| * nbme 5 questions
||1) 73 yo woman with osteoarthritis has back pain for the last 4 weeks. She says she has pain with twisting and turning motion. On physical examination she has lancinating midthoracic tenderness. She is 152 cm (5 ft) tall and weighs 54 kg (120 lb); BMI is 23 kg/m^2. Which of the following is the most likely diagnosis?
A. Breast cancer
B. Compression fracture of a vertebra
C. Herniated intervertebral disk
D. Lumbosacral strain
E. Spinal stenosis
Why is the answer not a?
3)An 82-year-old nursing home resident is admitted to the hospital through the emergency department because of acute cholecystitis confirmed by biliary ultrasonongraphy. The patient has a history of hypertension, diabetes mellitus, and vascular dementia with aphasia. Medications include Lisinopril, insulin, and aspirin. While in the emergency department, vital signs were temperature 38.5 C (101.3 F), pulse 104/min, respirations 20/min, and blood pressure 170/90 mm Hg. Abdominal examination disclosed an intact gastrostomy tube and localized abdominal tenderness with fullness in the right upper quadrant. Results of laboratory studies obtained at that time are shown:
ALT 120 U/L
AST 90 U/L
Amylase 50 U/L
Bilirubin, total 1.4 mg/dL
WBC 15, 600/mm^3
Intravenous ampicillin-sulbactam and crystalloid solution are administered. During the next 24 hours, the patient remains febrile and physical examination discloses increasing right upper quadrant tenderness. You recommend cholecystectomy. The patient has a “Do Not Resuscitate: Do Not Intubate” order but the patient’s guardian agrees to the operation. At this time, which of the following is the most appropriate step?
A. Ask the guardian to temporary suspend the order and proceed with the operation
B. Attempt the operation under regional anesthetic without intubation
C. Continue present medical management
D. Obtain a court order to proceed with the operation
E. Provide comfort measures only
Why is the answer a? and not b or e?
3). A 58-year-old homeless man is brought to the emergency department by the shelter manager because, the manager says, “I noticed him weaving when he walks and his speech is slurred. He wasn’t like that when he came in this morning. “ The patient says he is nauseated and has a headache. Vital signs are temperature 36.1 C (97 F), pulse 80/min, respirations 16/min, and blood pressure 150/90 mm Hg. On physical examination he is oriented but his speech is slurred. His gait is ataxic and he is unable to do the finger -to-nose test. The remainder of the examination is normal. He vomits during the examination. Results of initial laboratory studies are shown:
Na+ 140 mEq/L
K+ 3.0 mEq/L
Cl- 90 mEq/L
HCO3- 12 mEq/L
Glucose 120 mg/dL
These findings are most indicative of which of the following?
A. Alcohol intoxication B. Antifreeze intoxication C. Carbon monoxide poisoning
Why is the answer b and not a?
4). You regularly visit a 66-year-old African American woman at her home. She has had multiple sclerosis for the past 20 years. She is now quadriplegic and relies on her family for support and care. In addition, a visiting nurse service provides a home health aide 5 days weekly. Today she tells you she has been somewhat depressed recently. She says, “My husband and I just keep arguing about little things.” Her husband is present during this interview. Which of the following is the most appropriate response to this situation?
A. Arrange for a social worker to visit through the visiting nurse service
B. Ask the husband to leave so you can discuss the matter with the patient, alone
C. Ask the patient and her husband about the nature of their disagreements
D. Ask to speak to the husband in another room
E. Prescribe an antidepressant medication
Why is the answer c and not d?
5) A 2-month-old infant is admitted to the hospital because of lung congestion of several days’ duration. On admission, he has low-grade fever and tachypnea. The mother, who is a nurse, states that the child had severe conjunctivitis at about 1 week of age, which was successfully treated with ophthalmic erythromycin ointment. Chest x-ray shows hyperinflation and multiple areas of pulmonary interstital infiltrates. Which of the following is the most likely mode of transmission or acquisition of the organism causing this child’s illness?
A. Breast feeding
B. Droplet inhalation
E. Through an infected cervix at birth
why is the answer e? and not b? this baby is not a neonate, looks like rsv to me
Please if anyone can explain the reasoning behind these answers, I would really appreciate it