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NBME 2 B2 Q 11-15, please explain - irvinedawg - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: NBME 2 B2 Q 11-15, please explain - irvinedawg (/showthread.php?tid=439697) |
NBME 2 B2 Q 11-15, please explain - irvinedawg - ArchivalUser - 08-20-2009 11. A 62-year-old man comes to the emergency department because of progressive shortness of breath for 3 days. He has not had chest pain, orthopnea, or paroxysmal nocturnal dyspnea. He completed chemotherapy for small cell carcinoma of the lung 10 months ago. He has a history of twice nightly nocturia that has resolved over the past 3 days. He smoked two packs of cigarettes daily for 30 years but quit 1 year ago. His blood pressure is 96/60 mm Hg, and pulse is 116/min. There is jugular venous distention to the angle of the jaw. The lungs are clear to auscultation. Cardiac examination shows distant heart sounds, an S1 and S2, and no gallops or rubs. The liver has a span of 12 cm and is tender. There is no pedal edema. Laboratory studies show: Hemoglobin 10 g/dL Serum Na+ 135 mEq/L Cl“ 110 mEq/L K+ 4.2 mEq/L HCO3“ 22 mEq/L Urea nitrogen (BUN) 40 mg/dL Creatinine 1.6 mg/dL An ECG shows diminished amplitude of the QRS complexes. An x-ray film of the chest shows clear lung fields with an enlarged cardiac silhouette. Which of the following findings is most likely to be accentuated? A ) Cardiac output B ) Fall in systolic arterial pressure with inspiration C ) Left ventricular end-diastolic pressure D ) Mitral regurgitation E ) Ventricular septal wall motion 12. A 35-year-old woman comes to the physician because of two 12-hour episodes of dizziness over the past 3 months. During episodes, she experiences the acute onset of rotatory vertigo and imbalance, decreased hearing, tinnitus, a sense of fullness of the right ear, and vomiting. Examination shows a mild hearing loss of the right ear. Which of the following is the most likely diagnosis? A ) Acoustic neuroma B ) Benign positional vertigo C ) Brain stem transient ischemic attacks D ) Meniere's disease E ) Viral labyrinthitis 3. An obese 33-year-old woman has had four 12-hour episodes of severe, sharp, penetrating pain in the right upper quadrant of the abdomen associated with vomiting but no fever. She has no diarrhea, dysuria, or jaundice and is asymptomatic between episodes. There is slight tenderness to deep palpation in the right upper quadrant. Which of the following is the most appropriate next step in diagnosis? A ) Supine and erect x-ray films of the abdomen B ) Upper gastrointestinal series C ) Ultrasonography of the upper abdomen D ) CT scan of the abdomen E ) HIDA scan of the biliary tract 14. An otherwise healthy 19-year-old woman comes to the physician because of a 3-year history of intermittent facial blemishes. She drinks wine occasionally on weekends. She takes no medications. Examination shows multiple 1- to 2-mm red and white papules and larger red nodules on the forehead and cheeks. Which of the following is the most appropriate initial pharmacotherapy? A ) Oral isotretinoin B ) Systemic corticosteroids C ) Topical benzoyl peroxide D ) Topical corticosteroids E ) Topical metronidazole 15. A previously healthy 67-year-old man comes to the physician because of a 4-month history of hand weakness, intermittent tingling of the small fingers of his hands, and mild neck pain. Examination shows wasting, weakness, and fasciculations of the interossei muscles. Sensation is decreased to pinprick and vibration in the small fingers of each hand. Triceps tendon reflexes are decreased. Which of the following is the most likely diagnosis? A ) Amyotrophic lateral sclerosis B ) Cervical spondylosis C ) Multiple sclerosis D ) Myasthenia gravis E ) Myasthenic (Lambert-Eaton) syndrome F ) Myotonic muscular dystrophy G ) Polymyalgia rheumatica H ) Polymyositis I ) Progressive neuropathic (peroneal) muscular atrophY |