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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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| * Re:Anyone interested in quick NBME discussion? |
| #1078373 |
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Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:
Prosthetic cardiac valve
Previous endocarditis
Congenital heart disease only in the following categories:
–Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
–Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*
–Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
Cardiac transplantation recipients with cardiac valvular disease
this is from AHA
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| * Re:Anyone interested in quick NBME discussion? |
| #1078613 |
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hdoc,for 18 q;
it shud b pericardiocentesis,not paracentesis i guess.
Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity with the purpose of sampling or draining ascitic fluid. Fluid may be removed for either diagnostic or therapeutic purposes.
correct me if i'm wrong |
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| * Re:Anyone interested in quick NBME discussion? |
| #1078760 |
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11) Morphine pretty sure abt it.
12) D
13) D, if it were alcohol, cause u might think like me that she's depressed. sudn't AST wud be high. also, if she were depressed she won't be looking for a job. i'd say ESTROGEN...she's probably fat, like me! :P
14) E
15) C, THIS ONE'S A JOKE! :D
16) D
17) G
18) A
19) H....WAS ALMOST ABT TO MIX WITH BRUTON'S (BUT STEPT/ H.INFL MOST COMMON THERE)
20)N
21) B
22)I'M CONFUSED WHAT ARE WE TREATING HER FOR ???????
23) B, correct me if i'm wrong but isn't D the same thing :O |
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| * Re:Anyone interested in quick NBME discussion? |
| #1078768 |
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Guys am glad this is helping u.....plz..... contribute ur answers as well. BS rocks.....she's done a good job. CYA in some hrs then..now i'll be back in 4 myself. :P
24. After an uncomplicated laparoscopic cholecystectomy, a 62-year-old man has not had any urine output since the Foley catheter was removed 12 hours ago. During the hour before the operation, the 40 minutes of operating room time, and the 2 hours in the recovery room, his fluid input was 2.5 L and urine output was 1 L. Since that time, he has been receiving intravenous 5% dextrose in water with 0.45% saline and morphine. He is awake and alert and has a moderate amount of abdominal pain. Preoperative serum studies showed:
Na+ 137 mEq/L
K+ 4.2 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.2 mg/dL
One hour after receiving an intravenous bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management?
A
) Increase in the dose of morphine
B
) Intravenous administration of an additional bolus of 0.9% saline
C
) Intravenous administration of doxazosin
D
) Intravenous administration of furosemide
E
) Reinsertion of a Foley catheter
25. A healthy 55-year-old man comes for an initial health maintenance examination. His last visit to a physician was over 10 years ago. He does not smoke and drinks only on social occasions. Examination shows no abnormalities. Which of the following immunizations should be administered?
A
) Hepatitis A vaccine
B
) Influenza virus vaccine
C
) Measles-mumps-rubella vaccine
D
) Pneumococcal vaccine
E
) Diphtheria-tetanus toxoid
26. A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3 weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and valproic acid. Physical examination shows no abnormalities except for dried blood in the nares. Mental status examination shows an anxious mood and slight motor restlessness. Serum studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100). Which of the following is the most appropriate next step in management?
A
) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B
) Measurement of serum bupropion level
C
) Platelet count
D
) Discontinuation of lithium carbonate therapy
E
) Discontinuation of valproic acid therapy
27. An asymptomatic 32-year-old man comes for a routine health maintenance examination. He has a 10-year history of frequent sinus and pulmonary infections. He had an anaphylactic reaction to a blood transfusion following a motor vehicle collision 3 years ago. His temperature is 37 C (98.6 F). Examination shows mild erythema in the posterior pharynx. The lungs are clear to auscultation. A complete blood count and serum protein electrophoresis are within normal limits. Which of the following is the most likely cause of the frequent infections?
A
) Colonization with Streptococcus pneumoniae
B
) Common variable immunodeficiency
C
) HIV infection
D
) Selective IgA deficiency
E
) X-linked agammaglobulinemia
28.
A 37-year-old man is brought to the emergency department 6 hours after the onset of constant, increasingly severe abdominal pain and nausea. His symptoms awoke him from sleep, and he has vomited once since that time. He has no history of similar symptoms, and he does not take any medications or use alcohol or illicit drugs. Family history is noncontributory. He is in acute distress and lying in the fetal position. Any movement exacerbates the pain. His temperature is 37.8 C (100 F), blood pressure is 108/68 mm Hg, pulse is 112/min, and respirations are 24/min. The lungs are clear to percussion and auscultation. Examination shows a rigid abdomen; bowel sounds are absent. Laboratory studies show:
Hemoglobin 14 g/dL
Leukocyte count 18,200/mm3
Platelet count 150,000/mm3
Serum
Urea nitrogen (BUN) 34 mg/dL
Creatinine 1.9 mg/dL
Total bilirubin 1.2 mg/dL
An x-ray film of the chest shows a small amount of free air under the left diaphragm. Administration of antibiotics and fluids is begun. Which of the following is the most appropriate next step in management?
A
) Barium swallow
B
) CT scan of the abdomen
C
) Intravenous administration of an H2-receptor blocking agent
D
) Upper endoscopy
E
) Laparotomy
29. A 52-year-old woman with alcoholism comes to the physician after a serum cholesterol level of 290 mg/dL was found on a routine screening. She drinks a pint of vodka daily. She takes captopril for hypertension and glyburide for type 2 diabetes mellitus. She also has intermittent episodes of gout. Fasting serum studies show:
Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 μU/mL
Which of the following is the most appropriate next step in management?
A
) Alcohol cessation
B
) Better control of diabetes
C
) Switch from captopril to calcium-channel blocking agent therapy
D
) Gemfibrozil therapy
E
) Thyroid replacement therapy
30. A 23-year-old woman has pain, cramping, and swelling of the right calf 3 days after an uncomplicated labor and delivery. The right foot is swollen, and there is marked tenderness with dorsiflexion and palpation of the right calf. Examination shows no other abnormalities. A complete blood count and serum electrolyte levels are within normal limits. Which of the following is the most likely cause of this condition?
A
) Hypercoagulable state of pregnancy
B
) Hyperuricemia
C
) Peripheral artery aneurysm
D
) Platelet embolus
E
) Prolonged pressure on the vena cava during delivery
31. A 2-month-old boy is brought to the physician for a well-child examination. He smiles spontaneously and vocalizes without crying, but he does not appear to laugh or squeal. He will not work for a toy that is out of his reach. Which of the following is the most appropriate assessment of language and psychosocial development?
Language
Psychosocial
development
development
A
)
Normal
normal
B
)
Normal
delayed
C
)
Delayed
normal
D
)
Delayed
delayed
32. A previously healthy 24-year-old woman comes to the physician because of a low-grade fever and a nonproductive cough for 7 days. She has been able to continue her daily activities. Her temperature is 37.7 C (99.9 F). A few scattered inspiratory crackles are heard in the thorax. An x-ray film of the chest shows patchy infiltrates in both lungs. Which of the following is the most appropriate initial pharmacotherapy?
A
) Amoxicillin
B
) Cefaclor
C
) Ciprofloxacin
D
) Erythromycin
E
) Trimethoprim-sulfamethoxazole
33. A 45-year-old woman comes to the emergency department because of shortness of breath, chest pain, dizziness, and mild numbness and tingling around the lips for 2 hours. She says that she feels like she is going to die. She had three similar episodes last week when she was vacationing at the Grand Canyon; the first episode occurred while crossing a narrow bridge on a donkey. She takes a hypoglycemic drug for type 2 diabetes mellitus, verapamil for hypertension, and sumatriptan as needed for migraine. She is mildly diaphoretic and appears pale. Her blood pressure is 130/90 mm Hg, pulse is 120/min, and respirations are 28/min. Serum glucose level is 120 mg/dL. An ECG shows sinus tachycardia. Sublingual nitroglycerin therapy does not relieve her symptoms and gives her a headache. The most appropriate next step in management is administration of which of the following?
A
) Haloperidol
B
) Lorazepam
C
) Oxygen
D
) Sumatriptan
E
) Verapamil
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