nbme 6 ck fully solved 2024/2025

nbme 6 ck**52 yo M: 3 month hx increased urinary volume & increased urinary frequency at night. 6.8 kg *weight LOSS*. BP 160/85 in both arms. Nonfasting glucose 280. What's INCREASED? - correct answer *INSULIN* DX: T2 DM which is due to insulin resistance but in initial stages, the pancreas tries to *compensate by MAKING MORE INSULIN* RMR Glucagon is for when *glucose is GONE*. Here glucose is elevated so insulin will be elevated too while glucagon is low. -weight loss b/c of insulin resistance, the body can't use the glucose as much -BUT : i heard it's in early DM there's elevated insulin vs late DM there's elevated glucagon. how can u tell which phase of DM this is? b/c "in T2DM, cells are insensitive to insulin so they can't take up glucose & so body is in a state of perceived hypoglycemia and glucagon is secreted" **70 yo F: 2 day hx increasing abd pain. Renal failure &receives peritoneal diaylsis for 18 months. Last tx was 2 hrs ago. Appears toxic &has fever 102.2 F, BP 140/90, Abd is distended & diffusely tender to deep palpation w/REBOUND TENDERNESS*. Elevated WBC 18,000. next step? - correct answer *Gram stain of abd fluid* DX: Peritonitis -due to peritoneal dialysis causing loss of peritoneal integrity -rebound tenderness &distended tender abd Answer is NOT X ray of abd b/c w/fever-you got an infectious cause likely so work up should be based on that. If you chose X ray to r/o perforated viscus which could also cause a fever, rmr that this pt has had 2 days of abd pain already so if there was a perf, "she'd be in pretty rough shape & hYPOTENSIVE" **5 yo boy brought to ED 30 mins after he fainted at home after standing up from a sitting position. SX began 3 days ago w/diarrhea &vomiting. *No urine output for 18 hrs.*Alert, but quiet. BP 75/45, P 120, RR 28. Exam: *Dry lips &skin tenting.* Hyperactive bowel sounds. no abd tenderness. cap refill time is 5 seconds. IV 0.9% saline bolus is given & bladder cath=5 ml urine. UA will likely show? - correct answer *HYALINE casts*