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I took NBME form 2 recently, my score was ok, not great, so I want to solve these questions and read around this high yield topics. If anybody wants to join me, you are welcome. The idea of this is to review the questions, not just post your guessed educated answer, please provide some review to it. I AM NOT going to distribute the exam, so don't post your emails. My exam is in 1 month so I still have time to work on my weak areas, anybody in the same sac?
This is part 2 of Block 1 (NBME STEP 3, Form 2) "nbme exam" has the 1st half of qsn
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Questions 19 to 36
19.
A 10-year-old boy is brought to the office by his mother because of a 2-week history of refusal to attend school. Before the school problems began, he had had a mild fever, sore throat, and body aches for 3 to 4 days; his symptoms resolved and he went back to school for 2 days. That weekend he was unable to eat any meals without bringing his alarm clock from his bedroom to the table. The mother realized he was sitting down or getting up from the table only when the second hand was on the 12; he continues to do this. During the next few days he became much more anxious and worried about things that had not previously bothered him. At school, he was unable to stay in his seat and tried to coax another student out of her chair because, he claimed, the chair was "his." Family history is significant for major depressive disorder and obsessive-compulsive disorder in his father. The patient's vital signs are normal. You note that every 10 to 25 seconds he stretches out his neck, slightly thrusting his chin forward almost rhythmically. The remainder of the physical examination discloses no abnormalities. Which of the following studies is most likely to help identify the diagnosis?
A) Antinuclear antibody assay
B) Antistreptolysin O titer
C) Determination of serum C-reactive protein concentration
D) ESR
20.
A 19-year-old woman comes to the office for the first time because of an increase in urinary frequency and urgency during the past 4 days. Medical history is unremarkable. She has been sexually active with one male partner and they occasionally use condoms for contraception. She has not had a menstrual period for the past 3 months; menses are typically irregular. She has never been pregnant. She is 157 cm (5 ft 2 in) tall and weighs 55 kg (122 lb); BMI is 22 kg/m2. Vital signs are normal. Uterine size is consistent with a 12-week gestation; physical examination is otherwise unremarkable. Urine pregnancy test is positive. Results of urinalysis are within the reference range. Regarding this patient's increased urinary frequency and urinary urgency, specific additional history should be obtained regarding which of the following?
A) Daily fluid intake
B) Family history of diabetes mellitus
C) Medication use
D) Previous urinary tract infections
E) No further history is necessary
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19 BB (syndenham's chorea?)
20 EE
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19 B (? sydenhams chorea)
20 E (her increased urinary frequency and urgency are related to pregnancy )
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19)
Answer B is correct by NBME feedback
B) Antistreptolysin O titer
BUZZWORD here: "Chorea after URI"
Major criteria of rheumatic fever—“ JECSS”:
================================
1. Joints—migrant polyarthritis;
2. Erythema marginatum;
3. Carditis;
4. Subcutaneous nodules;
5. SYDENHAM'S CHOREA
Minor criteria:
==============
Fever,
polyarthralgias,
increased ESR,
prolonged PR interval,
preceding Strep infection
DIAGNOSE:
=========
Evidence of Streptococcal pharingitis with Culture or + Elevated Antistreptolysin (ASO) Ab titer
+ 2 Major criteria or
+ 1 major & 2 minor criteria
Treatment
1. Bed rest, salicylates ASPIRIN and PCN for acute cases.
Antibiotics help prevent complications from Strep infection, but not post-Strep nephropathy.
2. Antibiotic prophylaxis indications: During medical or dental procedures.
Gong MD, Yale (2013-02-05). Yale-G's Refined Clinical Review for USMLE Step 2 & 3 (New Edition) (Kindle Locations 1401-1403). www.usmle-yaleg.com. Kindle Edition.
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20)
E) No further history is necessary
I don't have the right answer from NBME feedback but E looks like a good answer.
Physiological Urinary changes in pregnancy
The increased blood volume and cardiac output during pregnancy cause a 50-60% increase in renal blood flow and glomerular filtration rate (GFR), thus increase in urine volume production. This causes an increased excretion and reduced blood levels of urea, creatinine, urate and bicarbonate.
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21.
A 32-year-old engineer is brought to the clinic by his supervisor. He has been noted by his colleagues to have been uncharacteristically active for the past several weeks. He seems to spend most of his time at the plant and gets little sleep. He has told another engineer that he is involved "in a research project that will earn me the Nobel Prize." Large amounts of expensive research equipment continue to arrive at his office. No one seems to know exactly what is going on because he is irritable, and it is hard to hold his attention. A classmate from graduate school recalls that the patient behaved in a similar way several times when he was in school. The patient's behavior is most consistent with a diagnosis of which of the following?
A) Alcoholism
B) Bipolar disorder
C) Cocaine abuse
D) Professional burnout syndrome
E) Schizophrenia
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Answer: By NBME Feedback
B) Bipolar disorder
Mania is defined as a distinct period of abnormally and persistently elevated mood that lasts for at least one week. Diagnosis requires at least three of the classic symptoms listed in the "DIGFAST" mnemonic:
Distractibility, Insomnia, Grandiosity, Flight of Ideas, Activity (goal-oriented), Speech (extreme talkativeness), and Thoughtlessness (excessive involvement in high-risk behavior, such as gambling).
First-line treatments of bipolar disorder include lithium or valproic acid. Carbamazepine is occasionally used as an alternative.
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22.
A 48-year-old woman, gravida 2, para 2, comes to the office for an annual health maintenance examination. She says that she has had swelling in both legs for the past year; the swelling is worse in the evening. Medical history includes type 2 diabetes mellitus managed with metformin. She routinely sees a nutritionist for management of her weight. She has smoked one pack of cigarettes daily for the past 25 years. She drinks two glasses of wine daily and three cups of coffee daily. She works as a county clerk and has a sedentary lifestyle. She is 157 cm (5 ft 2 in) tall and weighs 86 kg (190 lb); BMI is 35 kg/m2. Vital signs are temperature 36.7°C (98.0°F), pulse 80/min, respirations 16/min, and blood pressure 160/90 mm Hg. Physical examination shows no abnormalities. Results of laboratory studies are shown:
Serum Blood
Cholesterol Hemoglobin A1c 7%
Total 160 mg/dL
HDL 50 mg/dL
LDL 91 mg/dL
Triglycerides 145 mg/dL
Glucose 120 mg/dL
Which of the following is the most appropriate next step?
A) Administer sublingual nifedipine
B) Initiate sibutramine therapy
C) Prescribe a high-calcium diet
D) Recheck her blood pressure in 1 week
E) Recommend that the patient avoid caffeine
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