got some questions about nbme 2
1. lady with 1 wk of nausea, scleral icterus, and right sided abdominal cramps; already had lap chole 2 mo ago but no intra-op cholangiography; T bili 8, Direct 5, alk phos 650, ALT/AST normal
Cause of jaundice? i put primary biliary sclerosis (wrong) and other choices were choledocholithiasis, cirrhosis, pancreatic cancer, or postop bile leak
Maybe postop bile leak was the ans b/c the others don't make sense with the LFTs, but would appreciate if someone could explain
2. woman undergoing ex lap for chronic pelvic pain. already consented with husband as witness, but after receiving narcotics, she gets panics and doesn't want operation anymore. What do you do?
I put reconfirm with husband, give benzo, and proceed to operation b/c I thought she wouldn't have decision making capacity after getting the narcs, but that was wrong
other choices: cancel op, consult psych, proceed with op as planned, or proceed with op after giving opioid antagonist
3. 15 yo boy with small right pneumothorax. next step in eval?
I put CT chest since you could look for apical blebs (incorrect)
other choices: observation, PFTs, VQ scan, bronch