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+--- Thread: nbme 1 - rizowana (/showthread.php?tid=641259)
0 - ArchivalUser - 01-03-2012
having problem posting 23
24. D, which one is that, UC or chrons?
0 - ArchivalUser - 01-03-2012
25. An asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm Hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen (BUN) level is 23 mg/dL, and serum creatinine level is 1.4 mg/dL. Which of the following is the most likely cause of this patient's bruit?
A
) Accumulation of lipids in the arterial wall
B
) Hypertrophy of the arterial wall media
C
) Infiltration of arterial wall by giant cells
D
) Infiltration of round cells in the arterial wall
E
) Reflex vasodilation
26. An otherwise healthy 4-month-old girl is brought to the physician because of a birthmark on her arm that has increased in size over the past several weeks. Examination shows a 3 x 2-cm, bright red, raised, soft, nontender, compressible patch over the left forearm. Which of the following is the most appropriate next step in management?
A
) Topical corticosteroid therapy
B
) Biopsy
C
) Laser therapy
D
) Excision
E
) No intervention is necessary
27. A 7-year-old girl is brought to the physician in September because of fever and sore throat for 1 day. She is in the third week of second grade. Her temperature is 38.6 C (101.5 F). Examination shows an erythematous pharynx and slightly enlarged tonsils without exudate. There is no significant cervical lymphadenopathy. A rapid test for group A streptococcus is negative. Which of the following is the most appropriate next step in management?
A
) Monospot test
B
) Throat culture
C
) Intramuscular penicillin therapy
D
) Oral erythromycin therapy
E
) Oral penicillin therapy
0 - ArchivalUser - 01-03-2012
25.A, RAS,
26. E will go away
27. i think its B
0 - ArchivalUser - 01-03-2012
The response options for the next two items are the same. You will be required to select one answer for each item in the set.
For each patient with weakness, select the most appropriate test to establish the cause of the condition.
A
) Brain stem auditory evoked potentials
B
) Carotid ultrasonography
C
) Chromosomal analysis for trinucleotide repeat
D
) Electroencephalography
E
) Electromyography and nerve conduction studies
F
) MRI of the spine
G
) Muscle biopsy
H
) Repetitive nerve stimulation
I
) Somatosensory evoked potentials
J
) SPECT scan
K
) Temporal artery biopsy
L
) Visual evoked potentials
28. A 57-year-old man is brought to the emergency department 6 hours after the onset of weakness of his right face, arm, and leg. Three days ago, he had an episode of sudden visual loss in his left eye that he describes as "a shade coming down." The episode resolved completely within 10 minutes. He has hypertension and type 2 diabetes mellitus, both poorly controlled with lisinopril and glyburide. Examination shows expressive aphasia and right lower facial droop. There is moderate weakness on the right, worse in the upper extremity than the lower extremity. Deep tendon reflexes are 3+ in the right extremities and 2+ in the left extremities. Babinski's sign is present on the right. Sensory examination shows no abnormalities.
For each patient with weakness, select the most appropriate test to establish the cause of the condition.
A
) Brain stem auditory evoked potentials
B
) Carotid ultrasonography
C
) Chromosomal analysis for trinucleotide repeat
D
) Electroencephalography
E
) Electromyography and nerve conduction studies
F
) MRI of the spine
G
) Muscle biopsy
H
) Repetitive nerve stimulation
I
) Somatosensory evoked potentials
J
) SPECT scan
K
) Temporal artery biopsy
L
) Visual evoked potentials
29. A previously healthy 27-year-old woman is brought to the emergency department because of a 2-day history of weakness of her arms and legs and numbness of her hands and feet and a 4-hour history of mild shortness of breath while supine. The weakness began in her feet and has progressed to involve the hands. She describes a sensation of "electrical shocks" extending from the buttocks to the feet. Today, she tripped and fell several times and was unable to button clothes or hold utensils. Three weeks ago, she had a mild upper gastrointestinal illness that resolved within 5 days. Her respirations are 20/min and shallow. There is mild facial weakness; cranial nerves are otherwise intact. Muscle strength in the upper and lower extremities is 4/5 proximally and 2/5 distally. There is areflexia. Babinski's sign is absent bilaterally. Sensation to vibration is slightly decreased at the fingers and toes.
0 - ArchivalUser - 01-03-2012
28.B?
29.E GBS
0 - ArchivalUser - 01-03-2012
28-BB
29-EE
0 - ArchivalUser - 01-03-2012
30.
A 72-year-old man comes to the physician with his wife because of chronic abdominal pain and headaches for 4 months. His wife states that he has become more forgetful over the past 6 months. He has a history of gout. He has smoked one pack of cigarettes daily for 50 years and drinks 10 oz of homemade whiskey daily. He takes no medications. His temperature is 36.8 C (98.3 F), blood pressure is 160/98 mm Hg, pulse is 74/min, and respirations are 16/min. Neurologic examination shows mild short-term memory loss and decreased sensation to pinprick in the distal extremities. He has an ataxic gait. There are gouty tophi on the dorsal aspect of the left elbow. Laboratory studies show:
Hematocrit 33%
Mean corpuscular volume 70 μm3
Serum
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatinine 2 mg/dL
Uric acid 14 mg/dL
Which of the following is the most appropriate next step in management?
A
) Measurement of blood lead level
B
) Measurement of serum porphobilinogen level
C
) CT scan of the abdomen
D
) MRI of the brain
E
) Carbidopa-levodopa therapy
31. A county health officer investigates an outbreak of illness among persons attending a church picnic. The illness is characterized by the onset of nausea and vomiting 3 to 4 hours after attending the picnic. All affected persons recover without specific therapy. The investigation implicates egg salad as the vehicle of transmission. This episode is consistent with a foodborne outbreak caused by which of the following?
A
) Clostridium perfringens
B
) Giardia lamblia
C
) Salmonella species
D
) Staphylococcus aureus
0 - ArchivalUser - 01-03-2012
30. A? i certainly dont see any clue except some s/s, he doesnt have pica
31. D
0 - ArchivalUser - 01-04-2012
32. A 62-year-old woman comes to the physician because of generalized weakness for 2 weeks. She has a 20-year history of arthritis of the hands treated with aspirin and acetaminophen. She had two episodes of urinary tract infections 5 and 11 years ago, respectively. Examination shows no abnormalities except for Heberden's nodes on the hands. Laboratory studies show:
Erythrocyte sedimentation rate
15 mm/h
Serum
Na+
136 mEq/L
Cl–
100 mEq/L
K+
4.9 mEq/L
HCO3–
20 mEq/L
Urea nitrogen (BUN)
41 mg/dL
Creatinine
4 mg/dL
Urine
Protein
1+
WBC
2–4/hpf
RBC
none
Bacteria
none
Squamous epithelial cells
occasional
Granular casts occasional
Renal ultrasonography shows no abnormalities. Which of the following is most likely to have prevented this condition?
A
) Periodic PPD skin testing
B
) Screening for autoimmune causes of glomerulonephritis
C
) Periodic renal ultrasonography
D
) Avoidance of analgesics
E
) Suppressive antibiotic therapy for treatment of urinary tract infections
33. A 60-year-old man comes to the physician because of increasing shortness of breath for 1 week; it occurs at rest and is exacerbated by exertion. He has not had chest pain. He has smoked two packs of cigarettes daily for 40 years. Between the ages of 18 and 30 years, he worked in a warehouse with exposed bare insulation; for the past 15 years, he has driven a taxi. Medications include ipratropium bromide and albuterol metered-dose inhalers. His temperature is 37 C (98.6 F), blood pressure is 170/95 mm Hg, pulse is 100/min, and respirations are 24/min. Anterior and posterior diffuse wheezes are heard. Cardiac examination shows no murmurs. There is mild pretibial edema. An x-ray film of the chest shows calcified pleural plaques on the right hemidiaphragm and a 2-cm pleural-based mass. With regard to the findings on the x-ray film, which of the following is most likely to have prevented this patient's condition?
A
) Appropriate immunizations
B
) Different occupation
C
) Different medications
D
) Hypertension screening
E
) Smoking cessation
0 - ArchivalUser - 01-04-2012
32.D?
33.B