nbme f2 b2 - grazie

[ArchivalUser]

26c
27b
28d

[ArchivalUser]

hi perception, sorry but

22 D wrong by nbme . its confirmed

[ArchivalUser]

good morning to all

26 DD, conf by nbme
27 AA, conf by nbme, not BB conf by nbme
28 DD

[ArchivalUser]

@Joseph...Dear thank you for your kindness
22a......as you folks corrected

agreed with you on 26,27,28 aswell.

could you put a note for 27 if possible please.thanks

[ArchivalUser]

@jusupjoseph
28 DD is conf by nbme?
what's diff between D and E ?

[ArchivalUser]

about 27AA. Initially I choose B b/c left side lungs findings. I didn't paid attention for bilateral infiltrates, high temperature, postintubation, vomiting bilious content (which also gastric combined). I think presence of vomiting is the key.

[ArchivalUser]

thank you DOC

[ArchivalUser]

26.
A 55-year-old man is transferred to the coronary care unit from the emergency department after sustaining an acute myocardial infarction. Medical history is significant for essential hypertension, for which he takes thiazide diuretic medication. Vital signs are pulse 90/min, respirations greater than 30/min and regular, and systolic blood pressure 90 mm Hg. Upon arrival in the coronary care unit, his systolic blood pressure decreases to 70 mm Hg. He is given a bolus of crystalloid fluid, but he continues to be hypotensive. Physical examination shows distended neck veins. The patient's hypotension is refractory to maximal doses of dobutamine and dopamine. The most appropriate next step is to do which of the following?
A) Administer a bolus of lidocaine
B) Apply pneumatic antishock garments
C) Do emergency cardiac catheterization
D) Insert an intra-aortic balloon pump
E) Seek a Do Not Resuscitate order

Ans) D
D)Insert an intra-aortic balloon pump
(right answer by NBME)

Intra-Aortic Balloon Pump
For patients who have profound myocardial dysfunction and are unresponsive to volume resuscitation and significant pharmacologic therapy, IABP support may be indicated.

The IABP is a special Silastic balloon with a capacity of 40 to 60 mL that is positioned in the descending aorta just beyond the origin of the left subclavian artery. The balloon is designed to be actively inflated and deflated during each cardiac cycle. Intra-aortic balloon counterpulsation has the unique benefit of decreasing myocardial work and oxygen consumption while increasing coronary perfusion. The use of IABP is absolutely contraindicated in patients with aortic regurgitation and aortic dissection. It is relatively contraindicated in patients with peripheral vascular disease or aortic aneurysm.

[ArchivalUser]

27.
A 67-year-old man undergoes laparotomy and lysis of adhesions for a high-grade small-bowel obstruction. Postanesthesia extubation is unremarkable except for emesis of 100 mL of bilious fluid. On the first postoperative day vital signs are temperature 38.2°C (100.8°F), pulse 124/min, and respirations 34/min. Breathing is shallow and breath sounds are associated with wheezing and are diminished in both lung fields. Abdomen is mildly distended and tender. Which of the following is the most likely diagnosis?

A) Aspiration pneumonitis
B) Atelectasis
C) Postanesthesia respiratory insufficiency
D) Pulmonary edema
E) Pulmonary embolus

Ans: A
Not B (by nbme) so the only choice left would be A) Aspiration pneumonitis, especially if she vomited after the operation.

[ArchivalUser]

28.
A 73-year-old man is admitted to the hospital because of pancreatitis following a 2-day history of abdominal pain, nausea, and vomiting. On admission vital signs are temperature 37.8°C (100.0°F), pulse 90/min, respirations 16/min, and blood pressure 160/90 mm Hg. There is tenderness and voluntary guarding in the epigastrium with hypoactive bowel sounds. Physical examination is otherwise normal. Laboratory studies show a leukocyte count of 17,500/mm3 and a serum amylase concentration of 540 U/L. Orders are written that he is to be given nothing by mouth; intravenous fluids are administered and he is given meperidine intravenously for pain. Twenty-four hours after admission the patient becomes dyspneic. There are decreased breath sounds at the left lung base. Vital signs are temperature 39.4°C (103.0°F), pulse 120/min, and blood pressure 80/60 mm Hg. On physical examination there is splinting of the left hemithorax. Chest x-ray shows a left lower lobe infiltrate and bilateral small pleural effusions. Arterial blood gas analysis while breathing room air is shown:
Po2 78 mm Hg
Pco2 26 mm Hg
pH 7.45
Which of the following is the most likely cause for the patient's acute deterioration?
A) Infected pseudocyst
B) Massive atelectasis
C) Pancreatic fistula
D) Pneumonia ***
E) Sympathetic pleural effusion

Ans) D
Confirmed by nbme

Local and systemic complications can occur with pancreatitis. The major complication of acute pancreatitis is SIRS systemic inflammatory response syndrome, a hyperinflammatory state that the body creates to help defend itself against an invasion of some type. This defense attempt goes awry, leading to complications such as acute respiratory failure, ARDS acute respiratory distress syndrome, and shock.

Lung injury during an attack of acute pancreatitis is caused by the rapid infiltration of neutrophils as soon as 3 hours after the illness is triggered. As the blood travels through the portal circulation and the liver, alveolar macrophages leap into action. But they end up making the lung injury worse by helping to create pleural effusions, atelectasis, and pneumonia, all of which reduce oxygen uptake and carbon dioxide release within the capillaries.