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NBME4 discussion, every one is welcome! - grad1980
#31
3.B

20.C

41.B

42.B

44.C Htn is risk factor Aortic aneurysm??
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#32
@clotbuster, smoking is a risk factor for it not HTN, i just added it there to provoke a discussionSmile
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#33
42 B is wrong, extended feedback!!!
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#34
now moving to section2

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#35
19. One hour after undergoing a splenectomy for injuries sustained in a motor vehicle collision, a 42-year-old man has severe shortness of breath. Additional injuries include left rib and pelvic fractures. His temperature is 36.3°C (97.4°F), pulse is 133/min, respirations are 35/min, and blood pressure is 80/60 mm Hg. Breath sounds are absent on the left. Abdominal examination shows slight distention; bowel sounds are absent. Which of the following is the most appropriate next step in management?

A
) X-ray of the chest

B
) Transfusion of type-specific uncrossmatched blood

C
) Intravenous heparin therapy

D
) Fiberoptic bronchoscopy

E
) Endotracheal intubation

F
) Placement of vena cava filter

G
) Needle thoracostomy

is it G?
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#36

The response options for the next two items are the same. You will be required to select one answer for each item in the set.

For each patient with a parasitic infection, select the most appropriate next step in diagnosis.


A
) Aspiration of the lesion

B
) Examination of duodenal aspirate for ova and parasites

C
) Examination of stool for ova and parasites

D
) Serum antibody titer for Entamoeba histolytica

E
) Serum antibody titer for Plasmodium species

F
) Serum antibody titer for Strongyloides stercoralis

G
) Serum antibody titer for visceral larva migrans

H
) Skin test for Trichinella spiralis

I
) Thick and thin blood smears for malaria


22. A 37-year-old immigrant from Pakistan comes to the physician because of fever and pain in the right upper quadrant of the abdomen for 2 weeks. His temperature is 38.6°C (101.5°F). The liver edge is palpable with deep inspiration 4 cm below the right costal margin. Laboratory studies show:

Hemoglobin
10 g/dL
Serum

Total bilirubin
1.4 mg/dL
Alkaline phosphatase
120 U/L
AST
40 U/L

Ultrasonography of the right upper quadrant shows a single, right cystic mass of the liver.
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#37

For each patient with a parasitic infection, select the most appropriate next step in diagnosis.


A
) Aspiration of the lesion

B
) Examination of duodenal aspirate for ova and parasites

C
) Examination of stool for ova and parasites

D
) Serum antibody titer for Entamoeba histolytica

E
) Serum antibody titer for Plasmodium species

F
) Serum antibody titer for Strongyloides stercoralis

G
) Serum antibody titer for visceral larva migrans

H
) Skin test for Trichinella spiralis

I
) Thick and thin blood smears for malaria


23. A 37-year-old man comes to the physician because of fever and bilateral flank pain 1 month after returning to the USA from a 2-year stay in Kenya. He takes no medications. His temperature is 39°C (102.2°F). The spleen tip is palpable with deep inspiration 2 cm below the left costal margin. His hemoglobin concentration is 9 g/dL, reticulocyte count is 5%, and serum lactate dehydrogenase activity is 300 U/L.
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#38
37. A 62-year-old woman with hypertension comes to the physician for a follow-up examination. Her hypertension was well controlled until 1 year ago; during the past year, her blood pressure has ranged between 160/100 mm Hg and 180/120 mm Hg. Treatment with maximal doses of an ACE inhibitor, a diuretic, and a β-adrenergic blocking agent for 10 months has not controlled her hypertension. She has a 2-year history of increasing leg pain with walking that improves with rest; she is otherwise asymptomatic. Her last menstrual period was 7 years ago. She smoked one to two packs of cigarettes daily for 40 years but quit 1 year ago. Her exercise capacity has improved during the past year. She is 152 cm (5 ft) tall and weighs 48 kg (105 lb); BMI is 21 kg/m2. Her pulse is 85/min and regular, and blood pressure is 160/100 mm Hg in the right arm, 175/105 mm Hg in the left arm, and 155/90 mm Hg in the right leg. Cardiac examination shows a nondisplaced point of maximal impulse; there is an S4 but no murmurs, heaves, or thrills. Abdominal examination shows no abnormalities. Pulses are 2+ in the upper extremities; the femoral and dorsalis pedis pulses are 1+ bilaterally. Serum studies show a potassium concentration of 4.5 mEq/L, urea nitrogen concentration of 20 mg/dL, and creatinine concentration of 1.2 mg/dL. Which of the following is the most likely cause of this patient's hypertension?

A
) Atherosclerotic renal artery stenosis

B
) Coarctation of the aorta

C
) Fibromuscular hyperplasia of the renal artery

D
) Polycystic kidney disease

E
) Primary hyperaldosteronism

is it C?
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#39
40. A previously healthy 37-year-old woman, gravida 2, para 2, comes to the physician because of painful, irregular menses and intermittent vaginal spotting for 3 months. Menses occur at 26- to 28-day intervals. Her last menstrual period was 1 week ago. She is not sexually active. An endometrial biopsy 1 month ago showed secretory endometrium. Pelvic examination shows a 10-cm, soft, tender uterus. The ovaries cannot be palpated. There are no masses. Saline infusion ultrasonography shows a diffusely enlarged uterus and no other abnormalities. Which of the following is the most likely diagnosis?

A
) Adenomyosis

B
) Anovulatory bleeding

C
) Endometrial cancer

D
) Leiomyomata uteri

E
) Uterine polyp

is it D?
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#40
hey clotbuster, don't u think Q17 in section 1 should be E?
he has parkinsinism n prone to urge incontinence.
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