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+--- Thread: nbme 1 - rizowana (/showthread.php?tid=641259)
0 - ArchivalUser - 12-24-2011
42. A?
0 - ArchivalUser - 12-24-2011
for Q 41...pap and mamog every 2 years......i think it is BB
42-A..MIDSYST.
B-HOLOSYST
C-DIAST. RUBLING
D-HOLOSYST. +RT HEART FAILURE+JUG DIST............IT IS DD
E..HOLOSYST.
0 - ArchivalUser - 12-25-2011
43. A 24-year-old woman comes to the physician because of constant, severe pain in her neck, shoulders, and back for 3 months. She has been unable to enjoy her usual activities because of the pain. Use of over-the-counter ibuprofen and aspirin has not relieved her symptoms. She has a history of irritable bowel syndrome. Examination shows multiple tender spots over the neck, shoulders, and lumbar spine. Range of motion of all joints is full. There is no evidence of synovitis. Fluorescent serum antinuclear antibody and rheumatoid factor assays are negative. Which of the following is the most likely diagnosis?
A
) Ankylosing spondylitis
B
) Fibromyalgia
C
) Polymyalgia rheumatica
D
) Polymyositis
E
) Seronegative rheumatoid arthritis
44. A 72-year-old man comes to the physician because of a 6-month history of mild to moderate shortness of breath when climbing stairs. He had a myocardial infarction 2 years ago and has had an ejection fraction of 35% since then. His only medication is a β-adrenergic blocking agent. The lungs are clear to auscultation. Cardiac examination shows an S4 gallop. There is no peripheral edema. Laboratory studies are within normal limits. An ECG shows no acute changes. Which of the following is the most appropriate pharmacotherapy?
A
) α-Adrenergic blocking agent
B
) Angiotensin-converting enzyme (ACE) inhibitor
C
) Angiotensin2-receptor blocking agent
D
) Nitrates
E
) Thiazide diuretic
0 - ArchivalUser - 12-25-2011
43. multiple tender points fibromyalgia
44. B ejection fraction is less than normal
0 - ArchivalUser - 12-25-2011
45. A 42-year-old woman comes to the physician because of a 3-month history of a recurrent vivid dream that several men are assaulting her and her children. Upon awakening, she is anxious and distressed by the frightening images. She realizes that it is just a dream but is afraid to go back to sleep. She does not know why she is having this particular dream because she has never been the victim of an assault. She drinks two to three cups of coffee each morning. She does not use illicit drugs. Physical examination shows no abnormalities. There is no evidence of depressed mood or hallucinations. Laboratory studies are within normal limits. Which of the following is the most likely diagnosis?
A
) Acute stress disorder
B
) Nightmare disorder
C
) Panic disorder
D
) Sleep apnea
E
) Sleep terror disorder
46. A 57-year-old man is brought to the emergency department 30 minutes after he was found on the floor of his house; he has left hip pain and shortness of breath. He has renal failure but has missed his last two dialysis treatments. His renal failure was caused by inadvertent ingestion of ethylene glycol. His renal function did not improve, and he is currently on the transplantation list. Medications include amlodipine and doxazosin. On arrival, his temperature is 37.5 C (99.5 F), blood pressure is 150/100 mm Hg, pulse is 95/min and regular, and respirations are 24/min. His breathing is rapid and deep. Crackles are heard in the lung bases. Examination shows a soft abdomen. Bowel sounds are normal. The left lower extremity is externally rotated. Laboratory studies show:
Serum
Na+ 135 mEq/L
Cl– 102 mEq/L
K+ 7.1 mEq/L
HCO3– 12 mEq/L
Arterial blood gas analysis on 4 L/min of oxygen by nasal cannula:
pH 7.22
PCO2 31 mm Hg
PO2 61 mm Hg
An ECG shows peaked T-waves. It will be at least 45 minutes before dialysis can be started. Which of the following is the most appropriate next step in management?
A
) Observation until dialysis is initiated
B
) Intravenous calcium gluconate
C
) Intravenous glucose and insulin
D
) Intravenous 0.9% saline
E
) Intravenous sodium bicarbonate
F
) Rectal sodium polystyrene sulfonate (Kayexalate)
__________________________________________________________________________________________________________________________________
0 - ArchivalUser - 12-25-2011
45. B nightmare disorder, happens in REM sleep, thats why she can remember it
46. B calcium for high potassium level
0 - ArchivalUser - 12-25-2011
43...BB
44...BB
0 - ArchivalUser - 12-25-2011
Hi,
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Thank you.
0 - ArchivalUser - 12-25-2011
45...B
46...B
0 - ArchivalUser - 12-26-2011
For Question 20, Block 2
I think it is K- increase resp. rate to blow off CO2. This is the simplest maneuver. I don't think it is increase FI02 because sats are already good at 96%