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)
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)