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* nbme-em
 #846086  
  kennychan - 12/05/17 17:49
 
  A 47-year-old woman is brought to the emergency department 25 minutes after sustaining a gunshot wound to the abdomen. She is hysterical and is unable to give any other history. Her pulse is 100/min, respirations are 24/min, and blood pressure is 110/75 mm Hg. Examination of the chest shows no abnormalities. Abdominal examination shows an entrance wound in the right lower quadrant and no exit wound; the abdomen is mildly tender but not distended. Bowel sounds are hypo-active. X-rays of the chest and abdomen show a bullet in the left paraspinal area. Which of the following is the most appropriate next step in management?

a) Observation
b) Arteriography
c) Contrast study of the wound tract
d) CT scan of the abdomen
e) Intravenous pyelography
f) Laparoscopy
g) Laparotomy
h) Peritoneal lavage
i) Ultrasonography of the abdomen

Please help and give explanation!
 
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* Re:nbme-em
#3354366
  kennychan - 12/05/17 18:03
 
  A 34-year-old woman, G1, P1, comes to the emergency department because of a 7-hour of moderate diffuse lower abdominal pain, vaginal bleeding, and temperatures to 38.3. She says she felt well until this morning. One week ago, she had an uncomplicated spontaneous vaginal delivery of a female newborn at term. Her postpartum vaginal bleeding had been decreasing daily until today, when she began passing some blood clots and soaking through a sanitary pad every 2 hours. Her current temperature is 37.9, pulse is 110/min, respirations are 20/min, and blood pressure is 102/66 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. On examination, the abdomen is soft and diffusely tender to palpation of the lower quadrants; there is no rebound tenderness or guarding. The uterine fundus is firm, tender, and palpable inferior to the umbilicus. Her hematocrit is 29% and leukocyte count is 15,200/mm3. Pelvis ultrasonography shows echogenic material in the uterine cavity. Which of the following is the most appropriate next step in management?
a) Dilatation and curettage
b) Methotrexate therapy
c) Methylprednisolone therapy
d) Transfusion of packed red blood cells
e) Vaginal packing

Another one. Thanks for helping!
 
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* Re:nbme-em
#3354373
  kennychan - 12/05/17 18:21
 
  A 27-year-old man is brought to the emergency department 2 hours after he was involved in a head-on motor vehicle collision. He was the unrestrained front-seat passenger. Examination of the right lower extremity shows discoloration and a dislocation knee. Sensation is absent from the knee to the toes. There are no palpable pulses distal to the femoral artery. No motor activity is present. Which of the following is the most appropriate next step in management?
a) Measurement of ankle brachial indices
b) Venous duplex ultrasonography
c) Nerve conduction studies
d) Venography
e) Reduction of the dislocated knee
f) Arteriography

Another one
 
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* Re:nbme-em
#3354376
  kennychan - 12/05/17 18:39
 
  A 47-year-man is brought to the emergency department by a friend 30 minutes after a seizure. The friends says that while they were sitting on the couch at home, the patient suddenly became quiet, arched his back, and began to shake. The episode lasted 45 seconds. Immediately afterward, the patient was confused for 15 minutes. He has hypertension treated with amlodipine. He has no known drug allergies. He has smoked one pack of cigarettes daily for 20 years. He drinks eight to nine beers nightly. His last drink was 28 hours ago. On arrival, he is sleepy but responds to verbal stimul. He appears restless. His temperature is 38.1, pulse 106/min and regular, respirations are 18/min, and blood pressure is 148-92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Physical examination shows clammy skin. The remainder of the examination, including neurologic examination, shows no abnormalities. Which of the following is the most appropriate next step in management?
a) Administration of dextrose and vitamin B1 (thiamine
b) Administration of lorazepam
c) Administration of phenytoin
d) CT scan of the head
e) Intubation

Seizure vs alcohol withdraw.
Please give your opinions. I will appreciate it.
 
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