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nbme 7 questions for CK - grimlock
#11
67yo M with uncontrollable nosebleed for 6 hours. No Hx of HTN and takes no meds. Smokes 1-2 packs for 45 years. BP is 220/120. Exam shows lesion in left naris controlled with cauterization. Bilateral bruits over flank. Rental arteriography shows 13 cm kidneys with single renal arteries. Ostial lesions of both kidneys that occlude 85% of vessel orifice. After ACE inhibitor, BP drops to 140/80. Mechanism of response?
-No cleaving of C-terminal peptides on angiotensin I

Also if anyone could kindly explain this.
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#12
Nvm about ^^ one- I got it in Wiki.

Angiotensin I is converted to angiotensin II (AII) through removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE), primarily through ACE within the lung (but also present in endothelial cells and kidney epithelial cells).

Would appreciate an explanation to the earlier qsn tho.
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#13
72yo M with decreased UOP 2 days after Rx for cholecystitis. UOP has been 15 mL/h for 3 hours. On admission, results showed gram neg bacteremia and DIC. CUrrently receiving IV fluids, cefoxitin, and gentamicin. Temp 38.5C, Pulse 110/min, resp 24/min, BP 90/64. Mild RUQ tenderness. Serum Cr increased from 1.5 2 days ago to 3. Urinalysis findings?

Blood 1+, Protein 1+, RBC 0-5, WBC 0-5, Casts pigmented granular, Other microscopic findings renal tubular epithelial cells.

Anyone there to explain?
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#14
19yo African American man with 9-month Hx of watery diarrhea associated with abdominal cramps and bloating. Has occasionally had diarrhea after meals since age of 12, but has been worse since he started college 1 year ago. Exam shows no abnormalities. Cause of diarrhea?

Is this lactose intolerance? Because Immune damage of microvilli is not correct.
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#15
An 18 yo woman has had fever 12 hrs and obtundation 4 hrs. She had been attending a summer camp with 120 other students and was well until yesterday, when she developed a sore throat and nonproductive cough; this morning she couldn't be aroused. T= 101.5, P= 120, RR= 30, BP= 80/50. Extremities cool. Skin lesion shown over her extremities, chest and abdomen. Hsct 41%, leuko 21200 with shift to left. Dx?
A. Acute lyme disease
B. Cocaine OD
C. Meningococcemia
D. Pseudomonal sepsis
E. TSS- is wrong.

Previously healthy 82 yo woman comes because she is concerned she has Parkinson Disease. Over 6 months, she has had occ difficulty finding word that she wants to use, her ability to distinguish smells has decreased. She reports that her reaction time to shifts in posture seems slow, and she needs to use a handrail to steady herself while walking on stairs. She loves alond, able to manage her own finances. Pupils 3 mm, mild reduction of upward gaze andbrisk rotatory nystagmus on left lateral gaze. Audio- high frequency hearing loss. No tremor or rigidity. Gait is normal. MMSE 29/30. Which of following warrants further evaluation?
A. Brisk rotatory nystagmus on left lateral gaze
B. Dec sense of smell- is wrong
C. Dec upward gaze
D. High- pitched tone hearing loss
E. Small symmetric pupils.

The achalasia question: Is it dec esophageal peristalsis and increase LES tone in manometry?

A 32 yo man brought to ED by a firend because of sudden onset of confusion and agitation. He has long-standing H/O schizoaffective disorder, depressed type. 5 days ago, a new med was added to his regimen because of auditory hallucinations, but he is not sure what it is. He rarely drinks alcohol and does not use illicit drugs. He is confused and does not know why he is at ED. His T 103.1, P 110, RR 28, BP 160/100. Neuro exam shows muscle rigidity. His leukocyte count in 15000 CK 950. Which of the following NT is most likely responsible for this pt's condition?
A. GABA
B. Dopa
C. Glutamate
D. Histamine
E. NE
F. Serotonin
Should be Dopamine? I always get confused with Serotonin syndrome and this one.

What was the answer to Type I sliding hiatal hernia Mx?

72 yo woman has hypoNa 3 days after admission to hospital after cerebral infarction. She has been receiving 5% Dex in 0.45% saline since admission. urrent med are phenytoin and atenolol. She has expressive aphasia. P= 86, RR- 16, BP 130/86, Exam shows right dense hemiparesis. Lab: Na: 120, Os:255. Urine Na: 50, Osm 358. Is it d/t SIADH? What's the cause of SIADH?

4 yo boy develops chickenpox 8 hrs after visiting his NB sister in nursery. Six other full term NB were also exposed, all of the mothers have a H/O chickenpox prior to pregnancy. Which of the following is most appropriate recommendation to prevent chickenpox in NB?
A. Acyclovir for all exposed
B. Varicella vaccine to all exposed
C. Vacine to NB with negative varicella titers
D. Isolation of NB from each other
E. No intervention is necessary.

A 67 yo man has had an ulcer on ant surface of leg just above ankle for 2 wks. He had MV replacement 15 yrs ago because of Rheumatic valvular disease. Takes furosemide for CHF and oral hypoglycemic for DM II. Exam- 5 cm ulcer with 3 mm red border. There is moderate edema from toes to midcalf bilaterally; his feet are warm, pulses weakly palpable. Scattered crackles are heard at lung bases B/L. Dx?
A. Arterial insuff
B. Endocarditis with metastatic infection
C. Meleney ulcer
D. Mucormycosis
E. Stasis dermatitis with ulcer

6 wk old forceps delivery, torticollis. 2 cm hard, nontender, oval mass is palpated in right side of neck. Most likely cause?
A. Abscess of cervical LN
B. Fibrosis of SCM
C. # of clavicle
D. Hemivertebra of - spine
E. Mal tumor

52 yo woman 2 wk H/O progressive SOB. SOB when walking across room. 8 yrs ago, Dx of breast cancer, underwent mastectomy followed by chemo. Annual exam- no recurrence. T= 98.6, P= 90, RR- 24, NP- 130/80. Exam shows no JvD. Dullness to percussion over lower half of Right lung. Left lung is clear to auscultation. Heart sounds normal. No peripheral edema. Which of the following is like cause of dyspnea?
A. Hypothyroid
B. LV dysfxn
C. Pericardial tamponade
D. Pleural mets
E. Rt lower lobe pneumonia

NB with B/L clubfoot deformity. Born at term following uncomplicated preg and delivery. Did not more his lower extremities immediately after birth, did not cry when he receied a needlestick in his feet. On exam, he is vigorous and moves his upper extremirites but not his lower extremities. Bladder is palpable and full, Dx?
A. Cerebral palsy
B. Congenital hip dysplasia
C. GBS
D. Muscular dystrophy
E. Spinal dysraphism

22 yo college student is brought by friend for 1 month H/O difficulty sleeping and increasing paranoia. His friend reports that the pt has become suspicious of his roommates and has expresse concerns about effects of dorm food on his health. He often stays awake until 3 am watching for strangers in the vicinity of his building. His school performance has deteriorated, and he has become socially withdrawn. He admits to occ use of marijuana. He appears tense and restless. P/E- no abn. Mental status exam- anxious mood and audtory hallucinations. Urine toxicology screening is negative. Next step in Mx?
A. Biofeedback
B. Carbamazepine
C. Clonazepam
D. Clonidine
E. EEG
F. Exposure therapy
G. Lithium carbonate
H. Midaz
I. Olanzapine
J. Pentobarb
K. Sertraline

47 yo man comes to ED for 3 day H/O N/V, buning nonradiating epigastric pain. He notes that hte vomitus was initially yellowish, but last 2 episodes were darker. He consumed 1 pint of whiskey 4 days ago. Takes no medications. On arrival, he is awake and confused. T= 99.3, P= 128, RR- 12, BP- 90/50. Skin is cool and clammy. Cardiopulmonary exam shows no abn. Ab exam- diffuse tenderness w/o rebound. Neuro- no focal or sensorimotor abn. FOBT-ve. CXR- fine. ECG- sinus tachy. Cause of abn vital signs?
A. Cardiogenic shock
B. Eso rupture
C. Hypovol
D. Pulm emboli
E. Septic shock

New vaccine for HIV, tested on prisoners, Early parole. Concern?
A. Coercion of vulnerable population
B. Conflict of interest
C. Failure to use an app placebo
D. Inadequate informed consent
E. Lack of generalizability
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#16
for question 1 answer is the small bowel obstruction not a. pancreatitis because lipase not elevated, abdominal pain is aggravated by eating and is relieved by vomiting points obstruction
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