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4.
An 8-year-old girl is admitted to the hospital because of a 2-week history of bizarre behavior. Two weeks prior to admission she began to perform poorly in school and was inattentive. Vital signs are temperature 37.0°C (98.6°F), pulse 72/min, and blood pressure 110/70 mm Hg. Physical examination shows an alert and communicative girl who has involuntary movements of the muscles of her face and extremities. Auscultation of the chest discloses a new grade 2/6 blowing, apical systolic murmur. Complete blood count and blood chemistry profile are normal. It is most appropriate to inform the parents that the patient will be at increased risk for which of the following?
A) Chronic renal failure
B) Growth retardation
C) Infective endocarditis
D) Mental retardation
E) Rheumatoid arthritis
5.
A 92-year-old resident of a nursing home has an acute onset of back pain localized to the mid region of her spine. The pain has failed to respond to local heat, massage, or nonsteroidal anti-inflammatory drugs. The patient is receiving hospice care for widely metastatic breast cancer. She says, "I know I'm close to the end. I want to be comfortable here in my bed." Vital signs are temperature 37.5°C (99.5°F), pulse 88/min, respirations 14/min, and blood pressure 110/60 mm Hg. The patient is cachectic but is cognitively intact. A left mastectomy scar is present. She has tenderness over T8; marked paravertebral spasm is evident. Reflexes are normal. The liver is palpable 4 cm below the sternal border. In addition to prescribing opioid analgesic medication, which of the following is the most appropriate next step?
A) Administer alendronate
B) Apply a spinal support brace
C) Obtain surgical consultation to discuss vertebroplasty
D) Obtain x-rays of the spine
E) Prescribe a laxative
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4.no clue
5. E, as laxative is needed with opiod to manage constipation
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4.
An 8-year-old girl is admitted to the hospital because of a 2-week history of bizarre behavior. Two weeks prior to admission she began to perform poorly in school and was inattentive. Vital signs are temperature 37.0°C (98.6°F), pulse 72/min, and blood pressure 110/70 mm Hg. Physical examination shows an alert and communicative girl who has involuntary movements of the muscles of her face and extremities. Auscultation of the chest discloses a new grade 2/6 blowing, apical systolic murmur. Complete blood count and blood chemistry profile are normal. It is most appropriate to inform the parents that the patient will be at increased risk for which of the following?
A) Chronic renal failure
B) Growth retardation
C) Infective endocarditis
D) Mental retardation
E) Rheumatoid arthritis
q4
Ans) C
C) Infective endocarditis
(right by feedback)
A child with Chorea + new murmur, think about Rheumatic fever. The heart has been compromised, the only choice C.
========================
Rheumatic Heart Disease Vs Endocarditis Both end up producing vegetations although certainly by a different mechanism and bacteria
ENDOCARDITIS: The vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflam cells.
MC Case:
Post-dental procedure/on an already messed up valve: Streptococcus Viridans
Out of nowhere on a previously normal valve/IVDU = staph aureus
RHEUMATIC FEVER VEGETATION: Systemic disease affecting the peri-arteriolar connective tissue and can occur after an untreated Group A Beta hemolytic streptococcal pharyngitis.
It is caused by antibody cross-reactivity. This cross-reactivity is a Type II hypersensitivity reaction.
MC Case:
Immigrant with symptoms of fever, blah blah, and maybe some other signs of the jones criteria
http://i42.photobucket.com/albums/e338/G...594869.png
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5.
A 92-year-old resident of a nursing home has an acute onset of back pain localized to the mid region of her spine. The pain has failed to respond to local heat, massage, or nonsteroidal anti-inflammatory drugs. The patient is receiving hospice care for widely metastatic breast cancer. She says, "I know I'm close to the end. I want to be comfortable here in my bed." Vital signs are temperature 37.5°C (99.5°F), pulse 88/min, respirations 14/min, and blood pressure 110/60 mm Hg. The patient is cachectic but is cognitively intact. A left mastectomy scar is present. She has tenderness over T8; marked paravertebral spasm is evident. Reflexes are normal. The liver is palpable 4 cm below the sternal border. In addition to prescribing opioid analgesic medication, which of the following is the most appropriate next step?
A) Administer alendronate
B) Apply a spinal support brace
C) Obtain surgical consultation to discuss vertebroplasty
D) Obtain x-rays of the spine
E) Prescribe a laxative
Ans) E- Laxatives
(right by nbme)
This is a terminal patient, why are we going to order imagen studies or think about surgeries, let's respect her will. Having Morphine, sure she needs some laxatives. Nothing else we can do.
Sad case 
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6.
An 82-year-old Native American woman is admitted to the hospital because of the sudden onset of right-sided weakness and aphasia. Before becoming ill, she had a history of hypertension treated with hydrochlorothiazide but she was otherwise well and active. Vital signs on admission are temperature 37.0°C (98.6°F), pulse 80/min and regular, respirations 20/min, and blood pressure 156/87 mm Hg. Neck is supple and chest is clear to auscultation. Chest x-ray on admission was normal. She is placed in a monitored setting, given nothing by mouth, and observed. Twenty-four hours later a cough productive of purulent sputum develops. At this time temperature is 39.0°C (102.2°F). There are rhonchi and bronchial breath sounds over the right lower chest, posteriorly. Which of the following is the most likely explanation of these new findings?
A) Aspiration pneumonia with anaerobic organisms
B) Aspiration pneumonia with Klebsiella pneumoniae
C) Aspiration pneumonia with methicillin-resistant Staphylococcus aureus
D) Haemophilus influenzae pneumonia
E) Mycoplasma pneumonia
7.
A 65-year-old white woman with coronary atherosclerosis was admitted to the hospital 2 days ago for coronary artery bypass grafting. Now, on the second postoperative day, she says, "I feel like my heart is beating out of my chest. I knew I shouldn't have had this surgery." She had been hesitant to have surgery originally, but she finally consented after discussion with her children. Vital signs now are temperature 37.0°C (98.6°F), pulse 150/min, respirations 18/min to 20/min, and blood pressure 150/90 mm Hg. Cardiac examination discloses a rapid, irregularly irregular heart rate and rhythm. She is oriented to person and place but not to time. Which of the following is the most accurate statement about this patient's course during the next 24 hours?
A) Her symptoms will likely resolve spontaneously
B) Her symptoms will likely resolve with alprazolam therapy
C) Her symptoms will likely resolve with lidocaine therapy
D) She will likely develop a cerebrovascular embolus
8.
A 7-hour-old male neonate is being seen in the hospital nursery for a routine examination. The neonate was delivered vaginally at 38 weeks' gestation to an 18-year-old primigravid woman; pregnancy and delivery were uncomplicated. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Length is 52 cm (20 in; 75th percentile), weight is 2756 g (6 lb 1 oz; 10th percentile), and head circumference is 35 cm (14 in; 75th percentile). Vital signs are normal. Moro reflex is asymmetric. The remainder of the physical examination shows no abnormalities. Chest x-ray shows a fracture at the junction of the middle and lateral third of the right clavicle. At this time, the parents should be told which of the following?
A) The obstetrician caused the fracture during delivery
B) Their child has a fracture of the right clavicle, which should heal without treatment in approximately 10 days
C) Their child will need a figure-of-8 splint for the fracture for at least 3 weeks
D) Their child will need a genetics consultation for evaluation of osteogenesis imperfecta
E) They have a healthy child; it is not necessary to inform them of the fracture
9.
A 3-day-old Asian American neonate is ready for hospital discharge. The nurses report that the neonate has been breast-feeding well. However, on physical examination the infant appears clinically jaundiced. The neonate weighs 3000 g (6 lb 10 oz). Physical examination is otherwise normal. Laboratory studies done this morning show the neonate's blood type is O, Rh-positive and the mother's blood type is A, Rh-positive. Coombs test is negative. Serum total bilirubin concentration is 12 mg/dL. At this time, which of the following is the most appropriate management?
A) Begin in-patient phototherapy
B) Discharge the neonate home with follow-up in 2 days
C) Obtain complete blood count
D) Order determination of serum ALT and AST concentrations
E) Order determination of serum TORCH titers
10.
A 77-year-old woman with type 2 diabetes mellitus was admitted to the hospital 2 days ago for an elective cholecystectomy. She has mild isolated memory deficits and hearing impairments, but she is not demented. Prior to hospitalization, the patient lived alone and managed her household and personal affairs independently. Now, 2 days after the operation, the nurse calls you to report that the patient seems confused and is packing her suitcase to leave "this hotel." Vital signs are temperature 37.0°C (98.6°F), pulse 84/min, respirations 18/min, and blood pressure 156/84 mm Hg. Physical examination is normal except for surgical changes. Blood glucose concentration is 144 mg/dL. Which of the following is the most appropriate next step?
A) CT scan of the head
B) Determination of arterial blood gas values
C) Lumbar puncture
D) Mental status examination
E) Thyroid chemistry profile
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6. AA
7. AA
8. BB
9. AA
10. DD
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hi guys.I,m following you b/c just did nbme2 and its horrible result. about
9.
A 3-day-old Asian American neonate is ready for hospital discharge. The nurses report that the neonate has been breast-feeding well. However, on physical examination the infant appears clinically jaundiced. The neonate weighs 3000 g (6 lb 10 oz). Physical examination is otherwise normal. Laboratory studies done this morning show the neonate's blood type is O, Rh-positive and the mother's blood type is A, Rh-positive. Coombs test is negative. Serum total bilirubin concentration is 12 mg/dL. At this time, which of the following is the most appropriate management?
A) Begin in-patient phototherapy
B) Discharge the neonate home with follow-up in 2 days
C) Obtain complete blood count
D) Order determination of serum ALT and AST concentrations
E) Order determination of serum TORCH titers
According to my NBME feedback AA is wrong.
I think its BB.
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6.
An 82-year-old Native American woman is admitted to the hospital because of the sudden onset of right-sided weakness and aphasia. Before becoming ill, she had a history of hypertension treated with hydrochlorothiazide but she was otherwise well and active. Vital signs on admission are temperature 37.0°C (98.6°F), pulse 80/min and regular, respirations 20/min, and blood pressure 156/87 mm Hg. Neck is supple and chest is clear to auscultation. Chest x-ray on admission was normal. She is placed in a monitored setting, given nothing by mouth, and observed. Twenty-four hours later a cough productive of purulent sputum develops. At this time temperature is 39.0°C (102.2°F). There are rhonchi and bronchial breath sounds over the right lower chest, posteriorly. Which of the following is the most likely explanation of these new findings?
A) Aspiration pneumonia with anaerobic organisms
B) Aspiration pneumonia with Klebsiella pneumoniae
C) Aspiration pneumonia with methicillin-resistant Staphylococcus aureus
D) Haemophilus influenzae pneumonia
E) Mycoplasma pneumonia
Ans) A
(Right answer by nbme feedback)
Post stroke 82yo patient with pneumonia after 24h hospitalized, we think of Aspiration Pneumonia. This is the most important acute complication of stroke specially if compromise of gag reflex, there is usually oral or gastric contents (food, saliva, or nasal secretions) including bacterial pathogens (particularly anaerobic bacteria). Antibiotic recommendations for patients who have clearly aspirated secondary to stroke might reasonably include at least one drug with anaerobic coverage.
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my previous nbme2 9CC was wrong too, according to a feedback
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