NBME 4 Mistakes - medlife2014

[ArchivalUser]

@izaldavir clot has not formed in qsn A..
S/c erythematous hard cord like str is superficial thrombophlebitis ?? (Seems like to me)
and patient hAs OCP hx so there is always possibility of DVT so u start heparin right away!!

[ArchivalUser]

I rechecked my nbme form 4 and i have done it right as that qsn ain't among my wrong answer(question 2 as mentioned by midlife )
But now i am confused which ans i picked.... I think i picked ans packed red cells lol i dont remember...
Anyone who has taken recent nbme 4 online plz give ur views!!
I am sorry for the confusion but my gut feeling says that i picked ans E for qsn 2!!

[ArchivalUser]

For the superficial thrombophlebitis question, E is the answer. Compression stockings are only for very early stage of SVT. After that, "Use of the lowest dosage of fondaparinux (2.5 mg/day subcutaneously) for 45 days has been shown by Decousus et al to suffice for prevention of extension, recurrence, and embolization of superficial venous thrombosis." http://emedicine.medscape.com/article/46...w2aab6b6b3

For the post-op patient-- he is stable (look at the respiratory rate, the bp, the pulse, the temperature, the O2), there is no urgency of RBCs unless he's crashing or there is evidence of a bleed. Hematocrit is only an indicator of transfusion in children when less than 7g/dl or something like that (Don't quote me on that, I might be wrong, but basically low hematocrit is very RARELY the only indication for transfusion, so don't go off of just the hematocrit. There can always be false values too.)

The guy's oliguria on the other hand is not normal, and he either has urinary retention from being on morphine + post op from anesthesia or he has some sort of ureter injury caused during surgery. Either way, saline or half saline will force an osmotic diuresis. Normal saline would do it too, but it won't be as fast since its osmolality is closer to normal serum. The larger the difference, the faster it will work. The Dextrose solution is also mixed into half normal saline, so that's an option too really. But again, as it has more solutes (glucose) it will not be as fast as the half normal saline. The goal here isn't fluid expansion as much as it is to get the patient to diurese.

[ArchivalUser]

@mastariz i agree with you...
I didn't want to create the confusion...
It's just that i dont recall which ans i picked last week!!
Thanks for explanation!!

[ArchivalUser]

Same here, I don't know at all now which answers I marked on the correct answers for the nbme's. I can see all the incorrect ones, but it's worth reviewing correct ones too since half of them could have been guesses on my part at the time, especially if I was pressed for time. Reviewing them all will take a lot of time though.

[ArchivalUser]

@ Monter; @happy_studying.@medlife2014
Can you please send me offline NBME,s . reviewing them after online would be easy for me.Please..

dr_usa126