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+--- Thread: nbme 1 - rizowana (/showthread.php?tid=641259)
0 - ArchivalUser - 01-02-2012
21. A 42-year-old man comes to the physician because of progressive swelling of the legs over the past 2 months. He has a history of stage IIA Hodgkin's disease treated 1 year ago with radiation therapy to the neck and chest. His temperature is 37 C (98.6 F), blood pressure is 102/80 mm Hg, pulse is 110/min, and respirations are 22/min. Examination shows jugular venous distention that increases with inspiration. The lungs are clear to auscultation. Cardiac examination shows a nondisplaced point of maximal impulse; heart sounds are distant. An early diastolic sound is heard at the apex. Abdominal examination shows mild distention with shifting dullness. The liver is pulsatile, and its edge is palpated 4 cm below the right costal margin. There is 2+ peripheral edema extending up to the knees. Which of the following is the most likely mechanism of this patient's increased central venous pressure?
A
) Constrictive pericarditis
B
) Cor pulmonale
C
) Left-sided congestive heart failure
D
) Mitral stenosis
E
) Tricuspid stenosis
22. A 5-year-old boy is brought to the emergency department 30 minutes after he fainted at home after standing up from a sitting position. His symptoms began 3 days ago with diarrhea and vomiting. He has had no urine output for 18 hours. He is alert but quiet. His temperature is 37.5 C (99.5 F), blood pressure is 75/45 mm Hg, pulse is 120/min, and respirations are 28/min. Examination shows dry lips and tenting of the skin. There is no abdominal tenderness. Bowel sounds are hyperactive. The remainder of the examination shows no abnormalities. His capillary refill time is 5 seconds. Intravenous bolus doses of 0.9% saline are administered. Bladder catheterization yields 5 mL of urine. Urinalysis is most likely to show which of the following?
A
) Blood
B
) Erythrocyte casts
C
) Hyaline casts
D
) Leukocyte casts
E
) Oxalate crystals
0 - ArchivalUser - 01-02-2012
21. someone explain pl
22. C hyalin cast
0 - ArchivalUser - 01-02-2012
19-aa
0 - ArchivalUser - 01-02-2012
2-bb
0 - ArchivalUser - 01-02-2012
sorry 19...CC
0 - ArchivalUser - 01-02-2012
21-KUSSMUL SIGN+RT SIDE HEART FAILUER.............AA
NOT ..B COZ LUNG IS CLEAR ..
NOT ,,C COZ LUNG IS CLEAR
NOT D COZ LUNG ..IS CLEAR
NOT E COZ..WE HAVE HEPATOMEGALY
0 - ArchivalUser - 01-02-2012
22- CC
0 - ArchivalUser - 01-03-2012
23.
A 2-year-old boy is brought to the physician because of fever and cough for 2 days. He had Streptococcus pneumoniae meningitis at the age of 1 year, S. pneumoniae bacteremia at the age of 18 months, and pneumonia at the age of 22 months. Two maternal uncles died before the age of 2 years from "infection." His temperature is 39.8 C (103.6 F), pulse is 150/min, and respirations are 60/min. Examination shows subcostal retractions on inspiration. Laboratory studies show:
Hemoglobin 10 g/dL
Leukocyte count 36,000/mm3
Segmented neutrophils 70%
Bands 20%
Lymphocytes 8%
Monocytes 2%
Platelet count 240,000/mm3
Serum
IgA
0 - ArchivalUser - 01-03-2012
IgA
0 - ArchivalUser - 01-03-2012
24.
A previously healthy 13-year-old girl is brought to the physician because of a 2-month history of intermittent abdominal pain and loose stools. She has had a 2.3-kg (5-lb) weight loss during this period due to a decreased appetite, but she drinks up to 1 liter of fruit juice daily. At her last visit 9 months ago, she was at the 50th percentile for height and the 50th percentile for weight. She is now at the 50th percentile for height and the 10th percentile for weight. Her temperature is 37.8 C (100 F), pulse is 80/min, and respirations are 18/min. Examination shows no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:
Hemoglobin 8.5 g/dL
Leukocyte count 9100/mm3
Segmented neutrophils 55%
Lymphocytes 35%
Monocytes 10%
Platelet count 650,000/mm3
Erythrocyte sedimentation rate 75 mm/h
Serum
Na+ 139 mEq/L
Cl– 101 mEq/L
K+ 3.2 mEq/L
HCO3– 23 mEq/L
Urea nitrogen (BUN) 8 mg/dL
Glucose 73 mg/dL
Creatinine 0.2 mg/dL
A barium enema shows patches of ulcerations along the proximal colon with reflux of dye into the terminal ileum. Which of the following is the most appropriate next step in management?
A
) Eliminate fruit juice from the patient's diet
B
) Switch to a gluten-free diet
C
) H2- receptor blocking agent therapy
D
) Prednisone and aminosalicylate therapy
E
) Bowel resection