nbme 3 questions

[firstaid2012]

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Twenty-four hours after splenectomy for blunt trauma sustained in a motor vehicle collision, a previously healthy 25-year-old man has oliguria and pain at the incision site. Intraoperative complications included a 30-minute period of hypotension and a total blood loss of 2.5 L requiring 4 units of packed red blood cells. Currently, his temperature is 38°C (100.4°F), blood pressure is 120180 mm Hg, pulse is 1001min, and respirations are 14/min. Central venous pressure is 8 cm H 2O (N=5-8). The lungs are clear to auscultation, and breath sounds are heard bilaterally. Abdominal examination shows no distention, bowel sounds are absent. A Foley catheter is in place, and over the past 3 hours, his urine output has been 20 mL/h. Laboratory studies show a hematocrit of 28%, a serum urea nitrogen (BUN) level of 30 mg1dL, and a serum creatinine level of 2.5 mgfdL, serum electrolyte levels are within normal limits. Which of the following is the most likely explanation for these findings?
O A) Acute tubular necrosis
O B) Foley catheter malfunction
O C) Hypervolemia
O D) Transfusion reaction
0 E) Ureteral injury


please explain why not transfusion reaction

 

[firstaid2012]

On the fifth day of a 7-day cruise in the western Caribbean, a 37-year-old woman develops headaches, fever, chills, abdominal discomfort, and watery diarrhea over a 12-hour period. Many other passengers and crew members have had similar symptoms. Her temperature is 37°C (98.6°F). Abdominal examination shows diffuse tenderness without rebound, bowel sounds are hyperactive. Her leukocyte count is 11,000/mm3. Gram's stain of a stool specimen shows a small number of neutrophils. A stool culture grows Salmonella enteritidis. Two days after treatment with bismuth subsalicylate and oral rehydration, her symptoms subside. Which of the following is the most appropriate immediate measure to prevent further spread of this pathogen?

O A) Cancellation of shore leave for all crew members
O B) Elimination of seafood and shellfish from the ship's menu
O C) Exclusive use of pasteurized eggs
O D) Hyperchlorination of the ship's drinking water
O E) Reassignment of all food-handling personnel to other duties
O F) Treatment of all affected persons with doxycycline

is it F

 

[firstaid2012]

An 80-year-old man has had poor balance for 6 months. He has a history of hypertension treated with hydrochlorothiazide. His blood pressure is 136/86 mm Hg. Neurologic examination shows mild tremor of the hands when his arms are outstretched and decreased
vibratory sensation at the knees. Deep tendon reflexes of the quadriceps and gastrocnemius-soleus muscles are hyperactive. Babinski's sign is present bilaterally. He is unable to stand with his eyes closed. Which of the following is most consistent with normal
age-related changes?

O A) Babinski's sign
O B) Hyperactive deep tendon reflexes of the gastrocnemius-soleus muscles
O C) Inability to stand with the eyes closed
O D) Reduced vibratory sensation at the knees
0 E) Tremor of the outstretched hands


D or E???

 

[firstaid2012]

A previously healthy 6-month-old boy is brought to the physician because of a 12-hour history of vomiting and diarrhea. He vomits after all feedings, the vomitus does not contain blood or bile. His mother says that he has had fewer wet diapers than usual during this period. He appears dehydrated and is crying without tears. He is at the 50th percentile for length and 30th percentile for weight. He appears lethargic. His temperature is 38°C (100.4°F), pulse is 180/min, and blood pressure is 60/40 mm Hg. Examination shows sunken eyes, dry mucous membranes, and a sunken anterior fontanel. Arterial blood gas analysis on room air shows:
pH 7.2
PCO2 38 mm Hg
PO2 90 mm Hg

Which of the following is the most likely explanation for this patient's arterial blood gas findings?
O A) Excessive metabolic acid formation
O B) Impaired ventilation
O C) Increased chloride loss (Ã increase HCO3 which is not the case here)
O D) Increased CO2 concentration in the extracellular fluid
0 E) Increased metabolic acid produced by the gastrointestinal tract

 

[firstaid2012]

Over the past 2 weeks, a 60-year-old man has had shortness of breath on exertion. He also has paroxysmal nocturnal dyspnea with two-pillow orthopnea. He has taken aspirin daily since a myocardial infarction 3 years ago. He has a history of atrial fibrillation well controlled with digoxin and type 2 diabetes mellitus treated with diet. His blood pressure is 136188 mm Hg, pulse is 98/min and irregular, and respirations are 20/min. Jugular-venous pressure is increased. Breath sounds are decreased over the right lung base.. there is dullness to percussion. Cardiac examination shows an S. gallop. There is 2+ edema of the lower extremities. Pulse oximetry shows an oxygen saturation of 90%. Which of the following is the most appropriate next step in diagnosis?
O A) X-ray film of the chest
O B) Ambulatory ECG monitoring
O C) Thallium stress test
O D) Echocardiography
O E) Ventilation-perfusion lung scans

A or E

 

[firstaid2012]

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 Indirect Alkaline
Bilirubin Bilirubin Phosphatase Reticulocyte
(mg/dL) (mg/dL) (U/L) (ALT, GPT) (U/L) Count (%)
O A) 2 0.9 80 30 1.2
O B) 3 2.8 70 30 1.0
O C) 3 2.8 80 20 3.0
O D) 4 2.0 800 200 1.5
O E) 4 1.0 150 400 1.0

 

[firstaid2012]

Five years after being shot in the right thigh, a 21-year-old man comes to the emergency department because of a busing sensation adjacent to the scar. At the time of the initial wound, he was discharged after 6 hours of observation with no fractures or soft-tissue
swelling. A loud murmur is heard on auscultation, there is a thrill. He has dilated varicose veins with incompetent valves in the lower leg. Which of the following is the most likely diagnosis?
O A) Arterial spasm
O B) Arteriovenous fistula
O C) Deep venous thrombosis
O D) Occlusion of the superficial femoral artery
O E) Pseudoaneurysm

 

[firstaid2012]

A study is conducted to investigate the prevalence of past infection with genital herpes among students attending a large coeducational Midwestern university. After obtaining informed consent, the study participants undergo antibody testing for herpes simplex virus 2 (HSV). Which of the following is the most important factor in determining the validity of a positive test?

A) The number of sexual partners of the student
B) The proportion of students infected with HSV
C) The proportion of students with negative tests
D) The proportion of students with positive tests
E) The total number of students screened

 

[firstaid2012]

A 30-year-old woman, gravida 4, para 3, is admitted to the hospital in labor at 38 weeks' gestation. The cervix is 4 cm dilated. Contractions occur every4 minutes. The fundal height is 40 cm. The membranes are intact. The fetal lie cannot be determined by abdominal examination, and no presenting part is palpable in the pelvis. Which of the following is the most appropriate next step in management?

O A) Ultrasonography
O B) Administration of oxytocin
O C) Administration of tocolytic drugs
O D) Amniotomy
O E) Cesarean delivery

a or b??

 

[firstaid2012]

14. An 82-year-old man is brought to the emergency department because of the sudden onset of confusion 48 hours ago. His family says that he previously had been functional and independent. His temperature is 37.5°C (99.5°F), blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 12/min. The skin is warm and clammy. Bowel sounds are hypoactive, and there is guarding and tenderness in the right lower quadrant of the abdomen. Examination of the heart, lungs, and extremities shows no abnormalities. He is drowsy but arousable and oriented to person but not place or time. There are no focal deficits. Which of the following is the most likely
diagnosis?
O A) Appendicitis
O B) Colon cancer
O C) Meningitis
O D) Pneumonia
0 E) Urinary tract infection


isn't this E answer key says A

 

[firstaid2012]

anyone??? please help