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| * Anyone interested in quick NBME discussion? |
| | #249024 |
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How abt we post qs n follow thru with answers , that way we'll be sure of whatever we choose..... No arguements, just plain this is what i think! U can support ur answer if u want, not if u don't! Anyone???? Right here! |
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| #1077034 |
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bhanu love the way u wrote them up my answers are the same. Now am just surer. Tnx guys next batch.
For 1. C
9. Alz.
NBME Form 1/ Block 1.
(11-20)
11. A 5-month-old boy is brought for a follow-up examination. He was born at 37 weeks' gestation and has had persistent wheezing since shortly after birth despite treatment with nebulized and oral bronchodilators and oral corticosteroids. His diet consists of 32 ounces of iron-fortified cow's milk-based formula daily. He appears well nourished and happy. On examination, there is moderate relief of wheezing with extension of the neck. Which of the following is the most likely mechanism of this infant's wheezing?
A ) Allergic reaction to cow's milk
B ) Aspiration of a foreign body
C ) Compression of the airway by a vascular ring
D ) Concurrent upper respiratory tract infection
E ) Persistent immaturity of lungs
12. An 18-month-old boy is brought to the emergency department because he has not used his left arm since he fell while walking and holding hands with his 8-year-old sister 2 hours ago. On examination, he holds his left upper extremity at his side with his forearm pronated. There is no tenderness of the left lower extremity, but there is restricted movement of the elbow. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate initial step in management?
A ) Passive hypersupination of the forearm
B ) Application of figure-of-8 strap
C ) Administration of analgesics and application of ice
D ) Aspiration of the elbow joint
E ) In-place splint immobilization of the elbow
13. A 6-month-old girl is brought to the physician for a routine health maintenance examination. She was born with a lumbosacral myelomeningocele which was successfully repaired at 2 days of age. The anterior fontanelle is 6 x 8 cm and bulging, and the posterior fontanelle is 3 x 4 cm and bulging. She has severe motor and sensory deficits involving both lower extremities. A head growth chart shows the following values:
Age
Head circumference (cm)
Birth
34.2
1 month
36.6
2 months
38
4 months
44
6 months
47
Which of the following is the most likely cause of increased intracranial pressure?
A ) Acute cerebral edema
B ) Decreased absorption of cerebrospinal fluid
C ) Dilation of cerebral arteries
D ) Intracranial mass lesion
E ) Obstruction of lateral sinus
F ) Obstruction of superior vena cava
G ) Obstruction of cerebrospinal fluid flow
H ) Overproduction of cerebrospinal fluid
14. An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum α-fetoprotein (MSAFP) level is increased to 3 multiples of the median. Which of the following is the most appropriate next step in management?
A ) Repeat measurement of MSAFP level
B ) Triple screening for MSAFP, serum β-hCG, and serum estriol levels
C ) Ultrasonography
D ) Amniocentesis for measurement of α-fetoprotein level
E ) Amniocentesis for chromosomal analysis
15. A 28-year-old man is brought to the emergency department by police because of severe pain in the right lower quadrant of the abdomen for 36 hours. He has been incarcerated in the county jail, and his court hearing is scheduled in 12 hours. He takes no medications. Abdominal examination shows no rebound. Complete blood count, liver tests, and erythrocyte sedimentation rate are within normal limits. An x-ray film of the abdomen shows a normal gas pattern. Test of the stool for occult blood is negative. Which of the following is the most likely diagnosis?
A ) Adjustment disorder
B ) Conversion disorder
C ) Depressive disorder not otherwise specified
D ) Factitious disorder
E ) Hypochondriasis
F ) Malingering
G ) Somatization disorder
16. A 6-year-old girl is brought to the physician because of a 4-week history of headache, fatigue, and decreased appetite. During this period, she has had nausea and vomiting. At the age of 4 years, she was diagnosed with poststreptococcal glomerulonephritis. She is at the 15th percentile for height and the 10th percentile for weight. Examination shows no abnormalities. Her serum urea nitrogen (BUN) level is 50 mg/dL. Which of the following is most likely to limit progression of this patient's renal failure?
A
) Increased potassium and sodium bicarbonate intake
B
) Decreased sodium and daily calorie intake
C
) Low-protein diet
D
) Strict fluid restriction
E
) Dialysis
17. A previously healthy 62-year-old man comes to the emergency department because of abdominal pain for 48 hours. His temperature is 38.6 C (101.5 F), blood pressure is 130/80 mm Hg, pulse is 110/min, and respirations are 15/min. Abdominal examination shows diffuse left lower quadrant tenderness with no peritoneal signs. Rectal examination shows no abnormalities; test of the stool for occult blood is negative. His leukocyte count is 14,700/mm3. Which of the following is the most appropriate next step in diagnosis?
A
) Barium enema
B
) CT scan of the abdomen
C
) Colonoscopy
D
) Cystoscopy
E
) Exploratory laparotomy
18. A previously healthy 3-month-old girl is brought to the emergency department because of a 3-day history of grunting and increasing difficulty breathing. She appears ill. Her temperature is 36.7 C (98 F), pulse is 160/min, and respirations are 76/min. Examination shows grunting, nasal flaring, and marked intercostal retractions. Bronchial breath sounds and occasional bilateral crackles are heard on auscultation. Serum studies show:
Ca2+ 5.6 mg/dL
Phosphorus 11 mg/dL
Alkaline phosphatase 250 U/L
Capillary blood gas analysis on 100% oxygen:
pH 7.36
PCO2 38 mm Hg
PO2 46 mm Hg
An x-ray film of the chest shows bilateral, diffuse interstitial infiltrates and absence of the thymic shadow. Bronchoalveolar lavage is positive for numerous Pneumocystis carinii. Which of the following is the most likely mechanism of these findings?
A ) Adenosine deaminase deficiency
B ) Consumption of complement
C ) Defective opsonization
D ) Destruction of CD4+ T lymphocytes
E ) Developmental arrest of maturation of B lymphocytes
F ) Dysmorphogenesis of the third and fourth pharyngeal pouches
G ) Impaired chemotaxis
H ) Impaired phagocytic oxidative metabolism
19. A 4-year-old boy is brought to the emergency department 20 minutes after being involved in a motor vehicle collision. He was an unrestrained passenger. On arrival, his blood pressure is 110/70 mm Hg, pulse is 100/min, and respirations are 32/min with grunting and retractions. Examination shows multiple bruises over the chest. Arterial blood gas analysis while breathing 40% oxygen shows:
pH 7.38
PCO2 34 mm Hg
PO2 66 mm Hg
An x-ray film of the chest obtained 4 hours later shows diffuse infiltrates on the right side. Which of the following is the most likely diagnosis?
A
) Acute respiratory distress syndrome
B
) Aspiration pneumonia
C
) Fat embolism
D
) Hemothorax
E
) Pulmonary contusion
20. A 72-year-old man comes to the physician because of a 7-month history of leg weakness and dry eyes and mouth. He also has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. He has smoked one and a half packs of cigarettes daily for 50 years. He drinks 4 oz of alcohol daily. He has peptic ulcer disease and emphysema. Medications include cimetidine, theophylline, and low-dose prednisone. Examination shows mild ptosis. He has a barrel-shaped chest. Breath sounds are distant. There is moderate weakness of the proximal muscles of the lower extremities. Reflexes are absent. He has difficulty rising from a chair. Sensory examination shows no abnormalities. An x-ray film shows a hyperinflated chest and a 3 x 4-cm mass in the right hilum. His neurologic findings are most likely due to a lesion involving which of the following?
A
) Muscle membrane
B
) Parasympathetic nervous system
C
) Peripheral nerve
D
) Presynaptic neuromuscular junction
E
) Sympathetic nervous system
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| #1077275 |
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thank you very much for starting up this thread mytime..
11.C -wheezing since birth,relief with neck extension
12.A -nurse maid's elbow
13.G -arnold chiari ...i guess
14.C -u/s to confirm dates
15.F -malingering ...sec. gain
16.C -salt ,protein restriction
17.B -diverticulitis
18.D -pcp ...so,i guess HIV
19.E -unilat.infiltrates in x-ray in 4 hrs
20.D -lung ca ...eaton lambert syndrome
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| #1077349 |
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yes, u r right.thank you mimra..
Patients with DiGeorge anomaly who present with infections as the first manifestation are unusual because cardiac malformations and hypocalcemia are so severe that they usually manifest in the neonatal period. However, recurrent infections are a major problem and an important cause of later mortality.
Increased susceptibility to infections caused by organisms typically associated with T-cell dysfunction is observed. These include systemic fungal infections, Pneumocystis jiroveci (previously Pneumocystis carinii) infection, and disseminated viral infections (Marcinkowski, 2000; Sanchez-Velasco, 2001). |
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| #1077564 |
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ok 21-35
21. A 42-year-old man comes to the emergency department because of a 2-week history of increasingly severe headaches and a 2-day history of nausea, vomiting, neck stiffness, and unsteadiness. He has type 2 diabetes mellitus treated with glyburide. His temperature is 38.1 C (100.5 F). Funduscopic examination shows bilateral papilledema. Neurologic examination shows mild meningismus and diffusely brisk deep tendon reflexes. He walks with a moderately broad-based gait. He is able to recall two out of three objects after 5 minutes and makes several errors on serial sevens. A CT scan of the head shows no abnormalities. Cerebrospinal fluid analysis shows a glucose level of 18 mg/dL, a protein level of 108 mg/dL, and a leukocyte count of 59/mm3 (1% segmented neutrophils and 99% lymphocytes); a cryptococcal antigen assay is positive. Which of the following is the most appropriate pharmacotherapy for this patient?
A
) Acyclovir
B
) Amphotericin B
C
) Itraconazole
D
) Penicillin
E
) Vancomycin
22. A 3-year-old girl is brought to the physician after her mother noted blood on her underpants. Examination shows genital condylomata acuminata in the perineal, peri-introital, labial, and anal areas. Some of the pedunculated condylomata appear to have caused the bleeding. She has no visible intravaginal condylomata or vaginal or anal tears. Her mother has a palmar wart on her hand but no history of condylomata acuminata. Her mother has a boyfriend who does not live with them and who has never been left alone with the girl. They live with the mother's 27-year-old brother who only baby-sits the children when they are asleep. Which of the following is the most appropriate next step in management?
A
) Psychiatric assessment of the mother
B
) DNA typing of the mother's palmar wart for papillomavirus
C
) Treatment of the mother's palmar wart
D
) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child
E
) Laser therapy of the condylomata acuminata in the child
23. A 55-year-old man has had crushing substernal chest pain on exertion over the past 6 weeks. He had a myocardial infarction 2 months ago. He takes nitroglycerin as needed and one aspirin daily. He has smoked two packs of cigarettes daily for 30 years. Examination shows normal heart sounds and no carotid or femoral bruits. Treatment with a β-adrenergic blocking agent is most likely to improve his symptoms due to which of the following mechanisms?
A
) Decreasing diastolic relaxation
B
) Decreasing myocardial contractility
C
) Dilating the coronary arteries
D
) Peripheral vasodilation
E
) Preventing fibrin and platelet plugs
24. A previously healthy 52-year-old woman comes to the physician because she has had a large pimple on her right hand for 2 weeks that has failed to heal. She resides in southeastern USA where she owns a nursery and garden shop. Examination shows a painless red papule on the hand with several nontender subcutaneous nodular lesions above it. Which of the following is the most likely diagnosis?
A ) Blastomycosis
B ) Candidiasis
C ) Coccidioidomycosis
D ) Histoplasmosis
E ) Sporotrichosis
25. A 28-year-old woman at 28 weeks' gestation reports excessive fatigability and dyspnea. Her blood pressure is 118/74 mm Hg, pulse is 110/min and regular, and lungs are clear to auscultation. The cardiac apex is not palpable. S1 is loud, and there is a sharp sound after S2. A low-frequency diastolic murmur is heard at the apex that increases in intensity before S1. Which of the following is the most likely diagnosis?
A
) Aortic regurgitation
B
) Ebstein's anomaly
C
) Mitral regurgitation
D
) Mitral stenosis
E
) Tricuspid regurgitation
26. A 27-year-old woman comes to the physician because of a 2-year history of intermittent diarrhea and severe cramping abdominal pain. The stools are watery, occasionally foul-smelling, and nonbloody. She is currently pain-free and has not had diarrhea for 2 days. She also has intermittent constipation. She has not had fever or weight loss. She returned from a trip to Mexico 3 months ago. She had an appendectomy at the age of 12 years and a cesarean delivery 4 years ago. Examination shows no abnormalities. Which of the following is the most likely diagnosis?
A
) Bacterial gastroenteritis
B
) Crohn's disease
C
) Intermittent small-bowel obstruction
D
) Irritable bowel syndrome
E
) Laxative abuse
27. An asymptomatic 21-year-old woman is found to have an adnexal mass on pelvic examination. She uses oral contraceptives. A photograph of the mass is shown. Which of the following is the most likely diagnosis?
A
) Benign cystic teratoma
B
) Corpus luteum cyst
C
) Dysgerminoma
D
) Endometrioma
E
) Mucinous cystoadenoma
28. A 16-year-old girl is brought to the physician because of episodes of palpitations over the past 6 months. The episodes occur when she runs or plays basketball. She is otherwise asymptomatic. Her blood pressure is 124/46 mm Hg, pulse is 78/min, and respirations are 18/min. She weighs 55 kg (121 lb) and is 180 cm (71 in) tall. Her arm span is 188 cm (74 in), and the upper segment to lower segment ratio is 0.85. Her fingers appear long and are hyperextensible. A grade 4/6, early diastolic murmur is heard along the upper and middle left sternal border with radiation to the apex. Peripheral pulses are bounding. Which of the following is the most likely cause of these findings?
A
) Aortic incompetence
B
) Aortic stenosis
C
) Mitral incompetence
D
) Mitral stenosis
E
) Pulmonary incompetence
F
) Pulmonary stenosis
G
) Tricuspid incompetence
H
) Tricuspid stenosis
29. A previously healthy 87-year-old woman comes to the physician because of a 4-month history of vulvar itching. Examination shows excoriated areas from scratching and a white, thin vulva. The labia minora are absent, and there are small fissures at the introitus. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
A
) Escherichia coli infection
B
) Lichen sclerosus
C
) Squamous cell carcinoma
D
) Trichomoniasis
E
) Vulvar melanoma
F
) Vulvar vestibulitis
30. One month after undergoing an uneventful renal transplant for chronic renal failure secondary to glomerulonephritis, a 38-year-old woman is hospitalized because of increased serum urea nitrogen (BUN) and creatinine levels. Prior to transplantation, she had been receiving hemodialysis for 3 years. Current medications include cyclosporine and prednisone. Examination shows no abnormalities. Over the past 48 hours, urine output has remained stable. Both renal biopsy and a radionuclide scan confirm the diagnosis of acute rejection. Which of the following is the most effective treatment?
A
) Immediate discontinuation of cyclosporine
B
) Increased dosage of corticosteroids
C
) Diuresis and alkalinization of the urine
D
) Renal dialysis for 1–2 weeks
E
) Transplant nephrectomy
31. An 18-year-old man comes to the physician 1 week after he had a blood pressure of 140/110 mm Hg during a routine precollege examination. His temperature is 37.1 C (98.7 F), blood pressure is 140/100 mm Hg, pulse is 92/min, and respirations are 12/min. The upper extremities appear to be more muscular than the lower extremities. Radial pulses are normal; femoral, posterior tibial, and dorsalis pedis pulses are decreased. A grade 2/6 systolic murmur is heard over the precordium, anterior chest, and back. An ECG shows left ventricular hypertrophy. Which of the following is the most appropriate next step in management?
A ) Limiting physical activity
B ) Repeat blood pressure measurement in 1 month
C ) Initiate a low-sodium diet and exercise program
D ) Pharmacologic management
E ) Operative treatment
32. A 77-year-old woman comes to the physician because of a 2-day history of cramping abdominal pain and distention accompanied by nausea and vomiting. She is otherwise healthy and has no history of abdominal operations. Her temperature is 37.4 C (99.4 F), blood pressure is 110/86 mm Hg, pulse is 112/min, and respirations are 24/min. Cardiopulmonary examination shows no abnormalities. Examination of the abdomen shows distention and mild diffuse tenderness; bowel sounds are high-pitched. An x-ray film of the abdomen shows air-fluid levels throughout the small bowel and air in the liver; there is no gas in the colon or free air. Which of the following is the most likely diagnosis?
A
) Adhesive small-bowel obstruction
B
) Cecal cancer
C
) Gallstone ileus
D
) Intussusception
E
) Mesenteric infarction
F
) Ruptured appendicitis
G
) Small bowel lymphoma
33. Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient-controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes?
A
) Epidural-related hypotension
B
) Insufficient intraoperative fluid replacement
C
) Postoperative intra-abdominal hemorrhage
D
) Supine hypotensive syndrome
E
) Underestimated intraoperative blood loss
34. A 42-year-old woman comes to the physician for evaluation of persistently increased blood pressures. At her last two office visits during the past 3 months, her blood pressure has ranged between 150–170/105–115 mm Hg. During this period, she has had occasional headaches. In addition, she has had an increased urine output over the past 6 weeks that she attributes to a diet high in sodium. She is otherwise healthy and takes no medications. Her blood pressure today is 168/115 mm Hg, pulse is 68/min, and respirations are 14/min. Funduscopic examination shows mild arteriovenous nicking. The point of maximal impulse is not displaced. There is no edema, abdominal bruits, or masses. Serum studies show:
Na+
144 mEq/L
Cl–
90 mEq/L
K+
2.9 mEq/L
HCO3–
32 mEq/L
Urea nitrogen (BUN)
20 mg/dL
Creatinine
1.2 mg/dL
Which of the following is the most likely underlying cause of this patient's hypertension?
A
) Autonomous production of aldosterone
B
) Catecholamine-producing tumor
C
) Decreased arterial distensibility caused by atherosclerosis
D
) Excess production of atrial natriuretic peptide
E
) Juxtaglomerular cell hypertrophy and sclerosis
35. A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?
A
) Acetaminophen with codeine therapy
B
) Arthrocentesis
C
) Bone marrow aspiration
D
) Bone scan
E
) Immobilization and traction
F
) Lyme titer
G
) MRI of the spine
H
) Physical therapy
I
) Reassurance
J
) Serum rheumatoid factor assay
K
) Systemic antibiotic therapy
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| #1077582 |
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21.B
22.D i guess
23.B
24.E
25.D - murmur charecteristic of MS
26.D - intermittent constipation & diarrhea
27.A - i remember the fig. has hair,tooth
28.A - marfan's
29.B - typical of lichen sclerosis ; rx high potent steroids
30.B
31.E - coarctation of aorta
32.C - air fluid levels in small bowel,air in liver
33.C - normal intra operative BP
34.A - hypokalemic HTN;pri.hyper aldosteronism
35.D - i guess;OM |
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| #1077588 |
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21)B...fungal lympocytes n all.
22)D i think...not too sure though.
23)B
24)E hehehe!
25)D
26)D
27)D :p
28)A...Homocysteinemia
29)B
30)E, I'D Say but what will she do without a kidney! so?
31)C ????? Naaaaa D.
32)C
33)A
34)B
35)B
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