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s**********1
发帖数: 68 | 1 I'm a little confused with the following question. Different forums have
different answers. Anybo
the following vignette applies to the next 2 items.
You have been treating a 5-month-old child in the neonatal intensive care
unit (NICU). He was delivered at 26 weeks' gestation by cesarean delivery
because of premature rupture of membranes. The mother is 18 years old and is
unemployed. There are two other children in the home. The father is not
living with them, and he has not been in contact with the mother. The mother
rarely visits the NICU. The infant had severe respiratory distress syndrome
at birth and required dopamine for blood pressure support. His condition
progressed to pulmonary interstitial emphysema and bronchopulmonary
dysplasia by 4 weeks of age. At 4 months of age he required a tracheostomy
and medication for control of his blood pressure. Now, at 5 months of age,
the boy has a cardiac arrest requiring resuscitation and placement of chest
tubes. He then develops seizures that are eventually controlled with
medication. The neonatologist feels that the child will always require life
support. The mother refuses to discuss the possibility of withdrawing life
support. Her insurance is Medicaid. The hospital bill for this child is now
$350,000.
Item 1 of 2
12. To guide further treatment at this time, it is most important to assess
which of the following?
A) The extent of neurologic injury
B) The financial impact on the family
C) The mother's level of understanding of the child's prognosis
D) Whether another family member is better suited to make decisions about
the patient's care
E) Your state's law regarding futile care
(A or C?)
Item 2 of 2
13. One week later the mother and the attending physician are unable to
reach an agreement on the management plan. Which of the following is the
most appropriate next step?
A) Ask the court to appoint a guardian
B) Defer major decisions until the father can be located
C) Have the social worker contact Medicaid regarding further coverage
D) Involve the hospital bioethics committee
E) Maintain the patient on a respirator but transfer him out of the NICU
(C or D?)
34. A 10-year-old Asian-American boy is brought to the office for a sports physical examination. He has been healthy except for a few episodes of otitis media as an infant. He has had no shortness of breath, syncope or chest pain in the past. Growth has been normal. Vital signs are: temperature 36.6°C (97.8°F), pulse 80/min, respirations 16/min, and blood pressure 110/76 mm Hg. Cardiac examination discloses an early systolic click at the apex, a midsystolic ejection murmur at the right upper sternal border and a thrill in the suprasternal notch. The remainder of the physical examination is normal. The patient is referred to the cardiologist and the diagnosis of aortic stenosis is confirmed by echocardiogram. Close follow-up and graded exercise testing are recommended. The patient is at increased risk for which of the following?
A) Atrial arrhythmias
B) Complete heart block
C) Coronary artery disease
D) Pulmonary hypertension
E) Sudden death
(E?)
A 28-year-old man who lives in a small rural township is admitted to the hospital because of gastrointestinal bleeding. On admission the patient is pale and has orthostatic hypotension. Hemoglobin concentration is 8 g/dL. His condition is stabilized. Emergent upper endoscopy shows a visible gastric vessel, which is treated appropriately.
Item 1 of 2
17. Specific additional history should be obtained regarding which of the following?
A) Consumption of alcoholic beverages
B) Family history of cancer
C) Source of drinking water
D) Travel history
E) Use of tobacco products
(A or E?)
Item 2 of 2
18. Which of the following is the most appropriate laboratory study?
A) Antibodies for Helicobacter pylori
B) Vitamin B12 (cyanocobalamin) concentration
C) Ferritin concentration
D) Gastrin concentration
E) Iron concentration
(A?) | s*****9
发帖数: 445 | 2 我也就是直觉阿，不知道对不对。
C
D
E
A (Why E???) no idea at all...
D | s*****9
发帖数: 445 | 3 我也就是直觉阿，不知道对不对。
C
D
E
A (Why E???) no idea at all...
D | s*****9
发帖数: 445 | 4 step 3真是没热情复习阿，三天打鱼两天晒网。。。。。。我怕我会挂掉 | s**********1
发帖数: 68 | 5 same here.
My behavioral and psychological sessions are always not good.
On the online version, I picked
1. C 2. D
Since my performance is so bad, it might be wrong. The given answer with the
downloaded version for 1 & 2 are: A & C. | s*****9
发帖数: 445 | 6 更正，刚才一分钟前，我忽然醍醐灌顶。
最后一题两个答案应该分别是：A; B
Hint: visible exposed gastric vessels-----〉suspected alcoholic varicose
veins?
这个题目出得不好，太隐晦了。 | s**********1
发帖数: 68 | 7 I think esophageal varicose is from alcoholic abuse. Gastric varicose is
different (UW CK, but I don't remember exactly).
【在 s*****9 的大作中提到】
: 更正，刚才一分钟前，我忽然醍醐灌顶。
: 最后一题两个答案应该分别是：A; B
: Hint: visible exposed gastric vessels-----〉suspected alcoholic varicose
: veins?
: 这个题目出得不好，太隐晦了。
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