08-03-2014, 10:17 AM
Hey Guys. Please help me with the answers to these questions NBME 7 CK
1. 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 mcxlerate 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 d mucosa and le conjunctivae. he abdomen is distended, diffusely tender, and tympanitic. Bowel sounds are
decreased. Pelvic examination shows no abnormalities. Laboratory studies show:
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Gastric outlet obstruction
C) Gastroparesis
D) Migraine
E) Pelvic inflammatory disease
F) Pregnancy
G) Small-bowel obstruction
H) Viral gastroenteritis
2 A health status survey compares the clinical outcomes of patients treated for hip fracture at two hospitals. A total of 560 subjects are studied for 1 year after sustaining a hip fracture. After adjustment for age and gender, the level of physical functioning following treatment is found to be significantly lower among patients treated in one hospital (p=.02）Researchers conclude that treatment at this hospital was suboptimal. Which of the following raises the most concern about this conclusion?
A) The period of study is too short
B)The results are not adjusted for comorbidities
C) The results are not statistically significant
D) The statistical power is too low
E)The survey instrument does not include clinical measures- Wrong.. what is the right answer
3 A 27 year old nulligravid woman comes for a routine health maintenance examination. She is sexually active with one lifelong partner. She does not smoke. She has no history of stds. Pap smear now shows a high grade sq intraepithelial neoplasia. Prior pap smears have shown no abnormalities. Examination of the cervix and vagina shows no gross abnormalities. which of the following is the most appropriate next step in management?
A. repeat pap smear (Wrong)
B. HPV testing.
C. Colposcopy.
D. Cone biopsy of the cervix.
E. Random cervical biopsies.
4 An 87·year·old man 1 year history of difficulty starting urine stream & postvoid dribbling. 2 x nocturia. 30 year HX of DM2, with Orthostatic HoTN due to autonomic dysfunction. Current RX = lisinopril and glyburide. Supine BP 140/80 mm Hg , Standing BP= 100/60. Exam shows enlarged prostrate. most appropriate pharmacotherapy for this patient's urinary symptoms
A) Amlodipine
B) Doxazosin - Wrong
C) Finasteride
D) Metoprolol
E) Oxybutynin
I didnt realize the OrthoHypotension would be worse by taking this for his BPH, and Finasteride would shrink the BPH.. Is there something else im missing. Someone posted about obstruction which is why you dont give Doxazosin?
5 A previously healthy 6-year-old boy -> ER for cramping abdominal pain and right-sided scrotal pain for 4 hours. He vomited once on the way to the hospital. Exam shows distended abdomen. Bowel sounds decreased, ,diffuse tendemess to palpation w/ involuntary guarding. The right hemiscrotum is slightly discolored with swelling and tenderness superiorly. The left hemiscrotum is normal; the testicle is normal.
A) Transillumination of scrotum
B) Valsalva maneuver
C) Urinalysis
D) Doppler ultrasonography - Wrong,
E) CT scan
F) Antibiotic therapy
G) Operative procedure
I thought it was torsion, but superior tenderness could be Vericocele? or is it Indirect inguinal Hernia?, Is the answer E (CT Scan) or G (Surgery) ? Please Explain thought process, Thanks!
6. Four CAGE questions are used to screen for alcoholism. Currently, a "yes" answer to two questions is considered a positive screening test. If the number of "yes' responses needed for a screening test to be considered positive is decreased to one, which of the following is the most likely effect on sensitivity and specificity?
Sensitivity Specificity
A) Decrease decrease
B) Decrease increase
C) Decrease no change - WRONG
D) Increase decrease
E) Increase increase
F) Increase no change
G) No change Decrease
H) No Change Increase
I) No Change No Change
I got overwhelmed and didnt think properly.
But Now looking back at it (and FA 2013 pg 51) As cutpoint is lowered the middle line between both curves moves to the LEFT, so more TP and less FN.. MORE Sensitive, Less Specific
If cutoff is raised, then move line to the RIGHT, so more TN and less FP, more Specific and less Sensitive...
Is this the right way of thinking of it?
7. Four days after undergoing a right hemicolectomy for cecal volvulus, an obese 67-year-old woman has leakage of serosanguineous fluid between the incision
staples; the dressing is soaked. Medications include corticosteroids for chronic obstructive pulmonary disease. Her temperature is 37SC (99SF), pulse is 73/min,
and blood pressure is 140/90 mm Hg. Abdominal examination sho'NS distention with minimal incisional lenderness and no erythema. Which of the following is the
most likely diagnosis?
A) Anastomosic leak
B) Enterocutaneous fistula
C) Evisceration
D) Intra abdominal abcess
E) Intraabdominal Bleeding
G) Necrotizing fasciitis
H) Wound dehiscence
I) Wound infection
1. 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 mcxlerate 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 d mucosa and le conjunctivae. he abdomen is distended, diffusely tender, and tympanitic. Bowel sounds are
decreased. Pelvic examination shows no abnormalities. Laboratory studies show:
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Gastric outlet obstruction
C) Gastroparesis
D) Migraine
E) Pelvic inflammatory disease
F) Pregnancy
G) Small-bowel obstruction
H) Viral gastroenteritis
2 A health status survey compares the clinical outcomes of patients treated for hip fracture at two hospitals. A total of 560 subjects are studied for 1 year after sustaining a hip fracture. After adjustment for age and gender, the level of physical functioning following treatment is found to be significantly lower among patients treated in one hospital (p=.02）Researchers conclude that treatment at this hospital was suboptimal. Which of the following raises the most concern about this conclusion?
A) The period of study is too short
B)The results are not adjusted for comorbidities
C) The results are not statistically significant
D) The statistical power is too low
E)The survey instrument does not include clinical measures- Wrong.. what is the right answer
3 A 27 year old nulligravid woman comes for a routine health maintenance examination. She is sexually active with one lifelong partner. She does not smoke. She has no history of stds. Pap smear now shows a high grade sq intraepithelial neoplasia. Prior pap smears have shown no abnormalities. Examination of the cervix and vagina shows no gross abnormalities. which of the following is the most appropriate next step in management?
A. repeat pap smear (Wrong)
B. HPV testing.
C. Colposcopy.
D. Cone biopsy of the cervix.
E. Random cervical biopsies.
4 An 87·year·old man 1 year history of difficulty starting urine stream & postvoid dribbling. 2 x nocturia. 30 year HX of DM2, with Orthostatic HoTN due to autonomic dysfunction. Current RX = lisinopril and glyburide. Supine BP 140/80 mm Hg , Standing BP= 100/60. Exam shows enlarged prostrate. most appropriate pharmacotherapy for this patient's urinary symptoms
A) Amlodipine
B) Doxazosin - Wrong
C) Finasteride
D) Metoprolol
E) Oxybutynin
I didnt realize the OrthoHypotension would be worse by taking this for his BPH, and Finasteride would shrink the BPH.. Is there something else im missing. Someone posted about obstruction which is why you dont give Doxazosin?
5 A previously healthy 6-year-old boy -> ER for cramping abdominal pain and right-sided scrotal pain for 4 hours. He vomited once on the way to the hospital. Exam shows distended abdomen. Bowel sounds decreased, ,diffuse tendemess to palpation w/ involuntary guarding. The right hemiscrotum is slightly discolored with swelling and tenderness superiorly. The left hemiscrotum is normal; the testicle is normal.
A) Transillumination of scrotum
B) Valsalva maneuver
C) Urinalysis
D) Doppler ultrasonography - Wrong,
E) CT scan
F) Antibiotic therapy
G) Operative procedure
I thought it was torsion, but superior tenderness could be Vericocele? or is it Indirect inguinal Hernia?, Is the answer E (CT Scan) or G (Surgery) ? Please Explain thought process, Thanks!
6. Four CAGE questions are used to screen for alcoholism. Currently, a "yes" answer to two questions is considered a positive screening test. If the number of "yes' responses needed for a screening test to be considered positive is decreased to one, which of the following is the most likely effect on sensitivity and specificity?
Sensitivity Specificity
A) Decrease decrease
B) Decrease increase
C) Decrease no change - WRONG
D) Increase decrease
E) Increase increase
F) Increase no change
G) No change Decrease
H) No Change Increase
I) No Change No Change
I got overwhelmed and didnt think properly.
But Now looking back at it (and FA 2013 pg 51) As cutpoint is lowered the middle line between both curves moves to the LEFT, so more TP and less FN.. MORE Sensitive, Less Specific
If cutoff is raised, then move line to the RIGHT, so more TN and less FP, more Specific and less Sensitive...
Is this the right way of thinking of it?
7. Four days after undergoing a right hemicolectomy for cecal volvulus, an obese 67-year-old woman has leakage of serosanguineous fluid between the incision
staples; the dressing is soaked. Medications include corticosteroids for chronic obstructive pulmonary disease. Her temperature is 37SC (99SF), pulse is 73/min,
and blood pressure is 140/90 mm Hg. Abdominal examination sho'NS distention with minimal incisional lenderness and no erythema. Which of the following is the
most likely diagnosis?
A) Anastomosic leak
B) Enterocutaneous fistula
C) Evisceration
D) Intra abdominal abcess
E) Intraabdominal Bleeding
G) Necrotizing fasciitis
H) Wound dehiscence
I) Wound infection