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* nbme 1 block 3 q5,q14,q25,q27,q32,q45
 #433317  
  dr_cool - 07/30/09 08:44
 
  5. A 67-year-old man has had shortness of breath on exertion for 3 months; he has had an 11.3-kg (25-lb) weight loss during this period. He has smoked two packs of cigarettes daily for 25 years. He appears chronically ill. Examination shows decreased breath sounds on the left; heart sounds are normal. An x-ray film of the chest shows a large left-sided pleural effusion. Which of the following is the most appropriate next step in diagnosis?

A
) Bronchoscopy

B
) Thoracoscopy

C
) Closed pleural biopsy

D
) Open pleural biopsy

E
) Thoracentesis



14.

A previously healthy 47-year-old woman comes to the emergency department because of a 36-hour history of nausea, vomiting, and abdominal pain that radiates to her back. Over the past 3 years, she has had intermittent episodes of cramping abdominal pain 1 to 2 hours after meals; the pain lasts for several hours and resolves spontaneously. She does not smoke and drinks one to two glasses of wine each evening. There is a family history of coronary artery disease and hypertension. Her temperature is 37 C (98.6 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 20/min. Abdominal examination shows moderate epigastric and right upper quadrant tenderness with no guarding or rebound; bowel sounds are decreased. Laboratory studies show:


Hematocrit 45%
Leukocyte count 9000/mm3 with a normal differential
Serum
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 120 U/L
Aspartate aminotransferase (AST, GOT) 78 U/L
Amylase 365 U/L
Lipase 1223 U/L (N=1–160)
Triglycerides 300 mg/dL

Which of the following is the most likely diagnosis?

A
) Acute cholecystitis

B
) Alcoholic hepatitis

C
) Alcoholic pancreatitis

D
) Ascending cholangitis

E
) Gallstone pancreatitis

F
) Hepatitis A

G
) Pancreatic cancer

H
) Peptic ulcer disease

I
) Triglyceride-induced pancreatitis



25. An 18-year-old man comes to the physician for an initial examination because of a 3-year history of fatigue and migrating joint pain. He has brought a large folder containing information about previous medical consultations, laboratory tests, and x-ray films. He takes no medications. He weighs 50 kg (110 lb) and is 173 cm (68 in) tall. Physical examination shows no other abnormalities. On mental status examination, he is preoccupied with his symptoms. When asked about his mood, he states that the future appears bleak, and that he is too tired to think about it. Which of the following is the most appropriate next step in management?

A
) Ask about further symptoms of obsessions and compulsions

B
) Ask about sexual history including sexual orientation and practices

C
) Ask about suicidal feelings

D
) Ask about travel history over the past 6 months

E
) Obtain a detailed exercise history

F
) Measurement of serum Lyme (Borrelia burgdorferi) antibody level

G
) Urine toxicology screening




27. A 30-year-old woman, gravida 2, para 1, is brought to the emergency department in labor. An episiotomy is performed. Following delivery of the head, the shoulders do not follow with the usual traction and maternal pushing. Which of the following is the most appropriate next step in management?

A
) Flexing the woman's knees toward her shoulders

B
) More forceful traction and fundal pressure

C
) Delivering the posterior arm

D
) Rotating the head 180 degrees

E
) Symphysiotomy



32. A 25-year-old woman comes to the physician because of a 3-month history of the unexplained urge to eat a few tablespoons of cornstarch daily. The amount of cornstarch ingested has increased gradually during this time. She has leiomyomata uteri; she is otherwise healthy. Her weight is unchanged from her last visit 1 year ago; she weighs 61 kg (135 lb) and is 168 cm (66 in) tall. Her blood pressure is 120/80 mm Hg, and pulse is 100/min. Physical examination shows mild pallor. Neurologic examination shows no abnormalities. She is embarrassed about her problem. She has no compulsive behavior or obsessive thoughts. An ECG shows sinus tachycardia. Which of the following is the most appropriate next step in management?

A
) Psychiatric assessment

B
) Complete blood count

C
) Thyroid function studies

D
) Urine toxicology screening

E
) Admission to an eating disorders clinic

F
) Antipsychotic therapy

G
) Folic acid supplementation

H
) Selective serotonin reuptake inhibitor therapy




45 For each child with fever and cough, select the most likely diagnosis.


A
) α1-Antitrypsin deficiency

B
) Cystic fibrosis

C
) Pneumothorax

D
) Pulmonary alveolar proteinosis

E
) Pulmonary aspergillosis

F
) Pulmonary hemorrhage

G
) Pulmonary tuberculosis

45. A 20-month-old girl is brought to the physician because of fever and cough for 2 days. She has had several similar episodes since the age of 4 months. Three months ago, she and her family visited her grandmother in Finland for 2 weeks. She is at the 25th percentile for length and 5th percentile for weight. She appears thin and pale. Her temperature is 38 C (100.4 F), pulse is 150/min, and respirations are 40/min. Examination shows mild clubbing. Wheezing and bilateral crackles are heard at the lung bases. An x-ray film of the chest shows streaky densities bilaterally with mild hyperinflation.





 
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* Re:nbme 1 block 3 q5,q14,q25,q27,q32,q45
#1828900
  toha - 07/30/09 08:59
 
  THORACOCENTASIS
GALL STONE PANCREATITS
ASK ABOUT FURTHER SX OF OCD
DELIVERING POSTERIOR ARM
THYROID FUNCTION TEST
CYSTIC FIBROSIS
 
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* Re:nbme 1 block 3 q5,q14,q25,q27,q32,q45
#1828930
  dream88 - 07/30/09 09:41
 
  E) Thoracentesis
E) Gallstone pancreatitis
A) Ask about further symptoms of obsessions and compulsions
A) Flexing the woman's knees toward her shoulders ( fMac murray forget the name of maneuver)
B) Complete blood count ( pica + leiomyofib)
B) Cystic fibrosis
 
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* Re:nbme 1 block 3 q5,q14,q25,q27,q32,q45
#1828959
  yvyhope - 07/30/09 10:05
 
  E) thoracentesis
E) gallstone
A) ask about futher...
C) I don't know which one is the preferred in America, but I know this one is usually widely used
Jacquemier's maneuver (also called Barnum's maneuver), or delivery of the posterior shoulder first, in which the forearm and hand are identified in the birth canal, and gently pulled.


The McRoberts maneuver is employed in case of shoulder dystocia during childbirth and involves hyperflexing the mother's legs tightly to her abdomen.The technique is effective in about 42% of cases.





B) complet blodd cell count
B)Cystic fibrosis
 
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