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Discussion Starter · #1 · (Edited)
These are NBME 3 questions, please reply, but don't just copy the answer key found online :)

30. A 15-year-old girl comes to the physician because she is concerned about her risk for gonorrhea. Her sexual partner was recently diagnosed with this disease, and they had intercourse before he started treatment. After testing for Neisseria gonorrhoeae and Chlamydia trachomatis, which of the following is the most appropriate next step in management?

A) Treatment only if symptomatic
B) Treatment only if cultures are positive
C) Treatment for N. gonorrhoeae only, based on history of exposure
D) Treatment for N. gonorrhoeae and C. trachomatis, based on history of exposure

In sexual assault you do PEP according to CDC to Cefexime, Azithormycin, Metronidazole for all the possible bugs...
NAAT/PCR is gold standard for Neisseria and chlamydia, so maybe B is a poor choice because they would do culture

A 22-year-old man is brought to the emergency department 20 minutes after he sustained a gunshot wound to the abdomen. On arrival, administration of oxygen by face mask and fluid resuscitation with 2 L of lactated Ringer's solution are begun. He is alert but unable to move his lower extremities. His temperature is 37.4°C (99.3°F), blood pressure is 140/80 mm Hg, pulse is 105/min, and respirations are 14/min. The pupils are equal and reactive to light. Examination shows no jugular venous distention. Breath sounds are equal bilaterally, and heart sounds are normal. There is a single gunshot wound to the left of the umbilicus that is not bleeding. No exit wound can be found. The abdomen is nondistended and soft, there is mild tenderness around the wound. Bowel sounds are normal. Rectal examination shows no sphincter tone. Sensation is absent below the L2 level. Test of the stool for occult blood is positive. Insertion of a nasogastric tube yields clear fluid, and insertion of a urinary catheter yields clear urine. A urine dipstick is negative for blood. X-ray films of the chest, abdomen (supine and decubitus), and pelvis show a small caliber bullet just to the right of the spine at L2. No other abnormalities are seen. Which of the following is the most appropriate next step in diagnosis?

O A) Ultrasonography of the abdomen
O B) CT scan of the abdomen
O C) Colonoscopy
O D) Diagnostic peritoneal lavage
O E) Arteriography
O F) Laparotomy

for this one I am drawn between A and F.
UWorlds algorithm clearly says:
Patient stable: do FAST scan -> positive -> ex lap
FAST inconclusive -> peritoneal lavage -> pos -> ex lap

thanks
 
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