nbme 1 - rizowana

[ArchivalUser]

CC......

[ArchivalUser]

@raheem why its alcohol, GGT is high and what else is the clue?

[ArchivalUser]

16. A 15-year-old boy is brought to the emergency department 30 minutes after a 2-minute episode of loss of consciousness after completing a 400-meter race. On awakening, he says that he feels fine except for shortness of breath. He weighs 82 kg (180 lb) and is 191 cm (75 in) tall. His blood pressure is 110/70 mm Hg, pulse is 70/min and regular, and respirations are 15/min. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard at the left sternal border with minimal radiation to the neck; the murmur becomes louder when he stands.

For each patient with loss of consciousness, select the most likely diagnosis.


A
) Aortic stenosis

B
) Carotid sinus hypersensitivity

C
) Conversion reaction

D
) Hypertrophic obstructive cardiomyopathy

E
) Hypoglycemia

F
) Mitral valve prolapse

G
) Orthostatic hypotension

H
) Pulmonary embolus

I
) Seizure

J
) Vasovagal syncope

K
) Vertebrobasilar insufficiency

[ArchivalUser]

DD.....INC. HEART RATE(RUNNING) DEC. DIASTOLIC VOLUME WHICH DEC. COP

[ArchivalUser]

For each patient with loss of consciousness, select the most likely diagnosis.


A
) Aortic stenosis

B
) Carotid sinus hypersensitivity

C
) Conversion reaction

D
) Hypertrophic obstructive cardiomyopathy

E
) Hypoglycemia

F
) Mitral valve prolapse

G
) Orthostatic hypotension

H
) Pulmonary embolus

I
) Seizure

J
) Vasovagal syncope

K
) Vertebrobasilar insufficiency

17. A 62-year-old woman is brought to the emergency department 1 hour after a 1-minute episode of loss of consciousness; her symptoms began when she stood up after she passed a dark, watery stool. She has had diarrhea and dark stools for 2 days. She has been receiving warfarin therapy for deep venous thrombosis for 2 weeks. On arrival, her blood pressure is 82/60 mm Hg, and pulse is 150/min and regular. She is unable to stand. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard at the second right intercostal space with no radiation. Examination shows a soft, nontender abdomen. There is 1+ edema of the right lower extremity with no tenderness. Test of the stool for occult blood is positive.

[ArchivalUser]

JJ.........

[ArchivalUser]

no, orthostatic hypotension because of blood loss

[ArchivalUser]

SORRY I THOUGHT VALSALVAL HYPOTENSION.... DURING STRAINING AND STAND UP...THANKS

[ArchivalUser]

18. A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks two ounces of alcohol daily. She is dyspneic and diaphoretic. Her temperature is 37.2 C (99 F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. Examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, PCO2 of 30 mm Hg, and PO2 of 70 mm Hg. An x-ray film of the chest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?

A ) Echocardiography

B ) CT scan of the abdomen

C ) Ventilation-perfusion lung scans

D ) Bronchoscopy

E ) Paracentesis

[ArchivalUser]

pericarditis...........AA