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+--- Thread: NBME 17,plz help and give explanation,tks!! - susanusmle (/showthread.php?tid=806492)
NBME 17,plz help and give explanation,tks!! - susanusmle - ArchivalUser - 05-03-2015
40.
A new compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which of the following best describes this mechanism of transport?
A)
ATP-dependent active transport
B)
Carrier-mediated diffusion
C)
Group translocation
D)
Phosphorylation-linked transport
E)
Proton-gradient-mediated transport
43.
An 80-year-old woman is being evaluated for suspected temporal arteritis (TA). Her erythrocyte sedimentation rate (ESR) is 100 mm/h. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate next step in management?
A)
Additional testing to confirm the diagnosis of TA
B)
Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C)
Elimination of TA from further diagnostic consideration
D)
Repeat ESR; if again positive, corticosteroid therapy
E)
Repeat ESR; if normal, additional testing to confirm the diagnosis of TA
I select E,and it's wrong
39.
A 62-year-old woman with recurrent pulmonary emboli comes to the physician for a follow-up examination. Physical examination shows no abnormalities. Laboratory studies show a prothrombin time of 12 seconds. Warfarin therapy is begun. Which of the following clotting factors is the first to be decreased by 50% after the initiation of therapy?
A)
V (proaccelerin)
B)
VII (proconvertin)
C)
VIII (antihemophilic factor)
D)
XI (plasma thromboplastin antecedent)
E)
XII (Hageman factor)
C is wrong
14.
A 26-year-old woman comes to the physician 5 weeks after the birth of her first child. She worries constantly that the infant is ill and wakes him 10 to 14 times every night to make sure he is well. She has had no crying spells or problems with appetite. She is worried that she will infect the infant with her germs and washes her own hands 30 times per day. For 2 months prior to the delivery, she worried about people breaking into her house and checked the lock on the front door three to four times every night. She is not breast-feeding. Which of the following is the most appropriate pharmacotherapy?
A)
Alprazolam
B)
Haloperidol
C)
Lithium carbonate
D)
Methylphenidate
E)
Phenelzine
F)
Sertraline
B is wrong,i cannot understand this ,what's the diagnosis ?
18.
A 63-year-old woman is brought to the emergency department because of a 2-day history of fever, abdominal tenderness, and painful urination. She appears agitated. Her temperature is 38.8°C (101.8°F). Laboratory studies show a leukocyte count of 14,000/mm3. She is admitted to the hospital. Two hours later, the nurses note that she has torn up four breakfast menus because she found them to be too confusing. She is highly educated, and her husband says that she does not behave this way at home. Which of the following is the most likely cause of this patient's current mental status?
A)
Amnesia
B)
Delirium
C)
Dementia
D)
Mild cognitive impairment
E)
Occult cerebral infarction
why C is wrong ?
8.
A 34-year-old man is evaluated after becoming lightheaded after running 12 miles of a marathon on a hot day. His pulse is 130/min and his blood pressure is 80/60 mm Hg. Which of the following changes in his autonomic nervous system most likely occurred?
Sympathetic Efferent Activity Parasympathetic Efferent Activity
A) ↑ ↑
B) ↑ ↓
C) ↔ ↑
D) ↔ ↓
E) ↓ ↑
F) ↓ ↓
anybody can explain this one?thanks soooo much !!
27.
A 14-year-old boy is brought to the physician by his mother because of daily headaches for 2 months. The headaches are described as a bilateral aching in the temples. His mother states that he also "has not been himself" for the past few months. He seems more confused, often forgetting names, dates, and places, and he is clumsy with frequent falls. His school performance also has declined over the past quarter. Physical examination shows a broad-based, ataxic gait. He is alert and oriented to person, place, and time, but he is slow to answer questions. Chronic abuse of which of the following substances is the most likely cause of this patient's condition?
A)
Cocaine
B)
Ethanol
C)
Inhaled glue
D)
Methamphetamines
E)
PCP (phencyclidine)
0 - ArchivalUser - 05-03-2015
B
C
B
14) no clue haven't done my pharm yet sorry
D?
B
B
I can explain the answers if you can let me know if they are right please
would rather save all the typing if they are not haha.
0 - ArchivalUser - 05-03-2015
bump
0 - ArchivalUser - 05-03-2015
bump
0 - ArchivalUser - 05-03-2015
40. B carry me for free.......
43. B you have 99% , what else do you need for TA (start right now or patient will get blind)
39. B 1972 ROCK n roll
14. F SSRI the doctor's friend forever. She has OCD and plus....
18. B delirium, the most encountered dz in RECENTLY hospitalized...
8. B when you run from dinosaurs...... you increase sympathetic, decrease the otherone......
27. C GLUE, teenagers are poor, whatever they find in dad's garage is ok, that glue sticks to your vermis.
correct, add and challenge please.
thank you
0 - ArchivalUser - 05-03-2015
43. agreeing with monter..went back and reread the question..i read it to fast
18. i think she has a UTI because UTI are the number one cause of acute mental changes in the elderly
27. again monter you got me haha, i forgot about the 2 months
0 - ArchivalUser - 05-03-2015
@ monter, for number 43, if you have a 99% sensitivity..and she has a 50% chance of ESR, shouldn't that exclude the disease?
0 - ArchivalUser - 05-03-2015
thank you so much ,@jazpreet2000,@monter, for 43, do you think calculation posttest
probability for TA is necessary ?
0 - ArchivalUser - 05-03-2015
43. "The pretest probability for TA is 50% in this patient" -- I understand it as the patient has fifty/fifty chance of a disease. is that correct? I think this info is just to confuse you. It does not help in choosing the answer.
18. fever from UTI -- probably, or some medication.
0 - ArchivalUser - 05-03-2015
18) if it is an acute UTI shouldn't it be D? since its temporary.
43) it says you have 99% sensitivity..shouldn't that rule out the dx? and thus corticosteroids are not needed?