nbme 1 - rizowana

[ArchivalUser]

36-g
37-f
38-e
39-e.................what is the diagnosis

[ArchivalUser]

39. post partum hypothyroidism

40. The genetic disease institute at a university hospital has developed a rapid screening test for a serious but treatable inherited metabolic disorder. Although this disorder is predominantly found in a particular ethnic group, it is also found sporadically throughout the entire population. The screening test has a sensitivity of 95% and a specificity of 90%. When used in an ethnically prescreened population where the prevalence of this disorder is 30%, the positive predictive value is 80% and the negative predictive value is 96%. The institute proposes to use this screening test on the general population where the prevalence of this disease is 0.1%. Which of the following is the most likely result of this screening program?

A
) Negative predictive value decreases

B
) Positive predictive value decreases

C
) Sensitivity decreases

D
) Specificity decreases

41. A 32-year-old woman comes to the physician because of a 1-year history of increasingly severe dull pain in her lower back and buttocks. She also has had morning stiffness of the lower back that lasts for 1 to 2 hours. There is no history of trauma. Her job does not require heavy lifting. Her blood pressure is 110/70 mm Hg, pulse is 68/min and regular, and respirations are 16/min. Cardiopulmonary examination shows no abnormalities. There is tenderness to palpation over the sacroiliac joints bilaterally and decreased flexion and extension of the lumbar spine. An x-ray film of the lumbosacral spine shows sclerosis of the sacroiliac joints. Laboratory studies are most likely to show which of the following findings in this patient?

A
) Decreased erythrocyte sedimentation rate

B
) Histocompatibility human leukocyte antigen B27

C
) Increased serum antinuclear antibody titer

D
) Increased serum carcinoembryonic antigen (CEA) level

E
) Positive serum rheumatoid factor

[ArchivalUser]

39. post partum hypothyroidism

40. A

41. B

[ArchivalUser]

41-bb

[ArchivalUser]

What about 40? in the general population the incidence of the disease decreases, so if someone is dis negetive then the chance increases, so the answer and vice versa, so the answer is D, not A

[ArchivalUser]

I meant the answer is B

[ArchivalUser]

41. A 32-year-old woman comes to the physician because of a 1-year history of increasingly severe dull pain in her lower back and buttocks. She also has had morning stiffness of the lower back that lasts for 1 to 2 hours. There is no history of trauma. Her job does not require heavy lifting. Her blood pressure is 110/70 mm Hg, pulse is 68/min and regular, and respirations are 16/min. Cardiopulmonary examination shows no abnormalities. There is tenderness to palpation over the sacroiliac joints bilaterally and decreased flexion and extension of the lumbar spine. An x-ray film of the lumbosacral spine shows sclerosis of the sacroiliac joints. Laboratory studies are most likely to show which of the following findings in this patient?

A
) Decreased erythrocyte sedimentation rate

B
) Histocompatibility human leukocyte antigen B27

C
) Increased serum antinuclear antibody titer

D
) Increased serum carcinoembryonic antigen (CEA) level

E
) Positive serum rheumatoid factor

42. A 6-month-old boy is brought to the physician because of respiratory distress for 1 day. He had a persistent dry cough 3 days ago. He has not had a fever or nasal discharge, but he has had chronic watery stools. He is at the 50th percentile for height and 10th percentile for weight. He appears ill and is in respiratory distress. His temperature is 37 C (98.6 F), pulse is 140/min, and respirations are 78/min. Pulse oximetry shows an oxygen saturation of 70% while breathing room air. Examination shows white plaques on the mucous membranes of his mouth and diffuse adenopathy. There are intercostal retractions, and diffuse crackles are heard throughout all lung fields. In addition to oxygen and antibiotic therapy, which of the following is the most appropriate next step in management?

A
) Stool culture for bacterial pathogens

B
) Urinalysis

C
) HIV testing

D
) Quantitative measurement of immunoglobulins

E
) Nitroblue tetrazolium testing

F
) Platelet morphology evaluation

G
) Tympanocentesis

[ArchivalUser]

43. A 42-year-old man is brought to the physician by his wife because of a 2-month history of staring spells that last 1 to 2 minutes each. During episodes, he also smacks his lips and picks at his shirt collar. Four years ago, he was comatose for 2 weeks after sustaining a head injury in a motorcycle collision; he required 6 months of rehabilitation. He reports that, over the past year, he has had intermittent episodes of smelling burnt rubber that occur approximately every 2 weeks. He hears an intense hissing sound during these episodes. Examination shows no abnormalities. Which of the following is the most likely diagnosis?

A
) Absence seizures

B
) Complex partial seizures

C
) Transient ischemic attack

D
) Tourette's disorder

E
) Limbic encephalopathy

44.

A 47-year-old woman is admitted to the hospital for evaluation of a 2-week history of increased irritability and racing thoughts. Her family reports that she argues with anyone who does not agree with her. She has been talking incessantly at a rapid rate and pacing around the house. She says that, for years, she has been hearing the voice of God telling her that she has been chosen for a special mission. She has barely slept for the past week, waiting to hear further messages from God. She is disheveled and dehydrated. Serum studies show:


Na+ 137 mEq/L
Cl– 96 mEq/L
K+ 3.8 mEq/L
HCO3– 22 mEq/L
Urea nitrogen (BUN) 30 mg/dL
Glucose 68 mg/dL
Creatinine 1.2 mg/dL

Mental status examination shows disorganized thoughts and flight of ideas. She is agitated and has difficulty staying seated. She is too distractible to perform cognitive tests. Toxicology screening is negative. Which of the following is the most likely diagnosis?

A
) Acute renal failure

B
) Borderline personality disorder

C
) Diabetes insipidus

D
) Narcissistic personality disorder

E
) Schizoaffective disorder

F
) Schizoid personality disorder

[ArchivalUser]

41 B
42 C
43 B
44 E

[ArchivalUser]

45. A 20-year-old man comes for a routine health maintenance examination. He has a 15-year history of difficulty relaxing his hands after tightly gripping objects or after shaking hands. His father has cataracts and frontal baldness. Examination shows thin forearms. There is moderate weakness of the hands and difficulty releasing after gripping with his hands. Which of the following is the most likely diagnosis?

A
) Amyotrophic lateral sclerosis

B
) Cervical spondylosis

C
) Multiple sclerosis

D
) Myasthenia gravis

E
) Myasthenic (Lambert-Eaton) syndrome

F
) Myotonic muscular dystrophy

G
) Polymyalgia rheumatica

H
) Polymyositis

I
) Progressive neuropathic (peroneal) muscular atrophy

46. A 47-year-old man is admitted to the hospital after threatening to harm a radio announcer he believed was broadcasting his thoughts. Over the past 20 years, he has had multiple psychiatric hospitalizations for threatening people who he believed were plotting against him, trying to control his mind, or causing him to hear voices by implanting devices in his head. Past symptoms improved with neuroleptic therapy; after discharge, he discontinued the medication and his symptoms worsened. Which of the following is the most appropriate pharmacotherapy to decrease this patient's risk for future hospitalization?

A
) Clozapine

B
) Fluphenazine hydrochloride

C
) Haloperidol decanoate

D
) Risperidone

E
) Trifluoperazine hydrochloride