NBME4 discussion, every one is welcome! - grad1980

[ArchivalUser]

3. B
20. C
41. B
42. A
44. C

[ArchivalUser]

thank u friend!
u know, these were my first choices n then some thing happened n i changed them to the second guess!
thats why i got them wrong
u wanna do more?

[ArchivalUser]

8. A 77-year-old woman is brought to the emergency department by paramedics 1 hour after the sudden onset of right-sided weakness and difficulty speaking. Her son found her at home after he became concerned because he did not get his usual morning phone call. She has a history of hypertension and hypercholesterolemia treated with a β-adrenergic blocking agent and a lipid-lowering agent. Her pulse is 72/min, and blood pressure is 160/90 mm Hg. During examination, she is only able to give single-word answers with many paraphasic errors. She has good comprehension. Examination shows normal visual fields. There is weakness of the right side of the mouth. Muscle strength of the right upper extremity is 2/5. There is mild weakness of flexion of the right hip; muscle strength of the right lower extremity is otherwise normal. Sensation to pinprick is decreased over the right upper extremity. Deep tendon reflexes are more brisk on the right side than the left, and Babinski sign is present on the right. Which of the following arteries is most likely to be occluded?

A
) Basilar

B
) Left anterior cerebral

C
) Left internal carotid

D
) Left middle cerebral

E
) Left ophthalmic

F
) Left posterior cerebral

G
) Right anterior cerebral

H
) Right internal carotid

I
) Right middle cerebral

J
) Right ophthalmic

K
) Right posterior cerebral

[ArchivalUser]

9. A 17-year-old boy with mental retardation is brought to the physician because of low-grade fever and abdominal pain for 6 days. His temperature is 37.8°C (100.1°F), pulse is 110/min, respirations are 22/min, and blood pressure is 120/70 mm Hg. Examination shows splinter hemorrhages under the nails. A grade 2/6 systolic murmur is heard best at the upper left sternal border. There is a systolic ejection click. S1 and S2 are normal. Abdominal examination shows splenomegaly. Laboratory studies show:

Hemoglobin
9.1 g/dL
Leukocyte count
30,000/mm3
Platelet count
928,000/mm3
Erythrocyte sedimentation rate
110 mm/h
Urine

Blood
2+
Protein
1+

Which of the following is the most appropriate next step in management?

A
) 24-Hour urine collection for measurement of protein and creatinine concentrations

B
) Blood cultures

C
) Ultrasonography of the abdomen

D
) CT scan of the abdomen

E
) Broad-spectrum antibiotic therapy

[ArchivalUser]

10. A 25-year-old woman comes to the emergency department because of nausea, diarrhea, and anxiety for 2 days. She also has noticed dizziness and tingling sensations shooting down her forearms. Her sleep and appetite have been normal. She has a 3-year history of social phobia well controlled for the past year with paroxetine. She is attending an out-of-town conference and forgot to pack her medication; her last dose was 3 days ago. She does not drink alcohol or use illicit drugs. She is 163 cm (5 ft 4 in) tall and weighs 80 kg (176 lb); BMI is 30 kg/m2. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 110/75 mm Hg. Physical examination shows no other abnormalities. Mental status examination shows an irritable mood with a full range of affect. Her speech is of normal rate and rhythm. There is no evidence of suicidal ideation or hallucinations. She can recall three of three objects after 5 minutes. Long-term memory is intact. Serum studies show no traces of paroxetine. Which of the following is the most appropriate next step in management?

A
) Begin behavioral therapy

B
) Begin alprazolam therapy

C
) Begin bupropion therapy

D
) Begin clomipramine therapy

E
) Begin gabapentin therapy

F
) Resume paroxetine therapy

[ArchivalUser]

17. A 72-year-old man is brought to the physician by his wife because of a 6-month history of difficulty walking, cognitive decline, and urinary incontinence. He has not had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On examination, he has a broad-based, short-stepped gait with some reduction of step height. He is oriented to person and place but not to time. He learns four words with some difficulty and recalls zero after 3 minutes. Which of the following is the most likely explanation for the patient's urinary incontinence?

A
) Bladder neck dyssynergia

B
) Chronic bladder inflammation

C
) Detrusor-sphincter dyssynergia

D
) Failure of bladder neck closure

E
) Failure to inhibit the voiding reflex

[ArchivalUser]

19. A 15-year-old boy is brought to the physician because of headaches for 3 months. The headaches occur most often in the morning and are associated with vomiting. Over the past month, he also has had increasing visual difficulty. During this period, he has had a 4.5-kg (10-lb) weight gain, and his school performance has declined. He is also concerned that his pubertal development has been slower than his friends. Growth charts are shown. Genital development is Tanner stage 2. Funduscopic examination shows mild papilledema. Which of the following is the most likely diagnosis?

A
) Adrenal insufficiency

B
) Craniopharyngioma

C
) Gonadal dysgenesis

D
) Medulloblastoma

E
) Migraines

F
) Primary hypothyroidism

is it B?

[ArchivalUser]

25. A 25-year-old woman comes to the physician for an initial prenatal examination at 12 weeks' gestation. She has schizoaffective disorder and had been taking oral haloperidol sporadically until 2 months ago. She says that she was impregnated by evil and that she needs to get rid of the "Devil's baby." She states that she hears "angelic voices telling me to get an abortion." She says that she likes children and has two of her own but "obviously cannot have this one because it is evil!" She demands an abortion. Physical examination shows a uterus consistent in size with a 12-week gestation. On mental status examination, she is agitated. In addition to admitting the patient to the hospital, which of the following is the most appropriate next step in management?

A
) Defer the decision about abortion and observe the patient

B
) Defer the decision about abortion and begin valproic acid

C
) Defer the decision about abortion and resume haloperidol

D
) Arrange for an abortion and begin valproic acid

E
) Arrange for an abortion and resume haloperidol

F
) Arrange for an abortion and resume haloperidol after the abortion

should it be F?

[ArchivalUser]

33. A 37-year-old man comes to the physician 12 hours after the onset of vomiting and abdominal cramps and swelling. He has had constipation for the past 4 days. He was diagnosed with Crohn disease 7 years ago. His symptoms of diarrhea and right lower quadrant abdominal pain have been well controlled with mesalamine for the past 3 years. His temperature is 36°C (96.8°F), pulse is 98/min and regular, and blood pressure is 110/70 mm Hg. Examination shows a diffusely distended, tympanitic abdomen and visible peristalsis; high-pitched bowel sounds are heard. Rectal examination shows no stool in the rectal vault. An x-ray of the abdomen shows a small-bowel obstruction. Which of the following is the most likely cause of these findings?

A
) Colon cancer

B
) Ileocecal fistula

C
) Small-bowel adhesions

D
) Small-bowel fibrotic stricture

E
) Small-bowel intussusception

C or D?

[ArchivalUser]

38. A 3-month-old infant has had tachypnea and tachycardia for 10 days; during this period he has been feeding poorly. A grade 3/6 holosystolic murmur and a grade 2/6, apical mid-diastolic murmur are heard. An x-ray of the chest shows cardiomegaly with increased pulmonary vascular markings. Echocardiography shows a large ventricular septal defect. Which of the following is the most likely cause of these symptoms?

A
) Excessive pulmonary blood flow

B
) Mitral valve obstruction

C
) Reduced left ventricular contractility

D
) Reduced right ventricular preload

E
) Right ventricular pressure overload

is it A?