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NBME 19 Block 1 discussion - martini11
#21
Q18

A previously healthy 16 year odl girl is brough to the physician by her 18 year old sister because of a 2 day history of a thick, yelllow vaginal discharge and burning with uriniation. She does not want her parents to know that she is sexually acitve. Her temp is 98.6 F , pulse is 80/min and blood pressure 110/70 mm Hg. Examination shows a mucopurulent discharge at eh cervical os and friability of the cervix. The uterus is small, firm and nontender. There are no adnexal masses or external vaginal lesions. A Gram stain of the discharge shows gram negative diplocci in pairs and greater than 30 leukocytes/hpf. Urinalysis is within normla limits. Testing for Neisseria gonorrhoeae and Chlamydia trachomatis is ordered. Which of the following is the most appropriate course of action?

A) Do not prescribe antibiotics until testing results are available
B) Obtain written consent from a parent before prescribing antibiotics
C) Obtain written consent from her sister before prescriting antibiotics
D) Prescribe antiobiotics and notify her parents
E) Prescribe antiobiotics without notifying her parents
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#22
Q19

In Immunocopromised patients , the case definition of a postice PPD skin test can change from 10mm to 5mm of induration. This change in case definition has which of the following effects on incidence and prevalence of positive PPD skin test?

Incidence Prevalence
A) Inc Inc
B) Inc Dec
C) No change No change
D) Dec Inc
E) Dec Dec
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#23
Q20

A 25-year old man is brough to the ER dept by hs wife because of fever and swelling of his left calf since cutting his leg 2 days ago while mountain biking. He was awake but somewhat confused . Physical exam shows an exquisitely tender , edematous left calf. Palpatin of the swollen aera produce crepitus. There is foul smelling . water discharge form th edge of the wound. Which of the follwing is the most likely causal organism?

A) Clostridium botulinum
B) C. difficle
C) C prefringens
D) C septicum
E) C tetani
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#24
Q21

A 52 year old woman begins treatment with cisplatin for non-small cell carcinoma of the lung. Concomitant administration of which of the following drugs is most appropriate for this patient?

A) Dronabinol
B) Metoclopramide
C) Odansertron
D) Prochlorperazine
E) Scopolamine
Reply
#25
Q 22

A 52 year old woman with coronary artery dis found to have a heart with a right-dominat circulation. After angioplasty of the circumflex artery, which of the following structures supplied by it would reveive increased blood flow?

A) Atrioventricular node
B) Left ventricle
C) Right atrium
D) Right ventricle
E) Sinoatrial node
Reply
#26
Q23

Which of the following best explains the induction of galatorrhea by metocloramide?

A) Inc affinity of mammary gland prolactin receptors for prolactin
B) Stimulation of release of estrogen from developing ovarian follicles
C) Stimulation of release of growth hormone from adenohypophysis
D) Stimulation of release of oxytocin from the neurohypophysis
E) Stimulation of release of prolactin from the adenohypophysis
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#27
Q 24

A 30 year old woman with Marfan syndrome is brought to the ER dept 30 min after the onset of leaning chest pain. An electrocardiogram obtained 1 year old showed aortic root to be 5.5 cm ( N 4.0) . She stopped taking her prescribed propranolol 1 year agoa because of fatigue. her pulse is 120/min and blood pressure is 80/40 mm Hg. Physical exam shows jugular venous distention 6cm above the sternal angle that does not decrease with inspiration. The point of maximum impulse is not ------ ( something cant read) and the heart soudn cannot be distinguisted. Which of the following sets of findings is most likely on cardiac catheterization of the patient?

Cardic Index Right Atrial Press. PCWP Pul Diastolic Arterial Press. Syst. Vascular Resistan
(N-2.5-4.2) (N 0-8) ( 0-16) ( N 12-30) (N-770-1000)

A) 2.0 2 5 6 800
B) 2.0 5 15 15 1200
C) 2.0 18 18 20 2000
D) 4.0 2 5 6 600
E) 4.0 5 15 15 1200
F) 4.9 18 18 20 2000
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#28
Q25

A 53 year old man with angina pectoris is treated with nitroglycerin. Which of the following actions of nitroglycerin is most likely to be responsible for systomatic improvement?

A) Impaired transmembrane calcium flux
B) Increased concentration of cyclic GMP in smooth muslce
C) Induction of releae of acetlycholine by endothelial cells
D) Inuction of release of interleukin-1 by endothelial cells
E) Stimulatio of autonomic nervous system tone
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#29
Q26

A 6month old male infant has a history of frequent severe viral and bacterial infections. A tentative diagnosis of severe combined immunodeficiency is made. A def of which of the following enzymes would support this diagnosis?

A) Adenosine deaminase
B) Glucose 6-phospatase
C) Hypoxanthine-guanine phosphoribosyltransferase
D) Myeloperoxidase
E) NADPH oxidase
Reply
#30
Q 27

A 45 year old woman comes to the physician because of a 24 hr history of fever, cough , runny nose and muscle aches. She appears moderately ill. Her temp is 101.7 F. Cardiopulmonary examination shows no abnormalities. A test results for influenza virus antigen is postive. Which of the following types of medications is the most appropriate treatment for this patient?

A) Aminoglycoside anitbiotic
B) Beta-Lactam anti
C) Macrolide anti
D) Neuroaminidase inhibitor
E) Protease inhibitor
F) Thymidine kinase inhibitor
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