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* NBME-questions
 #846264  
  kennychan - 12/12/17 18:10
 
  A 54 yo M with type 2 DM is brought to the emergency department by paramedics 30 minutes after his wife found him lying unresponsive on the bed. His fingerstick blood glucose concentration was 20 ml/dL, she called 911. His medications are glimepiride and metformin. He has no know drug allergies. At the scene, paramedics could not obtain intravenous access and transported him to the hospital. On arrival, the patient is diaphoretic and moaning softly. He does not cooperate with the examination. His temperature is 34.8C, pulse is 90/min, respirations are 8/min, and blood pressure is 134/86 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Cardiopulmonary examination shows no abnormalities. No skin rashes are noted. Now, fingerstick blood glucose concentration is 15 mg/dL. The nurses continue to have difficulty obtaining intravenous access. Which of the following is the most appropriate next step in management?
a) Application of a warming blanket
b) Bag-valve-mask ventilation
c) Intramuscular administration of glucagon
d) Oral ingestion of hard candies
e) Rectal administration of dextrose

I think C or E. Please give your opinions.
 
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* Re:NBME-questions
#3354990
  kennychan - 12/12/17 18:23
 
  A 47-year-old man is brought to the emergency department by a friend 30 minutes after a seizure. The friend says that while they were sitting on the couch at home, the patient suddenly became quiet, arched his back, and began to shake. The episode lasted 45 seconds. Immediately afterward, the patient was confused for 15 minutes. He has hypertension treated with amlodipine. He has no known drug allergies. He has smoked one pack of cigarettes daily for 20 years. He drinks eight to nine beers nightly. His last drink was 28 hours ago. On arrival, he is sleepy but responds to verbal stimuli. He appears restless. His temperature is 38.1, pulse is 106/min and regular, respirations are 18/min, and blood pressure 148/92 mm Hg. Pulse oximetry on room air shows on oxygen saturation of 97%. Physical examination shows clammy skin. The remainder of the examination, including neurologic examination, shows no abnormalities. Which of the following is the most appropriate next step in management?
A) Administration of dextrose and vitamin B1 (thiamine)
B) Administration of lorazepam
C) Administration of phenytoin
D) CT scan of the head
E) Intubation

Seizure Vs Alcohol withdraw?
 
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* Re:NBME-questions
#3354991
  kennychan - 12/12/17 18:29
 
  A 27-year-old man is brought to the emergency department 2 hours after he was involved in a head-on motor vehicle collision. He was the unrest4rained front-seat passenger. Examination of the right lower extremity shows discoloration and a dislocated knee. Sensation is absent from the knee to the toes. There are no palpable pulses distal to the femoral artery. No motor activity is present. Which of the following is the most appropriate next step in management?
a) Measurement of ankle brachial indices
b) Venous duplex ultrasonography
c) Nerve conduction studies
d) Venography
e) Reduction of the dislocated knee
f) Arteriography

I think arteriography is needed to rule out compartment syndrome.
 
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* Re:NBME-questions
#3354992
  kennychan - 12/12/17 18:36
 
  A 48-year-old woman comes to the emergency department 9 hours after she was bitten on the right forearm by another woman during an altercation in a bar. Medical history is unremarkable and the patient takes no medications. Vital signs are within normal limits. Physical examination shows a 1-cm avulsion to the right forearm. The remainder of the physical examination discloses no abnormalities. Which of the following is the most appropriate management of this patientís wound?
A) Antibiotic therapy only
B) Closure and antibiotic therapy
C) Closure only
D) Irrigation and antibiotic therapy
E) Irrigation, closure, and antibiotic therapy
 
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* Re:NBME-questions
#3354994
  kennychan - 12/12/17 18:45
 
  A previously healthy 23-year-old woman comes to the emergency department because of a 3-day history of severe left lower abdominal pain and foul-smelling vaginal discharge. She is sexually active with multiple male partners and uses condoms inconsistently. Her last menstrual period was 2 weeks ago. Her temperature is 38.5 C, pulse is 110/min, respirations are 14/min, and blood pressure is 110/85 mm Hg. Abdominal examination shows tenderness to palpation in the left lower quadrant. Pelvic examination shows cervical motion tenderness and left adnexal tenderness. There is foul-smelling white discharge. A urine pregnancy test is negative. Which of the following is most likely to confirm the diagnosis?
a) Blood cultures
b) Urinalysis
c) Urine culture
d) Abdominal x-ray
e) Pelvis ultrasonography

Thank You for helping!
 
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* Re:NBME-questions
#3355111
  2pac - 12/13/17 22:18
 
  Chan i saw this q on uw

*SEvere hypoglycemia with LOC is typically treated with IM glucagon in the non medical setting and IV dextrose in the medical setting

so i think it's c
 
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* Re:NBME-questions
#3355397
  kennychan - 12/16/17 13:02
 
  For the first question: E is wrong, C is the right answer.  
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* Re:NBME-questions
#3355788
  vadev - 12/21/17 07:52
 
  2-B alcohol withdrawal delirium- can cause seizure fever tachycardia ...
3-I think E. Arteriography is not necessary, already we have ischemia of the limb we should surgicaly treat the cause of it(compartment s-m or dislocation decreases blood flow by compression)
4-E I am not sure
5-E Pelvic inflammatory disease-US, STD tests
 
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