Discuss NBME Form 3 Block 5 - grazie

[ArchivalUser]

q34)

Ans: D) Obtain serum hepatitis C antibody titer
nbme cert.

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Cryoglobulinemia syndrome is a systemic vasculitis that damages mainly small and medium vessels through immune complex deposition. Symptoms of Cryoglobulinemia wax and wane over periods of years, with cutaneous manifestations (palpable purpura), arthritis, arthralgias, and myalgias often worsening with cold exposure. Weakness or asthenia is also present.

THE INCIDENCE OF HEPATITIS C VIRUS INFECTION (HCV) associated with mixed Cryoglobulinemia ranges from 40% to 100%. The hallmarks of Cryoglobulins in HCV infection are that they appear only many years after the initial infection, and that they are mixed. That means that they contain IgM antibodies directed against the Fc portion of IgG, i.e. Rheumatoid Factors (RF) and polyclonal IgG as the antigen.

[ArchivalUser]

35.

A 73-year-old man who has hypertension, osteoarthritis, and chronic obstructive pulmonary disease returns to the office for a follow-up visit. He says that for the past week he has had a cough and mild shortness of breath. His current medications include hydrochlorothiazide, lisinopril, atenolol, verapamil, ibuprofen, and ipratropium. Today, vital signs are temperature 37.2°C (98.9°F), pulse 72/min, respirations 20/min, and blood pressure 130/75 mm Hg. Physical examination shows a mild nasal discharge, pharyngeal erythema, and a mild, diffuse expiratory wheeze in his lungs. Which of the following medications is contraindicated in the continued treatment of this patient?

A) Atenolol
B) Hydrochlorothiazide
C) Ibuprofen
D) Lisinopril
E) Verapamil

[ArchivalUser]

q35)

Ans: A) Atenolol

Giving Beta Blockers to a patient with Asthma or COPD? I don't think so

http://i4.photobucket.com/albums/y115/ch...eptors.jpg

[ArchivalUser]

36.
A 68-year-old man with a history of rectal carcinoma comes to the office because of pelvic pain for the past month and minimal urine output for the past 3 days. He had an abdominoperineal resection of a stage III rectal cancer 20 months ago, followed by postoperative chemotherapy and radiation therapy. He has hypertension that is controlled with labetalol. Vital signs are temperature 37.4°C (99.3°F), pulse 70/min, respirations 18/min, and blood pressure 140/90 mm Hg. He is slightly overweight and looks tired. Chest is clear. Cardiac examination is normal. Abdominal examination shows a left lower quadrant stoma with stool in the bag and a well-healed midline incision. No masses or organs are palpable. The perineum is well healed. The patient cannot produce a urine specimen on request, and no urine is obtained by catheterization. Diagnostic studies show extrinsic bladder compression and bilateral hydronephrosis with a large mass noted in the pelvis. Results of laboratory studies are shown:
Serum Blood
Urea nitrogen 70 mg/dL Hematocrit 34%
Creatinine 5.5 mg/dL WBC 8400/mm3
Na+ 136 mEq/L
K+ 4.8 mEq/L
Cl− 103 mEq/L
HCO3− 26 mEq/L
Which of the following is the most appropriate next step?
A) Bilateral percutaneous nephrostomy
B) Cystoscopy
C) Laparotomy for resection of the pelvic mass
D) Placement of ureteral stents
E) Suprapubic cystostomy

[ArchivalUser]

q36)

Ans: A) Bilateral percutaneous nephrostomy
nbme cert.

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Percutaneous Nephrostomy (PCN)

Percutaneous nephrostomy insertion is a commonly performed interventional procedure, most frequently for the relief of renal obstruction, with or without associated infection.

[ArchivalUser]

END OF THIS BLOCK!!!

Thank you Kat, Alexa and Perception
We are finally done!!!

[ArchivalUser]

@graize....i believe, you are a person faith and energy. thank you v much.

[ArchivalUser]

@graize...oops, i mean you are a person of faith and energy. thank you v much.

[ArchivalUser]

for q29, i think this is mid-cycle ovulation pain,if pt had her last period 4 days ago and the last time she had the "sharp pain" was 18 days ago and she runs a 28 days cycle then the "sharp pain" occurred on day 14.Also it occurred on either side of the lower abdomen.i.e from the ovary on the side that is shedding the egg for that month and the character of the pain"sharp"
The monthly pain is actually relieved by NSAID. By and large, the pt will benefit from OCP use,which will take care of both types of pain.She should also use condom as OCP will not protect her from STD from her multiple partner.

[ArchivalUser]

q13(this is q7 on mine,) i think this is leiomyoma uteri,...dull pressure,worsen during intercourse and menses (+or - menorrhagia).
uterine size is enlarged 14 wks with "IRREGULAR" contour of the fundus.
best test is ultrasound. sonohysterogram will only pick the submucous type.