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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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  #1  
Old 06-13-2014
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Default nbme 7

anyone wants to discuss nbme 7?
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  #2  
Old 06-13-2014
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i want to...i did nbme 7 today..and got 70 point more then nbm6....
i am looking for a answer keys but cant find it..
so lets see who did lets try to discuss and correct each other
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  #3  
Old 06-14-2014
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Quote:
Originally Posted by DrAGA View Post
i want to...i did nbme 7 today..and got 70 point more then nbm6....
i am looking for a answer keys but cant find it..
so lets see who did lets try to discuss and correct each other
when areyou taking it DR AGA ?? And how much did you score on nbme 6. I am taking exam in 2 wweeks.
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  #4  
Old 06-14-2014
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Default nbme 7

coll, let's make a new thread :nbme7 questions, and each of us type his incorrect answers and we will try to correct them
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  #5  
Old 06-14-2014
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my exam on june 27...to be honest iam scoring low but cant postpone my exam czuse i am pregnant and going to have my baby soon....so i have to take it now..its risky kind of...
anyways...

ppl i have offline nbme 7..need help to get correct answers..coz their are many new qs i would like to see how others will.. answer..
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  #6  
Old 06-14-2014
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Listening

here is a link of offline NBME 7
https://www.mediafire.com/#pppgc87kpqtkr

file on DOCUMENTS
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Old 06-14-2014
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Quote:
Originally Posted by DrAGA View Post
my exam on june 27...to be honest iam scoring low but cant postpone my exam czuse i am pregnant and going to have my baby soon....so i have to take it now..its risky kind of...
anyways...

ppl i have offline nbme 7..need help to get correct answers..coz their are many new qs i would like to see how others will.. answer..
Took it 2 weeks ago. Should be able to able help u wit most of the questions. Post a part of the question here n ill try to give u the answer.
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  #8  
Old 06-14-2014
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Quote:
Originally Posted by PinkPuffer View Post
Took it 2 weeks ago. Should be able to able help u wit most of the questions. Post a part of the question here n ill try to give u the answer.
thanks i will post my wrong ones....
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  #9  
Old 06-14-2014
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https://www.mediafire.com/#i0cx39po2z03d

nbme 7 offline try this link if previuos doesnt work
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  #10  
Old 06-14-2014
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27 yo man comes to Dr.with his 27 yo wife for infertility.wife has 4 yo daughter..husband has no have children.the wife menses regular 28 day intervals..her last exmaniation was 1 monthago without abnormality.examinaton of husband shoes ill-defind soft masses palpated bilateraly,high in the scrotum..which of the following is the most likely causes
A. b/l direct inguinal hearnia
B.b/l epididymitis
C. b/l varicoceles
D.pevious sports-related injury

my answers was D caus i think its possible post-injury lipoma;((

what u think?
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Old 06-14-2014
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https://www.mediafire.com/folder/i0c...z03d/NBME_7_CK
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  #12  
Old 06-14-2014
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lets discuss... post ques.
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Quote:
Originally Posted by DrAGA View Post
27 yo man comes to Dr.with his 27 yo wife for infertility.wife has 4 yo daughter..husband has no have children.the wife menses regular 28 day intervals..her last exmaniation was 1 monthago without abnormality.examinaton of husband shoes ill-defind soft masses palpated bilateraly,high in the scrotum..which of the following is the most likely causes
A. b/l direct inguinal hearnia
B.b/l epididymitis
C. b/l varicoceles
D.pevious sports-related injury

my answers was D caus i think its possible post-injury lipoma;((

what u think?
Answer should be C. Varicocele is almost always bilateral and presents as an ill defined mass in the Upper half of the scrotum (above the testes).

Injury could cause a mass but it would most likely be unilateral.
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  #14  
Old 06-14-2014
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2days after starting ACTH for Multiple sclerosis. a hospitalized 47 yr old women begins to have bizarre behavior. thinks nurses are terrorist. nurses reported she pulled her iv cath. has been wondering in halls at nyte with her walker. muslce strength in Lower extr is 2/5 mental stat exam fidgety labile affect and easily distracted. oriented to person not to place or time. which of the following in most appropriate pharmacotherapy for the this pt. sx?

A. alprazolam
B. amitriptyline
C. haloperidol
D. lithum carbonate
E. sertraline
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Old 06-14-2014
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Quote:
Originally Posted by dr.baig22 View Post
2days after starting ACTH for Multiple sclerosis. a hospitalized 47 yr old women begins to have bizarre behavior. thinks nurses are terrorist. nurses reported she pulled her iv cath. has been wondering in halls at nyte with her walker. muslce strength in Lower extr is 2/5 mental stat exam fidgety labile affect and easily distracted. oriented to person not to place or time. which of the following in most appropriate pharmacotherapy for the this pt. sx?

A. alprazolam
B. amitriptyline
C. haloperidol
D. lithum carbonate
E. sertraline
C. Antipsychotics r the drugs of choice for treating acute psychosis. Atypicals r preferred over typicals though.
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  #16  
Old 06-14-2014
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another question
22 y old pregnant women..they ask recurrent causes of UTI in pregnant women
A.decrease urinary ph
B.hypotonic environment in renal medulla
C.incease sodium excretion
D.increase urinary bladder tone
E.urinary stasis

i can say its not D(coz pregnancy cause decrease bladder tone) and not A(my wrong one)
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Old 06-14-2014
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I think it`s urinary stasis
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Quote:
Originally Posted by DrAGA View Post
another question
22 y old pregnant women..they ask recurrent causes of UTI in pregnant women
A.decrease urinary ph
B.hypotonic environment in renal medulla
C.incease sodium excretion
D.increase urinary bladder tone
E.urinary stasis

i can say its not D(coz pregnancy cause decrease bladder tone) and not A(my wrong one)
Yea its D. Due to compression of the bladder thrs some retention of urine after voiding which results in infections.
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Old 06-14-2014
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ok. in Preg - UTI
Increase progesterone. dec tone of ureters = dilated ureters. pH less acidic, decrease bladder tone. decrease sodium excretion. so choice left between B or E.
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  #20  
Old 06-14-2014
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Quote:
Originally Posted by PinkPuffer View Post
Yea its D. Due to compression of the bladder thrs some retention of urine after voiding which results in infections.
i found the answer..its urinary stasis...
read here
Loss of ureteral tone combined with increased urinary tract volume results in urinary stasis, which can lead to dilatation of the ureters, renal pelvis, and calyces. Urinary stasis and the presence of vesicoureteral reflux predispose some women to upper urinary tract infections (UTIs) and acute pyelonephritis.
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  #21  
Old 06-14-2014
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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
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  #22  
Old 06-14-2014
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Quote:
Originally Posted by DrAGA View Post
i found the answer..its urinary stasis...
read here
Loss of ureteral tone combined with increased urinary tract volume results in urinary stasis, which can lead to dilatation of the ureters, renal pelvis, and calyces. Urinary stasis and the presence of vesicoureteral reflux predispose some women to upper urinary tract infections (UTIs) and acute pyelonephritis.
Yea I remember contemplating between those 2 options n spending like 2 min on it. I eventually got it right but wasn't sure on wat i chose at the end. Urinary Stasis is a more common cause due to dilation of the Ureters from increased progesterone and increased total blood volume. So yea answer should be E.
Thanks for the correction DrAGA
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  #23  
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not sure about nystagmus but constricted pupil seen in opioid poisoning.
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Quote:
Originally Posted by dr.baig22 View Post
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
F. Bilateral Nystagmus w/ hypertonia and hypertension.
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  #25  
Old 06-14-2014
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Default nbme 7

Quote:
Originally Posted by pinkpuffer View Post
yea its d. Due to compression of the bladder thrs some retention of urine after voiding which results in infections.
it's urinary stasis for sure, i got it right
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  #26  
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6 hour after cabg 62 y o M decrease systoloc BP fro 120/80 tp 100/85.urinary output decrease from 60 to 10. CO decease fro 6 to 3.Pulmonary artery diastolic pressure has increased.CXR shows widened mediastinum..ost paropriate next step?
A.administration of 2 ampules of sodium bicarb
B,epinephrine
C.placememnt of intra-aortic balloon
D.revision of coronary gaft
E.surgical exploration of the mediastinum

i think its B-epinephrine
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  #27  
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Default nbme 7

1/ previously healthy 6 yo boy is brought to the ED because of cramping abdominal pain and right sided scrotal pain for 4 hours, he vomited once on the way to the hospital. examination shows a distended abdomen. bowel sounds are decreased and there is diffuse tenderness to palpation with involuntary guarding. the right hemiscrotum is slightly discolored with swelling and tenderness superiorly.the left hemiscrotum is normal, the testicle is normal. which of the following is the most appropriate next step in management?
a/translimmunation of scrotum
b/valsalva maneuver
c/urinalysis
d/doppler ultrasonography
e/ct scan
f/atb therapy
g/operative procedure
d is wrong, it's testicular torsion, isn't it?

2/ a homeless 66 yo man is admitted to the hospital because of jaundice for 1 week, he eats irregularly and has had a 9 kg weight loss over the past year.he has 20 year history of alcoholism. he appears wasted. examination shows icteric sclerae, palmar erythema and spider angiomata over the trunk, serum magnesium concentration is 0.8meq/l. serum studies are most likely to show which of the following:
a/decreased calcitonin
b/decreased calcium
c/decreased TSH
d/increased calcitonin
e/increased calcium
f/increased mag
g/increased PTH
h/increased TSH
i/increased T3

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, i thought it's raw egg

4/ a 47 yo woman comes to the physician because of fatigue for 1 week, she has a 10 year history of type 2 DM currently treated with short acting insulin before each meal as needed and 12 u of intermediate acting insulin at bedtime, over the past week, her blood glucose concentrations have been over 250 mg/dl and have been greater than 350 mg/dl on several occasions. her previous blood glucose had ranged between 90 and 110, she appears tired, she is 160 tall and weighs 68kg, BMI is 27, her t is 38.5, pulse 90 while supine and 120 while standing and BP is 110/70 while supine and 90/40 while standing, the remainder of the examination shows no abnormalities.her fingerstick blood glucose is 350, urine dipstick is positive for glucose and negative for protein and ketones, urinlysis shows 6 to 10 WBC/hpf and no RBC or casts.which of the following is the most likely cause of this patient's postural hypotension?
a/adrenal insufficiency
b/autonomic insufficiency
c/intravascular volume depletion
d/renal salt wasting
e/venous pooling

5/6h after CABG, a 62 yo man has a decrease in systolic BP from 120/80 to 100/85. urine output decreases from 60 to 10, and CO decreases from 6 to 3. pulm artery diastolic pressure has increased. an X ray of the chest shows a widened mediastinum, next step managment?
a/administration of 2 ampules of sodium bicar
b/administration of epinephrine
cplacement of intra-aortic ballon
d/revision of coronary grafts
e/surgical exploration of the mediastinum
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  #28  
Old 06-14-2014
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Default nbme 7

Quote:
Originally Posted by DrAGA View Post
6 hour after cabg 62 y o M decrease systoloc BP fro 120/80 tp 100/85.urinary output decrease from 60 to 10. CO decease fro 6 to 3.Pulmonary artery diastolic pressure has increased.CXR shows widened mediastinum..ost paropriate next step?
A.administration of 2 ampules of sodium bicarb
B,epinephrine
C.placememnt of intra-aortic balloon
D.revision of coronary gaft
E.surgical exploration of the mediastinum

i think its B-epinephrine
can u explain plz
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  #29  
Old 06-14-2014
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Quote:
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can u explain plz

iam not sure about epinephrine..i think ts B becuase of hypotension and decrease cardiac output..on case they give cardiogenic shock..... and bleeding onto mediastinum..so could be also surgery...confused dot know...(my answer ws A soits wrong)

also i had same wrong qs as u except..q1=a, q2-e(sarcoidosis casue hypercalcemia)
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  #30  
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Default nbme 7

Quote:
Originally Posted by DrAGA View Post
iam not sure about epinephrine..i think ts B becuase of hypotension and decrease cardiac output..on case they give cardiogenic shock..... and bleeding onto mediastinum..so could be also surgery...confused dot know...(my answer ws A soits wrong)

also i had same wrong qs as u except..q1=a, q2-e(sarcoidosis casue hypercalcemia)
can u explain plz why sarcoidosis, i was thinking to liver failure
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  #31  
Old 06-14-2014
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Originally Posted by usmleck View Post
can u explain plz why sarcoidosis, i was thinking to liver failure
sorryyy its not sarcoidosis i confused with other qs ....its liver function -escpecially alcohol indused cirrhosis...and its cause hypocalcemia


for food intoxication i founsd that itspoor hygiene coz of person to person transmission...but how i knew was also coz of poo refrigeration soo need more explaantion...

qs4-i think its autonomic insuffic
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  #32  
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Default nbme 7

Quote:
Originally Posted by DrAGA View Post
sorryyy its not sarcoidosis i confused with other qs ....its liver function -escpecially alcohol indused cirrhosis...and its cause hypocalcemia


for food intoxication i founsd that itspoor hygiene coz of person to person transmission...but how i knew was also coz of poo refrigeration soo need more explaantion...

qs4-i think its autonomic insuffic
q4 no it's not, i got it wrong
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Quote:
Originally Posted by usmleck View Post
q4 no it's not, i got it wrong

her blood glucose was well controlled but now its not 350 now..
HYPERglycemia causing polyuria leading to dehydration.
so answer C = intravascular volume depletion.
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  #34  
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Default BLOCK 1 answers (correct if wrong)

1. angina = exercise stress test
2. fat emboli
3. repeat bp in 4 wk
4. Diabetes insipidus ( serum osm inc. urine osm dec.)
5. central retinal vein occlusion
6. small bowel obstruction
7. bilateral varicocele
8. alcoholic cirrhosis = Decrease Calcium
9. pilosebaceous follicles = Acne
10. Upper resp. infection ( same ques. frm nbme 6)
11. Haloperidol for acute psychosis
12. CT scan (meningitis picture ruleout intracranial patho hemorr/mass)
13. child abuse ( shaken baby syndrome)
14. thymoma
15. Impetigo - topical mupirocin
16. urinary stasis
17. PCP (b/l nystagmus hypertonia HTN)
18. zenker diverticulum - barium swallow
19. Myasthenia gravis = dec ach receptors
20. GBS = demyelination of axons ( assending weakness + absent DTRs)
21 ?
22. Thoracic aorta (blunt trauma + wide mediastinum + c5 facet fracture)
23. reassurance
24. ?
25. sarcoidosis = Increase Calcium
26. case-control study ( past)
27. Bone Marrow aspiration
28. ?
29. encourage fluid intake
30. pericardial window
31. indomethacin
32. amniotomy + vaginal delivery
33. statin induced = Muscle
34. switch to s/c morphine
35. bipolar disorder
36. osteoperosis
37. splencetomy
38. Increase IV fluids
39. Intravascular volume depletion
40. poor hygiene by food handlers (s. aureus = egg salad)
41. Ankylosing spondylitis
42. compression fracture ( prednisone)
43. TGs ( gallstone pancreatitis)
44. T - lymphocytes (cellmediated immunity TB)
45. Latent TB ( PPD +ve CXR _ve) Rx 9m INH
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  #35  
Old 06-14-2014
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Default Block 2 answers

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
34. renal ultrasound
35. naloxone
36. botulism
37. urethral diverticulum
38. heparin treatment
39. enterotoxicgenic EColi - watery diarrhea
40. clomiphene
41. no treatment
42. HYPOkalemia
43. HYPOnatremia (cancer patients have electrolyte imbalance decNa)
44. carotid endarterectomy
45. abstinence from alcohol
46. CHF ( CXR perihilar densities and hazy with cephalization of pulmonary vasculature)
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  #36  
Old 06-15-2014
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Default Block 3 answers

1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)
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Old 06-15-2014
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Default Block 4 answers

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
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. ?
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
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  #38  
Old 06-15-2014
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Default Edited

Hey...Thank you so much for answering all these. It made it easier for me to go through offline after taking it. I edited some of your answers as I got them right on the extended feedback. I will look at other blocks in the upcoming days. Thanks DrAGA for putting this up. Appreciate it!
Block 1

Quote:
Originally Posted by dr.baig22 View Post
1. angina = exercise stress test
2. fat emboli
3. repeat bp in 4 wk
4. Diabetes insipidus ( serum osm inc. urine osm dec.)
5. central retinal vein occlusion
6. small bowel obstruction
7. bilateral varicocele
8. alcoholic cirrhosis = Decrease Calcium
9. pilosebaceous follicles = Acne
10. Upper resp. infection ( same ques. frm nbme 6)
11. Haloperidol for acute psychosis
12. CT scan (meningitis picture ruleout intracranial patho hemorr/mass)
13. child abuse ( shaken baby syndrome)
14. thymoma
15. Impetigo - topical mupirocin
16. urinary stasis
17. PCP (b/l nystagmus hypertonia HTN)
18. zenker diverticulum - barium swallow
19. Myasthenia gravis = dec ach receptors
20. GBS = demyelination of axons ( assending weakness + absent DTRs)
21 E
22. Thoracic aorta (blunt trauma + wide mediastinum + c5 facet fracture)
23. reassurance
24. ?
25. sarcoidosis = Increase Calcium
26. E
27. Bone Marrow aspiration
28. G
29. encourage fluid intake
30. pericardial window
31. indomethacin
32. amniotomy + vaginal delivery
33. statin induced = Muscle
34. E
35. bipolar disorder
36. osteoperosis
37. splencetomy
38. Increase IV fluids
39. Intravascular volume depletion
40. D
41. Ankylosing spondylitis
42. compression fracture ( prednisone)
43. TGs ( gallstone pancreatitis)
44. T - lymphocytes (cellmediated immunity TB)
45. Latent TB ( PPD +ve CXR _ve) Rx 9m INH

Last edited by DrRT; 06-15-2014 at 08:48 AM.
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  #39  
Old 06-15-2014
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Quote:
Originally Posted by drrt View Post
hey...thank you so much for answering all these. It made it easier for me to go through offline after taking it. I edited some of your answers as i got them right on the extended feedback. I will look at other blocks in the upcoming days. Thanks draga for putting this up. Appreciate it!
Block 1

u r welcome..
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  #40  
Old 06-15-2014
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Quote:
Originally Posted by DrRT View Post
Hey...Thank you so much for answering all these. It made it easier for me to go through offline after taking it. I edited some of your answers as I got them right on the extended feedback. I will look at other blocks in the upcoming days. Thanks DrAGA for putting this up. Appreciate it!
Block 1


r u sure on answer 26 and 40??..can u explain plz????? .
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  #41  
Old 06-19-2014
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@drAGA
26>> the Q is about chosing a treatment starategy, so we need an interventional study (e- RCT)
40>> this quote from uptodate "S. aureus toxin is heat-stable and is often associated with the consumption of foods prepared by a food handler such as dairy, produce, meats, eggs, and salads [ 7 ]. The food handler usually contaminates the product; after the food is left at room temperature, the organisms multiply and can produce a substantial quantity of toxin."
so the answer should be e- poor hygiene of handlers
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  #42  
Old 06-20-2014
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Quote:
Originally Posted by dr ashour View Post
@drAGA
26>> the Q is about chosing a treatment starategy, so we need an interventional study (e- RCT)
40>> this quote from uptodate "S. aureus toxin is heat-stable and is often associated with the consumption of foods prepared by a food handler such as dairy, produce, meats, eggs, and salads [ 7 ]. The food handler usually contaminates the product; after the food is left at room temperature, the organisms multiply and can produce a substantial quantity of toxin."
so the answer should be e- poor hygiene of handlers
thanks you...i was thinking about 40 E as well..but DrRt gave answer D which is refrigerator...so i confuse
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Old 06-21-2014
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Can someone help me with this one????? Thanks in advance

a 62-year old woman is brought to the emergency department because a 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 month ago she underwent a mastectomy for treatment of breast cancer ...... which of the following is the most appropriate next step in management

a) Azathioprine
b) Chemotherapy
C) Interferon
d) Pryridogstigmine
e) radiation therapy
f) Riluzone

Chemotherapy is wrong
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  #44  
Old 06-21-2014
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DrAga what's the answer of Q39 BLock 3 NBME 7,.. the urinalysis question..
__________________
Knowing trees, I understand the meaning of Patience.
Knowing grass, I can appreciate Persistence.
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Old 06-21-2014
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Default bone mets

Quote:
Originally Posted by rafael1970 View Post
Can someone help me with this one????? Thanks in advance

a 62-year old woman is brought to the emergency department because a 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 month ago she underwent a mastectomy for treatment of breast cancer ...... which of the following is the most appropriate next step in management

a) Azathioprine
b) Chemotherapy
C) Interferon
d) Pryridogstigmine
e) radiation therapy
f) Riluzone

Chemotherapy is wrong

I got this one right. i picked radiation therapy. spinal compression from bone mets
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  #46  
Old 06-21-2014
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Quote:
Originally Posted by tulip04 View Post
I got this one right. i picked radiation therapy. spinal compression from bone mets
Thanks

I am IMG. I did NBME 7 yesterday for 220, before I did NBME 6 for 225 abd the UW Assessment 235. Uword cumulative 61%.

Do you think I am ready?. I need something above 220

Exam in 1 week and I am so afraid about forgetting stuffs in one week.

Any advice please for this last week will be welcome.

Last edited by rafael1970; 06-21-2014 at 07:00 AM.
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  #47  
Old 06-22-2014
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Quote:
Originally Posted by abeer View Post
DrAga what's the answer of Q39 BLock 3 NBME 7,.. the urinalysis question..
the answer is A only becuase on case pt is dehydrated( post surgery) and dehydration gives hyaline casts
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  #48  
Old 06-22-2014
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Quote:
Originally Posted by DrAGA View Post
the answer is A only becuase on case pt is dehydrated( post surgery) and dehydration gives hyaline casts
although pt is dehydrated/has low B.P but how you were able to differentiate pre renal azotemia/hyaline casts vs Acute tubular necrosis/granular casts????
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  #49  
Old 06-22-2014
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Quote:
Originally Posted by offpiste View Post
although pt is dehydrated/has low B.P but how you were able to differentiate pre renal azotemia/hyaline casts vs Acute tubular necrosis/granular casts????
It's ATN for sure. Renal Tubular epithelial cells....Gentamicin induced!
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Quote:
Originally Posted by DrRT View Post
It's ATN for sure. Renal Tubular epithelial cells....Gentamicin induced!
..sorry but i am not agree..cause drug induced ATN need 5-7 days to increase creatinine....in this case they give 2 days..
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  #51  
Old 06-22-2014
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Quote:
Originally Posted by DrAGA View Post
..sorry but i am not agree..cause drug induced ATN need 5-7 days to increase creatinine....in this case they give 2 days..
I got this right. The answer is ATN - granular (tubular) casts. And its not coz of gentamicin. The patient had sepsis and hypovolemia resulting in ATN.
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  #52  
Old 06-23-2014
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Quote:
Originally Posted by dr.baig22 View Post
2days after starting ACTH for Multiple sclerosis. a hospitalized 47 yr old women begins to have bizarre behavior. thinks nurses are terrorist. nurses reported she pulled her iv cath. has been wondering in halls at nyte with her walker. muslce strength in Lower extr is 2/5 mental stat exam fidgety labile affect and easily distracted. oriented to person not to place or time. which of the following in most appropriate pharmacotherapy for the this pt. sx?

A. alprazolam
B. amitriptyline
C. haloperidol
D. lithum carbonate
E. sertraline
It is C. Got it right.
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  #53  
Old 06-23-2014
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Quote:
Originally Posted by PinkPuffer View Post
I got this right. The answer is ATN - granular (tubular) casts. And its not coz of gentamicin. The patient had sepsis and hypovolemia resulting in ATN.
Thanks for clearing up this concept. I was thinking gentamicin plus cefoxitin combination increasing nephrotoxicity.
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  #54  
Old 06-23-2014
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[QUOTE=usmleck;372585]1/ previously healthy 6 yo boy is brought to the ED because of cramping abdominal pain and right sided scrotal pain for 4 hours, he vomited once on the way to the hospital. examination shows a distended abdomen. bowel sounds are decreased and there is diffuse tenderness to palpation with involuntary guarding. the right hemiscrotum is slightly discolored with swelling and tenderness superiorly.the left hemiscrotum is normal, the testicle is normal. which of the following is the most appropriate next step in management?
a/translimmunation of scrotum
b/valsalva maneuver
c/urinalysis
d/doppler ultrasonography
e/ct scan
f/atb therapy
g/operative procedure
d is wrong, it's testicular torsion, isn't it?

It is G, stragulated hernia.
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  #55  
Old 06-23-2014
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Default NBME 7 question

A 14-month-old boy is brought for a well-child examination. His mother is concerned because he is not yet walking on his own. He will stand alone for several seconds before falling to the florr. He can empty raisins from a cup and tries to eat with a spoon. He is at the 25th percentile for length and 30th for weight. Examination shows no abnormalities, which of the following is the most appropriate next step in management?

A. Ressurance
B. Chromonsomal analysis
C. Measurement of serum creatine kinase activity
D. X-ray of the lower extremities
E. X-ray of the spine
F. MRI of the brain.
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  #56  
Old 06-23-2014
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Quote:
Originally Posted by Andante View Post
A 14-month-old boy is brought for a well-child examination. His mother is concerned because he is not yet walking on his own. He will stand alone for several seconds before falling to the florr. He can empty raisins from a cup and tries to eat with a spoon. He is at the 25th percentile for length and 30th for weight. Examination shows no abnormalities, which of the following is the most appropriate next step in management?

A. Ressurance
B. Chromonsomal analysis
C. Measurement of serum creatine kinase activity
D. X-ray of the lower extremities
E. X-ray of the spine
F. MRI of the brain.
ITS A GOT IT RIGHT...kids start to walk at 12 months..if boy can stand he will walk also...
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  #57  
Old 06-23-2014
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Originally Posted by DrAGA View Post
ITS A GOT IT RIGHT...kids start to walk at 12 months..if boy can stand he will walk also...
Thank you so much! Dr., but this boy can only stand for a few seconds. it is still normal by standing for a few seconds? Thank you for further explanation.
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  #58  
Old 06-23-2014
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Default NBME 7 question

A 32 y/o women is brought to ER because of a 2-day history of vomiting, diarrhea, and right-sided pelvic pain. Her LMP was 3 weeks ago.. Her vitals are T 39' C, R 20/min, P 100/min, Bp 120/70 mm Hg, abdominal examination shows right lower quadrant tenderness with rehound. bowel sounds are decreased, Pelvic examination shows right adnexal tenderness. A serum pregnancy tes is negative.

Lab:

Hb 12 g/d,
Wbc 15,000/ mm3
segmented neutrophile 80%
Bands 10%
lymphocytes 5%
monocytes 5%

Ultrasound shows no adnexal masses. Which of the following is the most likely diagnosis?

A. adnexal torsion
B. Appendicitis
C. Bowel obstruction
D. Corpus luteum cyst
E. Degenerating leiomyoma uteri
F. ovarian cancer
G. Ovarian hyperstimulation syndrome
H. Tubo-ovarian abscess
I. Urinary tract infection
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  #59  
Old 06-23-2014
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Default NBME 7 question

A 57 y/o woman comes to the physician because of increasing pain in the left groin and anterior thigh over the past year. Active range of motion of the hip joint reproduces the pain. There is a 20-degree hop flexion contracture. Her ESR is 20 mm/h. An x-ray of pelvis is shown. Which of the following is the most likely diagnosis?

A. Ankylosing spondylitis
B.. Osteoarthritis
C. osteonecrosis
D. Psoas abscess
E. Rheumatoid arthritis

C is wrong.
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A 32 y/o woman with asthma comes to the physician because of a 3-month history of progressive cough. Initially, the cough occurred once every 2 to 3 days and was nonproductive. For the post monthe, the cough has occurred daily and has been productive of thick yellow sputum occasionally tinged with blood. She also has a 1-month history of shortness of breath after walking two blocks. She received the diagnosis of asthma five years ago. Current medications include abuterol and budesonide inhalers, which she has had to use more frequently during the past month. She does not smoke. Today, she is in mild respiratory distress. Her temperatures is 37'C, pulse is 88/ min, respirations are 17/ min, and Bp is 110/65 mm Hg,. Pulse oximetry on room air shows an oxygen saturation of 93%. Scattereed end-expiratory wheezes are heard bilaterally with coarse rhonchi at the lung bases. The remainder of the examination shows no abnormalities. Lab:

Hct 42%
Wbc 10,000 /mm3
segmented neutrophils 67%
Eosinophils 8%
Lymphocytes 25%
Platelet 160,000/ mm3
Serum IgE 1250 IU/mL

A chest X-ray shows linear atelectasis at the lung bases and thickened airways and irregular cystic opacities primarily in a central distribution. Which of the following is the most likely diagnosis?

A. allergic bronchopulmonary aspergillosis
B. Alpha1-antitrypsis deficiency
C. Common variable immunodeficiency
D. cystic fibrosis
E primary ciliary dyskinesia
F. Pulmonary tuberculosis
G. sinusitis-infertility syndrome

Thank you for your answers and explanation.
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  #61  
Old 06-23-2014
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Quote:
Originally Posted by Andante View Post
A 14-month-old boy is brought for a well-child examination. His mother is concerned because he is not yet walking on his own. He will stand alone for several seconds before falling to the florr. He can empty raisins from a cup and tries to eat with a spoon. He is at the 25th percentile for length and 30th for weight. Examination shows no abnormalities, which of the following is the most appropriate next step in management?

A. Ressurance
B. Chromonsomal analysis
C. Measurement of serum creatine kinase activity
D. X-ray of the lower extremities
E. X-ray of the spine
F. MRI of the brain.
Reassurance because it's ok not to be walking by 14 months. It's not ok not to be walking by 18 months. You're concerned if his legs can't even support his weight for a second.
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  #62  
Old 06-23-2014
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Quote:
Originally Posted by Andante View Post
A 32 y/o women is brought to ER because of a 2-day history of vomiting, diarrhea, and right-sided pelvic pain. Her LMP was 3 weeks ago.. Her vitals are T 39' C, R 20/min, P 100/min, Bp 120/70 mm Hg, abdominal examination shows right lower quadrant tenderness with rehound. bowel sounds are decreased, Pelvic examination shows right adnexal tenderness. A serum pregnancy tes is negative.

Lab:

Hb 12 g/d,
Wbc 15,000/ mm3
segmented neutrophile 80%
Bands 10%
lymphocytes 5%
monocytes 5%

Ultrasound shows no adnexal masses. Which of the following is the most likely diagnosis?

A. adnexal torsion
B. Appendicitis
C. Bowel obstruction
D. Corpus luteum cyst
E. Degenerating leiomyoma uteri
F. ovarian cancer
G. Ovarian hyperstimulation syndrome
H. Tubo-ovarian abscess
I. Urinary tract infection
It's B i think
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Old 06-23-2014
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Quote:
Originally Posted by Andante View Post
A 32 y/o woman with asthma comes to the physician because of a 3-month history of progressive cough. Initially, the cough occurred once every 2 to 3 days and was nonproductive. For the post monthe, the cough has occurred daily and has been productive of thick yellow sputum occasionally tinged with blood. She also has a 1-month history of shortness of breath after walking two blocks. She received the diagnosis of asthma five years ago. Current medications include abuterol and budesonide inhalers, which she has had to use more frequently during the past month. She does not smoke. Today, she is in mild respiratory distress. Her temperatures is 37'C, pulse is 88/ min, respirations are 17/ min, and Bp is 110/65 mm Hg,. Pulse oximetry on room air shows an oxygen saturation of 93%. Scattereed end-expiratory wheezes are heard bilaterally with coarse rhonchi at the lung bases. The remainder of the examination shows no abnormalities. Lab:

Hct 42%
Wbc 10,000 /mm3
segmented neutrophils 67%
Eosinophils 8%
Lymphocytes 25%
Platelet 160,000/ mm3
Serum IgE 1250 IU/mL

A chest X-ray shows linear atelectasis at the lung bases and thickened airways and irregular cystic opacities primarily in a central distribution. Which of the following is the most likely diagnosis?

A. allergic bronchopulmonary aspergillosis
B. Alpha1-antitrypsis deficiency
C. Common variable immunodeficiency
D. cystic fibrosis
E primary ciliary dyskinesia
F. Pulmonary tuberculosis
G. sinusitis-infertility syndrome

Thank you for your answers and explanation.
It's A. Central distribution for allergic bronchopulmonary aspergillosis
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Old 06-23-2014
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Quote:
Originally Posted by Andante View Post
A 57 y/o woman comes to the physician because of increasing pain in the left groin and anterior thigh over the past year. Active range of motion of the hip joint reproduces the pain. There is a 20-degree hop flexion contracture. Her ESR is 20 mm/h. An x-ray of pelvis is shown. Which of the following is the most likely diagnosis?

A. Ankylosing spondylitis
B.. Osteoarthritis
C. osteonecrosis
D. Psoas abscess
E. Rheumatoid arthritis

C is wrong.
Its B osteoarthritis
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  #65  
Old 06-23-2014
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Default Nbme 7 questions

Hey, is it possible for someone to email me the set of questions for nbme 7 ...or any nbmes. I want to review the questions but wasn't able to get the questions, I would appreciate it...rohitmasih at yahoo com
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Old 06-24-2014
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PLEASE someone provide the correct answers for this and explain if possible

A study proposed to assess the effectiveness of new vaccine for prevention of HIV transmission. The study will include members of prisoner population. Those who agree to participate will be eligible for early parole. Which feature is of greatest potential concern?
a. Coercion of a vulnerable population
b. conflict of interest
c. failure to use appropriate placebo
d. inadequate informed consent
e. lack of generalizability
A healthy 40 yrs old woman comes to dr because she can express a few drops of yellow discharge from her left nipple on self exam of breast but there is no spontaneous discharge. Breast exam and mammography showed no masses/calcifications. What is most likely diagnosis?
a. DCIS
b. ductal ectasia
c. eczema
d. inflammatory carcinoma
e. intraductal papilloma
f. mastitis
g. lactiferous duct fistula
h. paget disease
i. physiological discharge
a 20yr old man is brought to the physician by his parents due auditory hallucinations and bizarre behavior over past yr. He dropped out of college and living with his parents and has not attempted to find a job. He says he feels strange and feels like in a dream and can talk to his great grandfather who died 50 yrs ago. Past history is significant for hep A 2 yrs ago and hypothyroidism for past 6 months for which he is taking thyroxine. Vitals normal. Face is immobile, voice monotonous, looks anxious and stares at physician and barely answers his questions. Lab tests normal and urine toxicology negative. Diagnosis?
a. ALS
b. BIPOLAR DISORDER
c. HEPATIC ENCEPHALOPATHY
d. MAJOR DEPRESSION WITH PSYCHOTIC FEATURES
e. PARKINSON’S DISEASE
f. PSYCHOTIC DISORDER DUE TO GENERAL MEDICAL CONDTION
g. SCHIZOPHRENIA
h. SUBSTANCE ABUSE PSYCHOTIC DISORDER
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these 4 as well please.


An asymptomatic 60yrs old man comes for a followup 2 months after an episode of upper gi bleeding due to salicyte induced ulcer. An upper gi series reveals a healed ulcer and type 1 sliding hernia. Next step in management?
a. Observation
b. Antacids
c. H2 receptor blockers
d. Lap nissen fundoplication
e. Transthoracic hernia repair
23 yrs old man brought by his mother because of auditory hallucinations following death of his wife 2 weeks ago. He couldn’t make any decisions for the funeral and has been confused and disorganized ever since. physical exam is normal except for sad affect. He looks preoccupied and has difficulty concentrating. He says he hears his brother’s voice that everything will be ok. His brother lives in another state according to mother. Diagnosis?
a.bereavement
b.brief psychotic disorder
c. PTSD
d. Schizoaffective disorder
e. schizophrenia

a 19 yrs old African American man comes with 9months h/o intermittent watery diarrhea alongwith abdominal bloating and cramps. He has had diarrhea after eating meals since age of 12 but now its worse since he is in college. Physical exam normal. Whats the cause
a. Bacterial overgrowth
b. Decreased bacterial growth
c. Decreased bowel motility
d. Digestive enzyme deficiency
e. Immunologic damage to microvilli
A 72 yr old man comes for follow up 4 weeks after starting a 10 day course of quinolones for UTI. His UTI symptoms are resolved. He has been drinking 12-15 glasses of water to prevent another UTI. Past history significant for schizoaffective disorder for which he takes risperidone. He is oriented in person but not place or time. Vitals and Physical exam is normal except for dry oral mucosa. Lab values are serum Na – 122mmmol/L
Urine osmolality – 200 mosm/kg
Urine Na – 20 meq/l
Cause of hyponatremia?
1. Adrenal insufficiency
2. Adverse effect of quinolone
3. Diabetes insipidus
4. Psychogenic polydipsia
5. Salt losing nephropathy
6. SIADH
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Originally Posted by DrAGA View Post
6 hour after cabg 62 y o M decrease systoloc BP fro 120/80 tp 100/85.urinary output decrease from 60 to 10. CO decease fro 6 to 3.Pulmonary artery diastolic pressure has increased.CXR shows widened mediastinum..ost paropriate next step?
A.administration of 2 ampules of sodium bicarb
B,epinephrine
C.placememnt of intra-aortic balloon
D.revision of coronary gaft
E.surgical exploration of the mediastinum

i think its B-epinephrine
its surgical exploration of mediastinum.
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Originally Posted by Nixy View Post
Its B osteoarthritis
Thank you for so much for your answers and explanation. Nixy!
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PLEASE someone provide the correct answers for this and explain if possible

A study proposed to assess the effectiveness of new vaccine for prevention of HIV transmission. The study will include members of prisoner population. Those who agree to participate will be eligible for early parole. Which feature is of greatest potential concern?
a. Coercion of a vulnerable population
b. conflict of interest
c. failure to use appropriate placebo
d. inadequate informed consent
e. lack of generalizability

It's A, got it right.

A healthy 40 yrs old woman comes to dr because she can express a few drops of yellow discharge from her left nipple on self exam of breast but there is no spontaneous discharge. Breast exam and mammography showed no masses/calcifications. What is most likely diagnosis?
a. DCIS
b. ductal ectasia
c. eczema
d. inflammatory carcinoma
e. intraductal papilloma
f. mastitis
g. lactiferous duct fistula
h. paget disease
i. physiological discharge

I picked E, but it is wrong, now my guess is I, but not sure.

a 20yr old man is brought to the physician by his parents due auditory hallucinations and bizarre behavior over past yr. He dropped out of college and living with his parents and has not attempted to find a job. He says he feels strange and feels like in a dream and can talk to his great grandfather who died 50 yrs ago. Past history is significant for hep A 2 yrs ago and hypothyroidism for past 6 months for which he is taking thyroxine. Vitals normal. Face is immobile, voice monotonous, looks anxious and stares at physician and barely answers his questions. Lab tests normal and urine toxicology negative. Diagnosis?
a. ALS
b. BIPOLAR DISORDER
c. HEPATIC ENCEPHALOPATHY
d. MAJOR DEPRESSION WITH PSYCHOTIC FEATURES
e. PARKINSON’S DISEASE
f. PSYCHOTIC DISORDER DUE TO GENERAL MEDICAL CONDTION
g. SCHIZOPHRENIA
h. SUBSTANCE ABUSE PSYCHOTIC DISORDER
It is G, got it right.
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Originally Posted by Nixy View Post
these 4 as well please.


An asymptomatic 60yrs old man comes for a followup 2 months after an episode of upper gi bleeding due to salicyte induced ulcer. An upper gi series reveals a healed ulcer and type 1 sliding hernia. Next step in management?
a. Observation
b. Antacids
c. H2 receptor blockers
d. Lap nissen fundoplication
e. Transthoracic hernia repair

A. observation.

23 yrs old man brought by his mother because of auditory hallucinations following death of his wife 2 weeks ago. He couldn’t make any decisions for the funeral and has been confused and disorganized ever since. physical exam is normal except for sad affect. He looks preoccupied and has difficulty concentrating. He says he hears his brother’s voice that everything will be ok. His brother lives in another state according to mother. Diagnosis?
a.bereavement
b.brief psychotic disorder
c. PTSD
d. Schizoaffective disorder
e. schizophrenia

It is B, got it right.

a 19 yrs old African American man comes with 9months h/o intermittent watery diarrhea alongwith abdominal bloating and cramps. He has had diarrhea after eating meals since age of 12 but now its worse since he is in college. Physical exam normal. Whats the cause
a. Bacterial overgrowth
b. Decreased bacterial growth
c. Decreased bowel motility
d. Digestive enzyme deficiency
e. Immunologic damage to microvilli

It is D, got it right.

A 72 yr old man comes for follow up 4 weeks after starting a 10 day course of quinolones for UTI. His UTI symptoms are resolved. He has been drinking 12-15 glasses of water to prevent another UTI. Past history significant for schizoaffective disorder for which he takes risperidone. He is oriented in person but not place or time. Vitals and Physical exam is normal except for dry oral mucosa. Lab values are serum Na – 122mmmol/L
Urine osmolality – 200 mosm/kg
Urine Na – 20 meq/l
Cause of hyponatremia?
1. Adrenal insufficiency
2. Adverse effect of quinolone
3. Diabetes insipidus
4. Psychogenic polydipsia
5. Salt losing nephropathy
6. SIADH
It is 4, got it right.
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How can it be psychogenic polydipsia if urine osmolality is 200! It should have been less than 100.
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Why is it digestive enzyme deficiency? They didn't write anything specific in diet. Is it not immunologic blunting of microvilli? Celiac disease. I wrote bacterial overgrowth though that was wrong.
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Quote:
Originally Posted by DrAGA View Post
thanks you...i was thinking about 40 E as well..but DrRt gave answer D which is refrigerator...so i confuse
I remember my answer was D too, and I got it right. Please anyone clarify this further. Thank you!
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Quote:
Originally Posted by Nixy View Post
Why is it digestive enzyme deficiency? They didn't write anything specific in diet. Is it not immunologic blunting of microvilli? Celiac disease. I wrote bacterial overgrowth though that was wrong.
Lactose intolerance due to lactase deficiency, milk with meals.
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I remember my answer was D too, and I got it right. Please anyone clarify this further. Thank you!
It should be refrigerator because in picnics the food stays out in the sun for long and provides ample conditions to breed staphylococcus and it's preformed toxin that causes food poisoning. I wrote A though and I knew I'd be wrong!
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Quote:
Originally Posted by Nixy View Post
How can it be psychogenic polydipsia if urine osmolality is 200! It should have been less than 100.
Urine osmolality is a measure of urine concentration,[1] in which large values indicate concentrated urine and small values indicate diluted urine. In healthy individuals with restricted fluid intake, urine osmolality should be greater than 800mOsm/kg, while a 24 hour urine osmolality should average between 500 and 800 mOsm/kg and a random urine osmolality should be 50 to 1400 mOsm/kg (from wiki)

PLUS

History of risperidone (side effect includes increasing thirst)

Hope it helps!
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Quote:
Originally Posted by Nixy View Post
It should be refrigerator because in picnics the food stays out in the sun for long and provides ample conditions to breed staphylococcus and it's preformed toxin that causes food poisoning. I wrote A though and I knew I'd be wrong!
THANK YOU, Nixy, that really helps!
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  #79  
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Quote:
Originally Posted by Andante View Post
Urine osmolality is a measure of urine concentration,[1] in which large values indicate concentrated urine and small values indicate diluted urine. In healthy individuals with restricted fluid intake, urine osmolality should be greater than 800mOsm/kg, while a 24 hour urine osmolality should average between 500 and 800 mOsm/kg and a random urine osmolality should be 50 to 1400 mOsm/kg (from wiki)

PLUS

History of risperidone (side effect includes increasing thirst)

Hope it helps!
Thanks for the explanation but I was going by the table for hyponatremia in uworld that specially mentioned urine osmolality less then 100 for polydipsia may be I shouldn't follow it too religiously.
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Quote:
Originally Posted by Andante View Post
Urine osmolality is a measure of urine concentration,[1] in which large values indicate concentrated urine and small values indicate diluted urine. In healthy individuals with restricted fluid intake, urine osmolality should be greater than 800mOsm/kg, while a 24 hour urine osmolality should average between 500 and 800 mOsm/kg and a random urine osmolality should be 50 to 1400 mOsm/kg (from wiki)

PLUS

History of risperidone (side effect includes increasing thirst)

Hope it helps!
Thanks for all the answers. Now I know answers to all of my incorrect questions. What a relief! I got about 28 questions wrong!
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Originally Posted by Nixy View Post
Thanks for all the answers. Now I know answers to all of my incorrect questions. What a relief! I got about 28 questions wrong!
Only 28 wrong ones! I think you are in good shape! Please double check the question with breast discharge, the answer might be ductal ectasia, not physical discharge. Just find this in wiki:

The term duct ectasia syndrome has been used to describe symptoms of nonpuerperal mastitis, possibly associated with nipple inversion and nipple discharge. In some contexts, it was used to describe a particular form of nonpuerperal mastitis coincident with fibrocystic disease, frequently involving pasty (coloured) nipple discharge, nipple retraction, retroareolar abscess and blue dome cysts. Abscessation is not very frequent but by some definitions recurrent subareolar abscess is merely a variant of duct ectasia syndrome - abscessation would be obviously more frequent with this definition.
Duct ectasia syndrome[/B] has been associated with histopathological findings that are distinct from a simple duct widening. In addition to nonspecific duct widening the myoepithelial cell layer is atrophic, missing or replaced by fibrous tissue. The original cuboidal epithelial layer may be also severely impaired or missing. Characteristic calcifications are often visible on mammographic images.
Periductal mastitis, comedo mastitis, secretory disease of the breast, plasma cell mastitis and mastitis obliterans are sometimes considered special cases or synonyms of duct ectasia syndrome.

what do you think? I have some incorrect questions and would like to get your help, I will post them later. Would you please help me?
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Quote:
Originally Posted by Andante View Post
Only 28 wrong ones! I think you are in good shape! Please double check the question with breast discharge, the answer might be ductal ectasia, not physical discharge. Just find this in wiki:

The term duct ectasia syndrome has been used to describe symptoms of nonpuerperal mastitis, possibly associated with nipple inversion and nipple discharge. In some contexts, it was used to describe a particular form of nonpuerperal mastitis coincident with fibrocystic disease, frequently involving pasty (coloured) nipple discharge, nipple retraction, retroareolar abscess and blue dome cysts. Abscessation is not very frequent but by some definitions recurrent subareolar abscess is merely a variant of duct ectasia syndrome - abscessation would be obviously more frequent with this definition.
Duct ectasia syndrome[/B] has been associated with histopathological findings that are distinct from a simple duct widening. In addition to nonspecific duct widening the myoepithelial cell layer is atrophic, missing or replaced by fibrous tissue. The original cuboidal epithelial layer may be also severely impaired or missing. Characteristic calcifications are often visible on mammographic images.
Periductal mastitis, comedo mastitis, secretory disease of the breast, plasma cell mastitis and mastitis obliterans are sometimes considered special cases or synonyms of duct ectasia syndrome.

what do you think? I have some incorrect questions and would like to get your help, I will post them later. Would you please help me?
Sure I'd write the correct ones I know! It seems physiological discharge though because it comes out only when squeezed and it's yellow. Dictate extasia has other symptoms as well like nipple inversion and discharge can be green or black.
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  #83  
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Default NBME 7 question

A previously healthy 47-year-old man comes to the physician because of a 6-month history or progressive weakness that began in his right leg and has gradually spread to his other extremities. During this period, he has had mild difficulty swallowing solids and liquids. Examination shows atrophy of the right quadriceps and both deltoid muscles and fasciculations in bothe quadriceps muscles. Babinsking sign bilaterally positive. Electromyography and nerve conductionstudies are most likely to show which of the following

A. Absence of bilateral nerve sensory responses
B. Fibrillation potentials in multiple muscles of multiple extremities
C. Myotonic discharges
D. Normal spontaneous and insertional activity
E. short duration, low amplitude motor unit potentials
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Quote:
Originally Posted by Andante View Post
A previously healthy 47-year-old man comes to the physician because of a 6-month history or progressive weakness that began in his right leg and has gradually spread to his other extremities. During this period, he has had mild difficulty swallowing solids and liquids. Examination shows atrophy of the right quadriceps and both deltoid muscles and fasciculations in bothe quadriceps muscles. Babinsking sign bilaterally positive. Electromyography and nerve conductionstudies are most likely to show which of the following

A. Absence of bilateral nerve sensory responses
B. Fibrillation potentials in multiple muscles of multiple extremities
C. Myotonic discharges
D. Normal spontaneous and insertional activity
E. short duration, low amplitude motor unit potentials

It's B as in ALS
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Default NBME 7 question

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
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Quote:
Originally Posted by Andante 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
I think I did elevation of head of bed or may be B but it was correct. Sorry font remember but if you did either one of them and it was incorrect then the other one is correct.
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Default NBME 7 question

A 67 y/o man comes to the physician because of easy fatigability and generalized weakness for 3 months and left chest pain for 1 month. The ches pain is worse on deep inspiration. He appears slightly pale. There is tenderness over the left 8th and 9th ribs laterally Examination shows no other abnormalities. His hematocrit is 28%. Serum and urine protein electrophoresis shows a monoclonal spike. A biopsy specimen of bone marrow shows greater than 40% plasma cell. An x-ray of chest shows 1 to 1.5 cm areas of radiolucenct in both ribs corresponding to the sites of tenderness. This patient's condition makes him most susceptible to infection with which of the following organisms?

A Aspergillus fumigatus
B. E Coli
C. Herpes zoster virus
D. Mycobacterium tuberculosis
E. Pneumocystic jiroveci
F Streptococcus pneumoniae

Please give correct answer and explanation if possible. Thanks!
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Originally Posted by Andante View Post
A 67 y/o man comes to the physician because of easy fatigability and generalized weakness for 3 months and left chest pain for 1 month. The ches pain is worse on deep inspiration. He appears slightly pale. There is tenderness over the left 8th and 9th ribs laterally Examination shows no other abnormalities. His hematocrit is 28%. Serum and urine protein electrophoresis shows a monoclonal spike. A biopsy specimen of bone marrow shows greater than 40% plasma cell. An x-ray of chest shows 1 to 1.5 cm areas of radiolucenct in both ribs corresponding to the sites of tenderness. This patient's condition makes him most susceptible to infection with which of the following organisms?

A Aspergillus fumigatus
B. E Coli
C. Herpes zoster virus
D. Mycobacterium tuberculosis
E. Pneumocystic jiroveci
F Streptococcus pneumoniae

Please give correct answer and explanation if possible. Thanks!
I did F because its most common. but later i read about it that MM patients are most susceptible to strep pneumoniae due to defective c3 binding for opsonization.
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A 27 y/o primigravid woman at 39 weeks' gestation is admitted to the hospital in labor, She had spontaneous rupture of membranes 1 hour ago. On admission, the cervix was 3 cm dilated, and the vertex was at -1 station. At point A on the labor curve shown, a fetal heart tracing shows recurrent late decelerations and decreased variability. which of the following is the most appropriate next step in management?

A continued observation
B Administration of oxytocin
C. Ammioinfusion
D. Forceps delivery
E. Cesaren delivery
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Quote:
Originally Posted by Andante View Post
A 27 y/o primigravid woman at 39 weeks' gestation is admitted to the hospital in labor, She had spontaneous rupture of membranes 1 hour ago. On admission, the cervix was 3 cm dilated, and the vertex was at -1 station. At point A on the labor curve shown, a fetal heart tracing shows recurrent late decelerations and decreased variability. which of the following is the most appropriate next step in management?

A continued observation
B Administration of oxytocin
C. Ammioinfusion
D. Forceps delivery
E. Cesaren delivery
its E because there was no progression of labor for past 3 hrs and late decelerations are never good it indicates uteroplacental insufficiency so c section it is.
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Originally Posted by Nixy View Post
It's B as in ALS
Thank you so much for all the answers! I really really appreciate it. Do you know what is the disease for answer E?
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Thank you so much for all the answers! I really really appreciate it. Do you know what is the disease for answer E?
Myopathies have low amplitude potentials.
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Myopathies have low amplitude potentials.
Thank you so much, Nixy.
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Originally Posted by Nixy View Post
I think I did elevation of head of bed or may be B but it was correct. Sorry font remember but if you did either one of them and it was incorrect then the other one is correct.
It should be elevation of head of bed, 'cause I picked naso..suction and got it wrong. Thanks!
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Default question about ulcerativive rectal mass

Can anyone tell me the correct answer for the question that mentions some mass in rectum.

I picked transanal resection of the mass and got it wrong.
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Can anyone tell me the correct answer for the question that mentions some mass in rectum.

I picked transanal resection of the mass and got it wrong.
Colonoscopy to cecum to look for the extent of the disease in the whole colon due to the high possibility of multiple masses, even if it is one single mass, it will be necessary to do colonoscopy to decide what treatment should be given.
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Colonoscopy to cecum to look for the extent of the disease in the whole colon due to the high possibility of multiple masses, even if it is one single mass, it will be necessary to do colonoscopy to decide what treatment should be given.
okay thanks a lot! did u get it right on the exam ?
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  #98  
Old 06-27-2014
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Originally Posted by a_usmle View Post
okay thanks a lot! did u get it right on the exam ?
Yes, got it right
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  #99  
Old 06-28-2014
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Default block 4 chickenpox question

Did someone get that chickenpox question right? Please let me know what was the answer to that? Thank you.
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  #100  
Old 06-29-2014
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Quote:
Originally Posted by DrRT View Post
Did someone get that chickenpox question right? Please let me know what was the answer to that? Thank you.
Can you type the question?
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