nbme exam - grazie

[ArchivalUser]

7) it's not A, I marked that and it was wrong
Probably E) is a better answer, because C > with tenderness? I don't think so. Patient can refer midepigastric pain but tenderness is tenderness to palpation in physical exam right? Oh brother , I need some guidance

8) E (correct answer)
Depends on response to antacids, we will know if our diagnosis was correct.
E was the correct answer in my exam.

Any inputs? Did anybody got this question 7 right?

[ArchivalUser]

midepigastric tenderness for pancreatitis

You don't do any tests because there are no alarm findings in this patient ( he is below 55 yrs old, no weight loss, dysphagia, odynophagia, obstructive sx, malignancy) so there's no point in doing them

[ArchivalUser]

AA is right with normal findings on physical exam since he only had intermittent dyspepsia for the last 3 months

http://img.ctrlv.in/img/14/08/19/53f2a4b46789a.png

[ArchivalUser]

AA?

[ArchivalUser]

You mean E E for q7 and q8

[ArchivalUser]

oh ya sry EE

[ArchivalUser]

9)

A 45-year-old woman comes to the office because of a 3-day history of gradually increasing nausea, vomiting, and abdominal pain. One week ago, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for symptomatic leiomyomata uteri. Today she says, "I ate some potato salad at a neighborhood cookout last night that I think made me sick." She says that several friends who attended the cookout have not had any gastrointestinal symptoms. The patient has a history of hypertension, type 2 diabetes mellitus, and degenerative joint disease of her knees. Medications include hydrochlorothiazide, glipizide, and ibuprofen as needed. She has smoked 3/4 pack of cigarettes daily for the past 23 years. She enjoys reading and describes herself as sedentary. She is 162 cm (5 ft 4 in) tall and weighs 130 kg (287 lb); BMI is 49 kg/m2. She is in mild distress. Vital signs are temperature 37.5°C (99.9°F), pulse 100/min, respirations 22/min, and blood pressure 146/78 mm Hg. Abdominal examination discloses mild tenderness to palpation and guarding, and hypoactive bowel sounds. The remainder of the physical examination discloses no abnormalities. Results of laboratory studies are shown:

Serum:
Glucose 284 mg/dL
Blood:
Hemoglobin 12 g/dL
Hemoglobin A1c 9.5%
WBC 13,000/mm3
Neutrophils, segmented 76%
Neutrophils, bands 2%
Basophils 1%
Monocytes 2%
Lymphocytes 2%
Platelet count 300,000/mm3
X-ray of the chest and abdomen is shown. Which of the following is the most likely explanation for this patient's current condition?
http://i42.photobucket.com/albums/e338/G...feaf01.png

A) Bowel perforation
B) Gastroenteritis
C) Hyperglycemia
D) Morbid obesity
E) Postoperative complication

[ArchivalUser]

EE bowel obstruction (multiple air fluid levels)

[ArchivalUser]

Aaa

[ArchivalUser]

Answer:

E) Postoperative complication >>> Bpwel Obstruction
This answer was right on my feedback.

Abdominal films demonstrate a stepladder pattern of dilated small-bowel loops, air-fluid levels, and a paucity of gas in the colon.

First Aid for the USMLE Step 2 CK, Eighth Edition (First Aid USMLE) (Kindle Locations 4055-4056).