A 7. 0- year- old woman has had increasing abdominal pain over the past 2 days. She has renal failure and has been receiving peritoneal dialysis for 1. Her temperature is 3. C (1. 02. 2 F), and blood pressure is 1. Hg. Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness. I uncovered a French Document from a renown investigative reporter of France, Thierry Meyssan, who EXPOSED “Operation Odyssey Dawn” as an AFRICOM operation. Friends and I used to. A List of Currently Acceptable Words to Query By: the. Hi goldenhand, do u have step 2 nbme form 1,2,3.i downloaded them the 2nd time from ur current post. The referring site you are going to visit is not controlled by us, so please remember not to enter your private information unless you are sure this is not scam. Leukocyte count is 1. Which of the following is the most appropriate next step? A ) X- ray films of the abdomen. B ) Comparison of abdominal fluid amylase with serum amylase activity. C ) Gram's stain of abdominal fluid. D ) Ultrasonography of the abdomen. E ) CT scan of the abdomen and pelvis. A 5- year- old girl is brought to the physician because of temperatures to 4. C (1. 04 F), tachypnea, and a nonproductive cough for 1. Four days ago she was treated with an oral antibiotic for suspected pneumococcal pneumonia. Examination shows diminished breath sounds over the lower right lung fields and dullness to percussion at the right costophrenic angle. Which of the following is the most likely diagnosis? A ) Bronchopleural fistula. B ) Empyema. C ) Lung abscess. D ) Pleurodynia. E ) Pneumothorax. A 4. 0- year- old man is brought to the emergency department 1 hour after a high- speed motor vehicle collision. On arrival, he is awake and alert but has severe pain over the sternum. His systolic blood pressure is 8. Hg, pulse is 8. 0/min, and respirations are 1. An ECG shows multifocal premature ventricular contractions but no ST- segment changes. After 1 L of lactated Ringer's solution is administered, his PO2 decreases to 6. Hg while breathing 4 L/min of oxygen by nasal cannula. Pulmonary capillary wedge pressure has increased from 1. Hg to 2. 4 mm Hg (N=1. Which of the following is the most likely explanation for the patient's poor response to fluid resuscitation? A ) Inadequate administration of fluids. B ) Myocardial contusion. C ) Myocardial infarction. D ) Pulmonary contusion. E ) Traumatic rupture of the aorta. A 2. 1- year- old African American college student has had increasing fatigue over the past 3 weeks. Since an episode of cystitis treated with trimethoprim- sulfamethoxazole 3 weeks ago, he has been unable to keep up with his physical education classes. For 6 months, he has been following a vegetarian diet that has been supervised by student health services. Examination shows no abnormalities. His hemoglobin level is 1. L, mean corpuscular volume is 8. Which of the following is the most likely cause of anemia in this patient? A ) Anemia secondary to infection. B ) Antibiotic therapy. C ) Gastrointestinal blood loss. D ) Sickle cell disease. E ) Vegetarian diet. An 8. 7- year- old nursing home resident with dementia, Alzheimer's type, is admitted to the hospital because of progressive lethargy and decreased appetite for 3 days. She had a flu- like illness followed by a deep cough 1 week ago. Over the past 1. 0 months, she has been hospitalized once for bacterial pneumonia. She is responsive only to painful stimuli. Her temperature is 3. C (1. 01. 5 F), blood pressure is 1. Hg, pulse is 1. 23/min and regular, and respirations are 2. Examination shows dry mucous membranes. There is no adenopathy. Crackles are heard in the right lung base. An x- ray film of the chest shows an infiltrate at the right lung base. The remainder of the examination shows no abnormalities. Which of the following is the most likely predisposing factor for this patient's pneumonia? A ) Decreased airway elasticity. B ) Decreased baroreflex. C ) Decreased gag reflex. D ) Decreased thyroid function. E ) Diastolic cardiac dysfunction. F ) Impaired cardiac response to exercise. G ) Impaired T- lymphocyte function. H ) Impaired thirst. I ) Increased lung compliance. J ) Renal salt wasting. A 2. 7- year- old woman comes to the physician because of feelings of anxiety about attending her 1. She has a 2- year history of profound anxiety, palpitations, and sweating associated with an uneasiness around people; she avoids family gatherings and visiting friends because she is afraid of being embarrassed. She acknowledges that this fear is unreasonable. She does not use illicit drugs but says that alcohol makes her more comfortable around people. Her blood pressure is 1. Hg, and pulse is 8. On physical examination, she appears healthy and well nourished. Occasional wheezing is heard over the left lung field. The remainder of the examination shows no abnormalities. On mental status examination, she appears worried. Her leukocyte count is 9. Which of the following is the most likely diagnosis? A ) Alcohol abuse. B ) Anxiety disorder due to a general medical condition. C ) Asthma. D ) Generalized anxiety disorder. E ) Panic disorder with agoraphobia. F ) Social phobia. The response options for the next two items are the same. You will be required to select one answer for each item in the set. For each patient with urinary incontinence, select the most likely cause. A ) Detrusor instability. B ) Interstitial cystitis. C ) Overflow incontinence. D ) Stress incontinence. E ) Urethra diverticulum. F ) Urinary fistula. A previously healthy 4. Examination shows a second- degree cystourethrocele. For each patient with urinary incontinence, select the most likely cause. A ) Detrusor instability. B ) Interstitial cystitis. C ) Overflow incontinence. D ) Stress incontinence. E ) Urethra diverticulum. F ) Urinary fistula. One day after an uncomplicated spontaneous vaginal delivery, a 2. She received epidural anesthesia during labor and delivery. Examination shows an episiotomy without evidence of hematoma. She is voiding 5. L of urine at a time. Postvoid residual volume is 3. L. The response options for the next two items are the same. You will be required to select one answer for each item in the set. For each patient with cognitive impairment, select the most likely diagnosis. A ) Acute stress disorder. B ) Dementia, Alzheimer's type. C ) Dissociative amnesia. D ) General paresis. E ) Head trauma. F ) Hepatolenticular degeneration (Wilson's disease)G ) HIV encephalitis. H ) Huntington's disease. I ) Major depressive disorder. J ) Multi- infarct (vascular) dementia. K ) Niacin deficiency. L ) Normal- pressure hydrocephalus. M ) Parkinson's disease. N ) Pick's disease. O ) Schizophrenia, catatonic type. P ) Normal aging. An 8. 2- year- old woman is brought to the physician by her granddaughter because of a 6- week history of increasing forgetfulness. She is a retired schoolteacher and lives independently. Her granddaughter is concerned because on several occasions she has left the stove on when she went to bed. During conversations with her granddaughter, she has difficulty remembering past events and seems unconcerned about her memory lapses. The patient describes trouble sleeping through the night and has had a decreased appetite resulting in a 4. She has a history of similar symptoms 2 and 5 years ago that were successfully treated with medication. She appears unkempt and has poor personal hygiene. Her temperature is 3. C (9. 8. 6 F), blood pressure is 1. Hg, and pulse is 8. Mental status examination shows psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence. She is unable to recall the names of recent presidents. Her serum urea nitrogen (BUN) level is 2. L, and serum creatinine level is 1. L. For each patient with cognitive impairment, select the most likely diagnosis. A ) Acute stress disorder. B ) Dementia, Alzheimer's type. C ) Dissociative amnesia. D ) General paresis. E ) Head trauma. F ) Hepatolenticular degeneration (Wilson's disease)G ) HIV encephalitis. H ) Huntington's disease. I ) Major depressive disorder. J ) Multi- infarct (vascular) dementia. K ) Niacin deficiency. L ) Normal- pressure hydrocephalus. M ) Parkinson's disease. N ) Pick's disease. O ) Schizophrenia, catatonic type. P ) Normal aging. A 4. 2- year- old computer science professor is brought to the physician by her husband, who reports insidious changes in his wife's personality and behavior. He reports that she believes that aliens have been speaking to her and tampering with their heating and air- conditioning systems. He says that she was upset when she turned 4. She was adopted, and her family history is unknown. Physical examination shows vermicular movements of the tongue and bilateral writhing motions of the upper extremities. Mental status examination shows indifference to her condition and mild to moderate difficulty with memory and calculations. A 5- month- old boy is brought for a follow- up examination. He was born at 3. His diet consists of 3. He appears well nourished and happy. On examination, there is moderate relief of wheezing with extension of the neck. Which of the following is the most likely mechanism of this infant's wheezing? A ) Allergic reaction to cow's milk. B ) Aspiration of a foreign body. C ) Compression of the airway by a vascular ring. D ) Concurrent upper respiratory tract infection. E ) Persistent immaturity of lungs. An 1. 8- month- old boy is brought to the emergency department because he has not used his left arm since he fell while walking and holding hands with his 8- year- old sister 2 hours ago. On examination, he holds his left upper extremity at his side with his forearm pronated. There is no tenderness of the left lower extremity, but there is restricted movement of the elbow. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate initial step in management? A ) Passive hypersupination of the forearm. B ) Application of figure- of- 8 strap. C ) Administration of analgesics and application of ice. D ) Aspiration of the elbow joint. E ) In- place splint immobilization of the elbow. A 6- month- old girl is brought to the physician for a routine health maintenance examination. She was born with a lumbosacral myelomeningocele which was successfully repaired at 2 days of age. The anterior fontanelle is 6 x 8 cm and bulging, and the posterior fontanelle is 3 x 4 cm and bulging. She has severe motor and sensory deficits involving both lower extremities.
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