Discuss NBME F3 B1 - grazie

[ArchivalUser]

q20)

Ans: E
nbme cert!

Is this Bronchiectasis? that's what I thought when I saw this picture

http://i42.photobucket.com/albums/e338/G...b0a82a.png

I got this ans right but maybe my Dx is wrong Please correct me if my Dx is not cool



Treatment of Bronchiectasis:


Nonpharmacologic Therapy
• Postural drainage (reclining prone on a bed with the head down on the side) and chest percussion with use of inflatable vests or mechanical vibrators applied to the chest may enhance removal of respiratory secretions.
• Adequate hydration.
• Supplemental oxygen for hypoxemia.



Acute General Rx
• Antibiotic therapy is based on the results of sputum, Gram stain, and culture and sensitivity; in patients with inadequate or inconclusive results, empiric therapy with amoxicillin/clavulanate 500 to 875 mg q12h, TMP-SMX q12h, doxycycline 100 mg bid, or cefuroxime 250 mg bid for 10 to 14 days is recommended.
• Bronchodilators are useful in patients with demonstrable airflow obstruction.

Chronic Rx
• Avoidance of tobacco
• Maintenance of proper nutrition and hydration
• Prompt identification and treatment of infections
• Pneumococcal vaccination and annual influenza vaccination

[ArchivalUser]

21.
A 14-year-old white boy comes to the office with his mother because he "physically collapsed" for a few seconds, yesterday evening; he did not lose consciousness. The patient says, "It was scary. I was sitting down, watching a funny movie, and it was like my muscles just gave out for a minute. Also, my basketball coach has asked me to leave the team because he doesn't think I've been alert during the last few games." His mother notes that for the past 2 months he has been increasingly sleepy during the day despite going to bed at a reasonable time. Both the patient and his mother do not understand why he is drowsy during the day. He has also been nodding off frequently in class. He has been generally healthy and has had no recent infectious illnesses. Past medical history is unremarkable except for a febrile seizure at 8 months. He does not use illicit drugs or drink alcoholic beverages. He is an A/B student. Family history is significant for two maternal aunts with similar daytime sleep episodes. The patient's mother requests a sleep test. He is 165 cm (5 ft 5 in) tall and weighs 52 kg (115 lb). Vital signs are pulse 85/min, respirations 18/min, and blood pressure 128/78 mm Hg. Physical examination is normal. This patient is most likely to have a history of which of the following?

A) Early morning awakening
B) Frequent nightmares
C) Hypnagogic hallucinations
D) Night terrors
E) Nighttime insomnia

[ArchivalUser]

C: Narcolepsy

[ArchivalUser]

Yes

q21) C
C) Hypnagogic hallucinations


The Tetrad of Narcolepsy includes:
* Excessive daytime sleepiness
* Cataplexy
* Hypnagogic hallucinations
* Sleep paralysis.





Thanks for adding me to skype kat I wont feel so alone

[ArchivalUser]

welcome!! thanks for doing this

[ArchivalUser]

22.
A 32-year-old white veterinary technician comes to the office saying, "I've had trouble swallowing during the past 4 or 5 months." He reports that the symptoms developed slowly and are becoming worse, and he occasionally regurgitates food. Initially he had some associated pain with swallowing, but this no longer occurs. The symptoms are worse when he eats rapidly and when he is stressed. Symptoms are induced about equally by intake of solids and liquids and are sometimes relieved if he stands up straight. Antacids have had no effect. The patient has been otherwise healthy. He reports drinking one or two cans of beer about four nights per week, and has smoked four to five cigarettes daily for the past 6 years. Physical examination shows no abnormalities. Barium swallow shows a dilated esophagus with an air-fluid level. Which of the following is the most likely diagnosis?

A) Achalasia
B) Early esophageal carcinoma
C) Esophageal diverticulum
D) Esophageal ring
E) Reflux esophagitis

[ArchivalUser]

q22)

Ans: A
A) Achalasia
nbme cert!
“Symptoms are induced about equally by intake of solids and liquids” > Achalasia

[ArchivalUser]

Yes correct !

[ArchivalUser]

23.
A 58-year-old woman comes to the office for a follow-up visit 4 weeks after being discharged from the hospital. She was treated in the hospital for 4 days following myocardial infarction. She has a 3-year history of hypercholesterolemia treated with simvastatin. Metoprolol and aspirin were added to her regimen during her hospitalization. She has no history of hypertension or diabetes mellitus. She smoked one pack of cigarettes daily for 25 years but quit 1 year ago. She has one gin cocktail about five times weekly with dinner. Her father had coronary artery disease and had a myocardial infarction at age 53 years. There is no family history of alcohol abuse. She is 168 cm (5 ft 6 in) tall and weighs 60 kg (132 lb); BMI is 21 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 54/min, respirations 18/min, and blood pressure 123/80 mm Hg. Physical examination shows no abnormalities. Results of laboratory studies are shown:
Serum
AST 23 U/L
Glucose, fasting 95 mg/dL
Cholesterol, total 160 mg/dL
HDL 50 mg/dL
LDL 92 mg/dL
Triglycerides 89 mg/dL
The patient asks, "Is it okay if I continue drinking gin?" Which of the following statements is the most appropriate response?

A) "Because of your heart attack, I cannot recommend any alcohol intake."
B) "Continuing your current intake may reduce your risk for another heart attack."
C) "For ethical reasons I cannot advise you on drinking alcohol."
D) "I cannot recommend resuming your consumption of alcohol because it will probably lead to alcohol dependence."
E) "To realize any benefit from alcohol consumption, you would need to increase the amount you consume to one to two drinks every day."

[ArchivalUser]

q23)

A is wrong by nbme fb

SOS HELP!