08-28-2014, 11:08 AM
Help with this please? 
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Discuss NBME Form 2 Block 4 - grazie
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08-28-2014, 11:10 AM
I am confused about q30
I marked a random answer, I left it for the end and then run out of time, I marked E  hehe, so this is not the answer by nbme.I will be back after lunch and pick up my kiddo. See u guys
08-28-2014, 11:13 AM
31.
A 19-year-old college sophomore is brought to the emergency department by a friend after being beaten and raped by several men at a college function 1 hour ago. She has numerous bruises and cuts along her upper and lower extremities. She states that she thinks she lost consciousness for a few minutes after being struck in the head during the incident. The police are notified and are present for the examination. Pelvic examination discloses numerous small vaginal tears that are not bloody. Prophylactic treatment to prevent pregnancy and sexually transmitted diseases is initiated. Arrangements are made to admit the patient to the hospital for observation. The patient is tearful and anxious. She responds only to female staff. Which of the following is the most appropriate management? A) Lorazepam therapy B) Psychiatric hospitalization C) Sertraline therapy D) Supportive psychosocial counseling E) No further management is indicated 32. A 22-year-old woman comes to the emergency department because of low back pain since lifting grocery bags at the supermarket 24 hours ago. She rates the pain as a 5 on a 10-point scale and says it radiates to her buttocks. The pain has made it difficult for her to rise from her bed and from a seated position. She reports no numbness or loss of bowel or bladder function. She has not had back pain in the past. Medical history is unremarkable and she takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 54 kg (120 lb); BMI is 21 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 100/min, respirations 16/min, and blood pressure 130/80 mm Hg. Examination of the back discloses diffuse tenderness in the lumbar and sacroiliac regions. Muscle strength and deep tendon reflexes are normal and sensation is intact. Range of motion testing of the back elicits pain. Straight-leg raising of both lower extremities elicits no pain or paresthesias. Which of the following imaging studies is most likely to confirm the diagnosis? A) CT scan of the lumbar spine B) Myelography of the lumbar spine C) Triple-phase bone scan D) X-ray of the lumbosacral spine E) No imaging study is required 33. A 22-year-old man is brought to the emergency department by his friends 1 hour after smoking crack cocaine. The friends say that he began acting agitated and complaining of chest pain shortly after he began smoking. They note that the patient has tried Ecstasy and marijuana in the past but that he had not tried cocaine until today. The patient has no known medical conditions. On admission the patient appears to be in moderate distress, is perspiring, is unable to sit still, and is verbally abusive to staff. Vital signs are temperature 37.2°C (99.0°F), pulse 100/min, respirations 24/min, and blood pressure 170/110 mm Hg. The patient appears agitated and anxious. ECG shows tachycardia. The most appropriate immediate step is to administer which of the following? A) Diazepam B) Haloperidol C) Meperidine D) Naloxone E) Promethazine 34. A 3-year-old boy is brought to the emergency department by his mother because of a 24-hour history of fever, sore throat, and hoarseness. He has been generally healthy. He takes no medications and has not received any vaccinations. On arrival today, the child is drooling. Vital signs are temperature 38.5°C (101.3°F), pulse 120/min, respirations 30/min, and blood pressure 90/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Physical examination discloses mild inspiratory stridor and suprasternal retractions. Which of the following is the most appropriate diagnostic study at this time? A) AP and lateral cervical x-rays B) Chest x-ray C) CT scan of the neck and chest D) Flexible bronchoscopy E) Nasotracheal suctioning for culture and sensitivity 35. An 18-month-old African American boy is brought to the emergency department by his mother, who is accompanied by her live-in boyfriend. The mother says, "My son has been fussy all day, but since late this afternoon all he wants to do is sleep. It is very hard to keep him awake." The boyfriend adds that the child "is clumsy and falls a lot." The child's height and weight are at the 20th percentile for age. Vital signs are temperature 37.0°C (98.6°F), pulse 70/min, respirations 18/min, and blood pressure 95/60 mm Hg. On physical examination the child is moderately lethargic and is difficult to arouse. Bruises are noted over the buttocks and lower back. Physical examination is otherwise unremarkable. Which of the following is the most appropriate diagnostic study at this time? A) Bone scintigraphy B) Complete blood count C) CT scan of the head D) X-rays of the lumbar spine E) X-rays of the pelvis 36. A 74-year-old man with chronic obstructive pulmonary disease is brought to the emergency department by ambulance from an assisted living facility because of a 1-week history of increasingly severe shortness of breath. He also has had associated low-grade fever and worsening of his chronic productive cough. Medications include combined ipratropium bromide and albuterol and theophylline. The patient has smoked two packs of cigarettes daily for 45 years. Vital signs on admission are temperature 37.6°C (99.7°F), pulse 94/min and irregularly irregular, respirations 30/min, and blood pressure 108/67 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 83%. Auscultation of the chest discloses scattered expiratory rhonchi and prolonged expiratory phase. Heart sounds are distant and irregular; a grade 2/6 systolic flow murmur is present. Examination of the extremities shows 1+ pretibial pitting edema. Arterial blood gas analysis is shown: Po2 46 mm Hg Pco2 51 mm Hg pH 7.31 ECG shows atrial fibrillation and no acute signs of ischemia and chest x-ray shows hyperinflation and apical bullae; findings on both studies are unchanged from previous study results. The patient is treated with 5 L/min of oxygen via nasal cannula, after which a repeat blood gas analysis shows the following: Po2 56 mm Hg Pco2 64 mm Hg pH 7.25 Which of the following is the most appropriate treatment at this time? A) Continued oxygen by nasal cannula B) Intubation with volume-controlled ventilation C) Noninvasive positive pressure ventilation D) Oxygen by Venturi mask
08-28-2014, 01:45 PM
q30)
We stick to A A) Development of dysphagia (not nbme confirmed but for majority of votes Ok guys, A) seems like a good answer, kind of what we expect in a severe allergic reaction Found this: ----------- Symptoms of a Severe Insect Sting Allergy (Anaphylactic reaction) may include one or more of the following: * Difficulty breathing * Hives that appear as a red, itchy rash and spread to areas beyond the sting * Swelling of the face, throat, or mouth tissue * Wheezing, Dysphagia * Restlessness and anxiety * Tachycardia * Dizziness, Hypotension
08-28-2014, 01:46 PM
Last 6 from this block
31. A 19-year-old college sophomore is brought to the emergency department by a friend after being beaten and raped by several men at a college function 1 hour ago. She has numerous bruises and cuts along her upper and lower extremities. She states that she thinks she lost consciousness for a few minutes after being struck in the head during the incident. The police are notified and are present for the examination. Pelvic examination discloses numerous small vaginal tears that are not bloody. Prophylactic treatment to prevent pregnancy and sexually transmitted diseases is initiated. Arrangements are made to admit the patient to the hospital for observation. The patient is tearful and anxious. She responds only to female staff. Which of the following is the most appropriate management? A) Lorazepam therapy B) Psychiatric hospitalization C) Sertraline therapy D) Supportive psychosocial counseling E) No further management is indicated
08-28-2014, 02:28 PM
q31)
Here he have a horrible traumatic event for this teenager, an Acute Stress Disorder. "The most appropriate management?" A) Lorazepam therapy B) Psychiatric hospitalization C) Sertraline therapy D) Supportive psychosocial counseling E) No further management is indicated I marked A, .............. I know, so cold but in Fisher he says BZD for acute anxiety(wrong by nbme) "ASD Treatment Give benzodiazepines acutely for anxiety symptoms. SSRIs and other antidepressants can be helpful for long-term therapy." ..... Fischer MTB But he also mentions this... "Group counseling is the most effective therapy to prevent PTSD following a traumatic event." So, I guessed they wanted us to mark choice D Ans: D? Any other inputs? |
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