h****8
发帖数: 278 | 1 做nbme有些题目的答案感觉都有说的过去的地方。请版上xdjm帮忙掌掌眼。
33. Four hours after undergoing a cesarean delivery at term followed by
tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and
confusion. The operation was uncomplicated, and blood loss is estimated to
be 800 mL. Patient-controlled epidural analgesia has been moderately
effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from
120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min
intraoperatively. Breath sounds are decreased bilaterally. No murmurs are
heard. Abdominal examination shows distention and tenderness. Bowel sounds
are absent. The incision is intact with no drainage. She is disoriented to
person, place, and time. Her hematocrit is 23%; preoperative hematocrit was
35%. Which of the following is the most likely cause of the hemodynamic
changes?
A
) Epidural-related hypotension
B
) Insufficient intraoperative fluid replacement
C
) Postoperative intra-abdominal hemorrhage
D
) Supine hypotensive syndrome
E
) Underestimated intraoperative blood loss
这道题，C E各有说的过去的解释。 |
h****8
发帖数: 278 | 2 38. A 32-year-old woman comes to the physician because of vaginal discharge
for 2 weeks. She has been sexually active with one female partner for 5
years. She has not been treated with antibiotics over the past 2 years. Her
last Pap smear was 6 years ago when she was sexually active with a male
partner. She has not used illicit drugs or alcohol. Examination shows a
grayish vaginal discharge with a pH greater than 4.5. A wet mount
preparation of the vaginal discharge is most likely to show which of the
following?
A
) Budding yeast
B
) Clue cells
C
) Ferning
D
) Leukocytes in sheets
E
) Trichomonas vaginalis
B 和 E之间犹豫不决。B是最常见的？所以选B？ |
o********r
发帖数: 193 | 3 The BP was fine during the surgery.
【在 h****8 的大作中提到】
: 做nbme有些题目的答案感觉都有说的过去的地方。请版上xdjm帮忙掌掌眼。
: 33. Four hours after undergoing a cesarean delivery at term followed by
: tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and
: confusion. The operation was uncomplicated, and blood loss is estimated to
: be 800 mL. Patient-controlled epidural analgesia has been moderately
: effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from
: 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min
: intraoperatively. Breath sounds are decreased bilaterally. No murmurs are
: heard. Abdominal examination shows distention and tenderness. Bowel sounds
: are absent. The incision is intact with no drainage. She is disoriented to
|
e*******a
发帖数: 246 | |
o********r
发帖数: 193 | 5 No genital inflammation when examed. also no itches or pain. it seems Clue
Cells to me.
discharge
Her
【在 h****8 的大作中提到】
: 38. A 32-year-old woman comes to the physician because of vaginal discharge
: for 2 weeks. She has been sexually active with one female partner for 5
: years. She has not been treated with antibiotics over the past 2 years. Her
: last Pap smear was 6 years ago when she was sexually active with a male
: partner. She has not used illicit drugs or alcohol. Examination shows a
: grayish vaginal discharge with a pH greater than 4.5. A wet mount
: preparation of the vaginal discharge is most likely to show which of the
: following?
: A
: ) Budding yeast
|
h****8
发帖数: 278 | 6 A 19-year-old man comes to the physician because of frequent nosebleeds over
the past 3 weeks. He has bipolar disorder currently well controlled with
lithium carbonate, bupropion, and valproic acid. Physical examination shows
no abnormalities except for dried blood in the nares. Mental status
examination shows an anxious mood and slight motor restlessness. Serum
studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–
1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100).
Which of the following is the most appropriate next step in management?
A
) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B
) Measurement of serum bupropion level
C
) Platelet count
D
) Discontinuation of lithium carbonate therapy
E
) Discontinuation of valproic acid therapy |
h****8
发帖数: 278 | 7 A 57-year-old man is brought to the emergency department 30 minutes after he
was found on the floor of his house; he has left hip pain and shortness of
breath. He has renal failure but has missed his last two dialysis treatments
. His renal failure was caused by inadvertent ingestion of ethylene glycol.
His renal function did not improve, and he is currently on the
transplantation list. Medications include amlodipine and doxazosin. On
arrival, his temperature is 37.5 C (99.5 F), blood pressure is 150/100 mm Hg
, pulse is 95/min and regular, and respirations are 24/min. His breathing is
rapid and deep. Crackles are heard in the lung bases. Examination shows a
soft abdomen. Bowel sounds are normal. The left lower extremity is
externally rotated. Laboratory studies show:
Serum
Na+ 135 mEq/L
Cl– 102 mEq/L
K+ 7.1 mEq/L
HCO3– 12 mEq/L
Arterial blood gas analysis on 4 L/min of oxygen by nasal cannula:
pH 7.22
PCO2 31 mm Hg
PO2 61 mm Hg
An ECG shows peaked T-waves. It will be at least 45 minutes before dialysis
can be started. Which of the following is the most appropriate next step in
management?
A
) Observation until dialysis is initiated
B
) Intravenous calcium gluconate
C
) Intravenous glucose and insulin
D
) Intravenous 0.9% saline
E
) Intravenous sodium bicarbonate
F
) Rectal sodium polystyrene sulfonate (Kayexalate)
when is glucose + insulin a better choice? when should we use calcium
gluconate? |
e*******a
发帖数: 246 | 8 I would pick up discontinuation of valproic acid. Lithium does exceed the
therapeutic level by a little bit, but it usually does not cause coagulation
issue. However, valproate does......
over
shows
【在 h****8 的大作中提到】
: A 19-year-old man comes to the physician because of frequent nosebleeds over
: the past 3 weeks. He has bipolar disorder currently well controlled with
: lithium carbonate, bupropion, and valproic acid. Physical examination shows
: no abnormalities except for dried blood in the nares. Mental status
: examination shows an anxious mood and slight motor restlessness. Serum
: studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–
: 1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100).
: Which of the following is the most appropriate next step in management?
: A
: ) Measurement of serum aspartate aminotransferase (AST, GOT) activity
|
h****8
发帖数: 278 | 9 since the patient is not in acute distress, is platelet count a better
solution for now?
coagulation
【在 e*******a 的大作中提到】
: I would pick up discontinuation of valproic acid. Lithium does exceed the
: therapeutic level by a little bit, but it usually does not cause coagulation
: issue. However, valproate does......
:
: over
: shows
|
e*******a
发帖数: 246 | 10 this is hyperkalemia (potentially fatal) and needs to be treated immediately
! I would use intravenous calcium glucoate to protect the heart and avoid
fatal cardiac arrhythmia! This is the 1st step and then use glucose+insulin
to lower K level......
he
of
treatments
.
Hg
is
【在 h****8 的大作中提到】
: A 57-year-old man is brought to the emergency department 30 minutes after he
: was found on the floor of his house; he has left hip pain and shortness of
: breath. He has renal failure but has missed his last two dialysis treatments
: . His renal failure was caused by inadvertent ingestion of ethylene glycol.
: His renal function did not improve, and he is currently on the
: transplantation list. Medications include amlodipine and doxazosin. On
: arrival, his temperature is 37.5 C (99.5 F), blood pressure is 150/100 mm Hg
: , pulse is 95/min and regular, and respirations are 24/min. His breathing is
: rapid and deep. Crackles are heard in the lung bases. Examination shows a
: soft abdomen. Bowel sounds are normal. The left lower extremity is
|
|
|
e*******a
发帖数: 246 | 11 the patient already has symptoms.... I would first discontinue any
suspicious drugs first :) of course, that's only my thinking and it could
be wrong....
【在 h****8 的大作中提到】
: since the patient is not in acute distress, is platelet count a better
: solution for now?
:
: coagulation
|
h****8
发帖数: 278 | 12 For 8 weeks, a 52-year-old man with a 5-year history of type 2 diabetes
mellitus has had deep burning pain in the ball of his right foot and big toe
when the foot is raised above chest level. He also has cramping in his
right calf when he walks more than 50 feet. He has smoked two packs of
cigarettes daily for 30 years. Femoral pulses are palpable; pedal pulses are
absent. Which of the following is the most likely diagnosis?
A
) Aortoiliac stenosis
B
) Femoral popliteal stenosis
C
) Mononeuropathy
D
) Vasculitis
E
) Venous stasis
struggle between B & D |
h****8
发帖数: 278 | 13 I agree with this one.
【在 o********r 的大作中提到】
: No genital inflammation when examed. also no itches or pain. it seems Clue
: Cells to me.
:
: discharge
: Her
|
h****8
发帖数: 278 | 14 ya. Probably should also consider the abd distention and tenderness.
【在 o********r 的大作中提到】
: The BP was fine during the surgery.
|
e*******a
发帖数: 246 | 15 D
toe
are
【在 h****8 的大作中提到】
: For 8 weeks, a 52-year-old man with a 5-year history of type 2 diabetes
: mellitus has had deep burning pain in the ball of his right foot and big toe
: when the foot is raised above chest level. He also has cramping in his
: right calf when he walks more than 50 feet. He has smoked two packs of
: cigarettes daily for 30 years. Femoral pulses are palpable; pedal pulses are
: absent. Which of the following is the most likely diagnosis?
: A
: ) Aortoiliac stenosis
: B
: ) Femoral popliteal stenosis
|
b****k
发帖数: 409 | 16 你看这句话就能排除E了，Her blood pressure now is 80/40 mm Hg, decreased from
120/72 mm Hg intraoperatively。说明intraoperation is uncomplicated.
【在 h****8 的大作中提到】
: 做nbme有些题目的答案感觉都有说的过去的地方。请版上xdjm帮忙掌掌眼。
: 33. Four hours after undergoing a cesarean delivery at term followed by
: tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and
: confusion. The operation was uncomplicated, and blood loss is estimated to
: be 800 mL. Patient-controlled epidural analgesia has been moderately
: effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from
: 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min
: intraoperatively. Breath sounds are decreased bilaterally. No murmurs are
: heard. Abdominal examination shows distention and tenderness. Bowel sounds
: are absent. The incision is intact with no drainage. She is disoriented to
|
b****k
发帖数: 409 | 17 See the color of discharge, it's grey. So it's more likely bacterial
vaginosis.Lack of vulvar lesion and sypmtom is another evidence.
【在 o********r 的大作中提到】
: No genital inflammation when examed. also no itches or pain. it seems Clue
: Cells to me.
:
: discharge
: Her
|
b****k
发帖数: 409 | 18 C. Bleeding problem first check CBC. Then coagulation study.
over
shows
【在 h****8 的大作中提到】
: A 19-year-old man comes to the physician because of frequent nosebleeds over
: the past 3 weeks. He has bipolar disorder currently well controlled with
: lithium carbonate, bupropion, and valproic acid. Physical examination shows
: no abnormalities except for dried blood in the nares. Mental status
: examination shows an anxious mood and slight motor restlessness. Serum
: studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–
: 1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100).
: Which of the following is the most appropriate next step in management?
: A
: ) Measurement of serum aspartate aminotransferase (AST, GOT) activity
|
h****8
发帖数: 278 | 19 35. A 62-year-old woman comes to the physician because of bloating and
cramping abdominal pain and intermittent diarrhea over the past 5 years. Her
symptoms have increased over the past month since she started a new diet
that emphasizes yogurt and cottage cheese as low-fat sources of calcium and
protein. Vital signs are within normal limits. Abdominal examination shows
diffuse tenderness to palpation with no rebound tenderness; there are no
masses or organomegaly. Bowel sounds are increased. Test of the stool for
occult blood is negative. Which of the following is the best explanation for
this patient's diarrhea?
A
) Impaired intestinal motility
B
) Inflammatory process
C
) Malabsorption
D
) Secretory process |
J*********4
发帖数: 1274 | 20 35. C. Increased bowel sound excludes A. Negative FOBT excludes B,
intermittent diarrhea excludes D. It is likely lactose intolerance, C |
h****8
发帖数: 278 | 21 谢谢斑竹。我也选的C。网上很多参考答案写的是A。费解。
【在 J*********4 的大作中提到】
: 35. C. Increased bowel sound excludes A. Negative FOBT excludes B,
: intermittent diarrhea excludes D. It is likely lactose intolerance, C
|
