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* nbme 1
  rizowana - 12/18/11 13:39
  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:
Head circumference (cm)

1 month
2 months
4 months
6 months

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

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* Re:nbme 1
  cgoose - 12/26/11 15:40
  yup, thanks got it... shall we continue the thread with sections 3 and 4?  
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* Re:nbme 1
  cgoose - 12/26/11 15:45
  Section 3:--

1. A 26-year-old woman is brought to the emergency department because of marked confusion for 2 hours; she also has had a flu-like illness for 3 days. Over the past 6 weeks, she has had increased fatigue, weakness, and nausea. She recently started thyroid hormone replacement therapy for autoimmune thyroiditis; 1 week ago, her serum thyroid-stimulating hormone level was 3 μU/mL. Her temperature is 38 C (100.4 F), blood pressure is 80/40 mm Hg, and pulse is 140/min. She appears confused and lethargic. Examination shows cool, mottled skin. There is generalized hyperpigmentation, especially involving the palmar creases. The lungs are clear to auscultation. Abdominal examination shows diffuse mild tenderness and no rebound. Laboratory studies show:

Hemoglobin 10 g/dL
Leukocyte count 9000/mm3
Segmented neutrophils 55%
Eosinophils 20%
Lymphocytes 25%
Na+ 124 mEq/L
Cl– 92 mEq/L
K+ 6.4 mEq/L
HCO3– 16 mEq/L

An x-ray film of the chest and urinalysis show normal findings. An ECG shows sinus tachycardia with peaked T waves. Which of the following is most likely to confirm the primary cause of this patient's condition?

A) Measurement of pulmonary artery pressure

B) Measurement of right atrial pressure

C) Measurement of serum antithyroglobulin antibody level

D) Measurement of serum lactate dehydrogenase activity

E) Measurement of serum thyroid-stimulating hormone level

F) ACTH stimulation test

G) Dexamethasone suppression test

H) Blood cultures

I) Echocardiography

FFF- cosyntropin test.
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* Re:nbme 1
  cgoose - 12/26/11 15:51
  2. A 27-year-old man comes to the physician because of a 1-week history of shortness of breath with exertion, paroxysmal nocturnal dyspnea, and swelling of his feet. He has not had chest pain or palpitations. He has been healthy except for a "bad cold" 1 month ago that resolved spontaneously after 10 days. His temperature is 37 C (98.6 F), blood pressure is 90/60 mm Hg, pulse is 120/min, and respirations are 24/min. Examination shows jugular venous distention to 8 cm. Bilateral basilar crackles are heard. Cardiac examination shows a diffuse, laterally displaced point of maximal impulse. There is a normal S1 and S2 and an S3. Examination shows 2+ pretibial edema bilaterally. An ECG shows no abnormalities. Echocardiography is most likely to show which of the following?

A) Asymmetric septal hypertrophy

B) Bicuspid aortic valve with stenosis

C) Diffuse hypokinesia and dilation of the ventricles

D) Dyskinesia of the left ventricular apex

E) Mitral valve prolapse
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* Re:nbme 1
  cgoose - 12/26/11 16:13
  10. A 28-year-old nulligravid woman comes for a routine health maintenance examination. She has had progressively severe dysmenorrhea over the past 6 months adequately controlled by nonsteroidal anti-inflammatory agents. Pelvic examination shows a normal vagina and cervix. The uterus is retroverted and fixed, and there is nodularity of the cul-de-sac. A 6-cm left adnexal mass is palpated. Transvaginal ultrasonography shows a 7-cm septated adnexal mass. Four weeks later, there is no change in the size of the adnexal mass. Which of the following is the most appropriate diagnostic test?

A) Measurement of serum CA 125 level

B) Barium enema

C) CT scan of the pelvis

D) MRI of the pelvis

E) Laparoscopy
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* Re:nbme 1
  cgoose - 12/26/11 16:16
  11. A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for 24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to a normal sinus rhythm, she began treatment with warfarin. Yesterday at a follow-up visit, her INR was 6, and her medication was discontinued. She takes no other medications. Her temperature is 37 C (98.6 F), blood pressure is 100/78 mm Hg, pulse is 120/min and regular, and respirations are 20/min. The abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium. There are no masses, organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the stool for occult blood is negative. Her hemoglobin level has decreased from 13 g/dL yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the following is the most likely explanation for this patient's abdominal symptoms?

A) Internal small-bowel herniation

B) Intestinal ischemia from a cardiac embolus

C) Intramural hematoma of the proximal small bowel

D) Intussusception of the small bowel

E) Malrotation of the small bowel
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* Re:nbme 1
  cgoose - 12/26/11 16:19
  I think 11 is C, blood gathering in small bowel wall which would explain the abrupt hb drop... NSR currently.  
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* Re:nbme 1
  raheem - 12/26/11 16:27
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* Re:nbme 1
  raheem - 12/26/11 16:35
  2- viral myocarditis...CC
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* Re:nbme 1
  cgoose - 12/26/11 16:57
  Is 10 - endometriosis?  
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* Re:nbme 1
  raheem - 12/26/11 17:19
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