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nbme f2 b2 - grazie
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08-20-2014, 04:52 PM
this is what I got
q9 - BB q11 - BB conf by nbme q12 - EE q13 -BB q14 - AA q15 - not EE by nbme q16 - BB conf by nbme q17 - CC q18 - DD; not AA, not BB by nbme
08-20-2014, 05:43 PM
whats the explanation for 12? why E? conversion disorder?
08-20-2014, 06:12 PM
img87,
12E.....is conversion disorder 17C 18D...is it hypoprotenemia....>edema,anasarca,hair loss etc....???
08-20-2014, 06:58 PM
11.
A 52-year-old white banker is admitted to the hospital because of rapidly progressive amyotrophic lateral sclerosis (ALS). He is unable to walk or move from his bed to his wheelchair, and his speech is garbled. He has lost all capacity to feed himself and is quickly losing the capacity to swallow. The patient's weight has gone from 68 kg (150 lb) to 59 kg (130 lb) during the past 2 months. Other than his deterioration from ALS, he is free of medical illness and remains fully alert and cognitively intact; he wants to continue supportive care. Which of the following is the most accurate statement regarding nutritional therapy in this patient? A) Parenteral nutrition should not be initiated unless clinical signs of malnutrition are apparent B) Percutaneous enteral feedings should be initiated C) Supplemental, but not total, parenteral nutrition should be initiated D) Supplemental feedings will not be beneficial E) Total parenteral nutrition should be initiated Ans: B B) Percutaneous enteral feedings should be initiated PEG TUBE Percutaneous endoscopic gastrostomy A PEG tube tube is an essential element of care when ALS has progressed to the point where it interferes with a person’s ability to swallow food and fluids. The feeding tube can reduce the stress and exhaustion of trying to swallow when swallowing becomes too difficult. Initially, it may supplement eating, or if swallowing is causing choking, may be used to replace eating. It can reduce the risks of choking and pneumonia by allowing another method of getting sufficient calories. A feeding tube can stabilize weight or help to recover lost weight. When a person has a feeding tube, it permits them to receive most of their nutrition through the tube, allowing them to eat foods that are enjoyable and safe to swallow, in amounts that feel comfortable for them.
08-20-2014, 07:17 PM
12.
A 14-year-old girl with a seizure disorder that has been unresponsive to medication has been undergoing video-EEG evaluation in the hospital during the past 3 days. Results showed that the patient had several shaking spells that were not associated with any EEG abnormalities. While the results are being discussed with the patient, she discloses that she is unable to see out of her right eye. Vital signs are normal. The patient appears calm. Pupils measure 4 mm in diameter and are equally reactive to light. Ocular movements are full. Ophthalmoscopic examination discloses no abnormalities. The patient blinks to threat bilaterally. Which of the following is the most appropriate next step? A) Initiate methylprednisolone therapy B) Observation only C) Obtain consultation with an ophthalmologist D) Order MRI of the brain E) Refer the patient to a psychiatrist Ans: E ? Could this be Psychogenic non-epileptic seizures (PNES), because the "seizures" don't have the characteristic electrical discharges associated with epilepsy in the EEG PNES are triggered by psychological problems, and frequently occur in CONVERSION DISORDER. It is estimated that 20% of seizure patients seen at specialist epilepsy clinics have PNES. B or E? ... I think after 3 days on EEG, we should take this girl a little serious, maybe calling the shrink would be a better option? What do u guys think?
08-20-2014, 07:20 PM
lol I thought referring pts is wrong answer on USMLE
08-21-2014, 06:49 AM
12- e
marked b i got wrong thank you all-discussion is very helpful
08-21-2014, 08:14 AM
Thank u vijita, then it's E for sure
 peace to my mind
08-21-2014, 08:31 AM
13.
A 27-year-old African American woman is admitted to the hospital because of a temperature that has fluctuated between 37.0°C (98.6°F) and 40.6°C (105.0°F) during the past 3 days. During this time, she also has had severe chills and sweats, frontal headache, nausea, and body aches. She does not have a rash. She had received all recommended vaccines prior to traveling to Africa 2 months ago. She is 160 cm (5 ft 3 in) tall and weighs 63.5 kg (140 lb); BMI is 25 kg/m2. Vital signs are temperature 40.3°C (104.5°F), pulse 100/min, respirations 14/min, and blood pressure 100/60 mm Hg. Skin is dry with poor turgor. Sclerae are anicteric. The nose is patent. Examination of the throat discloses a slightly injected posterior pharynx. Neck is supple with no significant adenopathy. Lungs are clear to auscultation, and cardiac examination discloses no abnormalities. Abdomen is mildly tender in the right upper quadrant, but there is no rebound tenderness or organomegaly. Examination of the extremities shows full range of motion and no edema. Pulses are full bilaterally. Which of the following is the most appropriate diagnostic study? A) Blood cultures B) Blood smear C) HIV antibody test D) Hepatitis C antibody test E) Stool culture Ans) B B) Blood smear MALARIA ESSENTIALS OF DIAGNOSIS Residence or exposure in a malaria-endemic area. Intermittent attacks of chills, fever, and sweating. Headache, myalgia, vomiting, splenomegaly; anemia, thrombocytopenia. Intraerythrocytic parasites identified in thick or thin blood smears. Complications of falciparum malaria: cerebral malaria, severe anemia, hypotension, noncardiogenic pulmonary edema, acute kidney injury, hypoglycemia, acidosis, and hemolysis. McPhee, Stephen (2013-09-13). CURRENT Medical Diagnosis and Treatment 2013,(p. 1448). McGraw-Hill. Kindle Edition.
08-21-2014, 08:36 AM
Laboratory Findings
Giemsa-stained blood smears remain the mainstay of diagnosis (Figures 35–2 through 35–5), although other routine stains (eg, Wright stain) will also demonstrate parasites. Thick smears provide efficient evaluation of large volumes of blood, but Thin smears are simpler for inexperienced personnel and better for discrimination of parasite species. Single smears are usually positive in infected individuals, although parasitemias may be very low in nonimmune individuals. If illness is suspected, repeating smears in 8- to 24-hour intervals is appropriate. CURRENT Medical Diagnosis and Treatment 2013, Kindle Edition. Once I got a questions about this and had to know the difference between thick and thin smear, I remember Thin Smear was the answer, but cause I come from South America, we used to order the Thick smear, I got it wrong, I think they mostly use Thin Smear here :? Huh |
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