nbme f2 b2 - grazie

[ArchivalUser]

We already answered the questions... please post answers

[ArchivalUser]

Q-15

Esophageal varices
They are often caused by Portal HTN and cirrhosis. Let's find out how compromised is this lady's liver.

B) Degree of cirrhosis and portal hypertension
correct answer by NBME

Board tips for esophageal varices:
* If pt is bleeding > Which drug will lower mortality?
Ciprofloxacin

* If bleeding has stopped > Which drug will lower mortality?
Propranolol

[ArchivalUser]

I will post more qs. oh boy, personal stuff is coming in the way I hope to be done with this today, my goal is to solve all blocks from form 2 this week

[ArchivalUser]

19.
A 65-year-old white man is in the intensive care unit because of end-stage cardiomyopathy. At the insistence of his wife, he was intubated yesterday in the emergency department because of severe hypoxia, coma, and pulmonary edema. Today his pulmonary and neurologic conditions are stabilized via a ventilator. You see him today while you are on rounds. He appears angry and motions you to the bedside. He writes, "I have a Living Will. Get me off this machine now. I'm ready to die. I'm tired of living hooked up to machines." The patient has been evaluated by a psychiatrist, who determined that he is competent to make decisions. You arrange a meeting with the patient and his wife, who is the patient's durable power of attorney. Which of the following is the most appropriate statement to the patient?

A
)
"I am legally bound to continue all support as long as you and your wife disagree."

B
)
"I cannot take you off the ventilator until you are medically ready."

C
)
"I will respect your wishes for palliative care only."

D
)
"Your Living Will only applies if you are comatose."

E
)
"Your wife as your proxy decision-maker may overrule your wishes."



20.
A 67-year-old man with metastatic lung cancer is seen in the nursing care facility because of progressive headache, vomiting, and pain in the extremities and abdomen for the past 2 days. He has tumors that have metastasized to multiple sites in the liver, lungs, bones, and brain. The patient has been receiving hospice care for the past month. Medications include 4 mg intravenous dexamethasone four times daily, morphine 10 mg/hour by intravenous infusion, and 10 mg intravenous metoclopramide six times daily. Now he is drowsy and moaning, but he responds to voices, follows commands with all extremities, and communicates in brief sentences. He is not oriented to place and time. Vital signs are temperature 37.0°C (98.6°F), pulse 105/min and regular, respirations 10/min, and blood pressure 110/60 mm Hg. Auscultation of the chest discloses normal breath sounds with crackles in the lung bases. The liver is enlarged and extremely tender to palpation. The abdomen is soft, and bowel sounds are decreased. There is diffuse tenderness over the bones. Which of the following is the most appropriate change to the patient's medication regimen?

A
)
Begin intravenous cefuroxime therapy

B
)
Begin intravenous lorazepam therapy

C
)
Begin intravenous mannitol therapy

D
)
Increase the dexamethasone dosage

E
)
Increase the morphine infusion rate


21.
An 18-year-old college student is admitted to the hospital for observation after sustaining a closed head injury in a fall from a second-story porch. According to paramedics, the patient was unconscious for several minutes after the fall. On arrival at the emergency department 9 hours ago, he was oriented to person but not to place or time. At that time, vital signs and physical examination, including funduscopic and neurologic examinations, were otherwise noncontributory. A CT scan of the head was normal. The patient's confusion improved during the next 8 hours. Now, he is alert and oriented. He says he remembers tripping on the stairs and falling after drinking beer and smoking marijuana with a group of older students. The patient was seen in the student health center 3 weeks ago because of difficulty sleeping. At that time, depression was diagnosed and fluoxetine therapy was initiated, in addition to recommending sessions at the campus counseling center. Which of the following is the most significant risk factor leading to this patient's injury?

A
)
History of depression

B
)
Patient's age

C
)
Use of alcohol

D
)
Use of fluoxetine

E
)
Use of marijuana





22.
A 62-year-old man with a history of chronic obstructive pulmonary disease is admitted to the hospital because of progressive shortness of breath and increasing cyanosis. Vital signs are temperature 39.2°C (102.5°F), pulse 110/min, respirations 32/min, and blood pressure 60/40 mm Hg. Physical examination discloses crackles in the right lung base with dullness to percussion and mottling of his skin. Pulmonary capillary wedge pressure is 10 mm Hg. Which of the following is the most likely pathophysiologic mechanism underlying the hypotension?

A
)
Decreased peripheral vascular resistance

B
)
Decreased right ventricular contraction

C
)
Increased cardiac output

D
)
Increased pulmonary vascular resistance

E
)
Increased renal loss of sodium


23.
A 26-year-old woman is admitted to the hospital 1 hour following dilatation and curettage for an incomplete abortion at 12 weeks' gestation. Preoperative hematocrit was 35%. Estimated blood loss was 200 mL. The patient is now alert but complains of shortness of breath and abdominal pain. There has been minimal vaginal bleeding. Pulse is 140/min and blood pressure is 80/60 mm Hg. Lungs are clear on auscultation. Abdomen is distended with notable guarding and rebound. Which of the following is the most appropriate next step?

A
)
Blood transfusion

B
)
Exploratory laparotomy

C
)
Paracentesis

D
)
Repeat dilatation and curettage

E
)
Ultrasonography of the pelvis

24.
A 28-year-old primigravid woman, who is at 29 weeks' gestation, is admitted to the hospital because of a 2-day history of fever, shaking chills, and right lower flank pain. Her prenatal course has been complicated by pyelonephritis at 20 weeks' gestation. The patient has been taking suppressive nitrofurantoin therapy daily since that time. Medical history otherwise is unremarkable. She is 167.5 cm (5 ft 6 in) tall. She weighed 68 kg (150 lb) prior to her pregnancy; BMI was 24 kg/m2. She has had a 6-kg (13-lb) weight gain during her pregnancy. Vital signs on admission are temperature 39.3°C (102.7°F), pulse120/min, respirations 30/min, and blood pressure 125/74 mm Hg. Fundal height is 30 cm. Fetal heart rate is 150/min. Palpation discloses right costovertebral angle tenderness. Leukocyte count is 12,700/mm3. Results of urinalysis are shown:

Urine
Leukocyte esterase Positive
WBC 15/hpf
RBC 2/hpf

Intravenous administration of cefazolin is begun. After 36 hours, urine culture shows colonies of Escherichia coli that are highly sensitive to the antibiotic; however, the patient's condition does not improve during the next 72 hours. At this time, which of the following is the most appropriate management?

A
)
Add intravenous clindamycin

B
)
Continue the cefazolin therapy

C
)
Order intravenous pyelography

D
)
Order renal ultrasonography


25.
A 44-year-old man is hospitalized for intravenous antibiotic treatment of subacute bacterial endocarditis. On the third hospital day he has abdominal cramps, weakness, and sweating. Vital signs are temperature 37.0°C (98.6°F), pulse 110/min, respirations 24/min, and blood pressure 140/90 mm Hg. On physical examination pupils are dilated, and the patient is diaphoretic and trembling. Which of the following is the most likely diagnosis?

A
)
Benzodiazepine withdrawal

B
)
Cocaine withdrawal

C
)
Drug allergy

D
)
Generalized anxiety disorder

E
)
Heroin withdrawal

[ArchivalUser]

E
D
B
A
A
D
E

[ArchivalUser]

Thank you "jusupjoseph"!

Q16 was a pain, I was between A and B, but as a lucky girl I marked A
Good thing you got it right , so confirmed

16.
A 43-year-old primigravid plastic surgeon, who is at 36 weeks' gestation, comes to the labor and delivery unit of the hospital because she has been having contractions every 10 minutes. She has an 11-month history of elevated blood pressure, for which she has not taken any medication. She has not had right upper quadrant abdominal pain or blurred vision. Her blood pressure was 150/90 mm Hg prior to pregnancy; blood pressure has been 140/90 mm Hg throughout the pregnancy. Blood pressure on arrival today is 140/95 mm Hg. Fundal height is appropriate for gestational age. Fetal heart rate is 130/min and reactive. The patient's cervix is dilated to 1 to 2 centimeters and is 50% effaced; the vertex is at 0 station. Examination of the extremities shows minimal edema. Urine dipstick shows no protein. She says, "I have to deliver today because I'm scheduled to do several breast augmentations and Botox injections in 2 weeks." Which of the following is the most appropriate management?

A) Admit the patient to the hospital for augmentation of labor

B) Discharge the patient with labor instructions

C) Initiate methyldopa therapy

D) Initiate terbutaline therapy

E) Schedule the patient for cesarean delivery


Ans:
B) Discharge the patient with labor instructions
(Confirmed by nbme)

So, For the exam... Treat your patients as equals, no red carpets because they are colleages

[ArchivalUser]

19... cc? living will trumps power of attorney
20.. EE? palliative for pain
21. cc ...alcohol worsens depression
23. BB... acute abdomen (peritonitis) emergency!

[ArchivalUser]

agree, u right img87
19-CC
20-EE; not DD by nbme
21-CC; not BB by nbme
22-AA; looks like septic shock
23-BB ; by nbme and not AA by nbme
24-DD if Abx not working, v need to r/o obstruction?
25-EE by nbme

[ArchivalUser]

19c
20e
21c
22d......copd...>pulm vasc vasoconstiction and vascu damage....>up goes pulm resistance.
23b
24 not sure....but joseph has a point...D..??
25e

thanks....grazie,img87.jusupjoseph

[ArchivalUser]

17.
A 21-year-old primigravid woman, who gave birth 1 day ago in the hospital, now has stinging pelvic pain that radiates down both thighs. The pain is exacerbated by standing up, walking, or carrying her newborn. The patient's pregnancy was complicated by hip and pelvic pain, especially on walking. Labor and delivery occurred at 39 weeks' gestation. Delivery required use of an epidural blocking agent and outlet forceps as a result of maternal exhaustion. During the procedure, a vaginal right sidewall laceration and midline second-degree laceration occurred and were repaired without complication. The newborn's birth weight is 3827 g (8 lb 7 oz; 90th percentile). Today the patient has tenderness to palpation of the suprapubic area surrounding the pubic symphysis that worsens when both trochanters are abducted. Which of the following is the most likely diagnosis?

A) Complication of the epidural anesthesia
B) Perirectal hematoma
C) Pubic diastasis
D) Pudendal nerve injury (right answer by nbme)
E) Spinal cord compression

Answer: C
Examination may reveal a palpable gap at the symphysis and abnormal mobility, with lateral to medial compression of the iliac wings or greater trochanters. One or both SI joints may be tender to palpation. Less acute signs of Diastasis include pain and difficulty with weight bearing, and a waddling or wide-based gait, with pain at the SI joint with flexion, abduction, and external rotation of the hip.