CocaCola
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16 - D (decreased venous return - due to tension pneumothorax)
I've been reading your logs... great thing you guys are doing here...
Thanks
It has been really helpful
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| zianab
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guys nobody is doing nbme with me ,please am I the only one !!!!
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| npas
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Don't worry Zainab..I'am with u..I looked upto 9th question..U should leave atleast one q wrong for others to intervene ..agree with u all the way upto 9.....good going
npas
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| npas
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10)..I think she can continue all the drugs during the pregnancy because the benifits over weighs the risk..even warfarin can be given in a patient with mechanical valve..She definitely needs councelling..for her chronic illness and pregnancy outcome..I don't know about "chemical dependency councelling"...
npas
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| zianab
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dear npas ,i think warfarin is contraindicated in pregnanc.it is teratogenic.
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| npas
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11)..E) Nortriptyline coz patient seems to be depressed and having chronic pain disorder..TCA is the drug..
npas
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| npas
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yes..it is very well contraindicated..but read this para..
"Warfarin is contraindicated during pregnancy and is classified as FDA pregnancy risk category X. It crosses the placenta and has been shown to cause abnormalities in the fetus, especially when taken during the first trimester after the 6th week of gestation, and may cause fatal hemorrhage in the fetus in utero. The teratogenic effects are known as the Fetal Warfarin Syndrome (FWS) and include chondrodysplasia punctata and CNS abnormalities. Women who become pregnant while taking the drug should be advised of the potential hazards (see Adverse Reactions) and the possibility of termination of the pregnancy in light of the risks to the fetus. Warfarin should be replaced by heparin, especially during the first trimester. In some cases, however, a decision to continue warfarin therapy during pregnancy could be justified (e.g., a patient with a mechanical heart valve, where there is a high risk of embolism and full-dose heparin cannot be used, or where a temporary loss of therapeutic control would be life-threatening). Warfarin should not be used during labor or immediately after obstetric delivery because of the possibility of hemorrhage.
npas
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| npas
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All the other qs..I don't have anything new to add..agree with Zainab and Coca cola..
BTW my friends I am glad we all have participated in these open discussions, I have learned lots of things from you and I also have learned quite a few things about myself..I feel I am more ready to the test than I was be4.. mazinger
My experience is also same as that of Mazinger..except the last line..I have learnt from these discussions that I'am not ready enough to take the test..
all the best to all my friends
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| mazinger
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Ok friends here go my answers... I agree on most but there are also a few in which I have a different opinion/perspective.. Be4 anyone try to crucify me take a deep breath and try to see through my thoughts...
(what the hell was that??)
Anyways have fun...
1. D) Begin ganciclovir therapy
2. D) Respiratory syncytial virus
3. C) Acyclovir therapy zianab I was also thinking of the same thing..
4. C) ACTH stimulation test This patient is on chronic steroid therapy, note that avascular necrosis of the femur may be seen in these patients.. ACTH has been chronically suppressed therefore there has been a loss of the trophic stimulus to the adrenal cortex...
5. B) Claim that pain is work-related
I disagree with you guys, from my perspective it may seem more like a malingering type of patient.. Due to the circumstances siunce it was a job related event and the patient is willing to sue this means she probably wants to get the most out of this event... BTW I am a disaster in these sort of questions...
6. E) IUD None of these risk factors are entirely related to cervical cancer.. Smoking as a well known carcinogen doesnt directly increase the risk of cervical cancer, what is thought to be is that people who smoke tend to have more risky behaviors --> and lets say more unprotected sex... I remember this being said by Dr barones in his path videos from step 1...
Anyways from my perspective non-monogamous women with IUD are more prone to have unprotected sex compared to smoking...
OJO this is just my perspective and perhaps we can bring up a good discussion about this...
7. B) Ask the patient if he wishes to discuss his test
results, preferably with his daughter present
Geez I dont know..
8. F) Vitamin B6
9. E) Urinary supersaturation with uric acid
10. D) Switching from warfarin to heparin before pregnancy
Warfarins produce osseus dysmorphogenesis... X rated all the way!
11. E) Nortriptyline TCAs are used for chronic pain coditions...
12. I disagree with you guys... This is an elderly patient with an ipsilateral loss of sensation, paresthesias, arreflexia who has been taking steroids.. Look also for dermal lesions this looks like a reactivation of a latent VZV infection...
F) Varicella-zoster virus
13. I am a dysthimic myself, I thought this question was describing me.. BTW dysthimia is ego syntonic so there is no possibiity by me saying this that I am really dysthimic...
D) Dysthymic disorder
14 Methacoline challenge test..
15 I disagree on this one, this patient has history of chronic infections, since she has had recurrent pulmonary infections which are reflected in the scarring of the lung parenchyma.. Obviously this is not Brutons agamma (xlinked) but is some sort of B lymphocite immune deficiency...
Measure Igs...
16.D) Decreased venous return
You got it coca cola...
and thats it...
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| zianab
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FOR QS I0 MY ANSWER IS STILL D.
SWITCH TO HEPARIN FROM WARFARIN IN PREGNANCY
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| zianab
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dear MAZINGER ,
KEEP UP THE GOOD WORK AND KEEP ON POSTING.YOUR QUESTIONS AND ANSWERS HELP US ALL IN BETTER UNDERSTANDING THE SUBJECT.
ALSO NAPS AND DR PUMKIN PLEASE GIVE YOUR VALUABLE CONTRIBUTIONS .WE ARE WAITING !!!!!
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| mazinger
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zianab wrote:DEAR MAZINGER, I LIKE YOUR ANSWERS ALOT.The no 6 in good.why would you assume that the ladies who have IUD have more sex.there is no percentage or any reserch on that.well in asian or eastern countries most of the ladies are married ,have single partner and use IUD as the most populat method of contraception.So I UNDERSTAND that it can vary from country to country but please donot assume that every women on contraception is having sex with multiple partners!!!!  smoking is a high risk factor fo cervical cancer and it increases the risk many fold for it...period............... so we just answer what is asked in qs,we donot assume things ,just answer straight forward to what is asked in qs. aslo the answer no 5 could have been B too.I was thinking but then i thought about the chronic problem with disc rupture and how it will radiate to lower extremity and cause chronic back problems,but i think both answers are correct.
Why do you think smoking increases the risk?? whats the biological biochemical, pathophysiological mechanism in which smoking increases the risk so much...? Is a matter of not just saying it increases the risk period give a good reason..
I said UID in NON-MONOGAMOUS... It doesnt say if the patient is or not monogamous, anyways I am not assuming anything about any particular woman taking contraceptive measures just making an assumption according to what I think is statiscally right....
I always tend to leave my personal thoughts and emotions out while answering questions...
BTW If a female is monogamous and use UID of course the risk is none..
Edited by mazinger on 12/16/06 - 09:53 AM
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| zianab
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dear mazingner,
I donot know the exact mechanism about the pathophisology of the cancer acusing cervical cancer.but here are few articles.hope it helps .and ofcourse what answer you think might be right .there is no one correct answer to nbme.
here are few what i found on the web.
Cigarette smoking. Chemicals from cigarettes and cigarette smoke have been found in the cervical tissue of women who smoke. These chemicals may damage cervical cells and weaken their ability to fight off infection, as well as make them more vulnerable to abnormal development. The exact mechanism linking cigarette smoking and cervical cancer has not been established, however.
Smoking May Increase Cervical Cancer Risk Smoking May Increase Risk of Cervical Cancer <!-- END SECTION A; HEA MODULE --> <!-- BEGIN News Article Date -->Article date: 2001/05/01 <!-- BEGIN SECTION B --> Smoking can increase a woman?s risk of developing cervical neoplasia, the precursor to cervical cancer, according to researchers who published their findings in the British Journal of Cancer (Vol. 82, No. 7).
Experts have also known that smokers infected with HPV are more likely to develop cervical neoplasia, but it was thought that smoking merely helped the process along.
Now, researchers have shown that smoking causes cervical neoplasia.
The study authors, led by Joakim Dillner, MD, of the Karolinska Institute in Sweden, examined 137 women with high-grade cervical intra-epithelial neoplasia and 253 healthy women of similar age. The women answered 94 questions about their diet, smoking, oral contraceptive use and sexual history and donated specimens for diagnosis of present HPV infection.
Dr. Dillner considers the most important finding of the study to be that "smoking is a cause of cervical neoplasia."
Although smoking appeared to be a risk factor in cervical neoplasia, diet and oral contraceptive use were not.
"We were somewhat surprised by the findings," Dr. Dillner says. "Data had shown that HPV infections were also among smokers, suggesting that the association between smoking and cervical neoplasia was merely secondary, but this study shows that smoking causes cervical neoplasia.
Carmen Rodriguez, MD, senior epidemiologist for the American Cancer Society (ACS) says the theory that smoking causes cervical cancer is not new. "The evidence is strong, and this study is one of several studies," she says.
Dr. Rodriguez says she believes the study?s conclusions would have been similar if it had been performed in the US rather than Sweden. "The main point of the study is that they were able to show that smoking by itself is associated with increased risk of cervical cancer," she says.
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| mazinger
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wow
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| mazinger
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wow...
I didnt know that I found this in the american cancer asociation website...
Smoking: Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. These harmful substances are absorbed by the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cells in the cervix and may contribute to the development of cervical cancer.
Sounds good to me...
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| dr.pumpkin
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hiee frns !!! can somone please answer this....
A 35-year-old woman comes to the emergency department complaining of chest pressure.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
She has had such episodes intermittently over the last 5 years, usually when sleeping, but
over the last year she has had more frequent severe symptoms that are occasionally
associated with severe migraine headaches. The pain is midsternal and is described as
pressure that extends as a band around her chest. The emergency department physician is
initially dubious that the pain is cardiac in origin, because the woman has no coronary disease
risk factors. An electrocardiogram, however, shows 2-mm ST-segment elevation and inverted
T-waves in leads V1 through V5 and 1-mm ST-segment depression in leads II, III, and aVF.
Before the cardiologist arrives in the emergency department, however, the patient's
electrocardiogram has returned to normal. This repeat normal electrocardiogram is obtained
after the administration of aspirin, nitroglycerin, morphine, and oxygen. Which of the following
is the most likely explanation for these findings?
A. Diffuse intimal thickening with focal areas of atherosclerotic narrowing
B. Intermittent thrombus formation and lysis in the left anterior descending artery
C. Intermittent thrombus formation and lysis in the right coronary artery
D. Plaque rupture and thrombus formation in the left anterior descending artery
E. Transiently increased coronary vascular tone in the right coronary artery
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| CocaCola
Forum Guru
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dr.pumpkin wrote:hiee frns !!! can somone please answer this.... ]A 35-year-old woman comes to the emergency department complaining of chest pressure. She has had such episodes intermittently over the last 5 years, usually when sleeping, but over the last year she has had more frequent severe symptoms that are occasionally associated with severe migraine headaches. The pain is midsternal and is described as pressure that extends as a band around her chest. The emergency department physician is initially dubious that the pain is cardiac in origin, because the woman has no coronary disease risk factors. An electrocardiogram, however, shows 2-mm ST-segment elevation and inverted T-waves in leads V1 through V5 and 1-mm ST-segment depression in leads II, III, and aVF. Before the cardiologist arrives in the emergency department, however, the patient's electrocardiogram has returned to normal. This repeat normal electrocardiogram is obtained after the administration of aspirin, nitroglycerin, morphine, and oxygen. Which of the follow is the most likely explanation for these findings? Diffuse intimal thickening with focal areas of atherosclerotic narrowing Intermittent thrombus formation and lysis in the left anterior descending artery Intermittent thrombus formation and lysis in the right coronary artery Plaque rupture and thrombus formation in the left anterior descending artery Transiently increased coronary vascular tone in the right coronary artery
Sounds like Prinzmetals Angina to me... transient transmural ishemia leads to ST elevation whenever the spasms are occuring... in this case in the right coronary as evidenced by the right precordial leads... so my answer
Transiently increased coronary vascular tone in the right coronary artery
the migraine could also be associated with printmetals angina - same pathogenesis - transient arterial spasms
Edited by CocaCola on 12/19/06 - 08:20 AM
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There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
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| dr.pumpkin
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thanx cocacola...i agree with u on the explanation , but if u note the leads depicting the inferior wall ( lead II , III, aVF ) supplied by RCA are showing ST segment depression...
i know the hints pretty clearly point out to Prinzmetal`s Angina ..its just i want to be sure...
it ll be nice if u culd clear this up...
thnx in advance...
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| CocaCola
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this also was a problem for me...
I came to the conclusion this must be an area of non-transmural ischemia... therefore showing up as ST depression on the ECG...
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There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
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| MDcooper
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sorry to interupt u guys but which qs are u doing?what is the source
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live and let live.
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| npas
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Long long time since I wrote in this forum..
Where r u guys,Dr Pumpkin,Zainab and Mazinger????Hope u all r studying really well..
When r ur exam dates?
Wish u all a very happy christmas and new year
npas
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| npas
Forum Senior
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MDcooper,we were discussing nbme qs earlier..sometimes we post a pre test q also..
Mazinger,I hope the block u were posting has been completed,right?
Regs
npas
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| mazinger
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Though a little late I wish you all a merry Xmas and a happy new year.. BTW npas we went through all of them.. I already have schedulled my test for the first days of feb...
GL
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| dr.pumpkin
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dear npas,mazinger,zianab..
hope u guys had a great christmas...wishing the best for u in the coming new year !!
may we all get what we ve been striving for!!!
may god bless us all ...take care n keep doing wellll....
Dr. P
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| dr.pumpkin
Forum Newbie
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Dear mazinger...
gud luck for ur exam buddy !! may u do even better as uve been doing uptill now
u were of great help all this while...looking forward to have colleagues like u in residency
once again, gud luck n take care...
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