Page 1 of 1: Some Questions for CK- Please give your comments.

paxyl171 · Credits: 2274 My Scrapbook

1) A 52-year-old, obese African American woman is admitted to the hospital for an elective gastric bypass operation for weight reduction. On post-op day 1, the patient acutely develops tachypnea, tachycardia, and an oxygen requirement of 4 L. She complains of left-sided pleuritic chest pain. Which of the following is the most appropriate diagnostic study?
A. Chest x-ray
B. CT scan
C. ECG with rhythm strip
D. MRI
E. Ventilation-perfusion scan
Ans : V/Q scan for PE.
Is PE possible on the 1st PO day???

2) A hospitalist on duty for the weekend is called to consult on a case involving a 53-year-old woman in the medical intensive care unit. The patient has been hospitalized for 5 weeks. Her initial injury was a massive subarachnoid bleed complicated by an ischemic infarct of her brain 3 days later. Since that time, she has been persistently vegetative. She requires mechanical ventilation and external feeding to maintain her vital functions. It is discovered that, during a previous admission to the hospital, the patient clearly stated that she would want to be maintained on life support only if she were likely to regain a meaningful quality of life. The medical team believes that she does not have a significant chance of regaining an acceptable level of function. The children maintain that the situation is reversible and want to continue care, whereas the husband wants to withdraw care in fulfillment of his wife's wishes. Which of the following is the most appropriate next step?
A. Arrange a family meeting, hoping to resolve the patient's previously expressed wishes with those of the children and husband
B. Begin the withdrawal of care, despite the reservations of the children, after discussion with the hospital lawyer
C. Consult a psychiatrist to speak to the children
D. Notify the department of social services for the question of elder abuse
E. Refer the case to the ethics committee for review
Explanation:
The correct answer is
A. Although it is clear that the physician is ethically bound to follow the patient's wishes, which in this case appears to be the withdrawal of care, it is always better to do so with the resolve of the family. Oftentimes, feelings such as guilt will drive family members to insist on seemingly unreasonable or inappropriate action. A thoughtful discussion, whereby the family members are allowed to express their reservations in a supportive setting, often will produce a resolution among previous disparate views.
Why the need of meeting with the family? Patient has shown his desires..

3) A 64-year-old man presents to the physican's office complaining of fevers for the past 2 days. Over the past 24 hours, he has developed a productive cough. He also reports that he has frequent chills, and has been waking for the past 2 nights with drenching sweats. His past medical history is remarkable only for mild exertional angina. On physical examination, he does not appear chronically ill but appears moderately dyspneic. His temperature is 38.6 C (101.4 F), blood pressure is 136/94 mm Hg, and respirations are 26/min. There is no jugular venous distention. The lungs have coarse rhonchi at the right lung base with increased fremitus in the same area. He has a regular heart rhythm, with a 1/6 systolic murmur at the left sternal border. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in diagnosis?
A. Chest x-ray film
B. Sputum Gram's stain
C. Chest CT scan
D. Pulmonary function test
E. Peak expiratory flow rate measurement
I am posting these not because i don't know the answer. I am confused with answer given by them- the makers of this question.. See the next question.

4) A 59-year-old man presents to his primary care physician with fever and chills. His past medical history is significant for osteoarthritis for many years. He has a long smoking history of greater than 150 pack-years. He routinely takes only a non-steroidal anti-inflammatory agent for pain. He presents with 5 days of fever and chills associated with a productive cough. He has not been hospitalized recently and lives at home with his wife and has no sick contacts. On physical examination he is comfortable, his temperature is 38.9 C (102 F) and has bibasilar crackles heard best at the left base. Which of the following is the most appropriate next step in diagnosis?
A. Arterial blood gas
B. Chest radiograph
C. Complete blood count
D. Oxygen saturation check
E. Sputum gram stain
!!! - Almost same kind of question as one above. and here the answer is CXR. I was right here. For the above question also I put CXR but I was wrong because they said B is better answer there. and gave a reason saying we do Sputum first and then CXR. Can anybody put some light on it.. please

Q. What is the most appropriate Treatment for Grave's disease?
1. propilthiouracil
2. methimazole
3. radioactive Iodide
4. surgery

Ans. radioactive iodide acc. to some Qbank.. Please give some explanation if anybody can. I thought Propilthiouracil is good with lesser side effects.

Q. Most common location of SYMPTOMATIC Carcinoid syndrome.
1. Small Bowel
2. Appendix
3. Lung
4. Rectum
5. Duodenum
PLEASE help here.

here is the most interesting question. u cannot imagine the answer. I don't how these question maker think. but this guy seems to be the best IMAGINATOR..
Q. 24 yrs female patient has hypotension and rash during an OT for hernia. 2 weeks ago she had similar complains while having Sexual intercourse with a new partner. Her past history is not remarkable except for similar syptoms during her pelvic examination before PAP smear.. what is the most likely cause??
1. Acute blood loss
2. coagulation Pathology
3. septic shock
4. allergic reaction
5. cardiac tampones
6. pneumothorax
Guys use ur imagination... i liked this question. actually its easy. but just can't imagine till what depth these guys go to prepare questions..

paxyl171 · Credits: 2274 My Scrapbook

Q. What is the cause of Vit B12 def in a 29 year old female from India? History is unremarkable for any other signs.

Ans: Veg Diet or Pernicious Anemia??

kuuul · Credits: 651 My Scrapbook

small bowel for symptomatic carcinoid

kuuul · Credits: 651 My Scrapbook

allergic reaction for last

paxyl171 · Credits: 2274 My Scrapbook

hi kuul,
hey can u tell me what does a score of 71% on USMLE world mean for USMLE . I m confused.
thanks for the answers u r right about the allergic one. I was just showing the extent to which they think. abot rubber usage...haha
anyways please tell me about USMLE world score.
thanks.
bye

kuuul · Credits: 651 My Scrapbook

ya its good one u will do best almost 99
if u r better on d day of exam?

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