docdoc9
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2. A 15-year-old girl is brought to the physician 3
months after she
had a blood pressure of 150/95 mm Hg at a routine
examination prior to
participation in school sports. She is asymptomatic
and has no history
of serious illness. Twelve months ago, she was
diagnosed with a
urinary tract infection and treated with oral
trimethoprim-sulfamethoxazole.
She currently takes no medications. Subsequent blood
pressure
measurements on three separate occasions since the
last visit have been: 155/94
mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the
50th percentile
for height and 95th percentile for weight. Her blood
pressure today is
150/90 mm Hg confirmed by a second measurement, pulse
is 80/min, and
respirations are 12/min. Examination shows no other
abnormalities. Her
hematocrit is 40%. Urinalysis is within normal limits.
Cardiac and
renal ultrasonography shows no abnormalities. Which
of the following is
the most appropriate next step in management?
A
) Exercise and weight reduction program
B
) Measurement of urine catecholamine levels
C
) Measurement of urine corticosteroid levels
D
) Captopril therapy
E
) Hydrochlorothiazide therapy
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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A 2-month-old boy is brought to the physician because
of a 6-week
history of persistent diarrhea and vomiting, most
pronounced after formula
feedings. He has had a 113-g (4-oz) weight loss since
birth. He
currently weighs 3100 g (6 lb 13 oz) and is 51 cm (20
in) in length. He
appears irritable. Examination shows jaundice. The
lungs are clear to
auscultation. No murmurs are heard. The liver is
palpated 2 to 3 cm
below the right costal margin, and the spleen is
palpated 1 to 2 cm below
the left costal margin. Laboratory studies show:
Serum
Glucose 35 mg/dL
Bilirubin (total) 2.3 mg/dL
Urine
Glucose negative
Reducing substances 3+
Which of the following is the most likely mechanism of
these findings?
A
) Decreased gluconeogenesis
B
) Decreased insulin secretion
C
) Increased glucagon secretion
D
) Increased gluconeogenesis
E
) Increased insulin secretion
F
) Insulin resistance
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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16.
A 57-year-old woman is extubated and transferred to
the recovery room
after a cholecystectomy. She appears restless. Her
blood pressure is
120/70 mm Hg, pulse is 80/min, and respirations are
10/min. Arterial
blood gas analysis on room air shows:
pH 7.24
PCO2 85 mm Hg
PO2 60 mm Hg
Intravenous naloxone therapy is begun, but she does
not improve. Which
of the following is the most appropriate next step in
management?
A
) Encouraging deep breathing and cough
B
) Administration of 40% oxygen via nasal cannula
C
) Administration of furosemide
D
) Transfusion of 1 unit of packed red blood cells
E
) Reintubation and mechanical ventilation
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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17. A previously healthy 24-year-old woman is
brought to the
physician by her husband because of several episodes
of loss of consciousness
over the past 4 days. Her husband reports that during
episodes, she
jerks her arms and legs wildly. Each episode lasts up
to 1 hour; between
episodes, her behavior is normal. She is planning to
move to another
state because of her husband's work. She has been
extremely anxious and
upset about the move because she will have to leave
her mother, who was
recently diagnosed with breast cancer. There is no
family history of
seizure disorder. Her temperature is 36.7 C (98 F),
blood pressure is
130/80 mm Hg, pulse is 84/min, and respirations are
18/min. Neurologic
examination shows no abnormalities.
Electroencephalography shows
normal findings during an episode of shaking. Which
of the following is the
most likely underlying cause?
A
) Catatonia
B
) Complex partial seizure
C
) Conversion reaction
D
) Dissociative fugue
E
) Malingering
F
) Tonic-clonic seizure
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| jmkhanzada
Forum Junior
Topics: 6
Posts: 82
|
i guess.....
B
) Measurement of urine catecholamine levels
F
) Insulin resistance
e) Reintubation and mechanical ventilation
E
) Malingering
make me corret if i m wrong
thanx
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| nightflight1945
banned
Topics: 32
Posts: 920
|
2-Exercise and weight reduction program
she is obese and normal abdominal sono
no indication for urinary catecholamine measurement
Decreased gluconeogenesis
probability of galactosemia or tyrosinemia
Encouraging deep breathing and cough
A-a gradient shows the reason is hypoventilation
Conversion reaction
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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why can't the last one be malingering?
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| nightflight1945
banned
Topics: 32
Posts: 920
|
Yes , I made a mistake.It is malingering
because for diagnosis of conversion the symptoms should last more than 6 months .
Thank you very much for your post.
Waiting for more posts from u.
Edited by nightflight1945 on 08/28/08 - 01:13 AM
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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32. A 5-month-old boy is brought to the physician
because of a
24-hour history of fever, cough, noisy breathing, and
difficulty feeding.
His symptoms began 3 days ago with nasal discharge,
mild cough, and
chest congestion. He appears somewhat irritable and
is crying. His
temperature is 38.5 C (101.3 F), pulse is 108/min, and
respirations are
32/min and shallow with a prolonged expiratory phase.
On examination, the
throat appears normal. A few small anterior and
posterior cervical
nodes are palpable. Both eardrums are pink but have
normal landmarks and
mobility. There is good air entry with diffuse
bilateral expiratory
wheezes on auscultation. An x-ray film of the chest
shows hyperinflation.
Which of the following is the most likely pathogen?
A
) Adenovirus
B
) Haemophilus influenzae
C
) Mycoplasma pneumoniae
D
) Respiratory syncytial virus
E
) Streptococcus pneumoniae
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
|
38. A 66-year-old man has had numbness and tingling
in the hands and
feet for 2 weeks. He lives in a homeless shelter and
is well fed. He
has been treated for pulmonary tuberculosis for 4
months with
isoniazid, rifampin, ethambutol, and pyrazinamide. He
is compliant with his
medication regimen but continues to abuse alcohol.
His temperature is 37
C (98.6 F), blood pressure is 136/76 mm Hg, pulse is
72/min, and
respirations are 20/min. He is well nourished but
depressed and irritable.
There is decreased sensation to pain and touch in the
hands and feet in
a stocking-glove distribution. Which of the following
is the most
likely nutritional deficiency?
A
) Folic acid
B
) Niacin
C
) Vitamin A
D
) Vitamin B1 (thiamine)
E
) Vitamin B2 (riboflavin)
F
) Vitamin B6
G
) Vitamin B12 (cyanocobalamin)
H
) Vitamin C
I
) Vitamin D
J
) Vitamin E
K
) Vitamin K
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
|
And can you explain the respiratory question?(Q no. 16)
|
| nightflight1945
banned
Topics: 32
Posts: 920
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one point , in the answer it is written conversion reaction and not disorder , so there is no need to last more than 6 months , so still I am dubious between conversion and malingering and
Conversion appeals more to me.
The question has a defect that it doesnot explains the internal conflicts of the patient thoroughly .
Q no 16:
A-a gradient is 150-1.25*85-60=5
it is normal so the reason for her hypoxia is hypoventilation that is also compatible with her post-op situation (pain prevents deep breathing) , analgesia and deep resp is the best step.
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| nightflight1945
banned
Topics: 32
Posts: 920
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32-Respiratory syncytial virus
38-Vitamin B6
INH therapy
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
|
nightflight1945 wrote:
one point , in the answer it is written conversion reaction and not disorder , so there is no need to last more than 6 months , so still I am dubious between conversion and malingering and
Conversion appeals more to me.
The question has a defect that it doesnot explains the internal conflicts of the patient thoroughly .
But the question also describes a motive.
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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Aree on the last two answers
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| nightflight1945
banned
Topics: 32
Posts: 920
|
docdoc9 wrote:nightflight1945 wrote:
one point , in the answer it is written conversion reaction and not disorder , so there is no need to last more than 6 months , so still I am dubious between conversion and malingering and
Conversion appeals more to me.
The question has a defect that it doesnot explains the internal conflicts of the patient thoroughly .
But the question also describes a motive.
But secondary gain is not obvious in this question ,e.g it does not say that if she has seizure , the won't move or ...
But she is under stress and the symptom of seizure is more classic for conversion.
However if you claim that the answer is malingering I won't object.
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
|
nightflight1945 wrote:docdoc9 wrote:nightflight1945 wrote:
one point , in the answer it is written conversion reaction and not disorder , so there is no need to last more than 6 months , so still I am dubious between conversion and malingering and
Conversion appeals more to me.
The question has a defect that it doesnot explains the internal conflicts of the patient thoroughly .
But the question also describes a motive. But secondary gain is not obvious in this question ,e.g it does not say that if she has seizure , the won't move or ... But she is under stress and the symptom of seizure is more classic for conversion. However if you claim that the answer is malingering I won't object.
May be you are right
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