nbme exam - grazie

[ArchivalUser]

http://i42.photobucket.com/albums/e338/G...1b1c3b.png

5.
An 18-month-old girl is brought to the office by her mother because of a worsening vulvar rash that the mother first noticed 10 days ago. She says the rash has become worse during the past week and that her daughter has become quite irritable. The mother has tried using several different brands of wipes without improvement. Three weeks ago the girl began amoxicillin therapy for otitis media that has since resolved. Medical history is otherwise unremarkable. Vaccinations are up-to-date. The child was placed in a day-care facility full time 4 weeks ago and was switched to disposable diapers from cloth diapers at that time. Vital signs are normal. Physical examination discloses the findings shown in the photograph. Which of the following is the most likely explanation for this patient's worsening condition?

A) Sexual abuse
B) Streptococcal infection
C) Use of amoxicillin
D) Use of disposable diapers
E) Vaginal foreign body

[ArchivalUser]

Ans) C

got it right with C by feedback of nbme

Antibiotic use can lead to increased growth of Candida species. The use of commonly prescribed antibiotics such as amoxicillin increases the risk for developing diaper rash. Amoxicillin use in infants decreases the number of bacteria and increases the number of C. albicans.

[ArchivalUser]

6.
A 48-year-old white woman, gravida 4, para 4, comes to the office because of urine leakage when she coughs, sneezes, and runs that has required daily use of absorbent pads. She says she first noticed the problem after her last child was born 11 years ago, but she notes that her symptoms have worsened during the past year. Medical history is remarkable for depression treated with citalopram. During her last pregnancy, she was hospitalized for 2 weeks for treatment of pyelonephritis with intravenous antibiotic therapy. Pregnancies were otherwise uncomplicated and resulted in spontaneous vaginal deliveries. The patient underwent tubal ligation 9 years ago. At that time she was told that filmy pelvic adhesions were noted between the ovaries and the bowel. She has not had any pelvic pain or symptoms since that time. She has smoked one pack of cigarettes daily for the past 30 years. She is 170 cm (5 ft 7 in) tall and weighs 64 kg (140 lb); BMI is 22 kg/m2. Vital signs are normal. Physical examination of the external genitalia shows a urethrocele. Pelvic examination discloses a second degree cystocele and a normal-appearing cervix. Uterine size is normal and there are no adnexal masses. Rectal examination shows a second degree rectocele. Which of the following studies is most likely to establish a diagnosis?

A ) Cystography
B ) Cystometrics
C ) Cystoscopy
D ) Intravenous urography
E ) Urine culture

[ArchivalUser]

BB CYSTOMETRICS

[ArchivalUser]

bb

[ArchivalUser]

Oh boy! I got this wrong, I marked C
but yes, B seems like a very good option

Thank you guys!

Cystometric study measures the amount of fluid in the bladder when you first feel the need to urinate, when you are able to sense fullness, and when your bladder is completely full. The test will help determine the cause of bladder voiding dysfunction.

[ArchivalUser]

q-7
Item 1 of 2


A 52-year-old man comes to the office because of a 3-month history of intermittent substernal burning. The burning is worse when he eats late at night or when he eats fatty or spicy foods. Over-the-counter antacids have provided occasional relief. He has been otherwise healthy and has not seen a physician for more than 10 years. He is 183 cm (6 ft) tall and weighs 104 kg (230 lb); BMI is 31 kg/m2. Vital signs are temperature 36.6°C (97.9°F), pulse 68/min, respirations 18/min and regular, and blood pressure 135/83 mm Hg.


The physical examination is most likely to show which of the following?

A) Erythematous pharynx

B) Left upper quadrant mass

C) Midepigastric tenderness

D) Positive Murphy sign

E) Normal findings



Item 2 of 2
Ranitidine is prescribed and a follow-up appointment is scheduled in 3 weeks. Which of the following is most appropriate diagnostic study?

A) Esophageal pH monitoring
B) Esophagogastroduodenoscopy
C) Ultrasonography of the abdomen
D) Upper gastrointestinal barium study
E) No further studies are indicated

[ArchivalUser]

E
E


i guess

[ArchivalUser]

AA

EE

[ArchivalUser]

AA
AA

IT IS GERD