Solving NBME Form 1 - maritzasf

[ArchivalUser]

NBME CK FORM 1
Question 5

5. A 37-year-old man is brought to the emergency department 6 hours after the onset of constant, increasingly severe abdominal pain and nausea. His symptoms awoke him from sleep, and he has vomited once since that time. He has no history of similar symptoms, and he does not take any medications or use alcohol or illicit drugs. Family history is noncontributory. He is in acute distress and lying in the fetal position. Any movement exacerbates the pain. His temperature is 37.8 C (100 F), blood pressure is 108/68 mm Hg, pulse is 112/min, and respirations are 24/min. The lungs are clear to percussion and auscultation. Examination shows a rigid abdomen; bowel sounds are absent. Laboratory studies show:

Hemoglobin 14 g/dL
Leukocyte count 18,200/mm3
Platelet count 150,000/mm3

Serum
Urea nitrogen (BUN) 34 mg/dL
Creatinine 1.9 mg/dL
Total bilirubin 1.2 mg/dL

An x-ray film of the chest shows a small amount of free air under the left diaphragm. Administration of antibiotics and fluids is begun. Which of the following is the most appropriate next step in management?

A ) Barium swallow
B ) CT scan of the abdomen
C ) Intravenous administration of an H2-receptor blocking agent
D ) Upper endoscopy
E ) Laparotomy

[ArchivalUser]

4 you ar right it is prostate ca
5 e laparatomy

[ArchivalUser]

Answer) E

This patient has Pneumoperitoneum (Free air below the Diaphragm)

ACUTE ABDOMEN
The most important question to ask yourself when presented a case of an acute abdomen is when to Operate and when to Treat Medically.

When is surgery the answer?

 Peritonitis (excluding primary peritonitis)
 Abdominal pain/tenderness plus signs of sepsis
 Acute intestinal ischemia
 Pneumoperitoneum ***

[Fischer, USMLE Master the Boards Step 3]

[ArchivalUser]

Thanks drpred!!! I don't feel so lonely here

[ArchivalUser]

NBME CK FORM 1
Question 6


6. An 87-year-old woman is brought to the physician by her son because of progressive memory loss over the past 2 years. Her son says that she repeats herself frequently and has been forgetting to take her routine medications. She takes hydrochlorothiazide for mild systolic hypertension and levothyroxine for hypothyroidism. She had vulvar cancer 10 years ago treated with wide excision. Her blood pressure is 138/78 mm Hg. Physical examination is within normal limits for her age. Mini-Mental State Examination score is 23/30. Laboratory studies, including serum vitamin B12 (cyanocobalamin), thyroxine (T4), and thyroid-stimulating hormone levels, are within normal limits. A CT scan of the head shows mild volume loss. Which of the following is the most appropriate pharmacotherapy?

A) β-Adrenergic agonist
B) Cholinesterase inhibitor
C) Dopamine agonist
D) Prednisone
E) Selective serotonin reuptake inhibitor

[ArchivalUser]

Answer) B


DEMENTIA
ALZHEIMER’S DISEASE (AD)
Alzheimer’s presents with slowly progressive loss of memory exclusively in older patients (> 65). Although there are no focal deficits, such as motor or sensory problems, these patients develop apathy and, after several years, imprecise speech.

Diagnostic Testing: For all patients with memory loss, you must order the following tests:
 Head CT (Diffuse, symmetrical atrophy)
 B12 level
 Thyroid function testing (T4/TSH)
 RPR or VDRL
Alzheimer’s disease is a diagnosis of exclusion. The only abnormal test will be the CT scan of the head showing diffuse, symmetrical atrophy.

Treatment
Anticholinesterase medications:
Donepezil, Rivastigmine, and Galantamine; are the standard of care
Memantine is a medication from another class with modest benefit. Combinations are not effective.

[Fischer, USMLE Master the Boards Step 3]

[ArchivalUser]

NBME CK FORM 1
Question 7

7. A previously healthy 24-year-old woman comes to the physician because of a low-grade fever and a nonproductive cough for 7 days. She has been able to continue her daily activities. Her temperature is 37.7 C (99.9 F). A few scattered inspiratory crackles are heard in the thorax. An x-ray film of the chest shows patchy infiltrates in both lungs. Which of the following is the most appropriate initial pharmacotherapy?

A) Amoxicillin

B) Cefaclor

C) Ciprofloxacin

D) Erythromycin

E) Trimethoprim-sulfamethoxazole

[ArchivalUser]

Answer: D)

Mycoplasma Infection.
Atypical pneumonia. Dry cough, low grade fever, no signs of consolidation..and B/L Interstitial lungs disease. Appears to young people.
Tx: Macrolides

---------------

Relate:
 Young healthy patients with > Mycoplasma
 GI Symptoms, confusion > Legionella
 Recent Viral syndrome > Staphylococcus
 Alcoholics > Klebsiella
 Present at the time of birth of Animals > Coxiella burnetti
 Arizona construction workers > Coccidioidomycosis
 HIV with < 200 CD4 cells > Pneumocystis (PCP)

[Fischer, USMLE Master the Boards Step 3]



Patient Type:
--------------
Outpatient community-acquired pneumonia,

[ArchivalUser]

I really appreciate the way you carry along these Qs.I agree with your answers uptill now. My exam gonna be in 10 days so i posted those Qs to make it a little faster.if can do me a favor post the Qs a little faster.

[ArchivalUser]

Thanks wasim, I am not only doing NBME, I am also doing MTB and UW parallel. My exam is in a 5 weeks so I kind of have some time left. But I will think about it Maybe I can finish the qs first, let me think about it.
I am not posting answers, I am actually reading every topic from my favorite books: MTB, FA, Kaplan or Deja Vu, but only the topics that are being touched in these qs, thats why is taking me long, but I think is worth it for the exam.