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*  not assessment
  bujji2015 - 06/14/17 21:23
  1 An 18-year-old G1P0 woman at 32 weeks' gestation is evaluated in the emergency department because of shortness of breath. The dyspnea has been present for several weeks, but became acutely worse today after the patient helped her mother paint the nursery. A ventilation-perfusion scan strongly suggests pulmonary embolism. The patient is admitted for therapy and eventually discharged with a prescription for injections of low-molecular-weight heparin.
Which of the following is an appropriate part of this patient's management?

A. Albuterol metered-dose inhaler
B. Maintaining anti-factor Xa levels at 1.0 U/mL
C. Maintaining the partial thromboplastin time at four times the control value
D. No additional follow-up is needed
E. Warfarin for 9 months postpartum
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* Re: not assessment
  bujji2015 - 06/14/17 21:24
  2 A 5-year-old boy with autism visits the physician with his parents, who are considering options for his enrollment in school. They are a bit wary of the public school system in the city, and they ask for advice on which private school is best for their child. The doctor states that, regardless of where he is taught, the federal government has ensured that autistic children have access to all the services they need in order to succeed.
Which of the following pieces of legislation federally mandate that such provisions be made in schools?

A. Equal Education Opportunities Act
B. Family Educational Rights and Privacy Act
C. Individuals with Disabilities Education Act
D. No Child Left Behind Act
E. Rehabilitation Act
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* Re: not assessment
  sweety_usmle - 06/15/17 11:33
  1. "D"
2. "C"
I am not sure on both though.
It would be great if you could explain a little while you give the answers :))

Thank you for the questions.
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* Re: not assessment
  bujji2015 - 06/15/17 12:56
  3.A 32-year-old G4P2 woman is brought into the emergency department accompanied by two police detectives. She tearfully states that she was sexually assaulted by a coworker 48 hours ago. Since the incident she has taken a shower and a very hot bath, has changed her clothes twice, and has had consensual sex with her boyfriend. She has a history of hypertension, type 2 diabetes mellitus, and schizophrenia. She currently denies any hallucinations. Her medications include lisinopril, aripiprazole and methadone because of past heroin addiction. Her temperature is 37.1C (98.8F), pulse is 98/min, respiratory rate is 18/min, and blood pressure is 144/88 mm Hg.
Regarding the physical examination and evidence collection in this patient, which of the following is true?

A. A police or law enforcement representative should be present for the history and all evidence collection to assure appropriate forensic validity
B. Because of the patient's history of schizophrenia and drug abuse, a psychiatric consult should be obtained before the sexual abuse evidence is collected
C. Because the patient has taken a hot bath and it has been 48 hours since the incident, a sexual abuse kit will yield no usable evidence
D. Even if the patient states she will not be pressing charges, evidence for a sexual abuse kit should be collected
E. The absence of physical findings of forced penetration on examination rules out sexual assault
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* Re: not assessment
  sweety_usmle - 06/15/17 13:05
Super confused with A or D.
I am still debating myself on C though. I know its 72 hours but she also had consensual sex with her boyfriend with taking shower and changed her clothing.
Thank you for the question.
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* Re: not assessment
  bujji2015 - 06/15/17 13:22
A 29-year-old woman with the relapsing-remitting form of multiple sclerosis presents to her neurologist for a scheduled routine follow-up. She had recently experienced a relapse of her condition, with weakness in both of her legs and spasms of her leg muscles. She also has developed urinary urge incontinence and vertigo. She is currently receiving monthly pulses of intravenous methylprednisolone and betaseron. Today she complains of severe stiffness of both of her legs that is especially bothersome at night.
What is the best management option at this time?

A. Addition of glatiramer
B. Intrathecal baclofen
C. Observation
D. Oral oxycodone
E. Physical therapy
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* Re: not assessment
  sweety_usmle - 06/15/17 13:35
Today complaining of Stiffness.
Thank you for the question.
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* Re: not assessment
  bujji2015 - 06/15/17 15:39
  1 B
2 C
3 D
4 E
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* Re: not assessment
  sweety_usmle - 06/15/17 15:53
  @bujji2015: If its not trouble could you please explain 1 and 4 please?
Thank you
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* Re: not assessment
  bujji2015 - 06/16/17 16:58
E is correct
Patients with multiple sclerosis especially those presenting with pyramidal signs (ie, limb weakness), can often develop muscle spasticity. Physical therapy with stretching exercises should start as early as possible to prevent contractures and preserve functionality. Benzodiazepines may help with nighttime symptoms; however, all patients should begin physical therapy first. If these measures do not help, oral baclofen may be added. Baclofen is a GABAB-receptor agonist and is thought to inhibit both monosynaptic and polysynaptic reflexes.

Intrathecal baclofen is the last resort for patients with severe spasticity after physical therapy and oral medications have been tried.

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* Re: not assessment
  bujji2015 - 06/16/17 17:02
B is correct
This patient has an acute pulmonary embolism (PE) based on a ventilation:perfusion scan and a high clinical suspicion. Management of PE during pregnancy is generally the same as that in a nonpregnant patient and consists of admission to the hospital for therapeutic heparin dosing. Often, treatment in both pregnant and nonpregnant patients involves low-molecular weight (LMW) heparin. For many patients, no monitoring is required; however, for pregnantpatients, obese patients, and for those patients in renal failure, it is recommended that anti-factor Xa levels be checked. The goal range is 0.5-1.2 U/mL and the value should be measured 4 hours after the patient's last injection. Of note, pregnancy itself is a risk factor for venous thromboembolic disease; the patient does not require additional work-up for thrombophilia.

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