NBME 7 questions - lad

[ArchivalUser]

1) 52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol----??
3)aspirin
4)dexamethasone
5) Indomethacin

So this is kind of tricky I picked dexamethasone and missed it. MTB 2 says steroids is answer when there's no response to NSAIDS or NSAIDS contraindication in renal insufficiency :< But allopurinol is the only other option but is for treatment of chronic gout, any ideas!!!

[ArchivalUser]

1) An 18 y/o woman comes to the physician because of a 3 day history of fatigue and yellow eyes. She has a history of mild anemia. Her temp is 36.7oC (98.7oF), pulse is 82/min, respiration is 14/min, and blood pressure is 105/60mmhg. There is scleral icterus. Examination shows multiple 1-cm, cervical lymph node that are mildly tender.

Hb 8.6mg/dl
MCHC 38% Hb/cell
Serum total bilirubin 3mg/dl
A direct antiglobulin (coombs) test is negative. A blood smear is shown. Which of the following is most likely to have prevented this patients current symptoms?

A) Intravenous IgG therapy
B) Monthly transfusion of packed red blood cells
C) Prednisolone therapy
D) Bone marrow transplant
E) Splenectomy
F) No preventive measures are efficacious



The image provided seem to look like hereditary spherocytosis (lots of spherocytes)to me but not a 100% sure.

[ArchivalUser]

can you give me nbme 7 please?

[ArchivalUser]

@seedidi

I only have the ones I missed

[ArchivalUser]

A 21 yr woman 1 day sudden sever right side chest pain that increases with deep inspiration.During this period sob n cant take deep breath.no cough .yesterday she returned from a 3 week vacation to the Andes mountain .No smoking cigarattes alcohol or drug .V/s temp 38 pulse 80 resp 14/min n Bp100/70.P/E =faint erythematous macular nonpruritic rash over z cheeks and trunck. there is dullness on rt lung base and an inspiratory rub with no crackles or weezes .Which of the following is the most likely dx ?
A.allergic granulomatous angitis
B.allergic pul aspergillosis
C.chronic bronchitis
D.costochondritis
E.Emphysema
F.Pneumothorax
G.Postinfectious bronchospasm
H.pul embolism
I .Sarcoidosis
J Viral pleurisy


I am thinking of J but not sure

Thx

[ArchivalUser]

Y viral she is having rash I was confused bw j n a also

[ArchivalUser]

can u tell me which virus


TRIP +the rush + pleuritic PUL dx =?

[ArchivalUser]

4) A 15 year old boy is brought to the doctor by his mother because she is concerned about changes in his behavior since he transferred to a new school 4 months ago. He has become withdrawn, and has been sleeping poorly which has resulted in day time fatigue. He has had a 4.5-kg (10-Ib) weight loss during this period. His academic performance has deteriorated, he is now failing half of his classes and is often late at school. His mother says the patients maternal uncle and grandmother have been treated for depression with medication. On questioning, he says he doesn't drink alcohol or use illicit drugs. Physical examination shows no abnormalities. On mental status exam, he is cooperative but has a flat affect. Which of the following is the most likely explanation for this patients behavior.

A) Learning disorder
B) Major depressive disorder
C) Malingering
D) Substance abuse
E) Age appropriate behavior


I picked C) which was wrong. But am guessing (D) Susbt abuse is correct; or maybe (B) Major depressive disorder though I doubt it. I suggestions people

[ArchivalUser]

1) NSAIDS is 1st option and that usually means 5/E) Indomethacin. I guess celecoxib thou an NSAID is not the 1st choice NSAID.

2) E is correct since hereditary spherocytosis is associated with anemia, jaundice and elevated MCHC.

3)? H or J

h- bcos of hx of trip and acute presentation of pleurisy & SOB but not complete due to absence of tachypnea and tachycardia
j- bcos of hx of low grade fever, rash on cheek and trunk suggests 5th disease which is commoner in children but when it occurs in adults can present more often with joint pain & not rash. These questions r bloody tricky man!!!

[ArchivalUser]

Any suggestions on #4 guys???