06-20-2014, 12:36 PM
HELLO GUYS! THESE QUESTIONS ARE FROM NBME 7, I DELETED MY WRONG QUESTIONS..PLEASE HELP ME TO DO THE EXERCISE TO FIND THE CORRECT ANSWER...
THANKS!
19. A 4-year-old boy has had increasing fatigue since a viral illness 3 weeks ago. He has been pale for 1 week, and yesterday his gums began to bleed when he brushed his teeth. Examination shows cervical, axillary, and inguinal adenopathy and hepatomegaly. Hemoglobin concentration is 8 g/dL, leukocyte count is 3000/mm3, and platelet count is 30,000/mm3. Which of the following is the most appropriate next step in management?
A.Intramuscular administration of vitamin K
B.Transfusion of packed red blood cells
D.bone marrow aspiration
E.Lumbar puncture
24.
A 19-year-old man is brought to the emergency department by police for evaluation after he was found standing in his neighbor's living room during the middle of the night. He is conscious but remains mute during questioning. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 18/min, and blood pressure is 160/95 mm Hg. Physical examination shows bilateral nystagmus, constricted pupils, hypertonia, and decreased sensation to pinprick. Which of the following is the most likely substance taken?
A.Alcohol
B.Amphetamine
C.Hallucinogen
D.Inhalant
F.PCP
25.
A previously healthy 6-year-old boy is brought to the emergency department because of cramping abdominal pain and right-sided scrotal pain for 4 hours. He vomited once on the way to the hospital. Examination shows a distended abdomen. Bowel sounds are decreased, and there is diffuse tenderness to palpation with involuntary guarding. The right hemiscrotum is slightly discolored with swelling and tenderness superiorly. The left hemiscrotum is normal; the testicle is normal. Which of the following is the most appropriate next step in management?
B.Valsalva maneuver
C.Urinalysis
D.Doppler ultrasonography
E.CT scan
F.Antibiotic therapy
G.Operative procedure
29.
A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter. The mother asks to speak to the physician alone and explains that she persuaded her daughter to come because the girl has begun to stay out late, receive many calls from several different boys, and wear tight clothing and excessive makeup. She says her daughter confides many details of her dates to her. She adds that the girl's father is furious and berates her about this behavior even though he does not know about most of what is going on. To protect her daughter, she does not want to tell him about all the daughter's activities. On individual interview, the girl says she does not understand why she does these things, but she would like to understand. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
B.Behavior therapy for the patient
C
)
Family therapy
D
)
Marital therapy for the parents
E
)
Psychodynamic psychotherapy for the patient
F
)
Triazolam therapy for the patient
32.
A 27-year-old woman comes to the physician because of a 5-day history of headache, severe, diffuse abdominal pain, and nausea and vomiting. The pain is exacerbated by eating and relieved by vomiting. The vomitus initially consisted of a large amount of semisolid material mixed with a clear green liquid but now consists of clear yellow liquid only. She has not had any other symptoms. She has Crohn disease treated with prednisone; she was instructed to taper her dosage 2 weeks ago. Additional medications include mesalamine and azathioprine. Her last menstrual period was 7 weeks ago. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill and is in moderate distress. Her temperature is 38.4°C (101.2°F), pulse is 120/min, respirations are 22/min, and blood pressure is 90/50 mm Hg. Examination shows dry oral mucosa and pale conjunctivae. The abdomen is distended, diffusely tender, and tympanitic. Bowel sounds are decreased. Pelvic examination shows no abnormalities. Laboratory studies show:
Hematocrit 31%
Leukocyte count 15,000/mm3
Serum
Amylase 300 U/L
Lipase 9 U/L (N=14–280)
Which of the following is the most likely diagnosis?
A
)
Acute pancreatitis
B
)
Gastric outlet obstruction
C
)
Gastroparesis
D
)
Migraine
E.Pelvic inflammatory disease
G.Small-bowel obstruction
H
)
Viral gastroenteritis
33.
Six hours after coronary artery bypass grafting, a 62-year-old man has a decrease in systolic blood pressure from 120/80 mm Hg to 100/85 mm Hg. Urine output decreases from 60 mL/h to 10 mL/h, and cardiac output decreases from 6 L/min to 3 L/min. Pulmonary artery diastolic pressure has increased. An x-ray of the chest shows a widened mediastinum. Which of the following is the most appropriate next step in management?
A.Administration of 2 ampules of sodium bicarbonate
C.Placement of an intra-aortic balloon
D.Revision of the coronary grafts
E.Surgical exploration of the mediastinum
38.
A 52-year-old woman is brought to the physician by her husband because of a personality change since the death of a close friend 2 weeks ago. He reports that she has been irritable, requires little sleep, and speaks rapidly, jumping from topic to topic. He says that she has never had these symptoms before, but she has had episodes of excessive sleeping, decreased energy, and loss of interest in her usual activities. He never thought these episodes were severe enough to seek medical attention. Mental status examination shows loud, rapid speech and flight of ideas. She is difficult to interview and is distracted by irrelevant stimuli. She paces in the examination room. She says that she is not sad, but uplifted by her friend's death. She hears her friend's voice and communicates with her. Which of the following is the most likely diagnosis?
A
)
Adjustment disorder with disturbance of conduct
B
)
Bereavement
C
)
Bipolar disorder
D
)
Cyclothymic disorder
E
)
Generalized anxiety disorder
F
)
Major depressive disorder
41.
A 27-year-old man comes to the physician with his 27-year-old wife because they have been unable to conceive for the past 10 months. The wife conceived her 4-year-old daughter from another marriage without difficulty, and the husband has no children. The wife's menses occur at regular 28-day intervals; her last examination 1 month ago showed no abnormalities. Examination of the husband shows ill-defined soft masses palpated bilaterally, high in the scrotum. Which of the following is the most likely cause of these masses?
A. Bilateral direct inguinal hernias
C.Bilateral hydroceles
D.Bilateral varicoceles
E.Previous sports-related injury
THANKS!
19. A 4-year-old boy has had increasing fatigue since a viral illness 3 weeks ago. He has been pale for 1 week, and yesterday his gums began to bleed when he brushed his teeth. Examination shows cervical, axillary, and inguinal adenopathy and hepatomegaly. Hemoglobin concentration is 8 g/dL, leukocyte count is 3000/mm3, and platelet count is 30,000/mm3. Which of the following is the most appropriate next step in management?
A.Intramuscular administration of vitamin K
B.Transfusion of packed red blood cells
D.bone marrow aspiration
E.Lumbar puncture
24.
A 19-year-old man is brought to the emergency department by police for evaluation after he was found standing in his neighbor's living room during the middle of the night. He is conscious but remains mute during questioning. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 18/min, and blood pressure is 160/95 mm Hg. Physical examination shows bilateral nystagmus, constricted pupils, hypertonia, and decreased sensation to pinprick. Which of the following is the most likely substance taken?
A.Alcohol
B.Amphetamine
C.Hallucinogen
D.Inhalant
F.PCP
25.
A previously healthy 6-year-old boy is brought to the emergency department because of cramping abdominal pain and right-sided scrotal pain for 4 hours. He vomited once on the way to the hospital. Examination shows a distended abdomen. Bowel sounds are decreased, and there is diffuse tenderness to palpation with involuntary guarding. The right hemiscrotum is slightly discolored with swelling and tenderness superiorly. The left hemiscrotum is normal; the testicle is normal. Which of the following is the most appropriate next step in management?
B.Valsalva maneuver
C.Urinalysis
D.Doppler ultrasonography
E.CT scan
F.Antibiotic therapy
G.Operative procedure
29.
A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter. The mother asks to speak to the physician alone and explains that she persuaded her daughter to come because the girl has begun to stay out late, receive many calls from several different boys, and wear tight clothing and excessive makeup. She says her daughter confides many details of her dates to her. She adds that the girl's father is furious and berates her about this behavior even though he does not know about most of what is going on. To protect her daughter, she does not want to tell him about all the daughter's activities. On individual interview, the girl says she does not understand why she does these things, but she would like to understand. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
B.Behavior therapy for the patient
C
)
Family therapy
D
)
Marital therapy for the parents
E
)
Psychodynamic psychotherapy for the patient
F
)
Triazolam therapy for the patient
32.
A 27-year-old woman comes to the physician because of a 5-day history of headache, severe, diffuse abdominal pain, and nausea and vomiting. The pain is exacerbated by eating and relieved by vomiting. The vomitus initially consisted of a large amount of semisolid material mixed with a clear green liquid but now consists of clear yellow liquid only. She has not had any other symptoms. She has Crohn disease treated with prednisone; she was instructed to taper her dosage 2 weeks ago. Additional medications include mesalamine and azathioprine. Her last menstrual period was 7 weeks ago. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill and is in moderate distress. Her temperature is 38.4°C (101.2°F), pulse is 120/min, respirations are 22/min, and blood pressure is 90/50 mm Hg. Examination shows dry oral mucosa and pale conjunctivae. The abdomen is distended, diffusely tender, and tympanitic. Bowel sounds are decreased. Pelvic examination shows no abnormalities. Laboratory studies show:
Hematocrit 31%
Leukocyte count 15,000/mm3
Serum
Amylase 300 U/L
Lipase 9 U/L (N=14–280)
Which of the following is the most likely diagnosis?
A
)
Acute pancreatitis
B
)
Gastric outlet obstruction
C
)
Gastroparesis
D
)
Migraine
E.Pelvic inflammatory disease
G.Small-bowel obstruction
H
)
Viral gastroenteritis
33.
Six hours after coronary artery bypass grafting, a 62-year-old man has a decrease in systolic blood pressure from 120/80 mm Hg to 100/85 mm Hg. Urine output decreases from 60 mL/h to 10 mL/h, and cardiac output decreases from 6 L/min to 3 L/min. Pulmonary artery diastolic pressure has increased. An x-ray of the chest shows a widened mediastinum. Which of the following is the most appropriate next step in management?
A.Administration of 2 ampules of sodium bicarbonate
C.Placement of an intra-aortic balloon
D.Revision of the coronary grafts
E.Surgical exploration of the mediastinum
38.
A 52-year-old woman is brought to the physician by her husband because of a personality change since the death of a close friend 2 weeks ago. He reports that she has been irritable, requires little sleep, and speaks rapidly, jumping from topic to topic. He says that she has never had these symptoms before, but she has had episodes of excessive sleeping, decreased energy, and loss of interest in her usual activities. He never thought these episodes were severe enough to seek medical attention. Mental status examination shows loud, rapid speech and flight of ideas. She is difficult to interview and is distracted by irrelevant stimuli. She paces in the examination room. She says that she is not sad, but uplifted by her friend's death. She hears her friend's voice and communicates with her. Which of the following is the most likely diagnosis?
A
)
Adjustment disorder with disturbance of conduct
B
)
Bereavement
C
)
Bipolar disorder
D
)
Cyclothymic disorder
E
)
Generalized anxiety disorder
F
)
Major depressive disorder
41.
A 27-year-old man comes to the physician with his 27-year-old wife because they have been unable to conceive for the past 10 months. The wife conceived her 4-year-old daughter from another marriage without difficulty, and the husband has no children. The wife's menses occur at regular 28-day intervals; her last examination 1 month ago showed no abnormalities. Examination of the husband shows ill-defined soft masses palpated bilaterally, high in the scrotum. Which of the following is the most likely cause of these masses?
A. Bilateral direct inguinal hernias
C.Bilateral hydroceles
D.Bilateral varicoceles
E.Previous sports-related injury
)