Nbme surgery form 3 questions – usmle forum

1. Six hours after sigmoid colectomy and colostomy for perforated diverticulitis, a 62yo woman has had a total post-op urine output of 65mL through a Foley. Preoperatively, pt had a serum urea nitrogen of 45 mg/dL and Cr of 2 mg/dL. She has been receiving 1/2NS at 90 mL/h since the operation. BMI is 24. Pulse 95, BP 130/90, normal electrolytes, urine specific gravity is 1.028. What is the next step in management?

2. 25yo woman presents 48 hours after onset of sharp pain in upper outer quadrant of right breast. Pain has been gradually resolving. PE shows 2cm tender area in upper outer quadrant of right breast; there’s no associated mass. Which of the following is the most appropriate next step in mgmt?

3. 11 months old girl brought to ED 1 hour after onset of fever and passing purple, jelly like stools.


During past 7 hours, she had episodes of drawing up her knees and crying. Does not appear to be in distress or dehydrated. Temp 37.8C (100F), pulse 110/min, RR 16, BP 100/50. Elongated mass palpated in RUQ abdomin. Which of the following is the most appropriate next step in management?

4. 47 yo woman undergoes open reduction and internal fixation of midshaft fracture of left humerus from MVA. post op, ketorolac is added to regimen b/c of poor pain control w/ morphine via patient-controlled pump. After pain improved, morphine is stopped, ketorolac is continued as sole analgesic agent. 2 days later pt has decreased UOP. Temp is 37C (98.6F) pulse 80/min, RR 12, BP 120/80. PE of left upper extremity shows well-healing incision. Her serum creatinine concentration increased from 0.7 mg/dL preop to 3.4. Which is most likely underlying mechanism of acute renal failure?

5. A 71 year old man comes to the physician because of a 4 month history of progressive hearing loss and ringing in his right ear and unsteadiness when walking. He has a history of hypercholesterolemia myocardial infarction and Mitral valve prolapse. He sustained a cerebral infarction 3 years ago. Medications include atorvastatine 81 mg of aspirine. His temp is 37 C (98.6 F), pulse 82/min, resp. 13/min, BP 130/82 mmHg physical examination shows decrease movement of the right side of the face. Weber test localizes to the left ear. Rinne test shows air conduction is greater than bone condution bilaterally. Muscle strength is 5/5 throughout. Deep tendon reflex and coordination are normal. Sensation to temperature is decrease over the right side of the face. His gait is unsteady. An MRI of the brain is most likely to show which of the following?

6. 52yo man with 3 day h/o upper abd pain and bloating and 1 day h/o nausea/vomiting. Bismuth prep and antacids have not relieved the n/v. He has h/o duodenal ulcer treated with omeprazole. Currently takes no meds. Pulse is 90/min and regular, and BP 130/88. Cardiopulmonary exam no abnormalities. Abdomen is distended with borborygmi in epigastric area and succussion splash. There is no rebound tenderness or guarding. Which is the most likely explanation for these findings?

7. 52yo man comes to physician b/c of 14kg (30lb) weight loss in past 6 mos. Oily floating stools during past 2 months. Received diagnosis of acute pancreatitis 2 year ago and has had 1- to 3-hour episodes of severe abdominal pain since then. Current meds include oxycodone. Mom has T2DM, dad died of alcoholic cirrhosis. Pt smoked 1-pack of cigarettes daily for 30 years. Has alcoholism but abstinent for 2 years. He is 173 cm andd 59kg (BMI 20). Pulse 100/min. BP 120/80. Abdomen scaphoid w/ mild diffuse tenderness. Liver edge is firm and palpated 2 cm below right costal margin. Labs:

9. 10 days after hospital admission, 22yo man w/ acute leukemia has onset of pain and edema of RUE. Completed 7 day course of induction chemo 3 days ago. On admission he received sodium bicarbonate and allopurinol and underwent placement of right atrial cath. Pulse is 80/min, BP 126/78. RUE approximately 1.5 times larger in circumference than LUE. Venous duplex ultrasonography of RUE shows occlusion of right axillary and subclavian veins. Most likely cause of pt’s sx?

10. 37yo woman with 3 week h/o progressive SOB on exertion. Has 3 year h/o HTN. Meds lisinopril and 81mg aspirin. Temp 37C (98.6F), HR 90/min, RR 14, BP 140/70. Crackles heard at both lung bases. Cardiac exam shows opening snap that introduces a grade 2/6, diastolic rumbling murmur heard best at apex and continues up to S1. Most likely diagnosis?