LBheartsGU
Forum Newbie
Topics: 1
Posts: 4
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A 72-year-old man is brought to the physician by his son because of a 4-day history of increasing confusion and memory problems. The son says that his father's ability to function independently has been generally declining over the past few years, and he has become much more impaired over the past week. The patient has had at least three to four previous episodes of a sudden decline of cognitive functioning over the past 3 years without full recovery. He has a history of hypertension. His blood pressure is 160/95 mm Hg without orthostatic changes. Neurologic examination shows no focal findings. Mini-Mental State Examination score is 21/30. Which of the following is the most likely underlying pathophysiologic process?
A ) Central nervous system demyelination
B ) Central nervous system infection
C ) Diffuse axonal injury
D ) Diffuse cortical atrophy
E ) Left temporal lobe infarction
F ) Multiple, small, central nervous system infarctions
A 75-year-old man with a 3-year history of progressive cognitive impairment due to dementia, Alzheimer's type, has had nocturnal disorientation for 2 weeks. He lives at home with his wife. He is otherwise healthy and takes no medications. Physical examination shows normal findings. He is disoriented to time and place, has poor short-term memory, is unable to do simple arithmetic, and has a poor understanding of general information. Which of the following is the most appropriate initial step in management?
A ) Increase in home nighttime lighting
B ) Prescription for chloral hydrate
C ) Prescription for diazepam
D ) Prescription for haloperidol
E ) Use of nighttime mechanical restraints
A 49-year-old woman is admitted to the hospital because of renal failure. She has had episodes of flank pain over the past 20 years. She has also had nocturia 2 to 3 times nightly for 10 years. Her blood pressure is 160/100 mm Hg. Examination shows pale mucous membranes. A mass is palpated in the right flank. Which of the following is the most likely diagnosis?
A ) Horseshoe kidney
B ) Nephrolithiasis
C ) Papillary necrosis
D ) Polycystic kidney disease
E ) Renal cell carcinoma
For each child seen in the emergency department because of abdominal pain, select the most appropriate next step in management.
A ) Administration of parenteral antibiotics
B ) Admission to the hospital for medical management
C ) Admission to the hospital for operative management
D ) Colon contrast studies
E ) Discharge for follow-up by personal physician
F ) Endoscopy
G ) MRI of the abdomen
H ) Observation in the emergency department
6. A previously healthy 6-month-old boy is brought to the emergency department because of a 12-hour history of intermittent episodes of inconsolable crying associated with drawing up of the legs. Over the past 6 hours, he has had intermittent diarrhea that is reddish and mucoid, and for the past 3 hours he has been somnolent. On examination, he is sleepy but arousable. His temperature is 38.1 C (100.6 F), blood pressure is 90/55 mm Hg, pulse is 140/min, and respirations are 38/min. He cries when his abdomen is palpated; a mass is felt in the right lower quadrant. His leukocyte count is 12,400/mm3 (50% segmented neutrophils, 8% bands, 1% eosinophils, 40% lymphocytes, and 1% monocytes). Serum electrolyte levels are within normal limits. An x-ray film of the abdomen shows no free air.
part 2A previously healthy 14-year-old girl is brought to the emergency department because of abdominal pain for 12 hours. She has a 1-week history of brownish vaginal discharge. Menarche was at the age of 12 years, and her periods have occurred at regular 28-day intervals over the past year. Her last menstrual period was 7 weeks ago. Her temperature is 37 C (98.6 F), blood pressure is 85/55 mm Hg, pulse is 145/min, and respirations are 24/min. Abdominal examination shows generalized tenderness, and there is guarding with rebound in the right lower quadrant. Her hematocrit is 24%, and leukocyte count is 9400/mm3 (60% segmented neutrophils, 3% bands, 1% eosinophils, 35% lymphocytes, and 1% monocytes). Serum electrolyte levels are within normal limits.
9. A 4-year-old boy is brought for a well-child examination. He uses two-word phrases, can say his first name but not his last name, and cannot identify colors. He is just beginning toilet training. His 7-year-old sister has a learning disability and attends special education classes. Genital development is Tanner stage 1; testes are large. Which of the following is the most appropriate next step in diagnosis?
A ) Reexamination in 6 months
B ) Thyroid function tests
C ) DNA testing
D ) Measurement of bone age
E ) CT scan of the head
12. A previously healthy 2-year-old boy is brought to the physician 20 minutes after an episode of cyanosis and loss of consciousness that lasted 3 minutes. The symptoms occurred after his mother scolded him for climbing onto the dining room table. The mother says that the child began to cry, let out a deep sigh, stopped breathing, and jerked his arms and legs back and forth. On arrival, he is alert and active. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?
A ) Reassurance
B ) Electroencephalography
C ) CT scan of the head
D ) Anticonvulsant therapy
E ) Lumbar puncture
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| Miradautas Vras
Forum Senior
Topics: 8
Posts: 154
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Well these are tough ones.
F - looks like multi infarct dementia to me
A - Not sure but mechanical restraint sounds too hyper, avoid BZD in elderlies , no psychosis no haloperidol , And between chloeal hydrate and A i'll select A
D - Polycycstic kidney. Palapable mass. She doesn't look like candidate for cancer to me
D - intususseption . Barium enema is diagnostic and in many cases curative. Patient is not that unstable so i won't go for operation now.
C - Ovarian cyst torsion , go and operate. [though i'm not sure regarding abdominal MRI]
C - Milestones are certainly delayed and looks like Fragile X to me. So DNA testing should be done [ though i am not sure abt observation]
A - tough. I was looking for something related to TOF since this looks like tet spells but here I'd just reassure. Don't know why. When in doubt pick the simplest option.
I'd look forward to answers from people more informed than me!!
___________________
Man who fights too long against the dragons becomes a dragon himself.
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| LBheartsGU
Forum Newbie
Topics: 1
Posts: 4
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I went with those answers too
F
A
D
D
C
A, I had no clue as far as the management of this one.
Thanks for the response
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| Miradautas Vras
Forum Senior
Topics: 8
Posts: 154
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you're welcome!
___________________
Man who fights too long against the dragons becomes a dragon himself.
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| nyimalay
Forum Elite
Topics: 9
Posts: 280
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I agree with all the answers.
Last one is cyanotic apnoea which is due to breath-holding because of anger.
There is another one called pallid apnoea due to sudden fear.
Both conditions just need reassurance.
Regarding No.6 part 2. The condition seems to be ruptured ectopic pregnancy. Answer is the same, operative management.
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| Miradautas Vras
Forum Senior
Topics: 8
Posts: 154
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Cool. Damn I gave lots of right answers on NBME 2 , at least from the forum solutions! Still managed just 550! USMLE doesn't like me!
___________________
Man who fights too long against the dragons becomes a dragon himself.
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| peter90036
Forum Elite
Topics: 28
Posts: 315
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whats up with #2?
Alzheimer dementia -- increase night time light ?!
is chloral hydrate too powerful?
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