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* nbme 1 block 4-qn 11,12,13,14
 #299763  
  kuttinguru - 05/07/08 18:36
 
  11. A 19-year-old man is brought to the emergency department 45 minutes after sustaining a single, large stab wound to the right upper quadrant of the abdomen. He is obtunded. His blood pressure is 60/palpable mm Hg, and pulse is 148/min. Breath sounds are equal bilaterally. Examination shows a 4-cm laceration in the right upper quadrant in the midclavicular line. The abdomen is distended. Which of the following is the most appropriate next step in management?

A
) X-ray films of the abdomen and pelvis

B
) Angiography

C
) Contrast study of the wound tract

D
) CT scan of the abdomen

E
) CT scan of the chest

F
) Laparoscopy

G
) Peritoneal lavage

H
) Laparotomy

I
) Local wound exploration


12. A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings?

A
) Decreased androgens

B
) Decreased estrogen

C
) Decreased follicle-stimulating hormone (FSH)

D
) Decreased luteinizing hormone (LH)

E
) Decreased progesterone

F
) Decreased prolactin

G
) Increased androgens

H
) Increased estrogen

I
) Increased FSH

J
) Increased LH

K
) Increased progesterone

L
) Increased prolactin



13.A 7-day-old newborn is brought for a well-child examination. He was born at home. His mother has taken acetaminophen for perineal discomfort. The newborn is breast-feeding well. He is at the 75th percentile for length and weight. Examination shows no abnormalities. After vaccination with hepatitis B, he has prolonged bleeding at the injection site. There is no family history of excessive bleeding. Laboratory studies show:


Hemoglobin 16 g/dL
Leukocyte count 6800/mm3
Segmented neutrophils 48%
Bands 2%
Lymphocytes 50%
Platelet count 280,000/mm3
Prothrombin time 20 sec (INR=1.6)
Partial thromboplastin time 60 sec

Which of the following is the most likely mechanism for these findings?

A
) Autoimmunization

B
) Bacterial toxic effect

C
) Factor VIII deficiency

D
) Factor IX deficiency

E
) Immunoglobulin deficiency

F
) Iron deficiency

G
) Pharmacologic effect

H
) Viral toxic effect

I
) Vitamin deficiency

J
) Zinc deficiency



14. A 67-year-old man with long-standing signs and symptoms of congestive heart failure is admitted to the hospital because of progressive shortness of breath. Examination shows no other abnormalities. An x-ray film of the chest shows cardiomegaly, cephalization of blood vessels, and a right-sided pleural effusion. Which of the following sets of pleural fluid findings is most likely in this patient?


Leukocyte Segmented
Protein Glucose count neutrophils Monocytes
(g/dL) (mg/dL) (/mm3) (%) (%)

A)

2.5


10


10,000


50


50

B)

2.5


90


2000


60


40

C)

3.8


40


30,000


80


20

D)

4.5


60


10,000


20


80

E)

4.5


90


2000


50


50

 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303301
  azaaza - 05/07/08 19:06
 
  11-h
12-c
13-a
14-i
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303302
  lacoperon - 05/07/08 19:08
 
  11.H
12.G???
14. no clue on this :(
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303304
  lacoperon - 05/07/08 19:09
 
  oops!! i missed 13. I  
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303306
  shasan - 05/07/08 19:15
 
  H
B(why c azaza????)
I
?
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303311
  kuttinguru - 05/07/08 19:21
 
  11.H

12.dont know-discuss pls

13.dont know-discuss pls

14.B(transudate-protein will be less,glucose high,leukocyte count low)
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303318
  shasan - 05/07/08 19:26
 
  mutting can u please upload qs 1 by one so it will be easy to discuss  
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303319
  shasan - 05/07/08 19:27
 
  thanks for uploading....:)  
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303328
  kuttinguru - 05/07/08 19:31
 
  yes,i will upload one by one from NBME FORM 2.

i am in india .Its 5 am now .not slept yet.Hopefully will get up at 8 am and post NBME 2.hope u will be around
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303338
  martian - 05/07/08 19:39
 
  11 H
12A
13 I
14 B
 
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* Re:nbme 1 block 4-qn 11,12,13,14
#1303382
  azaaza - 05/07/08 20:12
 
  11. H
12.A(I was wrong, thinking estrogen will decrease FSH. In fact, estrogen can increase sex hormone binding protein, cause testosterone unavailable, cause decreased libido).
13.I
14.B
 
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