zzpearl
Forum Senior
Topics: 51
Posts: 138
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Guys, please give your input on these NBME Qs. I have added the previous discussion found online before, and some extra info. But still can not reach the correct answer. Please help. Thanks<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
NBME 3
1. #20
A 47-year-old woman comes to the emergency department because of severe abdominal pain for 3 hours. The pain began after a 2-week drinking binge. She has a 15-year history of alcoholism. She has no history of jaundice or hepatitis. Current medications include multivitamins and iron. Her temperature is 38°C (100.4°F), blood pressure is 110/80 mm Hg, and pulse is 110/min. Examination shows mild jaundice and diffuse spider angiomata over the trunk and abdomen. The liver is tender to palpation. A complete blood count shows mild anemia with normal red cell indices. Ultrasonography of the abdomen shows normal-sized hepatic ducts. Which of the following is the most likely set of laboratory findings?
Total Serum Serum Indirect Serum Alkaline Serum Alanine
Bilirubin Bilirubin Phosphatase Aminotransferase Reticulocyte
(mg/dL) (mg/dL) (U/L) (ALT, GPT) (U/L) Count (%)
A) 2 0.9 80 30 1.2
B) 3 2.8 70 30 1.0
C) 3 2.8 80 20 3.0
D) 4 2.0 800 200 1.5
E) 4 1.0 150 400 1.0
??? Answer: B......alcoholic hepatitis without obstructive component as normal sized ducts on sono
so inc TSB, inc indirect bilirubin major component, normal alk phosphatase, and dec ret count as alcohol is a myelosupressant
2. #37 A 2-year-old girl is found floating facedown in a swimming pool. On rescue, she immediately coughs and breathes spontaneously. She is conscious and oriented. Without treatment, which of the following is the most likely outcome for this child?
AComplete recovery
BDevelopment of acute respiratory distress syndrome
CHemolysis
DPulmonary hypertension
ESevere neurologic deficit
??? Answer: A....complete recovery....as immediate resuscitation done and is effective.....ARDS is a potential complication but not the commonest outcome Or B according to Kaplan notes, even drowning pt looks fine after initial resuscitation, he should be closely observed and maintain airway and oxygen supply, since ARDS may develop later
3. #37 A 2-year-old girl is found floating facedown in a swimming pool. On rescue, she immediately coughs and breathes spontaneously. She is conscious and oriented. Without treatment, which of the following is the most likely outcome for this child?
A Complete recovery
B Development of acute respiratory distress syndrome
C Hemolysis
D Pulmonary hypertension
E Severe neurologic deficit
??? Answer: A....complete recovery....as immediate resuscitation done and is effective.....ARDS is a potential complication but not the commonest outcome Or B
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| MAGY17
Forum Elite
Topics: 30
Posts: 234
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1=D BECAUSE ALT/AST >2
2= B, EVEN IF THE PCTE APPEARS CONFORTABLE INITIALLY, OBSERVATION SHUOLD BE CONTINUED FOR 24HS BECAUSE ARDS MAY DEVELOPS AS A LATE FINDINGS
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| gingko
Forum Senior
Topics: 13
Posts: 226
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1. E...this is alcoholic hepatitis and like any other hepatitis, transaminases would be more than Alk. phosphatase..which is the case only with E
2. complete recovery will be the most likely outcome since the patient has not lost consciousness..as a rule drowing patients who recover on the spot have the best outcome..
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Old McDonald had an ERAS inbox..with a reject here and a reject there..here a reject, there a reject,everywhere a reject, reject.
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| zzpearl
Forum Senior
Topics: 51
Posts: 138
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MAGY17, there is no AST , one is ALk and the other is ALT.
gingko, can you explain more about : "alcoholic hepatitis and like any other hepatitis, transaminases would be more than Alk. phosphatase" ? ALk 150 is higher than normal, could this be in Alcohol hepatitis w/ normal-sized hepatic ducts?
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| gingko
Forum Senior
Topics: 13
Posts: 226
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hey pearl, sorry for the late reply..
alcoholic hepatitis is most often a hepatocellular pattern with inflammation and degeneration which leads to enzyme leakage with elevated transaminases(<400) and only moderate elevation of alk.po4..this pattern is evident only in E and since there is no evidence of obstruction, there doesnt seem to be a cause of marked elevation of alk.po4...interestingly the patient has anemia with normal indices..is it hemolysis..if it is than option C is the only one that fits the picture with an elevated retic and indirect bilirubin
___________________
Old McDonald had an ERAS inbox..with a reject here and a reject there..here a reject, there a reject,everywhere a reject, reject.
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