NBME help please

[drake19]

Hi I was wondering if anyone could help me with these NBME questions. Thanks

1) 40 y/o healthcare worker returns for f/u after his PPD skin test is (+) on annual testing. Test showed 17 mm of erythema and 11 mm induration at maximum measurement points. Annual PPD skin tests over past 5 years have been negative, CXR showed no abnormalities. Next best step in management
A) BCG
B) INH
C) rifampin
D) no treatment and repeat PPD
E) no treatment and repeat x-ray of chest annually
D is WRONG

2) Unconscious 25 y/o M brought to ER 15 min. after neighbor found him lying on street. Neighbor reports that patient was joggin before falling to the ground. Patient is wearing a medic alert bracelet stating type 1 DM. NO other history can be obtained. No evidence of trauma, does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. Temperature 37, pulse 90, respiration 12, BP 112/70. Exam shows no other abnormalities. Next best step
A) urine tox screen
B) MRI of brain
C) bolus of insulin
D) 50% dextrose in water
E) rapid infusion of 1 L normal saline
F) Lumbar puncture
E is wrong (rapid infusion of NS)

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[Longhorn91]

1 should be B to treat for TB
2 should be C to treat his DM1

Those are my best guesses

 

[JoshSt]

Hi I was wondering if anyone could help me with these NBME questions. Thanks

1) 40 y/o healthcare worker returns for f/u after his PPD skin test is (+) on annual testing. Test showed 17 mm of erythema and 11 mm induration at maximum measurement points. Annual PPD skin tests over past 5 years have been negative, CXR showed no abnormalities. Next best step in management
A) BCG
B) INH
C) rifampin
D) no treatment and repeat PPD
E) no treatment and repeat x-ray of chest annually
D is WRONG

2) Unconscious 25 y/o M brought to ER 15 min. after neighbor found him lying on street. Neighbor reports that patient was joggin before falling to the ground. Patient is wearing a medic alert bracelet stating type 1 DM. NO other history can be obtained. No evidence of trauma, does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. Temperature 37, pulse 90, respiration 12, BP 112/70. Exam shows no other abnormalities. Next best step
A) urine tox screen
B) MRI of brain
C) bolus of insulin
D) 50% dextrose in water
E) rapid infusion of 1 L normal saline
F) Lumbar puncture
E is wrong (rapid infusion of NS)

Got these right, know they're right b/c didn't get them wrong in extended feedback
1. B, always tx +PPD if no hx of BCG, even if -CXR (+CXR necessitates the full RIPE instead of just INH)
2. D, he was exercising and went into hypoglycemia. He didn't get spontaneous DKA in the middle of exercising and he doesn't need fluid resuscitation with the nl BP.

 

[drake19]

Got these right, know they're right b/c didn't get them wrong in extended feedback
1. B, always tx +PPD if no hx of BCG, even if -CXR (+CXR necessitates the full RIPE instead of just INH)
2. D, he was exercising and went into hypoglycemia. He didn't get spontaneous DKA in the middle of exercising and he doesn't need fluid resuscitation with the nl BP.

Hey thanks for your help. But why is his PPD (+)? I thought that patinets without risk factor need an induration > 15. In the question step it says his induration was 11 mm (erythema was 17 mm). Thanks

 

[Bagheera]

Hey thanks for your help. But why is his PPD (+)? I thought that patinets without risk factor need an induration > 15. In the question step it says his induration was 11 mm (erythema was 17 mm). Thanks

Hes a health care worker.

 

[wannabie]

Hey thanks for your help. But why is his PPD (+)? I thought that patinets without risk factor need an induration > 15. In the question step it says his induration was 11 mm (erythema was 17 mm). Thanks

You need to review the paramaters for positive PPD's, my friend:
>5mm induration means positive in immunocompromised patients (ie AIDS patients)
>10mm in high risk "worker" types: healthcare workers, prison guards, etc
>15mm for everyone else