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* CMS IM Form 3 Questions
 #828460  
  goatmilk - 07/01/16 12:30
 
  1. A 72-year-old woman is brought to the emergency department because of a 1-month history of progressive shortness of breath and fatigue. She has had no chest pain. There is no history of heart or pulmonary disease. She is in moderate respiratory distress. Her temperature is 37C, pulse is 100/min, respirations are 22/min, and blood pressure is 135/85 mmHg. Examination shows jugular venous distension. Crackles are heard halfway up both lungs. A grade 2/6, systolic ejection murmur is heard along the left sternal border. There is an S3. She has 2+ edema of the lower extremities. Rectal examination shows dark stool; test for occult blood is positive. Laboratory studies show:
Hemoglobin 5 g/dL
Leukocyte count 9000/mm3
Serum
Na+ 140 mEq/L
K+ 4 mEq/L
Cl- 105 mEq/L
HCO3- 25 mEq/L
Urea nitrogen 28 mg/dL
Glucose 120 mg/dL
Creatinine 1.2 mg/dL
Urine protein 1+
An x-ray of the chest shows a mildly enlarged cardiac silhouette with pulmonary vascular congestion. An ECG shows nonspecific ST-segment changes. Echocardiography shows trace mitral regurgitation and an ejection fraction of 70%; there are no wall motion abnormalities. Which of the following is the most likely cause of these findings?
A) High-output heart failure
B) Left ventricular diastolic dysfunction
C) Left ventricular systolic dysfunction (wrong answer)
D) Nephrotic syndrome
E) Valvular heart disease

48. A 67-year-old man comes to the physician because of pain of the fingertips for 1 month. Examination shows plethora and splenomegaly. Laboratory studies show:
Hemoglobin 20.2 g/dL
Leukocyte count 14,500/mm3 with a normal differential
Platelet count 400,000/mm3
Arterial blood gas analysis on room air shows:
Po2 92 mmHg
O2 saturation 94%
Which of the following is the most appropriate next step in management?
A) Administration of chlorambucil
B) Administration of heparin
C) Thrombopheresis
D) Phlebotomy
E) Splenectomy (wrong answer)

Please help with the answers and explantions. Thank you!

 
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* Re:CMS IM Form 3 Questions
#3299990
  whatsfordinner - 07/01/16 12:36
 
  1a - hf with sustained ef
48 - polycythemia - therapeuttic phlebotomy
 
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* Re:CMS IM Form 3 Questions
#3300123
  yllep13 - 07/02/16 13:35
 
  A 27 y.o with moderate mental retardation, frequent episodes of vomiting for 3 weeks. start 1 hr after eating and contain partially digested food. he has weight loss of 8 lb since 6 month ago. bowel sounds are present. Abdominal musculature contracts voluntarily with palpation. minical contractures in upper an dlower extremities and increased mucle tone. Whats the most likely diagnosis?

Achalasia (----wrong)
brain tumor
bulemia
cholecystitis
diabetic gastroparesis
drug toxicity
food poisoning
gastric benzoar
gastric carcinoma
pyloric channel ulcer
small bowel obstruction
uremia

any one knows this one ?
 
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* Re:CMS IM Form 3 Questions
#3300160
  djkesh2008 - 07/02/16 20:43
 
  High output failure and Phlebotomy?  
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* Re:CMS IM Form 3 Questions
#3302089
  madame_j - 07/16/16 15:10
 
  A 27 y.o with moderate mental retardation, frequent episodes of vomiting for 3 weeks. start 1 hr after eating and contain partially digested food. he has weight loss of 8 lb since 6 month ago. bowel sounds are present. Abdominal musculature contracts voluntarily with palpation. minical contractures in upper an dlower extremities and increased mucle tone. Whats the most likely diagnosis?

Achalasia (----wrong)
brain tumor
bulemia
cholecystitis
diabetic gastroparesis
drug toxicity
food poisoning
gastric benzoar
gastric carcinoma
pyloric channel ulcer
small bowel obstruction
uremia

Answer: Gastric benzoar (pt p/w a bald spot on his scalp---> his pulling his hair out and ingesting it--->obstruction from non-digestible substance)
 
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* Re:CMS IM Form 3 Questions
#3367838
  tbone903 - 06/06/18 23:16
 
  For Q1 I put Valvular disease (which is incorrect) because I was thinking Heyde's syndrome which is a combination of severe aortic stenosis that results in angiodysplasia and subsequent GI bleed. Given the murmur and GI bleed. I understand that the GI bleed and low Hg causing high output heart failure but what distinguishes this from Heyde's syndrome. Is it the sustained EF or the characteristic of the murmur?  
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* Re:CMS IM Form 3 Questions
#3367892
  cardio69 - 06/07/18 22:30
 
  Asso of GI bleeding & "severe" AS, not in pic here many of them have AVMs, as well as acquired abnorm of vWF (not been given in the lab) not pic here in a stem of Q. its simple pat anemic pat with very low Hgb that cause INC CO compared with val for the norm in resting state -> her corazon to overwork ->HF.  
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