nbme 4...need urgent help,either i know nothing or - shrukh

[ArchivalUser]

Few suggestions starting with #####

block 2 done plz need comments or correct answers..... add some corrections if u r sure

thankyou


1. D Block 1
2. A
3. E
4. A
5. D
6. B
7. E
8. C
9. D
10. D
11. F
12. A
13. E
14. B
15. D
16. B
17. F
18. E
19. A
20. E
21. B
22. D
23. G
24. B
25. D
26. A
27. F
28. G
29. C
30. A
31. B
32. D
33. D
34. A
35. A
36. E
37. E
38. A
39. A
40. A
41. B
42. A
43. D
44. C
45. B
46. E
1. E Block 2
2. C
3. G### y not Xray first to confirm effusion, its not tension pneumorhtorax such an emergency
4. B ###not sure about this but are they asking about air embolism from catheter it can be A
5. C..####B furosemide simple hypovolemia
6. E
7. C
8. D
9. B
10. B
11. D### adhesions what about exploratory laprotomy, therapeutic diagnostic both
12. B
13. A
14. C
15. A....###y not e...hyperlypidemia risk factor
16. C
17. M
18. C
19. B
20. F..#### hct is 24% in a pt with bypass.... y dont we administer packed cells to raise 2 30%
21. A
22. C####### lymph node involvement i guess its C.
23. D
24. E........y pancreatic insuficiency after pnemonia.....what about B...loss of villi
25. E.........#### B..tthts dysparunia i guess its endomertrosis
26. C
27. A
28. C
29. B
30. E
31. A
32. E
33. C
34. B
35. D
36. E
37. C
38. E...(####A..use intermitent catheters to avoide infections
39. D
40. B
41. D...#######A..wont u aspirate first....y titer directly...
42. I
43. B....######A..y penicillin, its not syphlis coz its painful
44. A
45. E
46. B
1. B fragile x Block 3
2. E discontinue
3. C
4. E biopsy
5. B
6. D
7. A anaphylaxis
8. B
9. B
10. A
11. D
12. C selenium
13. B
14. B
15. E
16. A
17. D
18. B
19. B
20. Q
21. H
22. E
23. J
24. E
25. C
26. B hats
27. A
28. B
29. E
30. A
31. D
32. rectal manometry
33. C
34. A passive smoker
35. A
36. E
37. D
38. A
39. A
40. A
41. C jra
42. G
43. C
44. A
45. F
46. A
http://www.usmleforum.com/showthread.php?tid=368605

few of above answer stand corrected
its warm compresses not compression stockings

one ans is vit d
second is major depressive disorder not adjustment disorder
third is alprazolam for anxiety disorder in patient who is off from fluqxetine
answer for urinary tract catheter is urinary briefs.

answer to cancer qs is primary squamous cell cancer.

one qs still debated is on endometriosis..we feel its benign cystic teratoma and vanco feels its endometriosis...qs is open for debate!
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Nbme form 4 block 4
1d
2e
3d
4d
5c
6 not sure either a or d
But citalopram is definitely wrong its side effect is insomnia
but still unsure
7c
8e
9c
10d

11b
12b
13c
14d
15c
16e
17c
18c
19A angioedema
20E
21a
22a
23a chf
24e
25b
26g
27f
28b pericardial tamponade
29b
30e
31b
32e intubation impending respi failure
33b
34d
35chlamydia
36f
37a
38g
39f
40e
41a
42d
43b
44g
45c echo
46b

[ArchivalUser]

3- hemothorax so thoracostomy. this guy has low BP and pulse 133, rib fracture.
4-one of complication is sepsis . i thought B hand washing for prevention of sepsis.
5- why frusemide and hypovolumia? don't know how long is he taking frusemide. old man with cor pulmonale. creatinine is increased from baseline 1, so think naproxen which he is taking for 6 weeks. .
11 subacute intestinal obstruction- so first conservative. nasogastric tube decompression. even if he needs surgery need prepare and NG tube to prevent further abdominal distenstion.
20- yes D-packed cell correct anaemia and volume deficit.

[ArchivalUser]

24- why small bowel villi? q is not very clear, looks like CF with malabsorption with pancreatic enzyme deficiency since given h/o pnemonia.
25- also feel endometriosis since h/o dyspareunia. but somebody previously commented teratoma. will go with endometriosis if it comes in my exam day.
38- personally feel A- incontinence brief but in one q in NBME don't remember which one, q stem has said taking prophylactic antibiotic for long time in dementia pt in nursing home.
41-D it's amebic liver abscess. no aspiration.stool R/E is not helpful and serology antibody titer is the investigation of choice.
43- it is HSV so condom use. B

Any comment welcome!! if anyone has other view please post.

[ArchivalUser]

block 2 few comments

41. i guess we tak out anchovy paste first by aspiration.
5. i still go for fureosemide all values are incresed bun cr and bp is a bit low.... sounds more lik hypovolemia... naproxen as a cause of incresed cr then bp should be high too i guess..nsaid causing renal problem
3. i was also thinking thoracostomy but pelvic fracture tooo.. hypovolemia thts y thought of confirming first with an x ray. how much fluid actualy..
4. central vein catheter..most imp stuff to take care air embolism. a slight push can cause death.

Block 1. i got 15 ans wrong by this key..... disappointing

5. isn't it a normal adolescent behaviour
19. he is already on heparin... wont we place filters ..cancer induced thrombophilia r hardy one. then we can go for spiral else it will cause further damage rite.
22. B..amphotericin is the answer
23. its odd. i was thinking of central d.I. pituitary
24. wont we save him from dieing of bleeding. i marked platele infusion.
26. i guess misclasification of exposure..filling up questionaeirs and takin it as exposure..
27. wont we go for cryo its already high grade...
36. vit k supplementation. he is already breast feeding y C
37.. major depression
38. G factor 8 problem
46. yup nifidipine but wht abt clonidine

Any comments will be greatly appreciated

[ArchivalUser]

block 2-5 amebic abscess. no aspiration recommended because of risk of bleeding, amebic peritonitis, puncture of an echinococcal cyst, secondary bacterial infection.

[ArchivalUser]

block 1-
5- definately D
19-will still go for A. filter kept in pt with dvt and if contraindication of fibrinolytic to prevent pe. no mention about dvt. pulmonary angio too invassive, fibrinolytic © - pt 3 pod. so won't give it and not diagnosed pe. first find cause.
22-fluconazole-candidial esophagitis. u give amphotericin for cryptococcal
23- don't know. what is the dx here? some body please !!
24-febrile neutropenia, so antibiotic first. he is not bleeding, is he? first antibiotic then blood.
Funny i don't have number 27 question. can u post it?
36- F- vitamin D. he is 2 month, breast milk lacks vit D. it is 100% sure. because my son was given it during 3 months visit.
46- nefidipine.

[ArchivalUser]

hi Shrukh
Can you send me the link to download NBME 4. My exam is in two weeks.Thanks
in advance.

[ArchivalUser]

http://www.sendspace.com/file/zbk4h8

answers

http://www.usmleforum.com/showthread.php?tid=400532



if it dont work.... search for nbme 4 u will get it..

[ArchivalUser]

27. is about pap smear which shows high grade in situ....

now they ask wht will u go for... either cone biopsy, culdoscopic biopsy or cryo surgery

[ArchivalUser]

ramri

thanks for your support. when i will be done with 3 and 4 block we will discuss them, rite now i m realy disapointed by my scores in thes 2 blocks approximatly 14 wrong in each..

kaplan states breast milk deficient in vit K thts y we giv k shot at birth.... cow's milk vit c and d