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nbme questions!! - poojy36
#1
1.55 yr old man with uncontrolled hypertention has dyspnea for 3 days .he slept sitting in a chair last night .vitals
pulse 110 /min
resp 30/min
bp-120/80 sitting
over the apex there is an early diastolic low freq sound after s2.this sound is most likely??

a)mid systolic click
b)opening snap
c)percardial rub
d)s2 splitting
e)s3

32 yr old woman comes with intermittant diarhea for the past 10 yrs...which occurs 3 to 4 times an year ,lasts for 2-4 days asso with deadlines at work ...during this episode stool is lose and there is no malena or frank bright blood.Between these diarrhea episodes she has 1 movemnt every 4 -5 days and the stool is hard and "pellet like" ...she drinks a glass of wine everyday .labs
hb:14.3 g/dl
hct:43%
leucocyte-8100
esr-7.mm/hr
wht is the diagnosis/

a)chrons
b)colon cancer
c)diverticulitis
d)irritable bowel syndrome
e)small bowel lymphoma
f)ulcerative colitis
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#2
1 ====> openning snap
2 ====> crohn's ?
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#3
1. S3,

2. d)irritable bowel syndrome, associated with stress.
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#4
agree with purplepen in both
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#5
thanks a lot guys....even i agree with purple pan
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#6
i think the answer to the first one is
opening snap and the second one is irritable bowel syndrome.
why is it not opening snap poogy36?
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#7
HI...to me it looks more like heart failure due to uncontroled hypertension ....he has noctural dypnea so he sat up whole night .....and if it was mitral stenosis there wus be a murmur of sum past history of rheumatic fever .
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#8
S3 is correct and Poojy your explanation is right too.
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#9
Thanks Poojy. Your explanation is very convincing.
Initially I thought that the correct answer was Opening snap but yes S3 makes more sense.
The other question is certainly irritable bowel syndrome
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