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* NBME-15 questions set #2-3
 #726607  
  ppkyaw - 03/23/13 01:57
 
  1) An 8-year-old boy is brought to the physician by his parents for a well-child examination. His sister died of leukemia 4 months ago. The parents state that he is sad at times, but he has had only minor performance difficult at school since his sister died. During the interview, the patient talks about his sister's death and cries. he then says that he has a headache. Physical examination shows no abnormalities. which of the following best describes this patient's condition?

A) Abnormal grief reaction
B) Conversion disorder
C) Major depressive disorder
D) Somatoform disorder
E) normal emotional response

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2) An 84-year-old woman with severe dementia is brought to the clinic by her daughter. The daughter tells the physician that her mother frequently refuses to eat despite being provided with her favorite foods. The patient is relaxed and cooperative but is unable to provide a reliable history because of her dementia. She is 167.6 cm (5 ft 6 in) tall and weight 86 kg (189.2lb); BMI is 31 kg/m2. She weighed 90 kg (198 lb) 3 months ago. Her temperature is 37 C (98.6 F), pulse is 86/min, blood pressure is 130/76 mm Hg, and respirations are 14/min. Examination shows no acute abnormalities. The daughter appears extremely worried and exhausted and is intermittently tearful during the visit. Which of the following interventions is most appropriate at this time?

A) Admit the patient to the hospital for placement of a feeding tube and initiation of enteral nutrition.
B) Admit the patient for parenteral alimentation and begin therapy with a selective serotonin reuptake inhibitor
C) Discuss the stresses of the patient's care with the daughter and provide information regarding possible assistance
D) Reassure the daughter that the weight loss is not a problem since her mother is still overweight
E) Reassure the daughter that weight loss is normal in elderly patients


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3) A study is conducted to evaluate the effectiveness of cough medication in children. A total of 120 patients under the age of 12 years who have been diagnosed with viral upper respiratory tract infection are randomly selected to receive dextromethorphan or no treatment. The participants were recruited from several emergency departments in an urban area. Parents complete a rating scale for their children's cough at baseline and 1 day after receiving the dextromethorphan or nothing. The results show a statistically significant improvement in cough scores for patients receiving dextromethorphan (p=0.04) compared with children receiving no treatment. Which of the following is the most significant limitation to the internal validity of this study?

A) Lack of blinding between groups
B) Limited number of paticipants
C) Marginal statistical significance
D) Study location limited to only emergency departments
E) Subjective nature of the survey instrument

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4) A 71-year-old woman comes to the physician for a follow-up examination. Shoe has a 30-year history of type 2 diabetes mellitus currently treated with insulin. She is 160 cm (5 ft 3in) tall and weighs 59kg (130lb); BMI is 23 kg/m2. Her blood pressure is 166/78 mm Hg. This patient is most likely to have an endogenous fasting serum insulin concentration (N=5-20 muU/mL) closest to which of the following?

A) 1 microU/mL
B) 10 microU/mL
C) 20 microU/mL
D) 40 microU/mL
E) 80 microU/mL

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5) A 75-year-old woman comes to the physician because of a 3 month history of an enlarging lesion on her face. Physical examination shows a 1.5-cm, brown-black, mottled, scaly lesion with irregular borders. Microscopic examination of a biopsy specimen of the lesion shows atypical melanocytes spread along the basilar layer of the epidermis. Which of the following is the mostly likely cause of these findings?

A) Acanthosis nigricans
B) Actinic keratosis
C) Compound nevus
D) lentigo maligna
E) Seborrheic keratosis


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6) 36-year-old woman is brought to the emergency department by her husband because of fever and shortness of breath for 2 hours. her husband says that she also has urinary frequency and pain with urination for 2 days. She is in respiratory distress. Her temperature is 38.7 C (101.7 F), pulse is 120/min, respiration are 30/min, and blood pressure is 80/50 mm Hg. Which of the following components of the causal organism is the most likely cause of the hypotension?

A) Flagellar H antigen
B) Lipopolysaccharide
C) P pilus
D) Polysaccharide capsule
E) Shiga-like cytotoxin

 
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* Re:NBME-15 questions set #2-3
#2857977
  vishdev88 - 03/23/13 02:11
 
  1 e
2 e i think i got it right
3 ? B got d wrong
4 A
5 d
6 b
 
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* Re:NBME-15 questions set #2-3
#2857980
  ppkyaw - 03/23/13 02:16
 
  No 4) please explain
 
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* Re:NBME-15 questions set #2-3
#2857983
  vishdev88 - 03/23/13 02:22
 
  no 4

pt has type 2 diabetes

getting treatment with insulin

as with any other hormone given from outside.... the endogenous production of insulin( or any hormone) will be suppressed as u are givin from outside.....

in type 2 u have insulin production ( as opposed to type 1 where there is auto immune destruction of beta cels) ... but there is a deficiency of insulin or peripheral resistance to insulin....

so If u give insulin from out... the body will stop make insulin inside.. negative feedbackk

like if u give thyroxine, endogenous t3 t4 will be suppressed rite??

they have given normal insulin level to be between 5 to 20, so when u take insulin from out... it shud be below 5... so 1........
 
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* Re:NBME-15 questions set #2-3
#2857985
  hamadis - 03/23/13 02:23
 
  for 1 in FA it says that grief more than 2 months is pathologic grief?  
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* Re:NBME-15 questions set #2-3
#2857987
  vishdev88 - 03/23/13 02:24
 
  when u give exogenous insulin.... pancreas goes to sleep, doesnt produce insulin due to negative loop.... hope this helps...

 
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* Re:NBME-15 questions set #2-3
#2857991
  vishdev88 - 03/23/13 02:36
 
  hamadis...

dont know abt that..when i read the question the child seems normal to me.. . the child in the question seems to be doin fine.... they just say his sister died 4 months back.... i dont think thinking back and cryin is pathological.. and they do say that he has only minor difficulty in school..and sad only at times.... nothin abt low mood all time...they dont say he is suffering in any way in performance.. dont know I may be wrong.. but I dont have it in wrong list.
 
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* Re:NBME-15 questions set #2-3
#2858014
  yuyu2013 - 03/23/13 05:23
 
  1 E
2 C
3 A
4 A
5 D
6 B
 
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* Re:NBME-15 questions set #2-3
#2858015
  yuyu2013 - 03/23/13 05:27
 
  would u pls tell me correct ans of question #3-35
Which is Changes in LVP RVP and LAP after VSD repair?
 
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* Re:NBME-15 questions set #2-3
#2858122
  samyusmle - 03/23/13 11:08
 
  all qs agree with @yuyu2013  
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* Re:NBME-15 questions set #2-3
#2858213
  hopedr - 03/23/13 13:50
 
  i also couldnt get the answer right on the vsd repair
 
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