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hi guys, just took the extended feedback form of nbme4,
wanna discuss some Qs here, any one who wants to join in is welcome.
it is supposed to be a healthy and informative discussion, plz don't hesitate to jump in. any one can join any time of the day suitable to them.
waiting.......
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hey...wanna discuss other nbmes too??
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why not targetstep2!
we did nbme2 last week, have a link in the examusmle link.
u'll find answers there but if u don't agree with any answer that we made there, ur free to ask n discuss it further, no body is perfect and no body has the real key!
u'll find the link in the last 3 or 4 pages of the examusmle link
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3. A hospitalized 22-year-old woman with acute myelogenous leukemia undergoes evaluation prior to discharge. She has received induction chemotherapy and transfusions via a subcutaneous central venous catheter for the past 4 weeks. Two days ago, results of a complete blood count and bone marrow biopsy showed no abnormalities. Examination shows well-healed skin over the catheter. The remainder of the examination shows no abnormalities. The physician reviews the patient's discharge plan with her and her parents. Which of the following is the most appropriate recommendation to avoid complications related to the catheter?
A
) Avoiding bathing in a shower or bathtub
B
) Hand washing with an antibacterial soap prior to contact with the catheter
C
) Placement of a new sterile dressing at the site of access
D
) Topical application of mupirocin at the site of access
E
) Oral penicillin therapy
is it B or A?
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20. A 17-year-old boy is brought to the emergency department by his parents because they were informed by his school counselor that he wants to commit suicide. Last week, he broke up with his girlfriend of 2 years, and today he learned that he did not get accepted to his university of choice. On questioning, he says that he is sad and admits that he had spoken of suicide to a friend but states that he does not want to hurt himself because of religious beliefs. "My family would be hurt, too," he states. He has no history of medical or psychiatric illness and takes no medications. He does not smoke cigarettes or drink alcohol. Physical examination shows no abnormalities. On mental status examination, he is cooperative and makes good eye contact. In addition to recommending outpatient therapy, which of the following is the most appropriate physician recommendation to this patient's parents?
A
) "Don't make him go to school until he feels better. He can't concentrate in his present state of mind."
B
) "Let him rest and spend time alone. He needs space to think."
C
) "Make sure he does not have access to guns."
D
) "Perhaps you should invite his ex-girlfriend over to cheer him up."
E
) "Pray with him daily. Religion is an important protective factor."
should it be C?
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41. A 16-year-old girl comes to the physician because of painful genital lesions for 2 days. Over the past 6 months, she has been sexually active with five male partners; she last had sexual intercourse 2 weeks ago. As far as she knows, her sexual partners have not had similar symptoms. Examination shows two 3 x 3-mm ulcerated lesions on the anterior vaginal vault. She currently has a new boyfriend with whom she has not had sexual intercourse and would like to know the best way to prevent transmission of her infection. Which of the following is the most appropriate strategy to prevent transmission?
A
) Use of condoms when lesions are present
B
) Consistent condom use
C
) Acyclovir therapy for the patient for 7 days
D
) Penicillin therapy for the patient for 3 weeks
E
) Prophylactic acyclovir therapy for the patient's partner for 10 days
B?
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42. An 87-year-old woman who is a resident of a skilled nursing care facility is brought to the physician by staff because of fever for 1 day. A urinary catheter was placed 2 weeks ago because of urinary incontinence. She has dementia, Alzheimer type, and is unable to communicate verbally. Her temperature is 37.8°C (100°F), pulse is 86/min, respirations are 14/min, and blood pressure is 120/74 mm Hg. Mucous membranes are moist and pink. Urinalysis shows:
Color
cloudy brown
pH
8.8
Blood
2+
Glucose
negative
Protein
2+
RBC
too numerous to count
WBC
20–25/hpf
Nitrites
3+
Leukocyte esterase
3+
Bacteria
many
A Gram stain of urine shows gram-negative bacilli. Which of the following measures is most likely to have prevented this patient's current condition?
A
) Use of incontinence briefs instead of the catheter
B
) Changing the catheter daily
C
) Cleaning the urethral orifice with povidone-iodine daily
D
) Flushing the catheter with an antibiotic solution daily
E
) Oral antibiotic prophylaxis
F
) Oral oxybutynin therapy
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44. A 67-year-old man with alcoholism comes to the physician for a routine examination. He has a 15-year history of poorly controlled hypertension; he takes hydrochlorothiazide and admits that he is not compliant with his drug regimen. His blood pressure is 170/102 mm Hg, unchanged from his last three office visits. Funduscopic examination shows arteriovenous nicking and tortuosity of the arteries. This patient is at greatest risk for which of the following?
A
) Aortic aneurysm
B
) Glaucoma
C
) Myocardial infarction
D
) Pulmonary hypertension
E
) Subarachnoid hemorrhage
answer C or A?
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comon guys!
all inputs encouraged!
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