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* NBME-Ped 3
 #846563  
  kennychan - 12/24/17 11:12
 
  A newborn is examined 12 hours after birth for excessive oral secretions and coughing following his first feeding. The symptoms resolve after suctioning. Polyhydramnios was diagnosed by ultrasonography at 35 weeks’ gestation. The pregnancy was otherwise uncomplicated. He was delivered at them with no complications. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. He weights 3005 g (6lb 10 oz). Examination shows no abnormalities. Which of the following is the most appropriate next step in management?
a) Genetic testing
b) Ultrasonography of the abdomen
c) CT scan of the chest
d) Laryngoscopy
e) Insertion of a nasogastric tube

Thanks for helping!
 
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* Re:NBME-Ped 3
#3356015
  kennychan - 12/24/17 11:41
 
  An 18-month-old girl is brought to the physician because of a 2-week history of symptoms of an upper respiratory tract infection. Over the past 15 months, she has had several episodes of acute otitis media. She is afebrile. On examination, she is alert and turns her head appropriately in response to sounds. The left external ear and canal appear normal. The left tympanic membranes is bluish gray with visible landmarks; an air-fluid level is present behind the inferior half of the tympanic membrane. There is minimal movement on pneumatic otoscopy. The right external ear, ear canal, and tympanic membrane appear normal. Which of the following is most likely diagnosis?
a) Acoustic neuroma
b) Acute otitis media
c) Bell palsy
d) Benign positional vertigo
e) Cholesteatoma
f) Mastoiditis
g) Perforation of the tympanic membrane
h) Retraction pocket of the tympanic membrane
i) Serous otitis media
 
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* Re:NBME-Ped 3
#3356016
  kennychan - 12/24/17 12:15
 
  A 17-year-old comes to the physician because of swelling of his lower lip that has slowly resolved during the past 2 days. He has a 12-month history of intermittent asymmetric swelling for his face, chest, and arms. During three of the episodes, the also had abdominal pain and diarrhea. There is no history of travel outside the USA. He takes no medications. He does not use illicit drugs. He is not sexually active. Examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
a) Skin testing for environmental allergies
b) Measurement of serum angiotensin-converting enzyme activity
c) Measurement of serum C1 esterase inhibitor concentration
d) Radioallegosorbent test (RAST)
e) Serum protein electrophoresis

Thanks for your opinions!
 
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* Re:NBME-Ped 3
#3356017
  kennychan - 12/24/17 12:23
 
  An 11-year-old boy is brought to the physician because of a 1-day history of lethargy, mild abdominal pain, and dark urine. He had a sore throat and an upper respiratory tract infection 10 days ago that resolved spontaneously. His pulse is 90/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. Examination shows slight swelling around the eyes. Urinalysis shows light brown urine with RBC and granular casts. Which of the following is the most likely mechanism for these findings?
a) Antigen-antibody immune complex
b) Bacterial infiltration of the basement membrane
c) Bacterial infiltration of the epithelial cells
d) Destruction of tubular epithelial cells
e) Renal ischemia

Thanks for your opinions!
 
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* Re:NBME-Ped 3
#3356018
  kennychan - 12/24/17 12:33
 
  A previously healthy 17-year-old girl comes to the physician with her mother because of an 8-month of increasing facial hair growth. The patient also has had a 5.4-jg (12-lb) weight gain during this time. Menarche was at the age of 10 years. Menses began to occur at regular 28-day intervals after the first 6 months. During the past year, menses have occurred at irregular 45-day intervals. The patient’s is concerned that her daughter may be depressed because she has become increasingly moody. The patient takes no medications. She is 163 cm (5ft 4 in) tall and weighs 64 kg (142 lb); BMI is 24kg/m2. Examination shows striae over the abdomen. There is no clitoromegaly. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?

a) Measurement of morning serum fasting cortisol concentration
b) Measurement of serum prolactin concentration
c) Measurement of serum testosterone concentration
d) CT of the abdomen
e) MRI of the brain

Thanks for your opinions!
 
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* Re:NBME-Ped 3
#3356051
  patel88 - 12/25/17 01:39
 
  1. esophageal atresia -- ng tube (E)
2. serous oitis media - air fluid level (I)
3. angioedema - measure C1 esterase inhibitor conc (C)
4. poststrep gmn - immune complex mediated (A)
5. cushings disease - measurement of morning serum fasting cortisol concentration (A)
 
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* Re:NBME-Ped 3
#3356059
  meerigo - 12/25/17 11:05
 
  @patel88 for 4,it sounds like PSGN.why can't it be D,destruction of tubular epithelial cells as urine is light brown with RBC and granular casts.please explain.thanks  
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