NBME7 questions!!!!!!!!!! - usmlerock99

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@ doctor15 Thank you!

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33 question: C) placement of Intra aortic balloon...as he is in cardiogenic shock.

uptodate.com:

Especially in patients with some damage to the heart muscle prior to CABG, low cardiac output (when a reduced volume of blood is pumped out of the heart to the body) can occur during or after surgery. This is often temporary and responds to intravenous fluids and/or a brief period of therapy to improve heart function. Therapy may include medications or a special mechanical device that can augment the heart's ability to contract (intraaortic balloon pump or left ventricular assist device).

32)why cant it be C) GAstroparesis?...Pt has decreased bowel sounds..usually in obstruction pts have Hyperactive bowel sounds...Correct me..

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33- D revision of coronary bypass graft I think , because whenever graft is mal function ,u have to take pt to OR again to repair before the tissues die, Obviously the graft is not working as C.O went down, urine output is down,; I dont choose medistinal exploration becacuse the main problem here is myocardial tissue injury from graft malfunction I think because PAP is high

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ques 32 - SBO (G) - vomitus green , so it is beyound gastric,could not figure out Dx because there is fever too but pt was vomiting so much, so hypokaelemic and intestinal sound decreased due to paralytic ileus.

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I just read paralytic ileus has been found in people taking Azathioprine and have crohn disease

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19 D
24 F
25 G discolored hemiscrotom could be due to adrenal hemorrhage or a retroperitoneal hemorrhage. he has acute abdomen.
29 C
32 G
33 is not bleeding. He has increased pulmonary artery pressure, doesnt happen with bleeding, plus low cardiac output so it is cardiogenic shock. Intraaortic pump would help.
C sounds like a good answer.
38 C
41 D
@ usmlerock, can you post all nbme form 7 questions please or email me if you can,
hippocra7
d very much appreciate it.

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Hello everyone... Please tell what the most accurate predector form of the NBME .. As I want to take only one of them ... Thanx in advance

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In any graft that you do on face or neck we keep checking the pulse and if there is no pulse or color change ,take back to operation room straight away to repair graft, CABG is a graft too, unless you go back to the operation room and repair it the graft will not survive or neither the tissue supplied by the graft.Intra aortic ballon pump will just delay the procedure. not only CO decreased , pulmonary pressure increased too means the graft is not working and myocardial tissue malfunctioning. I will go for D

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Does anyone have a full key for this exam?

Thanks. skype - mastahriz

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33. E. Surgical exploration of the mediastinum

(just took it and got it correct)