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NBME Questions Discussions -1 - brainteaser
#1
I had some doubts on these ones and didnt get them right

1. A 32-year-old woman comes to the office for follow-up 6 days after having a 12-cm lipoma removed from her left lateral thigh. During the past 2 days she has had swelling and a mild increase in tenderness on and around the incision site. She reports no fever, chills, nausea, or vomiting. Vital signs are normal. Examination of the incision site shows a bubble-like swelling underneath the incision without erythema, drainage, or lymphadenopathy. The area is ballotable and there is a fluid wave on palpation. Which of the following is the most likely diagnosis?
A) Abscess B) Cellulitis C) Hematoma D) Recurrent lipoma E) Seroma

2. A 28-year-old woman, gravida 2, para 1, is admitted to the labor and delivery unit of the hospital at 33 weeks' gestation in active labor. The patient has had routine prenatal care and her pregnancy had been uncomplicated. Vital signs on admission are temperature 37.7°C (99.9°F), pulse 120/min, respirations 22/min, and blood pressure 124/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Physical examination discloses a nontender abdomen. Fundal height is 36 cm. Pelvic ultrasound is shown. Which of the following is the most likely underlying cause of this patient's condition? A) Amniotic band syndrome B) Fetal anencephaly C) Fetal esophageal atresia D) Fetal polycystic kidneys E) Hydatidiform mole F) Maternal hypertension

10. A 32-year-old white man comes to the office for the first time for evaluation of elevated blood pressure. He does not have a regular physician. His blood pressure was recently taken at a shopping mall as part of a screening program. He brings a card with him that shows that his blood pressure taken at the mall was 180/110 mm Hg. He does not smoke cigarettes and he exercises regularly with free weights. He has a family history of high blood pressure on his father's side. His serum lipid status is unknown. Vital signs are pulse 88/min and regular, respirations 16/min, and blood pressure 165/105 mm Hg sitting and 155/105 mm Hg recumbent. Physical examination shows a well-developed, well-nourished man in no acute distress. Funduscopic examination shows grade 2 hypertensive changes. No thyroid enlargement or neck bruits are noted. Lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The point of maximum impulse is displaced to the left of the midclavicular line. There are no abdominal bruits and there is no peripheral edema. ECG shows normal sinus rhythm and mild left ventricular hypertrophy. There is trace protein on urinalysis. Before determining whether this patient needs pharmacotherapy, which of the following findings should be noted?
A) Numerous elevated blood pressure measurements on outpatient continuous blood pressure monitoring B) One additional elevated office blood pressure measurement in 2 weeks C) Two additional elevated measurements; one in the office, and one at home D) Two additional elevated office measurements, each separated by a period of 2 weeks E) No additional blood pressure measurements are needed to make the decision


15. A 65-year-old man comes to the emergency department because of urinary hesitancy for the past week. He also has had dull low back pain for the past month. He is employed at the local nuclear power plant as a maintenance worker. He underwent transurethral resection of the prostate 6 years ago. He has hypertension that is controlled with hydrochlorothiazide. His diet consists mostly of high-starch foods. Family history is remarkable for hyperlipidemia and prostate cancer in an uncle. Vital signs are normal. Physical examination discloses an enlarged, nontender prostate with a firm nodule on the right. Serum prostate-specific antigen concentration is 6.8 ng/mL (N
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#2
1. Seroma - a nonbloody (no erythema, no lymphadenopathy) collection of fluid that builds up under the surface of your skin with wave palpation. Seromas may develop after a surgical procedure, most often at the site of the surgical incision or where tissue was removed. The fluid, called serum, doesn’t always build up right away. The swelling and fluid may start collecting several weeks after surgery.

Seromas are common in body contouring surgerys, such as liposuction or arm, breast, or buttock lifts
breast augmentation or mastectomy
thigh surgery**
hernia repair
abdominoplasty, or a tummy tuck

2. Esophageal atresia: checking is performed by assessing a pocket of maximal depth of amniotic fluid which is free of umbilical cord and fetal parts. The accepted values are:

< 2cm indicative of Oligohydramnios
2-8 cm: normal, but should be taken in the context of subjective volume
>8cm: is indicative of Polyhydramnios

Some math has to be done to get this answer: 91.5 mm = 9.15cm*

10. No additional blood pressure measurements are needed to make the decision

15. - Didn;t get the question please repost
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#3
15. A 65-year-old man comes to the emergency department because of urinary hesitancy for the past week. He also has had dull low back pain for the past month. He is employed at the local nuclear power plant as a maintenance worker. He underwent transurethral resection of the prostate 6 years ago. He has hypertension that is controlled with hydrochlorothiazide. His diet consists mostly of high-starch foods. Family history is remarkable for hyperlipidemia and prostate cancer in an uncle. Vital signs are normal. Physical examination discloses an enlarged, nontender prostate with a firm nodule on the right. Serum prostate-specific antigen concentration is 6.8 ng/mL (N
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#4
15. A 65-year-old man comes to the emergency department because of urinary hesitancy for the past week. He also has had dull low back pain for the past month. He is employed at the local nuclear power plant as a maintenance worker. He underwent transurethral resection of the prostate 6 years ago. He has hypertension that is controlled with hydrochlorothiazide. His diet consists mostly of high-starch foods. Family history is remarkable for hyperlipidemia and prostate cancer in an uncle. Vital signs are normal. Physical examination discloses an enlarged, nontender prostate with a firm nodule on the right. Serum prostate-specific antigen concentration is 6.8 ng/mL (N < 4.5) . Which of the following is the strongest predisposing factor in this patient for developing prostate cancer?

A) Age B) Exposure to radiation C) Family history D) History of benign prostatic hyperplasia E) Low-fiber diet
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#5
for question 15 the answer can be found in Harrisons vol 1 page 796 - the risk of prostate cancer increases by a factor of 2 IF one first degree relative is affected and by 4 if two or more are affected.
40% of early onset and 5-10% of all prostate cancer is hereditary (FAMILy HISTORY)
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#6
thank you
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#7
ty
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