Discuss NBME Form 2 Block 4 - grazie

[ArchivalUser]

how is no18
only answer A and E is left
any body has right answer by nbme
i was thinking that sob,alcohol,stab wound so do we need to give antibiotic or not?
please help!!

[ArchivalUser]

@grazie....qs 20 is definitly resp alkalosis.so it is D or E. may be some one help.

[ArchivalUser]

grazie....one suggestion if you like to copy and paste qs20 in a new window,it will appear on the front page of our forum,then many would be help,if you like it.

[ArchivalUser]

20
A 30-year-old woman comes to the emergency department because of shortness of breath and numbness and tingling of her fingers. If arterial blood gas values were ordered, results would most likely show which of the following?

Po2 Pco2 pH HCO3−
(mm Hg) (mm Hg) (mEq/L)

A) 70 60 7.25 27
B) 40 60 7.37 33
C) 90 40 7.40 24
D) 110 25 7.50 19
E) 40 60 7.51 27

We just can't miss these questions ... I was checking some books and then got caught with NEJM, have you seen their interactive patients? It's awesome!!! Kind of CCS but looots of explanations, too much I think, but it was cool! Wanna look?
http://www.nejm.org/multimedia/interactive-medical-case


Ok, back to this qs ... a little review...

Respiratory Alkalosis

Example:
Clarence H, a 68-year-old male, is admitted for an Anxiety Attack. He almost passed out at his wife's funeral. His ABG values present as:
pH = 7.50
PaCO2 = 30
HCO3 = 24

Respiratory alkalosis is defined by a pH greater than 7.45 and a CO2 less than 35 mm Hg as average. Any condition that results in hyperventilation can lead to respiratory alkalosis. This can result from anxiety attacks, fear, pain, early asthma, CNS lesions, pneumothorax and pulmonary embolism. Disease states that may increase metabolic demands may also result in hyperventilation. This includes sepsis, fever, thyrotoxicosis, pregnancy, excessive mechanical ventilation.

So....

Our options:

---Po2 -- Pco2 -- pH -- HCO3−

A) 70 --- 60 ---- 7.25 --- 27 X (Low pH)

B) 40 --- 60 ---- 7.37 --- 33 X (Low pH)

C) 90 --- 40 ---- 7.40 --- 24 X (Low pH)

D) 110 -- 25 ---- 7.50 --- 19 Could be

E) 40 --- 60 ----- 7.51 --- 27 Could be, but PO2 is too low under the basement

I think I would stick to D

[ArchivalUser]

Thank you @Perception and @Sandar

[ArchivalUser]

@Sandar

About q18


18.
A 26-year-old man is brought to the emergency department by ambulance 20 minutes after he was stabbed in the right chest by a man on the street during a domestic dispute. On arrival, he is angry and appears distraught. He reports mild shortness of breath and says he has no other symptoms or injuries. There is an odor of alcohol on his breath. Paramedics initiated oxygen therapy and intravenous 0.9% saline at the scene. The patient's medical history is unremarkable. He takes no medications and says he does not use illicit drugs. Vital signs are temperature 37.0°C (98.6°F), pulse 92/min, respirations 24/min, and blood pressure 122/80 mm Hg. Pulse oximetry on 4 L of oxygen via nasal cannula shows an oxygen saturation of 99%. Auscultation of the lungs discloses normal breath sounds bilaterally. There is no palpable crepitus or tenderness. Petroleum gauze dressing is in place covering a 2-cm laceration in the right 4th intercostal space at the mid-clavicular line. The remainder of the physical examination shows no abnormalities. Chest x-ray is shown.
http://i42.photobucket.com/albums/e338/G...dbe950.png
Which of the following is the most appropriate next step?

A) Administer intravenous ciprofloxacin
B) Contact social services
C) Insert chest tube (wrong by nbme)
D) Obtain CT scan of the chest (wrong by nbme)
E) Suture the wound

I marked D but it was wrong by nbme. Now what?

[ArchivalUser]

Sorry, this is the pic for q18

http://i42.photobucket.com/albums/e338/G...dbe950.png

[ArchivalUser]

Do you see something on the Xray?

[ArchivalUser]

21.
A 75-year-old white man is brought to the emergency department by ambulance after having a seizure while playing golf. Oxygen by mask has been administered by the emergency medical technicians. On arrival he is mildly lethargic and has a diffuse headache. He has no history of previous neurologic problems and takes no medications. Vital signs are temperature 37.0°C (98.6°F), pulse 86/min and regular, respirations 15/min, and blood pressure 160/90 mm Hg. The physical examination is normal except for papilledema bilaterally. Which of the following is the most appropriate initial diagnostic study?

A) Contrast enhanced CT scan of the head
B) Doppler ultrasonography of the carotid arteries
C) Echocardiography
D) Electroencephalography
E) X-rays of the skull

[ArchivalUser]

q21)

Ans: A
A) Contrast enhanced CT scan of the head
(nbme cert)

This pt has Papilledema, which is a swelling of the optic disc caused by increased Intracranial Pressure. So, we found this on fundoscopy, what’s next? We have to act fast because vision loss can result if this is not treated. Let’s get some images of that brain, further evaluation with a CT or MRI of the brain.