion of a right subclavian catheter for hemodialysis. She is hospitalized for treatment of renal failure. P 92/min, R 16/min, Bp 114/72 mmHg with no orthostatic changes. Hemoglobin is 9g/L. Pulse oximetry shows an oxygen saturation of 94%. An x-ray of the chest shows a 10% apical pneumothorax. The subclavian catherter is in good position. Which of the following is the most appropriate next step in managemen?

A. observation
B. CT scan of the chest
C removal of the subclavian catheter
D. placement of a chest tube
E . Ppleurodesis

It is A. The subclavian catherter is in good position. A 10% apical pneumothorax can be absorbed spontaneously.

Please correct me if you know the correct answers for sure. Thank you so much.
Sorry about the mistakes. I spent the whole day looking for answers and I may have missed out on a few corrections.
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  #134  
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Originally Posted by TheSsm View Post
Sorry about the mistakes. I spent the whole day looking for answers and I may have missed out on a few corrections.
THANK YOU so much for correcting me and your clear explanation, especially the concept of sepsis.
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  #135  
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Quote:
Originally Posted by usmleck View Post
anyone wants to discuss nbme 7?
hey I would love to, just finished it and I couldnt find any answer key yet, so maybe through skype or something? please let me know : esaravia@ufm.edu \
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Originally Posted by Esteps View Post
hey I would love to, just finished it and I couldnt find any answer key yet, so maybe through skype or something? please let me know : esaravia@ufm.edu \

Most of the answer keys have been posted here. Please let us know if you have got an answer correct which is conflicting with this key.
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Originally Posted by earthpole View Post
can someone inbox me the url for nbme 7? thanx
can someone please inbox me the url too? thanks!
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hey guys,
i couldn't find the answers for these
i'd really appreciate any help with answers and explanations
thanks!!

22) An 82-year-old woman with metastatic breast cancer who is being cared for at home has had severe low back and left thigh pain for 5 days despite taking 5 mg of morphine syrup every 4 hours. She says that the morphine is moderately effective but loses its effectiveness 2-3 hours after each dose. She is otherwise tolerating the morphine without side effects. Which of the following is the most appropriate next step in pain management?
a) begin biofeedback
b) admit to hospital
c) add acetaminophen
d) continue the current dose + reassurance
e) increase the frequency of dose to every 3 hours
f) switch to SC morphone 1mg every 3 hours (WRONG)

27) A 62-year oldwoman is admitted to the hostpital because of shortness of breath. she has a 15 year hx of type 2 diabetes nd a 3-year history of chronic renal insufficiency. treatment with intravenous ceftriaxone and hepain is begun. she has poor oral intake. her temperature ranges from 37 to 38.4 and blood pressure ranges from 112/60 mm Hg to 146/84 mmHg. her serum glucose concentration is monitored four times daily and despite adjustment of insulin dosage her serumglucose range between 140-320mg/dL
which of the fllowing ismost likely to have prevented acute deterioration of this patients renal function?
a) low protein diet
b) better controlof serum glucose concentration in hte hospital
c)antihypertensive therapy
d) dosage adjustment of ceftriaxone
e) IV fluids
i think it's c. can anyone confirm?


29.
A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter. The mother asks to speak to the physician alone and explains that she persuaded her daughter to come because the girl has begun to stay out late, receive many calls from several different boys, and wear tight clothing and excessive makeup. She says her daughter confides many details of her dates to her. She adds that the girl's father is furious and berates her about this behavior even though he does not know about most of what is going on. To protect her daughter, she does not want to tell him about all the daughter's activities. On individual interview, the girl says she does not understand why she does these things, but she would like to understand. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
a) tell the mother thst her daughter is just going through a phase
b) Behavior therapy for the patient
c) Family therapy
d) Marital therapy for the parents
e) Psychodynamic psychotherapy for the patient
f) Triazolam therapy for the patient

20) A 55 year old woman with known metastatic cancer is admitted to the hospital because of confusion progressing to obtundation. she is barely arousable.
a) decreased calcium
b) decreased magnesium
c) decreased potassium
d) decreased sodium (WRONG)
e) increased calcium
f) increased magnesium
g) increased postassium
h) increased sodium

24) a 37-year oldwoman with alcoholism is admitted tothe ICU for treatment of severe alcoholic pancreatitits. she had severeal episodes of vomiting 2 hours before admission.
cadiac index=4.2 L/min/m2 central venous pressure=11cmH2O PCWP=10 mmHg
ABG on FiO2 of 60% and PEEP od 10 cm of H2O shows
pH = 7.32 pCO2 = 38 mmHG pO2 = 78 mmHg
An x-ray of the chest shows bilateral, diffuse, hazy densities with cephalization of the pulmonary vasculature and perihilar fullness. which of the following is the likely diagnosis?
a) ARDS
b) aspiration pneumonitis
c) atelectasis
d) CHF (WRONG)
e) fat embolism
f) interstitial lung disease

21) A 32-year old woman G3P1A1 is brought to the emergency department at 28 weeks gestation because of uterine contractions for the past 4 hours. her first pregnancy ended in a spontaneous abortion at 16 weeks.
a) desmopressin
b) ergonovine
c) magnesium sulfate
d) mifepristone
e) misoprostol
f) oxytocin
i think it's f, can anyone confirm?

46) a previously healthy 67 year old man has had an ching burning snsation in the distal lower extremities for 3 weeks, the symptoms are exacerbated by walking and relieved by elevation of the feet. The cetatarsalphalangeal joints and ankles are warm swolle, tender and erythematoud. 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 (WRONG)

thanks again!
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Quote:
Originally Posted by els224 View Post
hey guys,
i couldn't find the answers for these
i'd really appreciate any help with answers and explanations
thanks!!

22) An 82-year-old woman with metastatic breast cancer who is being cared for at home has had severe low back and left thigh pain for 5 days despite taking 5 mg of morphine syrup every 4 hours. She says that the morphine is moderately effective but loses its effectiveness 2-3 hours after each dose. She is otherwise tolerating the morphine without side effects. Which of the following is the most appropriate next step in pain management?
a) begin biofeedback
b) admit to hospital
c) add acetaminophen
d) continue the current dose + reassurance
e) increase the frequency of dose to every 3 hours
f) switch to SC morphone 1mg every 3 hours (WRONG)

It is E. Because the morphine is moderately effective but loses its effectiveness 2-3 hours after each dose

27) A 62-year oldwoman is admitted to the hostpital because of shortness of breath. she has a 15 year hx of type 2 diabetes nd a 3-year history of chronic renal insufficiency. treatment with intravenous ceftriaxone and hepain is begun. she has poor oral intake. her temperature ranges from 37 to 38.4 and blood pressure ranges from 112/60 mm Hg to 146/84 mmHg. her serum glucose concentration is monitored four times daily and despite adjustment of insulin dosage her serumglucose range between 140-320mg/dL
which of the fllowing ismost likely to have prevented acute deterioration of this patients renal function?
a) low protein diet
b) better controlof serum glucose concentration in hte hospital
c)antihypertensive therapy
d) dosage adjustment of ceftriaxone
e) IV fluids
i think it's c. can anyone confirm?

It is E. Poor oral intake, Bp is not that high.


29.
A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter. The mother asks to speak to the physician alone and explains that she persuaded her daughter to come because the girl has begun to stay out late, receive many calls from several different boys, and wear tight clothing and excessive makeup. She says her daughter confides many details of her dates to her. She adds that the girl's father is furious and berates her about this behavior even though he does not know about most of what is going on. To protect her daughter, she does not want to tell him about all the daughter's activities. On individual interview, the girl says she does not understand why she does these things, but she would like to understand. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
a) tell the mother thst her daughter is just going through a phase
b) Behavior therapy for the patient
c) Family therapy
d) Marital therapy for the parents
e) Psychodynamic psychotherapy for the patient
f) Triazolam therapy for the patient

It is C. father, mother, and the daughter have different opinions on the girl's development.

20) A 55 year old woman with known metastatic cancer is admitted to the hospital because of confusion progressing to obtundation. she is barely arousable.
a) decreased calcium
b) decreased magnesium
c) decreased potassium
d) decreased sodium (WRONG)
e) increased calcium
f) increased magnesium
g) increased postassium
h) increased sodium

It is E. calcium from metastatic cancer

24) a 37-year oldwoman with alcoholism is admitted tothe ICU for treatment of severe alcoholic pancreatitits. she had severeal episodes of vomiting 2 hours before admission.
cadiac index=4.2 L/min/m2 central venous pressure=11cmH2O PCWP=10 mmHg
ABG on FiO2 of 60% and PEEP od 10 cm of H2O shows
pH = 7.32 pCO2 = 38 mmHG pO2 = 78 mmHg
An x-ray of the chest shows bilateral, diffuse, hazy densities with cephalization of the pulmonary vasculature and perihilar fullness. which of the following is the likely diagnosis?
a) ARDS
b) aspiration pneumonitis
c) atelectasis
d) CHF (WRONG)
e) fat embolism
f) interstitial lung disease

It is A. ARDS is the complication of pancreatitits, x-ray, and blood gas.

21) A 32-year old woman G3P1A1 is brought to the emergency department at 28 weeks gestation because of uterine contractions for the past 4 hours. her first pregnancy ended in a spontaneous abortion at 16 weeks.
a) desmopressin
b) ergonovine
c) magnesium sulfate
d) mifepristone
e) misoprostol
f) oxytocin
i think it's f, can anyone confirm?

It is C.

46) a previously healthy 67 year old man has had an ching burning snsation in the distal lower extremities for 3 weeks, the symptoms are exacerbated by walking and relieved by elevation of the feet. The cetatarsalphalangeal joints and ankles are warm swolle, tender and erythematoud. 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 (WRONG)

It is A.

thanks again!
I got all these questions right. I have written the answers which I can remember below your questions. But I am not sure if I have remembered all of them right. Please anyone confirm or correct me if I remember them wrong.
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  #140  
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I agree

Quote:
Originally Posted by Andante View Post
I got all these questions right. I have written the answers which I can remember below your questions. But I am not sure if I have remembered all of them right. Please anyone confirm or correct me if I remember them wrong.
They seem to match mine. So I think we are good with this set of keys.
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  #141  
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Originally Posted by Andante View Post
1. 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

2. A 43 y/o man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa
E. Strep pneumonia.

3.A 72 y/o man is hospitalized because of dyspnea for 6 weeks. He has a history of type 1 diabetes and angina pectoris. Medications include insulin and warfarin. During the past 4 months, he was hospitalized once for deep venous thrombosis and another time for pulmonary emboli. Examination shows jugular venous distention, ascites, and pitting pretibial edema of both lower extremities. An chest X-ray shows mild cardiomegaly and no evidence of pulmonary edema. Which of the following is the most likely casue of this patient's worsening condition?

A. aortic stenosis
B. Cor pulmonale
C. ischemic heart disease
D. Mitral regurgitation
E. viral cardiomyopathy

4. A 72-year-old man has decreased urine 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?


Blood, protein, RBC, WBC, casts, other microscopic findings

A. none, none, none, none, hyaline, none
B. none, 4+, none, none, none, oval fat bodies
C. trace, 1+, 0-5,> 50, none, WBC clumps
D. 1+, 1+, 0-5, 0-5, pigmented granular, renal tubular epithelial cells
E. 1+, 1+, 5-10, 10-20, none, eosinophils
F. 3+, 1+, >50, none, RBC, none
G. 4+, 1+, none, none, pigmented granular, squamous epithelial cells
H. 4+, 1+, 10-20 dysmorphic, none, none, none.

Would you please let me know the correct answers to these 4 questions. I am very confused. Thank you so much.
Gram negative bacilli pneumonia for that question is H. Influenza I believe, it is more common in COPD/Smokers and overall is a more common cause of pneumonia than E coli
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Originally Posted by els224 View Post
hey guys,

27) A 62-year oldwoman is admitted to the hostpital because of shortness of breath. she has a 15 year hx of type 2 diabetes nd a 3-year history of chronic renal insufficiency. treatment with intravenous ceftriaxone and hepain is begun. she has poor oral intake. her temperature ranges from 37 to 38.4 and blood pressure ranges from 112/60 mm Hg to 146/84 mmHg. her serum glucose concentration is monitored four times daily and despite adjustment of insulin dosage her serumglucose range between 140-320mg/dL
which of the fllowing ismost likely to have prevented acute deterioration of this patients renal function?
a) low protein diet
b) better controlof serum glucose concentration in hte hospital
c)antihypertensive therapy
d) dosage adjustment of ceftriaxone
e) IV fluids

Answer is E, I think an important part of the Q that you left out here was the Pulmonary Angiography -> Contrast induced nephropathy
Answer was E for sure, I could be wrong on my reasoning.



thanks again!
Answer is E, I think an important part of the Q that you left out here was the Pulmonary Angiography -> Contrast induced nephropathy
Answer was E for sure, I could be wrong on my reasoning.
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  #143  
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Default Great discussion

Hey guys,
I have been following this discussion. Very helpful. I took NBME 7 3 days ago and was able to find most of the answers here. However here are some questions where i need help



1. 17 yo comes after MVC, she has facial trauma, open fractures of the maxilla, she is combative and makes gurgling sounds when she breathes. What is the best initial step?
a) Elevation of the head
b) Arterial blood gas
c) Chest XR
d) Thoracostomy
e) Cricothyrotomy



2. 7 yo boy with aortic valve replacement for congenital aortic valve stenosis gets dental cleaning. What bug is most likely to cause bacterial endocarditis in him?
a) Candida
b) H. influ
c) Moraxella
d) S. aureus
e) Viridans strep


3. 52 yo woman with personality change since the death of a close friend 2 weeks ago. Irritable little sleep, loss of interest, speaks rapidly, hears friend's voice, paces in exam room etc.
a) Adj. d/o
b) Bereavement
c) Bipolar
d) Cyclothymic
e) Generalized anxiety
f) Major depression (wrong)
g) Schizophreniform

4. 25 yo primigravid is in labor at 27 weeks. Vaginal culture is pos. for GBS. What is the next step in mgmt?
a) observation
b) Amoxicillin (wrong)
c) IM betamethasone
d) Cerclage
e) c section



5. 27 yo m brought to ED 30 min after MVA. Unconscious, Glasgow 10. Temp 98, RR 36, HR 130, BP 90/60. Breath sounds dec on Right; crepitus to palpation over right hemithorax. X-ray shows right hemopneumothorax. FAST normal. X-ray shows unstable pelvic fracture. Right thoracostomy tube yields 300 mL of blood. Given 3L of crystalloid but still tachy/hypotensive. What's next step?
a) epinephrine
b) hetastarch
c) recombinant factor vii
d) FFP
e) packed RBC's



6. 63 yo female has tightness and tenderness in her calf after midschaft fracture repair. What is the study to confirm the diagnosis?
a) Duplex scan
b) Radioactive fibrinogen
c) Angio
d) Impedance plethysmography
e) Venography

7. 42 yo man with severe flank pain and pain at costovertebral angle. Gets morphine, pain subsides. What's the management there?
a) Discharge home and encourage fluids
b) Discharge and schedule cystography
c) Discharge with antibiotics
d) Admit to general medical unit (wrong)
e) Admit to ICU
f) Admit for emergency operation



8. I have a question about the pituitary microadenoma question. According to UW, when PRL is less than 200, it is unlikely to be a PRLoma, but rather a nonfunctioning adenoma and should be resected. I applied this concept and got it wrong. What are your thoughts on this?



9. A previously healthy 18-year old woman comes to doc because of a lump in her neck that she first
noticed 1 month ago. She is asymptomatic. Examination shows a 3-cm left supraclavicular
lymph node that is firm and rubbery. Spleen is 3 cm below the left costal margln.What abnormal lab findings are most likely?
a) Low potassium
b) Increased RBC count
c) Increased calcium
d) Increased LDH
e) Increased TSH



10. Newborn gets surgery for coarctation of the aorta and is fussy, is on mechanical ventilation. RR 30/min, BP 110/70, pulse 160/min. What is the step in mgmt?
a) Additional sedation
b) beta blockers
c) Analgesics
d) Calcium-channel blockers
e) Diuretics




It would be great to get some answers. Thank you all.
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  #144  
Old 07-07-2014
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Quote:
Originally Posted by celena View Post
Hey guys,
I have been following this discussion. Very helpful. I took NBME 7 3 days ago and was able to find most of the answers here. However here are some questions where i need help



1. 17 yo comes after MVC, she has facial trauma, open fractures of the maxilla, she is combative and makes gurgling sounds when she breathes. What is the best initial step?
a) Elevation of the head
b) Arterial blood gas
c) Chest XR
d) Thoracostomy
e) Cricothyrotomy correct



2. 7 yo boy with aortic valve replacement for congenital aortic valve stenosis gets dental cleaning. What bug is most likely to cause bacterial endocarditis in him?
a) Candida
b) H. influ
c) Moraxella
d) S. aureus
e) Viridans strep correct


3. 52 yo woman with personality change since the death of a close friend 2 weeks ago. Irritable little sleep, loss of interest, speaks rapidly, hears friend's voice, paces in exam room etc.
a) Adj. d/o
b) Bereavement
c) Bipolar
d) Cyclothymic
e) Generalized anxiety
f) Major depression (wrong)
g) Schizophreniform may be this, don't remember

4. 25 yo primigravid is in labor at 27 weeks. Vaginal culture is pos. for GBS. What is the next step in mgmt?
a) observation
b) Amoxicillin (wrong)
c) IM betamethasone correct
d) Cerclage
e) c section



5. 27 yo m brought to ED 30 min after MVA. Unconscious, Glasgow 10. Temp 98, RR 36, HR 130, BP 90/60. Breath sounds dec on Right; crepitus to palpation over right hemithorax. X-ray shows right hemopneumothorax. FAST normal. X-ray shows unstable pelvic fracture. Right thoracostomy tube yields 300 mL of blood. Given 3L of crystalloid but still tachy/hypotensive. What's next step?
a) epinephrine
b) hetastarch
c) recombinant factor vii
d) FFP
e) packed RBC's correct



6. 63 yo female has tightness and tenderness in her calf after midschaft fracture repair. What is the study to confirm the diagnosis?
a) Duplex scan
b) Radioactive fibrinogen
c) Angio
d) Impedance plethysmography
e) Venography may be this not sure

7. 42 yo man with severe flank pain and pain at costovertebral angle. Gets morphine, pain subsides. What's the management there?
a) Discharge home and encourage fluids correct
b) Discharge and schedule cystography
c) Discharge with antibiotics
d) Admit to general medical unit (wrong)
e) Admit to ICU
f) Admit for emergency operation



8. I have a question about the pituitary microadenoma question. According to UW, when PRL is less than 200, it is unlikely to be a PRLoma, but rather a nonfunctioning adenoma and should be resected. I applied this concept and got it wrong. What are your thoughts on this?



9. A previously healthy 18-year old woman comes to doc because of a lump in her neck that she first
noticed 1 month ago. She is asymptomatic. Examination shows a 3-cm left supraclavicular
lymph node that is firm and rubbery. Spleen is 3 cm below the left costal margln.What abnormal lab findings are most likely?
a) Low potassium
b) Increased RBC count
c) Increased calcium
d) Increased LDH this again don't remember exactly
e) Increased TSH



10. Newborn gets surgery for coarctation of the aorta and is fussy, is on mechanical ventilation. RR 30/min, BP 110/70, pulse 160/min. What is the step in mgmt?
a) Additional sedation
b) beta blockers
c) Analgesics correct
d) Calcium-channel blockers
e) Diuretics




It would be great to get some answers. Thank you all.
I wrote my answers above that I remember. Don't remember the microadenoma question, if patient had nipple discharge then bromocriptine is the answer if there was such an option
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  #145  
Old 07-07-2014
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Quote:
Originally Posted by celena View Post
Hey guys,
I have been following this discussion. Very helpful. I took NBME 7 3 days ago and was able to find most of the answers here. However here are some questions where i need help



1. 17 yo comes after MVC, she has facial trauma, open fractures of the maxilla, she is combative and makes gurgling sounds when she breathes. What is the best initial step?
a) Elevation of the head
b) Arterial blood gas
c) Chest XR
d) Thoracostomy
e) Cricothyrotomy



2. 7 yo boy with aortic valve replacement for congenital aortic valve stenosis gets dental cleaning. What bug is most likely to cause bacterial endocarditis in him?
a) Candida
b) H. influ
c) Moraxella
d) S. aureus
e) Viridans strep


3. 52 yo woman with personality change since the death of a close friend 2 weeks ago. Irritable little sleep, loss of interest, speaks rapidly, hears friend's voice, paces in exam room etc.
a) Adj. d/o
b) Bereavement
c) Bipolar
d) Cyclothymic
e) Generalized anxiety
f) Major depression (wrong)
g) Schizophreniform

4. 25 yo primigravid is in labor at 27 weeks. Vaginal culture is pos. for GBS. What is the next step in mgmt?
a) observation
b) Amoxicillin (wrong)
c) IM betamethasone
d) Cerclage
e) c section



5. 27 yo m brought to ED 30 min after MVA. Unconscious, Glasgow 10. Temp 98, RR 36, HR 130, BP 90/60. Breath sounds dec on Right; crepitus to palpation over right hemithorax. X-ray shows right hemopneumothorax. FAST normal. X-ray shows unstable pelvic fracture. Right thoracostomy tube yields 300 mL of blood. Given 3L of crystalloid but still tachy/hypotensive. What's next step?
a) epinephrine
b) hetastarch
c) recombinant factor vii
d) FFP
e) packed RBC's



6. 63 yo female has tightness and tenderness in her calf after midschaft fracture repair. What is the study to confirm the diagnosis?
a) Duplex scan
b) Radioactive fibrinogen
c) Angio
d) Impedance plethysmography
e) Venography

7. 42 yo man with severe flank pain and pain at costovertebral angle. Gets morphine, pain subsides. What's the management there?
a) Discharge home and encourage fluids
b) Discharge and schedule cystography
c) Discharge with antibiotics
d) Admit to general medical unit (wrong)
e) Admit to ICU
f) Admit for emergency operation



8. I have a question about the pituitary microadenoma question. According to UW, when PRL is less than 200, it is unlikely to be a PRLoma, but rather a nonfunctioning adenoma and should be resected. I applied this concept and got it wrong. What are your thoughts on this?
I think the point of the question was a trial of bromocriptine first is >>> surgery. The options they gave were something like transsphenoidal resection, microablation, etc. Bromocriptine can shrink the tissue and possibly resolve all symptoms, and either way, they are slow growing and do not mets so you don't need to worry about doing anything immediately so you're safe with trial of bromocriptine.



9. A previously healthy 18-year old woman comes to doc because of a lump in her neck that she first
noticed 1 month ago. She is asymptomatic. Examination shows a 3-cm left supraclavicular
lymph node that is firm and rubbery. Spleen is 3 cm below the left costal margln.What abnormal lab findings are most likely?
a) Low potassium
b) Increased RBC count
c) Increased calcium
d) Increased LDH
e) Increased TSH



10. Newborn gets surgery for coarctation of the aorta and is fussy, is on mechanical ventilation. RR 30/min, BP 110/70, pulse 160/min. What is the step in mgmt?
a) Additional sedation
b) beta blockers
c) Analgesics
d) Calcium-channel blockers
e) Diuretics
It's either A or C, if you picked one and got it wrong it is the other, I want to say sedation, but I'm not 100% i'll let you know when I find out.
Just took the test yesterday so the one I've marked I'm sure about.



It would be great to get some answers. Thank you all.
How did you guys do on this test compared to the other forms? I took NBME 4 a week ago and got a 244 and a little studying inbetween and then took 7 and got a 246 but 7 definitely felt awful while I was taking it.
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  #146  
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Quote:
Originally Posted by celena View Post
Hey guys,
I have been following this discussion. Very helpful. I took NBME 7 3 days ago and was able to find most of the answers here. However here are some questions where i need help




10. Newborn gets surgery for coarctation of the aorta and is fussy, is on mechanical ventilation. RR 30/min, BP 110/70, pulse 160/min. What is the step in mgmt?
a) Additional sedation
b) beta blockers
c) Analgesics
d) Calcium-channel blockers
e) Diuretics




It would be great to get some answers. Thank you all.
The answer is analgesics, for sure.
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Quote:
Originally Posted by TheSsm View Post
They seem to match mine. So I think we are good with this set of keys.
Thank you.
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Quote:
Originally Posted by 2cool4medschool View Post
Answer is E, I think an important part of the Q that you left out here was the Pulmonary Angiography -> Contrast induced nephropathy
Answer was E for sure, I could be wrong on my reasoning.
Thank you. That is a very sound reason.
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Some questions I hadn't seen the definite answers to here, appreciate any help/discussion!

42yo with fatigue palpatations etc. hyperthyroid, lidlag exophthal, DTR okay, TSH >0.1, T4 16, scan shows diffuse increased uptake, initial step in management?
a. Intravenous cortisol
b. IV sodium iodide
c. Oral 131 (wrong – I realize now that it says initial step, so this is def wrong, but ive heard of steroids being good, but I would have been looking for propranolol? Oral PTU seems okay, I don’t know if the specified oral vs IV in this case the IV drug will be better?)
d. Oral PTU
e. Oral terazosin
f. Subtotal thyroidectomy


A male newborn has bilateral club foot deformity, born uncomplicated, didn’t’ move his lower extremities immediately after birth and did not cry when he received needlestick in his heel on exam he is vigoreous and moves his upper extremities but not his lower ones . bladder is full and palpable which is dx?
a. Cerebral palsy (wrong - this reminded me of something i saw on my peds rotation but i really had no idea)
b. Congenital hip dysplasia
c. Guinne barre syndrome
d. Muscular dystrophy
e. Spinal dysraphism


2 month old girl routine health maintenance, she was born at 34 weeks, temp istability and slow weeding for 2 weeks, recently runny nose and cough, growth and development is okay when corrected for premature, T=100, remainder okay, green rhinorrhea, what is most appropriate for vaccines?
a. Avoid live immunizations during illness ( wrong)
b. Delay the immunization for 6 weeks tocorrect for prematurity
c. Delay all until her upper respiratory tract infection resolves
d. Give all recommended immunizations for age
e. Reduce the dose of immunizations according to gestational age


77 year old man brought to the emergency deparment after 15 minutes since the onset of cough productive of large amounts of blood tinged sputum, life long history of chronic productive cough and recurrent episodes of pneumonia in the right lower lobe of the lunge, 15 minutes after arriving the bleeding stops spontaneously his temp is ok, pulse is 110, resp 24, bp OK exam shows bronchophony in the right lateral lungm CXR shows thin walled cystic spaces in the right lower loe with some air fluid levels., which is the most likely explanation of these findings?
a. Alveolar hypoventilation
b. Defective sodium channels
c. Destruction and dilation of distal airways
d. Excess extravascular fluid
e. Fibrosis throughout the lung parenchyma
f. Laryngeal penetration by foods and liquids (wrong)
g. Small airway inflammation
h. Thromboembolism


82year old man with CHF comes to physician for a follow up exam one month ago he had worsening of dyspnea while lying in bed and walking up stairs, and his dose of furosemide was increased, only lother med is Lisinopril, CHF 5 yeears ago after MI, coronary angio and stent at that time, no chest pain since then, 10 yr history of CKD, creatinine from 1.3 to 1.5 UA no protein, today pulse is 90 respirations 14 BP 130/86 no cardiopulmonary exam findings, there is trace edema of ankles, which has decreased since examination 1 month ago. Serum studies show slight increase in Na/K/Cl/HCO3, but all still normal, (hco3=28) urea nitrogen increased from 15->24, creatinine increased from 1.8 -> 2.3, no UA findings, whats most likely reason for change in past month?
a. Decreased renal blood flow
b. Glomerular inflammation
c. Renal cortical necrosis
d. Renal interstitial inflammation
e. Renal tubular necrosis (wrong)
f. Renal tubular obstruction


32 year old man changes 2 weeks since witnessing close friend die in MVC, pt offered to drive, friend declined, got hit by a car. Patient doesn’t remember much but for 2 weeks hes been waking up at night sweating and shouting “watch out!” she says hes distant, doesn’t wanna socialize, hasn’t driven car for 10 days, difficulty sleeping and concentrating and things don’t seem real, hes been drinking 2-3 beers nightly for 3 weeks to help calm his mind, vitals okay, flat affect, irritable, not feeling much of anything lately, has thought about death frequently during the past two weeks but says that he does not want to commit suicide, labs are okay. Dx?
a. Acute stress disorder
b. Adjustment disorder
c. Bereavement (wrong i thought since he didnt have suicidality or hallucinations pretty much everything was classified bereavement? i guess with the timeline acute stress disorder might be better?)
d. Dissosciative identity disorder
e. Major depressive disorder
f. Panic disorder
g. Substance induced mood disorder


72 year old woman with increased abdominal girth over 2 months, 8 lb weight gain, not able to finish meals, one martini daily after 3 miloe walk, had a lumpectomy and radiation for stage 1 breast Ca 4 years ago and treated with tamoxifen since then, abdominal exam shows fluid wave, pelvic exam shows 8cm fixed nontender mass in culdesac, labs normal, next step?
A. Intravenous albumin
B. IV abx
C. IV cisplatin and paclitaxel
D. Oral ACE
E. Oral spironolactone
F. Therapeutic paracentesis (wrong - recently worked with IR, clearly i'm answering very biased lol)
G. Ex Lap


3 days after ORIF of right midshaft femoral fracture a 63 year old woman has tightness and tenderness to palpation of the left calf. Which of the following is the most appropriate study to confirm the diagnosis?
a. Duplex scan
b. Radioactive labeled fibrinogen study
c. Angiography
d. Impedance plethysmography (wrong, i guess this is noninvasive but not confirmatory?)
e. Venography


14yo boy with sickle cell pain in left thigh and knee, unable to bear weight, no catching or locking, he was evaluated 6 daysd ago during basketball game twisting of knee, X ray at the time shown, took NSAID and applied icepacks, and crutches, felt ok for next 3 days, so he d/c. cruches and medicine. On arrival, BMI 32, afebrile, normotensive, left lower extremity shows jointline tenderness of knee, no effusion, rangeof motion of hip is limited by pain, no other progblems, Leukocytes 8000, esr 10, next step?
a. Xray of the lumbar spine
b. Xray of left hip
c. Whole body bone scan
d. Mri of left knee (wrong)
e. Aspiration of left knee

70 year old woman with peeling scaling and cracking of the right nipple for 2 months, eam shows no masses, mammography shows no masses or calcifications. Dx?
a. Ductal carcinoma in situ
b. Ductal ectasia
c. Eczema (wrong)
d. Inflammatory carcinoma
e. Intraductal papilloma
f. Mastitis
g. Lactiferous duct fistula
h. Pagets disease of the breast
i. Psyiologic discharge


Woman treated for GBS at 20 weeks, for urinary tract infection, shes in labor, what do you give for prophylaxis prevention of gbs transmission to kid
a. IM vanco
b. IV cephalothin
c. IV clindamycin
d. IV pen G
e. No prophy needed (wrong, should they have done a test of cure? just give her IV pen G anyways since we're not sure?)


37 year old woman with sickle cell disease comes to physician because of a 24 hour history of fever, right upper abdominal pain after eating and nausea, last SC crisit was 5 months ago, only takes folic acid, 23BMI, T=100.8 pulse is 90 mild scleral icterus, abd distended, bowel sounds decreased, murphy sign present, ultrasonography shows cholelithiasis, pericholecystic fluid, normal commmonsized ZCBD,
Leuk=12,000
Bili=3
Alk phos=60
Amylase=90
Lipase=40
A. Acute cholecystitis
B. Acute pancreatitis
C. Acute viral hepatitis
D. Cholangitis (wrong)
E. Sickle cell crisis


Asymptomatic HIV CD4 450, received MMR 4 years ago, tetanus 6 years ago, HepB Ab + 3 weeks ago, what vaccine do u recommend?
A. Hep A (wrong)
B. Hep B
C. MMR
D. Pneumococcal
E. Tetanus toxoid
F. No immunizations necessary


24yo with painful sores on his penis for 5 days, lymphadenopathy, no fever or chills, lesions shown. Which is most likely diagnosis?
A. Chancroid (wrong)
B. Genital herpes
C. Granuloma inguinale
D. Lymphogranuloma venereum
E. Primary syph


Person with hyperparathyroidism has stones, whatis the pathophsy?
A. decreased urinary excretion of citrate
B. Decreased urinary exretion of uric acid
C. Increased GI absorption of oxalate(wrong- is this the pathophys for vitamin D toxicity?)
D. Decreased urinary excretion of calcium
E. Increased urine pH
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  #150  
Old 07-07-2014
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Default Thank you!

Thanks so much guys. That was very helpful.

One more thing about the pituitary adenoma. I think it is just a bad question b/c ANYTHING that causes compression or disruption of the stalk gives you a high PRL, this does not mean it's a PRLoma. I remember one UW question using the exact same principle and both options were present (resection and bromocriptine) but resection was the right answer b/c PRL was just above the upper limit of normal.
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Originally Posted by 2cool4medschool View Post
Some questions I hadn't seen the definite answers to here, appreciate any help/discussion!

A male newborn has bilateral club foot deformity, born uncomplicated, didn’t’ move his lower extremities immediately after birth and did not cry when he received needlestick in his heel on exam he is vigoreous and moves his upper extremities but not his lower ones . bladder is full and palpable which is dx?
a. Cerebral palsy (wrong - this reminded me of something i saw on my peds rotation but i really had no idea)
b. Congenital hip dysplasia
c. Guinne barre syndrome
d. Muscular dystrophy
e. Spinal dysraphism X


2 month old girl routine health maintenance, she was born at 34 weeks, temp istability and slow weeding for 2 weeks, recently runny nose and cough, growth and development is okay when corrected for premature, T=100, remainder okay, green rhinorrhea, what is most appropriate for vaccines?
a. Avoid live immunizations during illness ( wrong)
b. Delay the immunization for 6 weeks tocorrect for prematurity
c. Delay all until her upper respiratory tract infection resolves
d. Give all recommended immunizations for age X
e. Reduce the dose of immunizations according to gestational age


77 year old man brought to the emergency deparment after 15 minutes since the onset of cough productive of large amounts of blood tinged sputum, life long history of chronic productive cough and recurrent episodes of pneumonia in the right lower lobe of the lunge, 15 minutes after arriving the bleeding stops spontaneously his temp is ok, pulse is 110, resp 24, bp OK exam shows bronchophony in the right lateral lungm CXR shows thin walled cystic spaces in the right lower loe with some air fluid levels., which is the most likely explanation of these findings?
a. Alveolar hypoventilation
b. Defective sodium channels
c. Destruction and dilation of distal airways X
d. Excess extravascular fluid
e. Fibrosis throughout the lung parenchyma
f. Laryngeal penetration by foods and liquids (wrong)
g. Small airway inflammation
h. Thromboembolism
I put the answers I know in the quote
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  #152  
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Quote:
Originally Posted by Andante View Post
In question 1, if all mothers are negative for antibodies of chickenpox, should the correct answer be: Acyclovir or isolation each other, it seems more reasonable to give Acyclovir to each baby. What do you think?

In question 4, what disease would be for G?

Thanks again.
hi, so the answer is D. He is in septic shock (g negative infections + Hypotension+fever) and he developed ATN, which in the urinalysis would show as granular "muddy brown" pigmented granular, tubular cells.
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  #153  
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Default Hi guys couldnt find the answer to this one

A previously healthy 27-year old is brought to the E.R 30 mins after a 1-min episode of loss of consciousness; during the episode, his pulse was 45/min. His symp occured while viewing the body at the morgue of his brother....His loss of consciousness was preceded by sweating and light-headedness. on arrival pulse: 100 bpm, BP 140/80. he says he has not eaten for 14 hrs... Which is the Dx?

a.) aortic diss
b.)Carcinoid
c.) conversion reaction
d.) Hypoglycemia
e.) Tussive Syncope
f.) vasovagal syncope
G.) vertebrobasilar insuff.


My answer was D. since he had nothing to eat for 14 hrs. But I got it wrong.... w else could it be? vasovagal was my 2nd choice?

Thx for the answers in advance...and good luck
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Quote:
Originally Posted by Esteps View Post
A previously healthy 27-year old is brought to the E.R 30 mins after a 1-min episode of loss of consciousness; during the episode, his pulse was 45/min. His symp occured while viewing the body at the morgue of his brother....His loss of consciousness was preceded by sweating and light-headedness. on arrival pulse: 100 bpm, BP 140/80. he says he has not eaten for 14 hrs... Which is the Dx?

a.) aortic diss
b.)Carcinoid
c.) conversion reaction
d.) Hypoglycemia
e.) Tussive Syncope
f.) vasovagal syncope
G.) vertebrobasilar insuff.


My answer was D. since he had nothing to eat for 14 hrs. But I got it wrong.... w else could it be? vasovagal was my 2nd choice?

Thx for the answers in advance...and good luck
It's vasovagal, I think if he was truly hypoglycemic he would have been tachycardic.
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  #155  
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Default Block 3 question 23?

A 72 yr old w/ progressive dyspnea over the past 4 d. his pulse 95/min, resp 20, bp 165/95. Examination shows jugular venous distension 6cm above sternal angle. Bilateral basilar crackles are heard. CAROTID UPSTROKE DIMINSHED. A grade 4/6 SYSTOLIC MURMUR is heard throughout the precordium w/ radiation to carotids. liver span is 13 cm in the midclavicular line. Which is the Dx?

a.) aortic insufficiency
b. aortic stenosis
c. HOCM
d. Mitral insufficiency
e. Mitral stenosis

please can someone explain me why this patient has HOCM instead of MR. there's a couple of things I think I just haven't "clicked" with
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  #156  
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Quote:
Originally Posted by Esteps View Post
A 72 yr old w/ progressive dyspnea over the past 4 d. his pulse 95/min, resp 20, bp 165/95. Examination shows jugular venous distension 6cm above sternal angle. Bilateral basilar crackles are heard. CAROTID UPSTROKE DIMINSHED. A grade 4/6 SYSTOLIC MURMUR is heard throughout the precordium w/ radiation to carotids. liver span is 13 cm in the midclavicular line. Which is the Dx?

a.) aortic insufficiency
b. aortic stenosis
c. HOCM
d. Mitral insufficiency
e. Mitral stenosis

please can someone explain me why this patient has HOCM instead of MR. there's a couple of things I think I just haven't "clicked" with
Aortic stenosis radiates to the carotids, pulsus parvus et tardus or something should be the slow upstroke. Also, age is a important factor in the pathogenesis of calcific aortic valvular stenosis.
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  #157  
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Originally Posted by celena View Post
3. 52 yo woman with personality change since the death of a close friend 2 weeks ago. Irritable little sleep, loss of interest, speaks rapidly, hears friend's voice, paces in exam room etc.
a) Adj. d/o
b) Bereavement
c) Bipolar
d) Cyclothymic
e) Generalized anxiety
f) Major depression (wrong)
g) Schizophreniform

6. 63 yo female has tightness and tenderness in her calf after midschaft fracture repair. What is the study to confirm the diagnosis?
a) Duplex scan
b) Radioactive fibrinogen
c) Angio
d) Impedance plethysmography
e) Venography
the answers are:
3. C
she had an episode of mania: needing little sleep, speaking rapidly jumping from topic to topic
and previous episodes of depression: sleeping a lot, loss of interest in normal activities

6. A
will show blood flow in the leg and is less invasive
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  #158  
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1) 42 y/o man comes at midnight, 6 hrs after onset of severe flank pain. Temp 98.6, HR 110, RR 12, BP 130/90. Tenderness over RLQ of abdomen and CVA. U/A shows 50-100 RBC's, 3-5 WBC. 2 hrs after morphine, symptoms subside. Next step?

A) discharge and encourage fluid intake
B) discharge and schedule cystography
c) discharge w/ oral abx
d) admit to general medical unit
e) admit to ICU
f) admit for emergency operation

2) 22 y/o w/ organophosphate poisoning gets tonic-clonic seizure. What's best rx?

a) atropine
b) diazepam

I put diazepam to stop the seizures but you go for atropine first?

3 & 4 same choices:

a) culdocentesis
b) CT abd
c) measure platelet count
d) measure amylase
e) paracentesis
f) single-shot IV pyelography
g) test stool for occult blood
h) U/S pelvis

3) for 12 hrs, 25 y/o G2P1 at 20 wks gestation has had severe epigastric pain radiating to back. vomited once. temp 100, HR: 90, BP 120/80. Fundus nontender, fundal height 21 cm. fetal HR 138, hematocrit 42%, WBC 9000, platelets 220,000. Next step?

- are they suggesting pancreatitis here so get amylase? I went for U/s pelvis to make sure baby is ok

4) 21 y/o primigravid at 37 wks gest, mild epigastric pain and moderate headache for 72 hrs. pregnancy normal otherwise. temp 98.6, BP 150/98, fundus nontender, fundal height 38 cm, fetal HR 130. DTR 3+ bilaterally, urine protein 3+.

Thanks guys, will try to help out with other Q's
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  #159  
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hey,
i wrote the answers in red in the quote, hope they're helpful!

Quote:
Originally Posted by 2cool4medschool View Post
Some questions I hadn't seen the definite answers to here, appreciate any help/discussion!

42yo with fatigue palpatations etc. hyperthyroid, lidlag exophthal, DTR okay, TSH >0.1, T4 16, scan shows diffuse increased uptake, initial step in management?
a. Intravenous cortisol
b. IV sodium iodide
c. Oral 131 (wrong – I realize now that it says initial step, so this is def wrong, but ive heard of steroids being good, but I would have been looking for propranolol? Oral PTU seems okay, I don’t know if the specified oral vs IV in this case the IV drug will be better?)
d. Oral PTU
e. Oral terazosin
f. Subtotal thyroidectomy

oral I131 is wrongbecause it will percipitate the exophthalmos, you start with treatment with PTU (i was also looking for beta-blockers because you first treat the hypertension in hyperthytoid, but since it wasn't an option, you start with PTU)

82year old man with CHF comes to physician for a follow up exam one month ago he had worsening of dyspnea while lying in bed and walking up stairs, and his dose of furosemide was increased, only lother med is Lisinopril, CHF 5 yeears ago after MI, coronary angio and stent at that time, no chest pain since then, 10 yr history of CKD, creatinine from 1.3 to 1.5 UA no protein, today pulse is 90 respirations 14 BP 130/86 no cardiopulmonary exam findings, there is trace edema of ankles, which has decreased since examination 1 month ago. Serum studies show slight increase in Na/K/Cl/HCO3, but all still normal, (hco3=28) urea nitrogen increased from 15->24, creatinine increased from 1.8 -> 2.3, no UA findings, whats most likely reason for change in past month?
a. Decreased renal blood flow
b. Glomerular inflammation
c. Renal cortical necrosis
d. Renal interstitial inflammation
e. Renal tubular necrosis (wrong)
f. Renal tubular obstruction
it's A. his diuretic dose was just increased recently- this decreases blood flow to the kidney

32 year old man changes 2 weeks since witnessing close friend die in MVC, pt offered to drive, friend declined, got hit by a car. Patient doesn’t remember much but for 2 weeks hes been waking up at night sweating and shouting “watch out!” she says hes distant, doesn’t wanna socialize, hasn’t driven car for 10 days, difficulty sleeping and concentrating and things don’t seem real, hes been drinking 2-3 beers nightly for 3 weeks to help calm his mind, vitals okay, flat affect, irritable, not feeling much of anything lately, has thought about death frequently during the past two weeks but says that he does not want to commit suicide, labs are okay. Dx?
a. Acute stress disorder
b. Adjustment disorder
c. Bereavement (wrong i thought since he didnt have suicidality or hallucinations pretty much everything was classified bereavement? i guess with the timeline acute stress disorder might be better?)
d. Dissosciative identity disorder
e. Major depressive disorder
f. Panic disorder
g. Substance induced mood disorder
A, acute stress disorder- it's like PTSD but lasts 2 days-1 month. having vivid dreams/flashbacks with reexperiencing the trauma/stressful event is more specific for PTSD/acute stress disorder, not bereavement. also, his waking up sweating and shouting is more a sign of the stress disorder symptomsof fear and horror (not seen in bereavement)

72 year old woman with increased abdominal girth over 2 months, 8 lb weight gain, not able to finish meals, one martini daily after 3 miloe walk, had a lumpectomy and radiation for stage 1 breast Ca 4 years ago and treated with tamoxifen since then, abdominal exam shows fluid wave, pelvic exam shows 8cm fixed nontender mass in culdesac, labs normal, next step?
A. Intravenous albumin
B. IV abx
C. IV cisplatin and paclitaxel
D. Oral ACE
E. Oral spironolactone
F. Therapeutic paracentesis (wrong - recently worked with IR, clearly i'm answering very biased lol)
G. Ex Lap
G. you wanna do an ex-lab because she has a mass that's likely a metastasis and you need to get that sucker out for histology

3 days after ORIF of right midshaft femoral fracture a 63 year old woman has tightness and tenderness to palpation of the left calf. Which of the following is the most appropriate study to confirm the diagnosis?
a. Duplex scan
b. Radioactive labeled fibrinogen study
c. Angiography
d. Impedance plethysmography (wrong, i guess this is noninvasive but not confirmatory?)
e. Venography
A duplex scan. lass invasive and will show the blood flow in/out of her leg

14yo boy with sickle cell pain in left thigh and knee, unable to bear weight, no catching or locking, he was evaluated 6 daysd ago during basketball game twisting of knee, X ray at the time shown, took NSAID and applied icepacks, and crutches, felt ok for next 3 days, so he d/c. cruches and medicine. On arrival, BMI 32, afebrile, normotensive, left lower extremity shows jointline tenderness of knee, no effusion, rangeof motion of hip is limited by pain, no other progblems, Leukocytes 8000, esr 10, next step?
a. Xray of the lumbar spine
b. Xray of left hip
c. Whole body bone scan
d. Mri of left knee (wrong)
e. Aspiration of left knee
B. you gotta xray his hip because he likely has avascular necrosis of the femoral head (which has bad blood supply as is, and especially in a kid with sickle cell who is likley to have decresed blood flow because of the sickling and double especially in an obese kid who is predisposed as well).
MRI looks more at soft tissue- you'd use this to diagnoze an ACL/MCL etc which are unlikely because he would have lots of swelling around his knee and he would have probably heard a pop when he twisted it.
another point, pestana said a knee injury can refer pain to the hip but a hip injury will NOT refer to the knee, so a hip injury is more likely here


70 year old woman with peeling scaling and cracking of the right nipple for 2 months, eam shows no masses, mammography shows no masses or calcifications. Dx?
a. Ductal carcinoma in situ
b. Ductal ectasia
c. Eczema (wrong)
d. Inflammatory carcinoma
e. Intraductal papilloma
f. Mastitis
g. Lactiferous duct fistula
h. Pagets disease of the breast
i. Psyiologic discharge
H. paget's presents like eczema of the nipple . plain eczema usually effects skin flectures

Woman treated for GBS at 20 weeks, for urinary tract infection, shes in labor, what do you give for prophylaxis prevention of gbs transmission to kid
a. IM vanco
b. IV cephalothin
c. IV clindamycin
d. IV pen G
e. No prophy needed (wrong, should they have done a test of cure? just give her IV pen G anyways since we're not sure?)
D. yea penicillin G, but not because we're not sure.
you give EVERY lady penicillin G without testing in weeks 35-38 if she 1. had GBS at all during labor or 2. ever had GBS at a previous labor 3. prolonged rupture of membranes
anyway, this woman had GBS during this current pregnancy so you don't need to even test for it, automatically treat with penicillin G


37 year old woman with sickle cell disease comes to physician because of a 24 hour history of fever, right upper abdominal pain after eating and nausea, last SC crisit was 5 months ago, only takes folic acid, 23BMI, T=100.8 pulse is 90 mild scleral icterus, abd distended, bowel sounds decreased, murphy sign present, ultrasonography shows cholelithiasis, pericholecystic fluid, normal commmonsized ZCBD,
Leuk=12,000
Bili=3
Alk phos=60
Amylase=90
Lipase=40
A. Acute cholecystitis
B. Acute pancreatitis
C. Acute viral hepatitis
D. Cholangitis (wrong)
E. Sickle cell crisis
A. acute cholecystits because she has increased bilirubin from hemolytic anemia (from her sickle cell disease) which formed pigment stones. (murphy sign is positive in cholecystits and cholangitis)

Asymptomatic HIV CD4 450, received MMR 4 years ago, tetanus 6 years ago, HepB Ab + 3 weeks ago, what vaccine do u recommend?
A. Hep A (wrong)
B. Hep B
C. MMR
D. Pneumococcal
E. Tetanus toxoid
F. No immunizations necessary
D. pneumococcal vaccine. hep A vaccine is not indicated
(you give hep A vaccine to someone who has hep C because if they get hep A on top of it, the hep C will become much worse-->fulminant)


24yo with painful sores on his penis for 5 days, lymphadenopathy, no fever or chills, lesions shown. Which is most likely diagnosis?
A. Chancroid (wrong)
B. Genital herpes
C. Granuloma inguinale
D. Lymphogranuloma venereum
E. Primary syph
B. herpes. H ducreyi (chancroid) has no systemic symptomsbut this guys has fever+chills. also the picture shows vesicles, not ulcers like in H ducreyi

Person with hyperparathyroidism has stones, whatis the pathophsy?
A. decreased urinary excretion of citrate
B. Decreased urinary exretion of uric acid
C. Increased GI absorption of oxalate(wrong- is this the pathophys for vitamin D toxicity?)
D. Decreased urinary excretion of calcium
E. Increased urine pH
D. hyperparathyroidism increases serum calcium which then increases urinary excretion of calcium --> forms calcium oxalate/phosphate stones
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  #160  
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hey,
i wrote the answers in red in the quote
hope they're helpful!

Quote:
Originally Posted by LookAtMeNow View Post
1) 42 y/o man comes at midnight, 6 hrs after onset of severe flank pain. Temp 98.6, HR 110, RR 12, BP 130/90. Tenderness over RLQ of abdomen and CVA. U/A shows 50-100 RBC's, 3-5 WBC. 2 hrs after morphine, symptoms subside. Next step?

A) discharge and encourage fluid intake
B) discharge and schedule cystography
c) discharge w/ oral abx
d) admit to general medical unit
e) admit to ICU
f) admit for emergency operation
A. he has no symptoms now so his stone probably passed, he can prevent further stones with increased fluid intake

3 & 4 same choices:

a) culdocentesis
b) CT abd
c) measure platelet count
d) measure amylase
e) paracentesis
f) single-shot IV pyelography
g) test stool for occult blood
h) U/S pelvis

3) for 12 hrs, 25 y/o G2P1 at 20 wks gestation has had severe epigastric pain radiating to back. vomited once. temp 100, HR: 90, BP 120/80. Fundus nontender, fundal height 21 cm. fetal HR 138, hematocrit 42%, WBC 9000, platelets 220,000. Next step?

- are they suggesting pancreatitis here so get amylase? I went for U/s pelvis to make sure baby is ok
D. yes, they want you to checkif it's pancreatitis. i think if you wnated to check if the baby is ok, you'd first check fetal heart monitor, at 25 weeks the baby is not in the pelvis (at the umbilicus by 20 weesk).
also, it's most important to make sure the mom is ok. a dead mom = dead baby at 25 weeks


4) 21 y/o primigravid at 37 wks gest, mild epigastric pain and moderate headache for 72 hrs. pregnancy normal otherwise. temp 98.6, BP 150/98, fundus nontender, fundal height 38 cm, fetal HR 130. DTR 3+ bilaterally, urine protein 3+.
C. measure platelets. she has high blood pressure so we're afraid she has preeclampsia which can also present with low platelet count (normally diagnosed with hypertension+proteinuria, but if no proteinuria, can also diagnose with hypertension AND evidence of kidney dysfunction/evidence of liver dysfunction/thrombocytopenia/pulmonary edema/cerebral or visual disturbances)
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  #161  
Old 07-08-2014
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Thank you! I appreciate that you included explanations, makes much more sense. Can I borrow your brain for the exam? lol
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hey,
i wrote the answers in red in the quote, hope they're helpful!
Very helpful, thank you very much!
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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

can someone please explain to me y the answer to this question is E). Is it b/c the mother developed chickenpox before so there r IgG titer in the blood and transfers to the babies. So the baby will already have protection against chickenpox?
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CDC does not recommend VZV vaccine to <12 months old. I think that is the reason, but I do not know the mechanism.
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Quote:
Originally Posted by irisiqi View Post
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

can someone please explain to me y the answer to this question is E). Is it b/c the mother developed chickenpox before so there r IgG titer in the blood and transfers to the babies. So the baby will already have protection against chickenpox?
exactly. mom's IgGs are given transplacentally to baby --> baby is protected until 6 months
if mom didn't have IgG i think you'd isolate the baby, you don't give live vacines (like VZV) to newborn babies (but that's not the case heer bc mom all have IgG against VZV)
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i wanna correct what i wrote (just got a uworld question on this)
to treat non-immune neonates (who's mom did NOT have IgG against VZV) or immunocompromised, you don't just isolate, you give them VZIG (varicella zoster immunoglobulins)
[my answer and reasoning for this question is still correct though- mom gave baby IgG, so don't need to do anything for the baby's in this case]

Quote:
Originally Posted by els224 View Post
exactly. mom's IgGs are given transplacentally to baby --> baby is protected until 6 months
if mom didn't have IgG i think you'd isolate the baby, you don't give live vacines (like VZV) to newborn babies (but that's not the case heer bc mom all have IgG against VZV)
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Quote:
Originally Posted by els224 View Post
i wanna correct what i wrote (just got a uworld question on this)
to treat non-immune neonates (who's mom did NOT have IgG against VZV) or immunocompromised, you don't just isolate, you give them VZIG (varicella zoster immunoglobulins)
[my answer and reasoning for this question is still correct though- mom gave baby IgG, so don't need to do anything for the baby's in this case]
Just to add on this, everything that Els224 said sounds right to me but I saw another tidbit recently about a timeline - if it's more than 5 days after the exposure to vzv, VZIG is not going to be useful. I think the context I saw it in was an adult/pregnant woman who was exposed to shingles and she didn't have a history of chickenpox, you would end up giving her Acyclovir to prevent complications of intrapartum VZV infection during the first trimester but the question was alluding to the fact that after 5 days or so VZIG isn't going to do anything, but for acute exposure if it had been less than 5 days she would have benefitted from VZIG. Any clarification on this if I am wrong would be appreciated!
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Quote:
Originally Posted by celena View Post
Thanks so much guys. That was very helpful.

One more thing about the pituitary adenoma. I think it is just a bad question b/c ANYTHING that causes compression or disruption of the stalk gives you a high PRL, this does not mean it's a PRLoma. I remember one UW question using the exact same principle and both options were present (resection and bromocriptine) but resection was the right answer b/c PRL was just above the upper limit of normal.
I just did a Uworld question on it and they said that medical treatment with bromocriptine (cabergoline is new and better) is indicated for both micro and macro prolactinomas, micro being less than 10mm. so basically you should alsways try medical therapy first, if theres severe occular problems like bitemporal hemianopsia that hasn't responded to medical treatment then go for surgery.
uworld Qid: 3492
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  #169  
Old 07-12-2014
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Where can I get NBME 7 offline ? DrAGA was very helpful by sharing the link but Block4 is missing 22 questions. Would greatly appreciate it.
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  #170  
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Quote:
Originally Posted by 2cool4medschool View Post
I just did a Uworld question on it and they said that medical treatment with bromocriptine (cabergoline is new and better) is indicated for both micro and macro prolactinomas, micro being less than 10mm. so basically you should alsways try medical therapy first, if theres severe occular problems like bitemporal hemianopsia that hasn't responded to medical treatment then go for surgery.
uworld Qid: 3492
You are right! A prolactinoma (whether macro or micro) should always be treated with a DA-agonist first. However, if the adenoma is NOT a PRLoma, ie a non-functioning adenoma that is derived from the gonadotropic cells, neither bromocriptine nor cabergoline would help b/c the adenoma is not made of PRL-producing cells and the elevated PRL (<100) is merely due to a mass effect and loss of dopaminergic inhibition of PRL release. Therefore, resection, not cabergoline or bromocriptine, should be done.

However, resection was not the correct answer, which I'm trying to understand.
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  #171  
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Default Block 3 q 13

this guy ahs a urine osm of 200, according to uworld, in psychogenic polydipsia,
urine osm has to be <100. also his oral mucosa is dry. Anyone whose done it online can u help me?
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  #172  
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Quote:
Originally Posted by druic View Post
this guy ahs a urine osm of 200, according to uworld, in psychogenic polydipsia,
urine osm has to be <100. also his oral mucosa is dry. Anyone whose done it online can u help me?
It was by exclusion I think. Can you please put the question here. I vaguely remember it.
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Quote:
Originally Posted by celena View Post
You are right! A prolactinoma (whether macro or micro) should always be treated with a DA-agonist first. However, if the adenoma is NOT a PRLoma, ie a non-functioning adenoma that is derived from the gonadotropic cells, neither bromocriptine nor cabergoline would help b/c the adenoma is not made of PRL-producing cells and the elevated PRL (<100) is merely due to a mass effect and loss of dopaminergic inhibition of PRL release. Therefore, resection, not cabergoline or bromocriptine, should be done.

However, resection was not the correct answer, which I'm trying to understand.

Where was this question? For a craniopharyngeoma with symptoms, Trans-sphenoidal surgery is the answer. Let me know where you got it wrong. Or maybe the full question if you can . Thanks
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  #174  
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A 72 year old man come to the physician for a follow up exam after beginning a 10 day course of quinolone therapy for a UTI.
his pain with urination and increased frequency have resolved, and his urine has been clear. He says he has been drinking 12 to 15 glasses of water daily to prevent another infection. He has a 30 yr hx of schizoaffective disorder. Current medications include risperidone. He is oriented to person but not to place and time. His pulse is 20 bp 128/60 with no orthostatic changes. Exam shows dry oral mucosa and no JVD. The lungs are clear. Abd exam show no prole. No peripheral edema. Muscle strength normal, sensation intact. Reflexes 1+ bilaterally.
Lab:

htc 40
na 122
cl 94
BUN 16 Cr 1.1

Urine
osm 200
Sodium 20

what is the most likely cause?

-adrenal insuff
-polydipsia
-SIADH
-SE of quinolone
-DI
-Salt losing nephropathy
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  #175  
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Also, the question with 34 yr old woman with left hemithorax pain,
she has 24 resp rate and 110 HR. she is using ocps and she smokes,
to me this is Pulmonary Embolism, not costochondritis, as I would not expect resp rate to be this High!
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  #176  
Old 07-13-2014
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can you send me nbme 4 please?
Quote:
Originally Posted by ron2006 View Post
Where can I get NBME 7 offline ? DrAGA was very helpful by sharing the link but Block4 is missing 22 questions. Would greatly appreciate it.
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  #177  
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Quote:
Originally Posted by druic View Post
A 72 year old man come to the physician for a follow up exam after beginning a 10 day course of quinolone therapy for a UTI.
his pain with urination and increased frequency have resolved, and his urine has been clear. He says he has been drinking 12 to 15 glasses of water daily to prevent another infection. He has a 30 yr hx of schizoaffective disorder. Current medications include risperidone. He is oriented to person but not to place and time. His pulse is 20 bp 128/60 with no orthostatic changes. Exam shows dry oral mucosa and no JVD. The lungs are clear. Abd exam show no prole. No peripheral edema. Muscle strength normal, sensation intact. Reflexes 1+ bilaterally.
Lab:

htc 40
na 122
cl 94
BUN 16 Cr 1.1

Urine
osm 200
Sodium 20

what is the most likely cause?

-adrenal insuff
-polydipsia
-SIADH
-SE of quinolone
-DI
-Salt losing nephropathy
This is polygenic polydipsia. Requirements are Na <137, polyuria, low urine Na and low urine osm.
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  #178  
Old 07-17-2014
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Three days after hospitalization for treatment of severe muscle weakness secondary to Guillain-barre syndrome, a 21-year-old woman has a T39'C. Arterial blood gas analysis on 2L /min of oxygen via nasa cannula shows:

pH 7.33
Pco2 32 mm Hg
Po2 50 mmHg

An x-ray of the chest shows infiltrates in the middel and lower lobes. Bronchoscopy is performed. Gram stain of material obtained from the right main-stem bronchus show numerous segmented neutrophils, gram-positive cocci, and gram-negative cocci and bacilli. Which of the following is most likely to have prevented her acute pulmonary symptoms?

A. Elevation of the head of the bed
B. Nasogastric suction
C. Adminsitration of IV cephalospone
D. IV cimetidine
E. administration of subcutaneous heparin


b is wrong!
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  #179  
Old 07-17-2014
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Can some one plz ans and explain this ques-

A 27 year old nulligravid woman comes for a routine health maintenance examination. She is sexually active with one lifelong partner. She does not smoke. She has no history of stds. Pap smear now shows a high grade sq intraepithelial neoplasia. Prior pap smears have shown no abnormalities. Examination of the cervix and vagina shows no gross abnormalities. which of the following is the most appropriate next step in management?
A. repeat pap smear
B. HPV testing.
C. Colposcopy.
D. Cone biopsy of the cervix.
E. Random cervical biopsies.

my ans was colposcopy and it was wrong.
Thanx in advance.
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  #180  
Old 07-17-2014
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Quote:
Originally Posted by starcrossed View Post
Three days after hospitalization for treatment of severe muscle weakness secondary to Guillain-barre syndrome, a 21-year-old woman has a T39'C. Arterial blood gas analysis on 2L /min of oxygen via nasa cannula shows:

pH 7.33
Pco2 32 mm Hg
Po2 50 mmHg

An x-ray of the chest shows infiltrates in the middel and lower lobes. Bronchoscopy is performed. Gram stain of material obtained from the right main-stem bronchus show numerous segmented neutrophils, gram-positive cocci, and gram-negative cocci and bacilli. Which of the following is most likely to have prevented her acute pulmonary symptoms?

A. Elevation of the head of the bed
B. Nasogastric suction
C. Adminsitration of IV cephalospone
D. IV cimetidine
E. administration of subcutaneous heparin


b is wrong!
I answered A and got it right.
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  #181  
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3/a county health officer investigates an outbreak of illness among persons attending a church picnic, the illness is characterized by the onset of nausea and vomiting 3 to 4h after attending the picnic. all effected persons recover without specific therapy, the investigation implicates egg salad as the vehicle of transmission. which of the following is the factor most commonly contributing to an outbreak of this type?
a/ contamination of equipment used to prepare the implicated food
b/an implicated food that is inherently dangerous
c/ inadequate cooking of the implicated food
d/inadequate refrigeration of the implicated food
e/poor personnal hygiene by the person serving ty the implicated food

c is wrong,
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  #182  
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75 y/o f after perforated gastric ulcer repair has pvc's .on digoxin & diuretics. w/c electrolyte abnormality?

hyperkalemia was wrong!
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  #183  
Old 07-17-2014
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I thought the guy sufferred from digoxin toxicity(frequent PVCs) 2nd to low K+. I thought Potassium and Digoxin compete for the same bind site or channel...cannt remember step 1 was 6 months ago.
Quote:
Originally Posted by starcrossed View Post
75 y/o f after perforated gastric ulcer repair has pvc's .on digoxin & diuretics. w/c electrolyte abnormality?

hyperkalemia was wrong!
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  #184  
Old 07-17-2014
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what artery is invovled in pad if dorsalis pedis is absent?
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  #185  
Old 07-17-2014
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femopop?
stenosis occurs more common at the proximal vessels. aorta, illiac will give you more symptoms than just claudication, probably pain in the thign, butts, ED etc. so next one on the list is femopop.
Quote:
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what artery is invovled in pad if dorsalis pedis is absent?
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  #186  
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Quote:
Originally Posted by nacht hund View Post
I thought the guy sufferred from digoxin toxicity(frequent PVCs) 2nd to low K+. I thought Potassium and Digoxin compete for the same bind site or channel...cannt remember step 1 was 6 months ago.
i think its hypokalemia.. still not sure
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  #187  
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I put down hypokalemia, got it right
Quote:
Originally Posted by starcrossed View Post
i think its hypokalemia.. still not sure
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  #188  
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what was the diag of back pain in 15 y/o f on steroids with xray lateral spine givenn??

muscle strain was wrong !
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  #189  
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wasnt it a compression fracture 2nd to steroid overuse?
Quote:
Originally Posted by starcrossed View Post
what was the diag of back pain in 15 y/o f on steroids with xray lateral spine givenn??

muscle strain was wrong !
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  #190  
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prevention of staph aureus food poisoning?

heating food was wrong.!

can some 1 who got it right pls clarify?
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  #191  
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I remember that q from step 1 micro. Staph grows fast in hot environoment esp in potato, egg whatever salad with mayo ...you leave them outside on a hot day, they grow fast and they release toxin which made ppl puke. you leave in the fridge, they dont grow as fast, they dont release as much toxin. I got that q right
Quote:
Originally Posted by starcrossed View Post
prevention of staph aureus food poisoning?

heating food was wrong.!

can some 1 who got it right pls clarify?
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  #192  
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Quote:
Originally Posted by nacht hund View Post
wasnt it a compression fracture 2nd to steroid overuse?

but the x ray did not show a fracture i felt .. ?!

and she had dull pain over several continuos vertebra with paravertebral spasm !
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  #193  
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15 y/o boy with behaviour change?

substance abuse was wrong!
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  #194  
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52 y/o f with jaundice,fever after cholecystectomy ... next best step?

exploratory lap was wrong!
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  #195  
Old 07-17-2014
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I think that was ERCP. charcot triad

Quote:
Originally Posted by starcrossed View Post
52 y/o f with jaundice,fever after cholecystectomy ... next best step?

exploratory lap was wrong!
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  #196  
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50 y/o m urinary incontinenece immediately after removal of epidural cather?

residual anesthetic effect was wrong!
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  #197  
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47 y/o m , constipation 9 mnths, hemorrhoids seen, next best step in mgmt?

anoscopy was wrong!
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  #198  
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it was a hematoma
Quote:
Originally Posted by starcrossed View Post
50 y/o m urinary incontinenece immediately after removal of epidural cather?

residual anesthetic effect was wrong!
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  #199  
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15 y/o boy pain with swallowing 4 days, smoker - 4 yrs, ibuprofen, .. diagnosis??
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  #200  
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pill esophagitis

Quote:
Originally Posted by starcrossed View Post
15 y/o boy pain with swallowing 4 days, smoker - 4 yrs, ibuprofen, .. diagnosis??
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