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+--- Thread: nbme-7 Q - picu (/showthread.php?tid=824453)
nbme-7 Q - picu - ArchivalUser - 03-26-2016
A 27-year-old woman comes to the physician because of a 5-day history of headache, severe, diffuse abdominal pain, and nausea and vomiting. The pain is
exacerbated by eating and relieved by vomiting. The vomitus initially consisted of a large amount of semisolid material mixed with a clear green liquid but now consists
of clear yellow liquid only. She has not had any other symptoms. She has Crohn disease treated with prednisone; she was instructed to taper her dosage 2 weeks
ago. Additional medications include mesalamine and azathioprine. Her last menstrual period was 7 weeks ago. She is sexually active with one male partner, and they
use condoms inconsistently. She appears ill and is in mcxlerate distress. Her temperature is 38.4•c {101.2.F), pulse is 120/min, respirations are 22/min, and blood
pressure is 90/50 mm Hg. Examination shows d mucosa and le conjunctivae. he abdomen is distended, diffusely tender, and tympanitic. Bowel sounds are
decreased. Pelvic examination shows no abnormalities. Laboratory studies show:
Hct:31%
leukocyte:15.000
Serum
Amylase 300 U/L
Lipase 9/L
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Gastric outlet obstruction
C) Gastroparesis
D) Migraine
E) Pelvic inflammatory disease
F) Pregnancy
G) Small-bowel obstruction
H) Viral gastroenteritis
0 - ArchivalUser - 03-26-2016
14 month boy brought in for well-child exam. Mother is worried because he is not yet walking on his own. He will stand for several seconds before falling. He can empty raisins from a cup and tries to eat with a spoon. 25th % percentile for length and 30th %ile for weight. Exam shows no abnormalities. Most appropriate next step in management?
A-Reassurance
B-Chromosomal Analysis
C-Measurement of serum CK activity
D-X-ray of the lower extremities
E-X-ray of the spine
F-MRI of the brain
0 - ArchivalUser - 03-26-2016
Green vomit + chron +abd difussely tender
my answer : G
0 - ArchivalUser - 03-26-2016
14 mont old boy ,,,looks like a tricky qs
12 months--> stand
15 months-->walk
if there is normal phisical examen , why suspect chromosomal,CNS or musculoskeletal disorder?
but low heigt and weight (growth delay)
so i will go A
0 - ArchivalUser - 03-26-2016
fuser00 thank you very much.
7. A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter. The mother asks to speak to the physician alone and explains that she persuaded her daughter to come because the girl has begun to stay out late, receive many calls from several different boys, and wear tight clothing and excessive makeup. She says her daughter confides many details of her dates to her. She adds that the girl's father is furious and berates her about this behavior even though he does not know about most of what is going on. To protect her daughter, she does not want to tell him about all the daughter's activities. On individual interview, the girl says she does not understand why she does these things, but she would like to understand. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
B.Behavior therapy for the patient
C) Family therapy
D) Marital therapy for the parents
E) Psychodynamic psychotherapy for the patient
F)Triazolam therapy for the patient
0 - ArchivalUser - 03-26-2016
1-G
2-A
3-C
0 - ArchivalUser - 03-26-2016
A previously healthy 6-year-old boy is brought to the emergency department because of cramping abdominal pain and right-sided scrotal pain for 4 hours. He vomited once on the way to the hospital. Examination shows a distended abdomen. Bowel sounds are decreased, and there is diffuse tenderness to palpation with involuntary guarding. The right hemiscrotum is slightly discolored with swelling and tenderness superiorly. The left hemiscrotum is normal; the testicle is normal. Which of the following is the most appropriate next step in management?
B.Valsalva maneuver
C.Urinalysis
D.Doppler ultrasonography
E.CT scan
F.Antibiotic therapy
G.Operative procedure
0 - ArchivalUser - 03-26-2016
@pasargad thank you very much. Could you please explain your opinion. Why family therapy?
For the last Qs: from another post they told its 'G' but why?
0 - ArchivalUser - 03-26-2016
A previously healthy 6-year-old boy ....
TESTITULAR TORSION
DONT WASTE TIME IN ULTRASOUND
RUSH TO OPERATION ROOM
MY ANSWER G
0 - ArchivalUser - 03-26-2016
7. A 16-year-old girl is brought to the physician by her mother who requests contraception for her daughter....
mother-->submisive behabior w/husband
girl-->suddenly changes behavior
father-->"furious", sounds like agreesive behavior
so involve all the family
my answer C
PD...for the usmle purpose will be wrong just to treat the patient when is evident a unfavorable environment(parents)