plz help,, clinical mastery series... medicine 1 - hakunamatata1 - 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: plz help,, clinical mastery series... medicine 1 - hakunamatata1 (/showthread.php?tid=810886) |
plz help,, clinical mastery series... medicine 1 - hakunamatata1 - ArchivalUser - 07-16-2015 Here are some qs from the Medicine test form 1. Thanks to @liaison4fun for the help!!!! For each patient with jaundice, select the most likely diagnosis. A) Acute hepatitis B) a1-Antitrypsin deficiency C) Biliary atresia D) Cholangiocarcinoma E) Choledocholithiasis F) Gi I bert syndrome ® G) Glucose 6-phosphate dehydrogenase deficiency H) Liver abscess I) Peptic ulcer disease 1. Two days after undergoing surgical repair of a torn anterior cruciate ligament, a 24-year-old man develops jaundice. He has not had fever, nausea, vomiting, or abdominal pain. Examination shows no abnormalities except for mild scleral icterus. Laboratory studies show: Hemoglobin Serum Bili rubin, total Direct Alkaline phosphatase AST ALT Lactate dehydrogenase 16 g/dL 3.5 mg/dL 0.2 mg/dL 38 U/L 14 U/L 12 U/L 120 U/L 3. A 52-year-old woman with breast cancer is brought to the emergency department 8 hours after the onset of temperatures to 39.4•c (1 03.F), shaking chills, and generalized malaise. She has been receiving chemotherapy via an indwelling central venous catheter for 2 months; her last treatment was 3 weeks ago. She was treated in the hospital 1 month ago for pneumonia. She had diarrhea 2 days ago. Current medications include prochlorperazine as needed, lorazepam, and sertraline. She appears acutely ill. Her temperature is 39ZC (1 02SF), pulse is 120/min, respirations are 24/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows no erythema surrounding the catheter site. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the upper left sternal border without radiation. Laboratory studies show: Leukocyte count 3200/mm3 Segmented neutrophils 70% Bands 10% Lymphocytes 12% Monocytes 8% Urine RBC WBC Bacteria 2/hpf 2/hpf occasional An x-ray of the chest shows no abnormalities. In addition to ceftazidime, empiric antibiotic therapy for this patient should include which of the following medications? A) lmipenem B) Levofloxacin C) Metronidazole D) Nafcillin E) Vancomycin @ F) No additional antibiotics are indicated A 57-year-old man comes to the physician because of a 3-month history of moderate left leg pain that began at the knee and now involves the entire left leg. He has no history of leg trauma. He has hypertension well controlled with a {3-adrenergic blocking agent. His only other medication is acetaminophen as needed, which does not relieve his pain. His blood pressure is 130/80 mm Hg. Examination shows warmth and tenderness to palpation over the left anterior tibia. Sensation and motor function are intact. Distal pulses are 1 +.An x-ray of the left leg shows increased cortical thickness along the tibia with slight anterior bowing; there is no periosteal reaction. His serum alkaline phosphatase activity is 100 U/L. A whole-body bone scan shows several areas of increased uptake, including the tibial region. Which of the following is the most likely cause of these findings? ® A) Areas of spindle cells and dysplastic bone B) Decreased bone mineralization C) Decreased osteoid production D) Increased bone turnover E) Trabecular microfractures An unconscious 25-year-old man is brought to the emergency department 15 minutes after his neighbor found him lying in the street. The neighbor reports that the patient was jogging before falling to the ground. The patient is wearing a medic alert bracelet that states that he has type 1 diabetes mellitus. No other history can be obtained. There is no evidence of trauma. He does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. His temperature is 3r C (98.6.F), pulse is 90/min, respirations are 12/min, and blood pressure is 122/70 mm Hg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management? A) Urine to xi co logy screening B) MRI of the brain C) Administration of a bolus of insulin D) Admi ni strati on of 50% dextrose in water @ E) Rapid infusion of 1 L of 0.9% saline F) Lumbar puncture 10. An African American husband and wife come to the physician for advice concerning their risk for having children with sickle cell disease. The wife has hemoglobin A on screening; the husband has not been screened. This couple's risk for having offspring with sickle cell disease is closest to which of the following? A) O% B) 25% C) 50% D) 75% @ E) Unable to be determined without screening of the husband 12. A 25-year-old man who is HIV positive comes to the physician because of a 3-week history of cough and wheezing. He stopped taking his antiretroviral therapy 6 months ago because of adverse effects, and he has had an increasing plasma HIV viral load since then. He has required treatment with prednisone for immune thrombocytopenia over the past 2 months with improvement of his platelet count from 25,000/mm3to 1 OO,OOO/mm3. His temperature is 38.9•c (1 02.F), pulse is 95/min, respirations are 30/min, and blood pressure is 100/60 mm Hg. Examination shows shotty bilateral cervical adenopathy. There is dullness to percussion over the left upper posterior thorax, and rhonchi are heard over the same area. Laboratory studies show: Hematocrit Leukocyte count Segmented neutrophils Bands Eosinophils Monocytes Platelet count 30% 10,000/mm3 70% 5% 10% 15% 1 OO,OOO/mm3 An x-ray of the chest shows a nodular density in the left upper lung field posteriorly. Which of the following is most likely to confirm the diagnosis? A) Examination of duodenal aspirate B) Examination of the stool for ova and parasites C) Toxoplasmosis titers D) Blood cultures E) Biopsy and culture of the lung mass @ F) Lymph node biopsy 0 - ArchivalUser - 07-16-2015 1.F) Gi I bert syndrome 3E) Vancomycin A 57-year-old man comes to the physician because of a 3-mont B) rickets, decreased mineralization An unconscious 25-year-old man is brought to the emergency department 15 minutes D) Admi ni strati on of 50% dextrose in water 10.A)0% 12E) Biopsy and culture of the lung mass 0 - ArchivalUser - 07-16-2015 1. gilbert - hint is that the "surgery" caused "xtra" stress on him as he has normal everything on the liver .young age also . 3. vancomycin due to central venous catheter unconsiuos 25 yr give 50 % dextrose in h20 others qn listed i also missed . decreased bone mineralization i chose which was wrong i chose lymph node bisy for the last one was also wrong 0 - ArchivalUser - 07-16-2015 @CAPTAN = COULD YOU EXPLAIN LUNG MASS BIOPSY I GUESS ANSWER IS DECREASED OSTEOID FR THE BONE QN ? AS MINERALIZTION IS WRONG FOR SURE 0 - ArchivalUser - 07-16-2015 12.Patient with HIV,a 3-week history of cough and wheezing , biopsy and staining may show pneumocyxtic jiroveci cysts 0 - ArchivalUser - 07-16-2015 1gilbert 2,vanco,low wbc ,increase chance of pseudomona.sonadd vanco to ceftazidime 3,its paget disease.increase turne over 4.dexterose 50% 0% May be TB OR even pcp so i think biopsy and culture of lung mass 0 - ArchivalUser - 07-16-2015 A 57-year-old man comes to the physician because of a 3-month history i don't know about Paget d ,b/c ALF in normal range 0 - ArchivalUser - 07-16-2015 thank you guyzz.. |