nbme 6 online discussion - priya06

[ArchivalUser]

A 37-year-old primigravid woman at 9 weeks' gestation is admitted to the hospital because of progressive nausea and vomiting. Her symptoms began at 6 weeks' gestation but have worsened so that she can no longer keep food or fluids down. Her temperature is 36.9°C (98.4°F), pulse is 105/min, respirations are 16/min, and blood pressure is 110/60 mm Hg. Examination shows a uterus consistent in size with a 9-week gestation. Serum electrolyte concentrations are within the reference range. Urinalysis shows 3+ ketones. In addition to beginning intravenous hydration, which of the following is the most appropriate initial step in management?

A
)
High-protein diet

B
)
Total parenteral nutrition

C
)
Antiemetic therapy

D
)
Insertion of a nasogastric tube

E
)
Therapeutic abortion




A 5-year-old girl is brought to the physician because of temperatures to 40°C (104°F), tachypnea, and a nonproductive cough for 12 hours. Four days ago she was treated with an oral antibiotic for suspected pneumococcal pneumonia. Examination shows diminished breath sounds over the lower right lung fields and dullness to percussion at the right costophrenic angle. Which of the following is the most likely diagnosis?

A
)
Bronchopleural fistula

B
)
Empyema

C
)
Lung abscess

D
)
Pleurodynia

E
)
Pneumothorax


.
A 72-year-old man comes to the physician because of a 2-month history of urination twice nightly and occasional urinary frequency and urgency. He has a 15-year history of type 2 diabetes mellitus now moderately well controlled with glyburide. His father was diagnosed with prostate cancer at the age of 70 years, and his sister died of complications from systemic lupus erythematosus. His blood pressure is 135/86 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows no suprapubic fullness or tenderness. There is mild enlargement of the prostate with no palpable nodules. His postvoid residual volume is 10 mL. Serum studies show a urea nitrogen concentration of 45 mg/dL and creatinine concentration of 3.8 mg/dL. Urine dipstick shows 3+ protein. Which of the following is most likely to have prevented progression of this patient's renal disease?

A
)
Intermittent Foley catheterization

B
)
Intravenous mannitol therapy

C
)
Oral cyclophosphamide and prednisone therapy

D
)
Oral enalapril therapy

E
)
Oral finasteride therapy

F
)
Oral prednisone therapy only

G
)
Oral terazosin therapy

[ArchivalUser]

.
An asymptomatic 21-year-old woman is found to have an adnexal mass on pelvic examination. She uses oral contraceptives. A photograph of the mass is shown. Which of the following is the most likely diagnosis?

A
)
Benign cystic teratoma

B
)
Corpus luteum cyst

C
)
Dysgerminoma

D
)
Endometrioma

E
)
Mucinous cystoadenoma


.
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.


aortic stenosis is wrong ans

[ArchivalUser]

42-year-old woman comes to the physician because of right-sided abdominal cramps and nausea. During this period, she has noticed that her eyes are yellow. She has not had any other symptoms and has no other history of jaundice. Two months ago, she underwent a laparoscopic cholecystectomy for acute cholecystitis; intraoperative cholangiography was not performed at that time. She currently takes no medications. Vital signs are within normal limits. Examination shows scleral icterus. Cardiopulmonary examination shows no abnormalities. The abdomen is nondistended with mild right upper quadrant tenderness. There are no peritoneal signs. Bowel sounds are normal. Serum studies show:


Bilirubin, total 8 mg/dL
Direct 5 mg/dL
Alkaline phosphatase 650 U/L
AST 20 U/L
ALT 18 U/L

Abdominal ultrasonography shows dilation of the intrahepatic biliary ducts. Which of the following is the most appropriate next step in management?

A
)
CT scan of the abdomen

B
)
HIDA scan

C
)
Intravenous antibiotic therapy

D
)
Endoscopic retrograde cholangiopancreatography

E
)
Surgical exploration of the abdomen


A 37-year-old woman, gravida 2, para 1, at 12 weeks' gestation comes to the physician for her first prenatal visit. She has hypertension treated with a β-adrenergic blocking agent. Her first pregnancy was complicated by premature rupture of membranes at 26 weeks' gestation, followed rapidly by a preterm vaginal delivery. She is a carrier of the sickle cell trait. She has a history of an appendectomy at the age of 14 years. She does not smoke cigarettes, drink alcohol, or use illicit drugs. Her blood pressure is 130/82 mm Hg; other vital signs are within normal limits. Examination shows a uterus consistent in size with a 12-week gestation. Which of the following is the greatest risk factor for preterm delivery in this patient?

A
)
History of an abdominal operation

B
)
Maternal age

C
)
Maternal hypertension

D
)
Previous preterm delivery

E
)
Sickle cell status



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 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

A 3-month-old boy is brought for a well-child examination. He has poor head control. Examination shows generalized hypotonia. The point of maximal impulse is at the left anterior axillary line. The liver edge is palpated 4 cm below the right costal margin. The spleen is not palpable. Which of the following is the most likely diagnosis?

A
)
Congenital muscular dystrophy

B
)
Glycogen storage disease, type II (Pompe's disease)

C
)
GM1 gangliosidosis

D
)
Infant botulism

E
)
Ventricular septal defect

[ArchivalUser]

10)
A 52-year-old woman comes to the physician because of difficulty sleeping through the night and concentrating during the day since her son graduated from high school 2 months ago. At that time, she and her husband found a comment in their son's yearbook implying that he is gay. They were upset and confronted their son. He confirmed that he is gay and said he was surprised that they did not know. Since then, she has had constant scenarios running through her mind that involve her son and his friends. She occasionally feels short of breath and senses that her heart is racing. She has taken a 2-week leave of absence from her job, and she avoids talking to family members. She says that she still enjoys going out with her husband but starts to feel anxious when she is alone. She has no history of serious illness and takes no medications. She drinks a glass of wine with dinner most evenings. Physical examination shows no abnormalities. On mental status examination, she appears mildly anxious. Her thought process is logical and goal directed. She is preoccupied with her son's well-being. Which of the following is the most likely diagnosis?

A
)
Acute stress disorder

B
)
Adjustment disorder with anxiety

C
)
Generalized anxiety disorder

D
)
Panic disorder

E
)
Post-traumatic stress disorder

F
)
Primary insomnia


11)
A 20-year-old man is brought to the emergency department on a summer day 20 minutes after developing headache, nausea, and unsteady gait while running the last 2 miles of a marathon. On arrival, he is confused and disoriented. His temperature is 40°C (104°F), blood pressure is 100/60 mm Hg, and pulse is 155/min. His skin is warm and dry. Neurologic examination shows no focal findings. Which of the following is the most likely mechanism of this patient's condition?

A
)
Depletion of total body potassium

B
)
Depletion of total body sodium

C
)
High-output cardiac failure

D
)
Inadequate dissipation of body heat

E
)
Release of creatine kinase from muscle cells


12)A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37°C (98.6°F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium concentration is 120 mEq/L. An x-ray of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment?

A
)
Bisphosphonate therapy


I
)
Hydrocortisone therapy

B
)
Calcitonin therapy


J
)
Lactated Ringer's solution

C
)
Calcium therapy


K
)
Mannitol therapy

D
)
Dexamethasone therapy


L
)
Potassium therapy

E
)
5% Dextrose in 0.225% saline therapy


M
)
0.9% Saline therapy

F
)
5% Dextrose in 0.45% saline therapy


N
)
3% Saline therapy

G
)
5% Dextrose in water therapy


O
)
Sodium bicarbonate therapy

H
)
Fluid restriction


13)
A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings?

A
)
Decreased androgens


G
)
Increased androgens

B
)
Decreased estrogen


H
)
Increased estrogen

C
)
Decreased follicle-stimulating hormone (FSH)


I
)
Increased FSH

D
)
Decreased luteinizing hormone (LH)


J
)
Increased LH

E
)
Decreased progesterone


K
)
Increased progesterone

F
)
Decreased prolactin


L
)
Increased prolactin

14)
An asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm Hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen concentration is 23 mg/dL, and serum creatinine concentration is 1.4 mg/dL. Which of the following is the most likely cause of this patient's bruit?

A
)
Accumulation of lipids in the arterial wall

B
)
Hypertrophy of the arterial wall media

C
)
Infiltration of arterial wall by giant cells

D
)
Infiltration of round cells in the arterial wall

E
)
Reflex vasodilation


15)
A 70-year-old woman has had increasing abdominal pain over the past 2 days. She has renal failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours ago. She appears toxic. Her temperature is 39°C (102.2°F), and blood pressure is 140/90 mm Hg. Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness. Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?

A
)
X-rays of the abdomen

B
)
Comparison of abdominal fluid amylase with serum amylase activity

C
)
Gram stain of abdominal fluid

D
)
Ultrasonography of the abdomen

E
)
CT scan of the abdomen and pelvis

16)
Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient-controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes?

A
)
Epidural-related hypotension

B
)
Insufficient intraoperative fluid replacement

C
)
Postoperative intra-abdominal hemorrhage

D
)
Supine hypotensive syndrome

E
)
Underestimated intraoperative blood loss



I have posted these 16 questions . please if u know the answers post here with a brief explanation. thanks in advance.

[ArchivalUser]

can anyone please answer thses questions? or are they too easy to answer?

[ArchivalUser]

answers toyour questions:
1. C) Antiemetic therapy
2.
3. D) Oral enalapril therapy
4. A) Benign cystic teratoma
5. Orthostatic Hypotension
6. D) Endoscopic retrograde cholangiopancreatography
7. D) Previous preterm delivery
8.
9. B) Glycogen storage disease, type II (Pompe's disease)
10.
11. D) Inadequate dissipation of body heat
12. H) Fluid restriction
13. A) Decreased androgens
14. A) Accumulation of lipids in the arterial wall
15. C) Gram stain of abdominal fluid
16. C) Postoperative intra-abdominal hemorrhage

[ArchivalUser]

2) empyema
8)??? its probably cardiac tamponade so ? echo?
10) B)Adjustment disorder with anxiety

thanks for your help. how much did u score?

[ArchivalUser]

2. B) Empyema

[ArchivalUser]

yeah its tamponade and thats the second best option left ( echo )...i thought of paracentesis but it was wrong

[ArchivalUser]

i was thinking the same but was not 100% sure....thats why didn't answer...thanks for answers