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* NBME family medicine form 1 help
 #847048  
  palaver - 01/13/18 18:55
 
  A 42-year-old man comes to the physician because of a 2-month history of severe leg pain, especially at night. He has poorly controlled type 1 DM complicated by diabetic nephropathy. One month ago, his urine creatinine
clearance was 20 ml/min. Current medications include insulin and captopril. Sensation to pain and light touch is decreasedover the lower extremities in a stocking-glove distribution. His hemoglobin A1c is 10.2/o. In addition to tighter glucose control, which of the following is the most appropriate next step in management of this patient's leg pain?

0 A) Topical capsaicin therapy
0 B) Oral acetaminophen with codeine therapy
0 C) Oral amitriptyline therapy (wrong)
0 D) Oral ibuprofen therapy
0 E) Oral morphine therapy


A 42-year-old woman with type 2 DM comes to the physician because of a lesion on her perineum for 3 months. Examination shows an ulcerated plaque on the perinea! body. A biopsy specimen of the lesion shows invasive squamous cell carcinoma; there is extensive intraepithelial disease on the perineum. She asks how she could have acquired this cancer. Which of the following is the most likely underlying cause?
0 A) Exposure to herpesvirus
0 B) Exposure to human papillomavirus
0 C) Exposure to lymphogranuloma venereum
0 D) Prolonged periods of hyperglycemia that alter immune function (wrong)
0 E) Use of excessive amounts of talcum powder



A 27-year-old man comes to the physician for a routine health maintenance examination in April. He feels well and has no history of serious illness. He received all childhood immunizations. He has smoked one pack of cigarettes daily for 5 years. Examination shows no abnormalities. Which of the following vaccines are most appropriate to administer at this visit?
0 A) 23-Valent Pneumococcal No, H flu no, influenza no
0 8) 23-Valent Pneumococcal No, H flu yes, influenza yes
0 C) 23-Valent Pneumococcal Yes, H flu no, influenza yes (wrong)
0 D) 23-Valent Pneumococcal Yes, H flu yes, influenza no
0 E) 23-Valent Pneumococcal Yes, H flu yes, influenza yes


A 62-year-old woman comes to the physician because of a 6-month history of shortness of breath with exertion and leg swelling. Her last visit to a physician was
15 years ago. She takes no medications. Bilateral basilar crackles are heard on auscultation. Cardiac examination shows a dyskinetic, laterally displaced point of
maximal impulse and an S3. There is 2+ pitting edema of the lower extremities. Laboratory studies show:

Serum:
Na+ 132
c1- 104
K+ 3.8
HC03- 22
Urea nitrogen 14
Glucose 98
Creatinine 1.2

Urine:
Specific gravity 1.020
Protein negative

Which of the following is the most likely explanation for th is patient's hyponatremia?
0 A) Baroreceptor-mediated ADH (vasopressin) secretion
0 B) Ectopic production of ADH (wrong)
0 C) Inappropriate suppression of ADH
0 D) Inappropriate suppression of ADH receptors
0 E) Renal unresponsiveness to ADH


 
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* Re:NBME family medicine form 1 help
#3357568
  r0ja - 01/14/18 10:50
 
  can I get the new FM CMS? my email is rsuri910@gmail.com  
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* Re:NBME family medicine form 1 help
#3357709
  krystal0130 - 01/15/18 16:15
 
  42-year-old man comes to the physician because of a 2-month history of severe leg pain, especially at night. He has poorly controlled type 1 DM complicated by diabetic nephropathy. One month ago, his urine creatinine
clearance was 20 ml/min. Current medications include insulin and captopril. Sensation to pain and light touch is decreasedover the lower extremities in a stocking-glove distribution. His hemoglobin A1c is 10.2/o. In addition to tighter glucose control, which of the following is the most appropriate next step in management of this patient's leg pain?

I know that the answer is not (A. Topical capsaicin) either as I put this and got it wrong.

A 42-year-old woman with type 2 DM comes to the physician because of a lesion on her perineum for 3 months. Examination shows an ulcerated plaque on the perinea! body. A biopsy specimen of the lesion shows invasive squamous cell carcinoma; there is extensive intraepithelial disease on the perineum. She asks how she could have acquired this cancer. Which of the following is the most likely underlying cause?

The answer is: B) Exposure to human papillomavirus

A 27-year-old man comes to the physician for a routine health maintenance examination in April. He feels well and has no history of serious illness. He received all childhood immunizations. He has smoked one pack of cigarettes daily for 5 years. Examination shows no abnormalities. Which of the following vaccines are most appropriate to administer at this visit?

I know that the answer is also not (B) 23-Valent Pneumococcal No, H flu yes, influenza yes) as I put this and got it wrong as well.

A 62-year-old woman comes to the physician because of a 6-month history of shortness of breath with exertion and leg swelling. Her last visit to a physician was
15 years ago. She takes no medications. Bilateral basilar crackles are heard on auscultation. Cardiac examination shows a dyskinetic, laterally displaced point of
maximal impulse and an S3. There is 2+ pitting edema of the lower extremities. Laboratory studies show:

The answer is: A) Baroreceptor-mediated ADH (vasopressin) secretion



 
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* Re:NBME family medicine form 1 help
#3357710
  krystal0130 - 01/15/18 16:19
 
  Can you help me on these?

A 37 yo man comes to the physician because of a 6 wk h/o epigastric pain. The pain is most severe 1 hr after eating and is relieved by OTC antacids. He has had no fever, nausea, or weight loss. He has HTN treated with HCTZ. He does not smoke and drinks one glass of wine with dinner daily. His pulse is 76/min, and blood pressure is 136/88 mm HG. There is mild epigastric tenderness w/o rebound or guarding. The stool is brown, and test for occult blood is negative. His hemoglobin concentration is 13.8 g/dL. Liver function tests show no abnormalities. Which of the following is the appropriate next step?
A. Esophageal pH monitoring (wrong)
B. Measurement of serum amylase activity
C. Serum Helicobacter pylori antibody assay (is this it??)
D. Abdominal ultrasound
E. Abdominal CT

 
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* Re:NBME family medicine form 1 help
#3357711
  krystal0130 - 01/15/18 16:26
 
  A 67 yo man comes to physician requesting a prescription for nicotine patches. He has smoked 2 packs of cigarettes daily for 50 yrs. He tried to quit abruptly several times w/o success. 5 yrs ago, he used nicotine gum successfully for 3 mo but then began smoking again. He has a 3 yr h/o stable angina pectoris. Exam shows no abnormalities. Which of the following is the most effective management for this pt?
A. Advise the pt he should not use transdermal nicotine because its use is contraindicated in pts with angina pectoris (wrong)
B. Prescribe nicotine gum since it has been proven to be superior to transdermal nicotine in randomized trials in pts w/ heart disease (is this it?)
C. Prescribe transdermal nicotine at lower than recommended dosages and allow pt to smoke 2 cigarettes daily to prevent relapse
D. Prescribe transdermal nicotine at lower than recommended dosages to prevent angina pectoris
E. Prescribe transdermal nicotine and recommend a behavioral modification program.
 
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* Re:NBME family medicine form 1 help
#3358368
  palaver - 01/21/18 12:58
 
  krystal,

37 year old man: C
this is gastric ulcers (pain is most severe after eating)
most common cause of peptic ulcers is h pylori

67 year old man: E
transdermal nicotine patch can be used with decreasing doses until no longer nicotine dependent
 
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* Re:NBME family medicine form 1 help
#3358369
  palaver - 01/21/18 13:00
 
  A 42-year-old man comes to the physician because of a 2-month history of severe leg pain, especially at night. He has poorly controlled type 1 DM complicated by diabetic nephropathy. One month ago, his urine creatinine
clearance was 20 ml/min. Current medications include insulin and captopril. Sensation to pain and light touch is decreasedover the lower extremities in a stocking-glove distribution. His hemoglobin A1c is 10.2/o. In addition to tighter glucose control, which of the following is the most appropriate next step in management of this patient's leg pain?

Answer is C) Oral amitriptyline therapy

this is a typo in first post, C is actually right


 
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* Re:NBME family medicine form 1 help
#3358479
  virgo32 - 01/22/18 09:09
 
  NBme form clinical science mastery series is for step 2 CK?  
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* Re:NBME family medicine form 1 help
#3360663
  thirdyearcrusin - 02/13/18 10:08
 
  A 27-year-old man comes to the physician for a routine health maintenance examination in April. He feels well and has no history of serious illness. He received all childhood immunizations. He has smoked one pack of cigarettes daily for 5 years. Examination shows no abnormalities. Which of the following vaccines are most appropriate to administer at this visit?

The answer is A: No to all of them. He has no reason to receive the first two and the Flu shot is too late in the year to be of benefit. That's why it specifically says April in the title.
 
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* Re:NBME family medicine form 1 help
#3368531
  chenchen01 - 06/24/18 15:11
 
  RE: thirdyearcrusin - 02/13/18 10:08

According USPSTF, age 19-64 years smoker should get 1 dose of PPSV23. I picked C myself too, but I am so sure if A is correct.
 
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