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nbme 2 - someguy
#1
23. A 27-year-old man is brought to the hospital by family members
because he has remained in his room for 3 days. He
has refused to go to work or eat with the family, and he expresses concern
that family or friends may try to kill him. One week ago, he was
despondent when his girlfriend of 5 years abruptly ended their
relationship. He has no history of psychiatric illness. Which of the following
is the most likely diagnosis?

A) Adjustment disorder with depressed mood

B) Bipolar disorder

C) Brief psychotic disorder

D) Dysthymic disorder

E) Schizoaffective disorder


28. A 40-year-old man has the sudden onset of
excruciating head and neck pain while carrying books from the basement to
the attic. His temperature is 37 C (98.6 F), blood pressure is 130/90
mm Hg, and pulse is 90/min. He has photophobia and develops eye pain with
lateral eye movements. His neck is markedly stiff and cannot be
passively flexed. He has diffuse hyperreflexia in all extremities with
normal strength and sensation. Plantar reflexes are flexor bilaterally.
Which of the following is the most likely diagnosis?

A) Cervical osteoarthritis
B) Meningitis
C) Ruptured cervical disc
D) Subarachnoid hemorrhage
E) Syringomyelia


41. A 60-year-old man comes to the physician
because of difficulty sleeping and concentrating and a 5-kg (10-lb) weight
loss over the past 3 months. He also has become withdrawn. He has had
chronic pain since sustaining fractures of the left lower extremity,
pelvis, and several ribs in a motor vehicle collision 2 years ago. He has
a previous history of alcohol abuse. He takes a nonsteroidal
anti-inflammatory drug. Which of the following is the most appropriate
pharmacotherapy?

A) Carbamazepine

B) Chlordiazepoxide

C) Disulfiram

D) Lithium carbonate

E) Nortriptyline
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#2
23_C
28_B
41_C
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#3
well i c like this
c,d,e
first patient after the basis of exclusion comes under brief psychotic disorder... ( though lacking pschotic features )

2nd i think it is intracranial bleed and it is not meningtis because patient temperature is normal..

3rd patient is in depression we need to start antidepressant and the options make me to pick nortryptaline.

lets knw what others think as well ..
Reply
#4
C
D - as explained above
E( it will treat the chronic pain too)
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#5
28.

SAH: Pt typically has acute severe headache and neck stiffness with an elder age and Hx of HTN. Mcc berry anerurysm rupture but can also be from an A-V malformation.
Dx: CT Scan or spinal Tap.
Tx: Clipping an unruptured aneurysm
Prognosis: Poor with a ruptured aneurysm (with 75% death or disability), and with increased ischemic strokes from vasospasm after 3-5 days
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