| * NBME 12 Q's need help
||Q1) A 19-year-old man comes to the emergency department because of increasingly severe shoulder and abdominal pain for 3 days. His temperature is 39°C (102.2°F). Physical examination shows signs of acute peritonitis. An abdominal x-ray is shown. Which of the following is the most likely cause of this patient's current condition?
B Intraperitoneal abscess
D Perforated viscus
E Retained foreign body
i chaose C don't know why but it was wrong
Q2) A 56-year-old man with alcoholism comes to the physician because of a 2-month history of increasingly severe stomach pain and increased volumes of foul-smelling stool; he also has had a 9-kg (20-lb) weight loss during this period. He has a history of multiple visits to the emergency department because of severe abdominal pain. He has consumed one bottle of red wine daily for 5 years. His temperature is 37°C (98.6°F). Physical examination shows epigastric tenderness. His fasting serum glucose concentration is 150 mg/dL. A CT scan of the abdomen shows pancreatic calcifications. The most likely cause of this patient's current symptoms is a decrease in which of the following?
A) Bile acid synthesis
B Colonic bacteria
C Duodenal pH
D Fecal elastase
E 7α-Hydroxylase activity
i chose A & its wrong i know D is also worng
A 55-year-old man is admitted to the hospital because of a 2-day history of vomiting and severe abdominal pain in the right upper quadrant. He drinks six 12-ounce beers daily. Abdominal examination shows spider angiomata. The liver is hard and nodular on palpation. A CT scan of the abdomen is shown; the arrow indicates a mass. Hypertension of which of the following veins is most likely in this patient?
B Inferior phrenic
D Short gastric
i chose A & its wrong
Q4) A 62 yo man has had petechiae and easy bruising for the past month. He has a 2 yr history of alcoholic cirrhosis and portal HTN. Lab studies show
hemoglobin - 10g/dl
hematocrit - 30%
Leukocyte count - 4000Reticulocyte count - 8% of red cells
MCV - 102
platelet count - 68000
PT time - 16s
PTT - 28s
fibrinogen and fibrin split products = normal
Which of the following is the most likely cause of the pancytopenia
c. Fe def
d. B1 def
e. Vit C def.
i chose D & its wrong, so is the ans B ??
Q5) During an experiment on the effect of ATP on renal function, a kidney is exercised from an experimental animal and perfused with a mitochondrial inhibitor.
The kidney is then studies using micropuncture of single nephrons. In which of the following nephron segments is the greatest decease in sodium resorption most likely?
a) collecting duct
b) distal convoluted tubule
c) proximal convoluted tubule
d) Thick ascending limb of loop of Henle
e) Thin ascending limb of loop of Henle
f) Thin descending limb of loop of Henle
i chose f & its wrong
A 56-year-old man is brought to the emergency department 45 minutes after being found in a semicomatose condition in a public restroom. His pulse is 96/min, respirations are 28/min and labored, and blood pressure is 80/40 mm Hg. Physical examination shows cool, dry skin and partial obtundation. Laboratory studies show:
Na+ 133 mEq/L
K+ 6.7 mEq/L
HCO3− 3 mEq/L
Urea nitrogen 82 mg/dL
Glucose 900 mg/dL
Creatinine 3.8 mg/dL
Arterial blood gas analysis on room air:
Pco2 13 mm Hg
Po2 128 mm Hg
Which of the following best represents the renal compensatory response to the acid-base findings in this patient?
A Decreased H+ secretion into the tubule
B Decreased proximal tubule HCO3– reabsorption
C Decreased titratable acid excretion
D Increased HCO3– excretion
E Increased NH4Cl excretion
i chose D & its wrong
Q5) A 6-year-old boy is brought to the emergency department because of coughing, wheezing, and rapid breathing for 6 hours. He was diagnosed with an upper respiratory tract infection 2 days ago. His temperature is 37.2°C (99°F), pulse is 120/min, respirations are 44/min, and blood pressure is 90/60 mm Hg. Inspiratory and expiratory wheezes are heard throughout the lung fields. There is decreased tactile fremitus. Which of the following is the most likely diagnosis?
D Left-sided heart failure
E Pneumococcal pneumonia
i choase C & its wrong is the ans A ??
Q6) A 41 year old woman comes to the physician for a follow up examination 6 weeks after the diagnosis of hypertension was made. Her blood pressure today is 162/ 104 mm hg. A right abdominal bruit is heard. Physical examination shows no other abnormalities . Serum studies show :
urea nitrogen 9
on renal arteriography, sampling shows a left renal vein activity of 5 mu/ml( n 5-97) and renal vein renin activity of 176 mu/ml ( N 9-97). the systemic hypertension in the patient is directly mediated by a vasoconstrictor that emerges from which of the following ?
a- adrenal medullary chromafin cells
b- glomerular afferent arteriole
c- glomerular efferent arteriole
d- pulmonary vasculature
e- renal juxtaglomerular cells
i chose e & its wrong
explain the ans please.
|* Re:NBME 12 Q's need help
||I don't have any Ans key of NBME which u have mentioned but here are my best guess of the answers... I may be wrong...
1) d ... Acute peritonitis is caused by some sort of visceral perforation... May be appendix or gastric.
2) c... Symptom of epigatric pain, and pancreatic calcification , tells that secretin and cck is not secreting from pancreas causing malabsorption symptoms as well.
3) d... This is a case of portal hypertension, so the closest option for abdominal spider naive could be because of gastric vessels( my guess)
4) a.., Because that's the only option connects cirrhosis and pancytopenia
5) d.. That Is the site for k, na , ca (i am not sure ca or cl) atlases symporter...
6) no question
5) e...Decreased tactile fermitus tells that it is not a obstructive disease... And streptococcal pneumonia isore common in children that chf
6) b...Abdominal bruit tells their is a renal artery stenosis = renal afferent artery, as the pressures are lower side of normal range...
Hope that helps... Correct me if I am wrong