Medical Case Studies and Corresponding Treatments, Exercises of Nursing

Download Medical Case Studies and Corresponding Treatments and more Exercises Nursing in PDF only on Docsity! NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ 62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due to which of the following? Correct Ans - Decreased Osteoclast Activity Cohot Study of elderly women - relative risk ratio for hip fractures among those who exercise regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the following is the conclusion about the effect of exercise on the risk of hip fracture? Correct Ans - Statistically Significant Overall Increase Risk 52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse is 80/min and blood pressure is 130/70. The most immediate treatment mechanism of action? Correct Ans - Increased nitric oxide concentration 24 year old woman - spilled hot grease on her left leg while working at a fast-food restaurant. Exam of leg shows 7cm pink, soft, granular, edematous wound. The formation of this tissue was most likely caused by increased activity of which? Correct Ans - a. Vascular Endothelial Growth Factor VEGF - stimulates angiogenesiss. NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ TYPE III Collagen = Blood Vessels - early wound repair 27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture - increased serum osm and decreased urin osm. Following desmopressin urine osm increases. Desmopressin's effect is due to the activation of which of the following? Correct Ans - a. Adenylyl Cyclase Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- Ca v2 A 10 month old boy - 4 day history of fever and cough. He attends day care center. Chest exam shows intercostal retractions along with bilateral, diffuse wheezes and expiratory rhonchi. The infectious agent most likely has which of the following properties? Correct Ans - Mediation of Cell Entry via a fusion protein A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but no difficulty swallowing- Bilateral wheezing - Which is most appropriate pharmacotherapy for this patient? Correct Ans - B2- Agonist 14 year old boy - 2 day history of sore throat and fever that peaks in NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ by androgens b. ACNE = Propionibacterium ACNE 4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with diffuse regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts Lymphoma/ Starry night) - which of the processes most likely to occur in the region indicated by the arrow? Correct Ans - Apoptosis b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion, puffy face). 51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass on apex of tongue. It is most appropriate to evaluate which lymph nodes first for evidence of metastasis? Correct Ans - Submental 15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache, stif f neck, and vomiting - since returned from summer camp - patient is hallucinating - lumbar puncture - shows cysts and trophozoites- most likely pathogen? Correct Ans - a. Olfactory Nerve NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ Naegleria fowleri Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500 patients receive new drug and 2500 patients receive placebo. If alpha is set at 0.01 instead of 0.05, which of the following is most likely result? Correct Ans - Significant findings can be reported with greater confidence A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral opening. Which is most likely finding? Correct Ans - Pulmonary Hypoplasia A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery - Physical exam shows jaundice and hepatomegaly. The concentration of which of the following metabolites is most likely increased?Correct Ans - a. Galactose - 1 - phosphate b. Congenital intolerance to breast milk NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of his neck, underarms, and groin after camping in New Mexico Generalized scattered black maculae. Examination of the right upper extremity shows erythematous, solid, tender mass. Mass is draining blood and necrotic material. The most effective antibiotic for patient disorder will interfere with which of the following processes? Correct Ans - a. Ribosomal Assembly b. Yersenia Pestis 45 year old - progressive weakness - muscle fasciculations of the upper extremities and weakness of the lower extremity - What additional findings? Correct Ans - Atrophy b. ALS = Lou Gherig A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? Correct Ans - Avoids Concerns of reversion to virulence b. Killed vaccines - avoids reversion to virulence c. live vaccines - can (but rarely do) cause the disease they're designed to prevent A 33 year old - keratinizing squamous cell carcinoma of cervix. Which of NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ 54- year-old man - intense overwhelming fear. Which portion of brain stimulated? Correct Ans - Amygdala b. Fear = amygdala 30 year old woman - recurrent URI - Sweat is Salty- Genetic testing for 36 most common mutations shows detectable G551D in one allele of CFTR - What is patients clinical phenotype? Correct Ans - The Second CFTR Gene was not detected by the testing obtained 74 year old - COPD - "I enjoy coming to see you because you remind me of my daughter. She died 35 years ago". Which is most appropriate response by physician? Correct Ans - You must miss your daughter very much. Tell me about her. b. PT = Transference 9 month old boy - awakens and cries at least once nightly and settles back to sleep after drinking a bottle of formula - Explanation for patient's sleep pattern? Correct Ans - Normal Development Pubertal gynecomastia in males is norma NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ A 32 year old - abnormal movement in hands and worse when he feels angry - Unable to fix his gaze on one point or protrude his tongue for more than 30 sec - Pt most likely has anatomic abnormalities in which of the following locations? Correct Ans - Basal Ganglia A 14-year-old boy - recurrent otitis media since infancy - underwent tonsillectomy for obstructive sleep apnea - Cardiac auscultation exam listen - shows S3 - which is most likely finding? Correct Ans - Normal Findings b. normal physiologic splitting 12-year-old - 2 month history of headaches - 6 day history of nausea and vomiting - bilateral papilledema - broad based gait An MRI - shows tumor in pineal region. Pt most likely oculuomotor impairment? Correct Ans - Upward Gaze Parinaud Syndrome due to compression of tectum- vertical gaze palsy occurs with pineolmas 52 year old man - 1 day history of nausea, vomiting, and right sided abdominal pain - radiates to his back - CT scan - shows enlarged right NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ kidney and wedge shaped areas of hypodensity - no nephrolithiasis - strongest predisposing factor? Correct Ans - Atrial Fibrillation Wedge Shaped renal infarct Correct Ans - coagulative necrosis 24 year old - rash from hot tub- the infectious agent causing these findings most likely began to proliferate in which of the following locations? Correct Ans - Hair Follicle b. Hot Tub Folliculitis = Pseudomonas 45-year-old - picture of H. Pylori - epigastric heartburn and weight loss - Which process likely involved? Correct Ans - Elaboration of proteases and urease with local support tissue A 14-year-old - hit with baseball bat - unable to dorsiflex his foot. Which of the following nerves is most likely injured? Correct Ans - Common Fibular Nerve (peroneal nerve) 26 year old woman - brought to ED - 8 hour history - severe back and abdominal pain - persistent vaginal bleeding - Ultrasonography shows 2 NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ protruded - proprioception and sensation to light touch are absent over the left upper and lower extremity - Which site in brain stem is damaged Correct Ans - =Area Labeled C 68 year old woman - end stage renal disease - initially she did well - within 3 months she has been admitted for fluid overload - poor adherence to fluid and salt restrictions - Which is most appropriate initial response? Correct Ans - It is tough to change your diet and fluid intake, but what sorts of things were you doing first when you were following recommendations 17 year old girl - physical exam shows normal female body habitus - normal breast development - refuses to have a pelvic or rectal examination.- no axillary or pubic hair - most likely clinical presentation? Correct Ans - Androgen Insensitivity 16 year old boy - 3 day abdominal pain and vomiting - CT scan shows perforated appendix - Exam of peritoneal fluid shows which organism? Correct Ans - Escherichia Coli NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ 45 year old woman 6 month history of hot flashes, night sweats, and insomnia- Physician informed consent on new treatment - most appropriate next step? Correct Ans - Could you tell me the results of the hormone treatment options we have discussed? A randomized control trial - assess risk of GI adverse risk using azithromycin compared to erythromycin in the pertussis - 100 children with pertussis enrolled - 50 azithromycin and 50 erythromycin - vomiting among 5 pts in azithromycin group and 15 patients in erythromycin group - Which represents absolute risk reduction? Correct Ans - a. 0.2 . 15/50 - 5/50 = .2 34 - year -old woman with a 10 year history of Hep C - progressive fatigue - vitals normal. - liver biopsy shows hepatocellular injury - infiltration and early fibrosis - which mechanism is most likely to A 50 year old - high blood pressure - If left untreated, which of the following is most likely to decrease in this patient? Correct Ans - NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ Baroreceptor Firing A 62-year-old with interstitial pneumonitis - compared with a healthy man, analysis of this patients biopsy is most likely to show the following patterns in the cell population (Type 1, Type II, and Fibroblast)? Correct Ans - Type I pneumocytes decreased Type II pneumocytes increased Fibroblasts increased 31 year old - with T2DM - comes to physician because of an oozing, foul smelling wound - patient has crepitant bullae - Gram Statin shows gram-positive rods - The causal organism has which of the following virulence factors? Correct Ans - A -toxin 4 month year old with SCID received a bone marrow transplant. - six days later - he develops a widespread, erythematous, maculopapular rash - Exam of skin shows diffuse degeneration of basal epidermal cells with mononuclear inflammatory cell infiltrate- Which is cause of rash? Correct Ans - Graft vs Host Disease 37 year old woman - right lower extremity edema - sudden SOB+, If NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ A 36 year old man - fluid is presenting adbomen in which of the following areas as indicated by the arrow? Correct Ans - Omental Bursa (lesser sac) What is the positive predictive value (refer to chart)? Correct Ans - .67 Probability that a patient with a positive test has a disease A/(A+B) A 75 year old woman with T2DM and HTN - Emigrated from Argentina - Which of the following is the most appropriate person to serve as an interpreter for this patient encounter? Correct Ans - Telephone Interpreter During a study of renal glomeruli - if efferent arteriole is constricted - which starling forces are likely to change in the glomeruli? Correct Ans - Increased Hydrostatic Pressure 2 year old with neurocognitive dysfunction - fine during birth - both parents have learning disabilities - maternal uncle with cognitive disabilities - Irritable making eye contact with flapping his hands? NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ Correct Ans - Trinucleotide Repeat Expansion b. Fragile X - intellectual disability - trinucleotide repeat in FMR1 gene A 33 year old man - undergoes radical thyroidectomy - postop serum calcium is 7.5 and albumin concentration of 4g/dl - PTH concentration of 200 - damage to which vessel causes finding? Correct Ans - Branch of Thyrocervical Trunk b. inferior thyroid arteries, which arise from the thyrocervical trunk. c. External carotid - superior thyroid 46 year old woman - 2 month history of fatigue and muscle weakness - 10 year history of hypertension - treated with thiazide diurectics - measured hypokalemia, hypotension and decreased BP- brisk reflexes. Likely cause? Correct Ans - Adverse Drug Effect b. Treated with a thiazide diuretic for HTN with measured hypokalemia, hypotension and decreased Hg Splitting b. Cluster B - borderline personality (BANH) NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ A Study designed to evaluate the feasibility of acupuncture in children with chronic headache - 60 children recruited - In addition to their usual therapy - all children are treated with acupuncture three times per week for 2 months - Describe findings? Correct Ans - Case-Series 2 year old boy - severe pain, swelling, and redness of his left thumb (image). PE shows oral vesicle, cervical lymphadenopathy - infectious agent causing findings in thumb? Correct Ans - DNA Virus Herpetic Whitlow Herpetic Whitlow Correct Ans - vesicles on fingers 7 year old - lives in Kentucky - 2 week history of cramping abdominal pain and diarrhea - mother looked in underpants and saw earthworm - no travel history- Transmission via? Correct Ans - Ingestion of Soil b. Ascaris - fecal oral transmission 23 year old man with multiple sex partners - dysuria and yellow NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ An 18 year old woman - fever, dizziness, weakness, and vomiting (toxic shock) - using synthethic pads and tampons - Physical exam shows injected conjunctiva and rash- Pts use of which increased risk? Correct Ans - Tampons A 53 year old man - - 6 month history of blood in stool - 1 cm anal mass - If mass is malignant, evaluate which lymph nodes? Correct Ans - Superficial Inguinal 1 cm mass below dentate line 24 year old - brought to ED - MVC - face struck steering wheel - facial pain and double vision - Exam of left eye shows infraorbital edema - ocular movement restricted vertically - CT scan shown. Which of the following impaired on left side? Correct Ans - Sensation over the upper lip V2 = maxillary nerve 23 year old - collapsed at finish line - no loss of consciousness Associated with prolonged use of vaginal tampons or nasal packing NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ Correct Ans - Orthostatic Hypotension .decrease in systolic blood pressure of 20 mm Hg (110-85) e. decrease in diastolic blood pressure of 10 mm Hg. (70-50) 27 year old - ER - pain in navel - nausea and one episode of vomiting 1 hour ago - underwent appendectomy 2 years ago- CT scan of abdomen shows fat stranding in small bowel with areas of inflammation in terminal illeum - 2 cm bulge on antimesenteric border of the inflamed segment. Histological specimen - most likely to show which of the following? Correct Ans - Gastric Mucosa b. Crohns with the multiple episodes over the last year, fat stranding, terminal ileum involvement 14 year old girl -parents divorced - starts acting sullen, defiant, and truant at school, sexual intercourse with new partners and no condoms, previously honor studenty- which defense mechanisms? Correct Ans - Acting Out 38 year old - pregnant woman - ultrasound shows oligohydramnios and a full term fetus with a large kidney and empty right renal fossa. Need NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ history on maternal use of which during pregnancy? Correct Ans - ACE Inhibitors A 65 year old - bilateral wheezing - accumulation of which of the following? Correct Ans - Leukotrienes 19 year old - with asthma - comes to ER multiple times for acute asthma exacerbations - "All doctors don'g understand me" - they keep prescribing steroid inhalers. What is the most appropriate statement by the physician? Correct Ans - Tell me more about what you know about steroid inhalers and how are they supposed to work? A healthy 22 year old man - in study for glucose metabolism - He consumes an 800 calories meal consisting - 12 hours later serum glucose is within reference range - Which is involved in maintaining serum glucose? Correct Ans - Glycogenolysis of Liver 30 year old man - 6 week history of colicky abdominal pain and diarrhea with occasional blood - on autopsy - small bowel is seen in the wall of a thickend loop of small intestine - Photomicrographs NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ 52-year-old - newly diagnosed with Type 2 diabetes mellitus. Four weeks later, her hepatic glucose out is decreased and target tissue glucose uptake are increased. Which agent? Correct Ans - Metformin An asymptomatic 44-year-old man - with HIV infection during routine screening to donating blood. A complete blood count- platelets are low - which of the following finds are most likely? Correct Ans - Petechiae Platelet problem Correct Ans - epistaxis, ecchymoses, petechia, bleeding from superficial scratches Coagulation problem Correct Ans - late re-bleed, Menorrhagia, GI bleeds, hemarthroses 23 year old - bone marrow failure - given a large dose of rabbit antimyocyte globulin - 10 days later - develops fever, lymphadenopathy, arthralgias, and erythema on her hands and feet. Which is the most likely cause of these symptoms? Correct Ans - Immune complex deposition in tissues NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ b. Serum sickness - TYPE 3 hypersensitivity 42 year old - gunshot wound - 36 hours post-operatively she is receiving morphine. she needs morphine - she has expressed concern she is becoming addicted. Which of the following initial actions by the physician is most appropriate? Correct Ans - Reassure the patient has a miniscule chance of becoming addicted to narcotics A 22 y/o woman -- itchy, red rash on her arm - new hair dye - picture (contact dermatitis) - Which ligand pairs play a role in the proliferation of the T Lymphocytes Correct Ans - CD28 on T Lymphocytes and CD80 on epidermal Langerhans cells 6 healthy subjects in a study of muscle metabolism - Increased malonyl- CoA directly inhibits which of the following processes in these subjects Correct Ans - Fatty Acid Oxidation b. Malonyl-CoA inhibits the rate limiting step in beta-oxidation of fatty acid. Over 1 year - study is conducted to assess the antileukemic activity of a new tyrosine kinase inhibitorwith CML in blast crisis - All patients in the NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+ study had SML and are informed that they would be treated with tyrosinase inhibitor. What type of study design? Correct Ans - Open Label Clinical Trial A 63 year old man - 4 day history of increasingly severe left leg pain and swelling on his left calf - CT scan shows no abnormalities - A CT scan of the abdomen shows a 3 cm mass in the body of pancreas - Ultrasound shows a femoropopliteal venous clot - Which of the following is the most likely cause? Correct Ans - Hypercoagulability of advanced malignancy A 40 year - comes to physician because of 6-month history of facial hair growth - temporal balding and coarse hair on the upper lip chin - ultrasound shows a 12 cm ovarian mass - Describe mass? Correct Ans - Sertoli - Leydig Cell Tumor 35 year old man - pain and swelling in right arm when scraped a tree branch - Temp 101F- Examination of the right arm shows edema around a lesion - primary mechanism of edema? Correct Ans - Separation of endothelial Junction NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) Latest 2023/2024 Graded A+