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Hi "grazie" thanks for posting these questions,i have benefited o lot from the discussions.
I have my exam in four days please could you send me the whole nbme 3 (and2 if possible)with the answers to be able to crosscheck mine.
i will really appreciate this, got 220 on uworld and i am a bit apprehensive.
Thanks

Oops, forgot to include my e mail.
my email is bernasanya.to send the nbme 3 question and answer
Thanks

I am sorry I am not distributing the exam please don't post your emails. I am just discussing the qs. The qs are there you can copy them, whatever, but I am not sending them to nobody.
Thank you.

7.
A 42-year-old white woman returns to the office because she has had intermittent headaches, sore throat, dysuria, fatigue, and difficulty sleeping during the past 10 months. She has been evaluated by numerous physicians during this period, and this is her third visit to your office in 6 months. She says her symptoms are worse than they were at her last visit 3 months ago. She says her hair and skin are dry and her legs feel weak. She notes that approximately 1 month ago a new copy machine was installed in the hallway outside her office. Since that time she has had almost daily headaches at work and increasing inability to think clearly. She reports that she no longer pumps her own gas because the smell of gasoline causes severe headaches. Physical examinations during the past two visits have disclosed no abnormalities. Throat culture was negative for β-hemolytic streptococci. MRI of the brain done 4 months ago was normal. Fasting laboratory study results from previous visits are shown:
Serum Blood
Glucose 80 mg/dL ESR 14 mm/h
TSH 3.5 μU/mL Hematocrit 37.6%
Urinalysis Normal
The patient is 168 cm (5 ft 6 in) tall and weighs 66 kg (145 lb); BMI is 23 kg/m2. Her weight has been stable. Vital signs are temperature 36.6°C (97.8°F), pulse 86/min, respirations 18/min, and blood pressure 106/60 mm Hg. Optic disc margins are sharp and there is no neck stiffness. Neurologic examination discloses good strength in both lower extremities. Mental status seems normal, although when asked to recall three objects she says, "I just can't remember." She refuses to do serial 7's because she says, "I've always been terrible at math." At this time, which of the following is the most appropriate diagnostic study?

A) EEG
B) Electromyography of the lower extremities
C) Lumbar puncture for examination of cerebrospinal fluid
D) Repeat MRI of the brain
E) No additional testing is necessary

q7)E

This pt sound like a Hypochondrioac type. Remember that DSM-5 redefines hypochondriasis to Somatic Symptom Disorder. There is no reason to order new tests.

8.
A 2-week-old newborn is brought to the office by her mother for her first well-child visit. The newborn was born at 37 weeks' gestation following normal pregnancy and uncomplicated delivery. Birth weight was 2300 g (5 lb; 5th percentile). Apgar scores were 8 at 1 minute and 9 at 5 minutes. The mother is breast-feeding her daughter and reports that the infant is now feeding more eagerly than she had been initially. The newborn is 46 cm (18 in; 5th percentile) in length and weighs 2500 g (5.5 lb; 5th percentile); head circumference is 32.5 cm (13 in; 5th percentile). Vital signs are temperature 37.0°C (98.6°F), pulse 126/min, and respirations 32/min. On physical examination, skin is faintly jaundiced but sclerae are not icteric. There is no rash other than some mild perineal inflammation. The anterior fontanel is patent. A white reflex is noted in the right eye; the left eye has a red reflex. There are no heart murmurs. Liver edge is palpable. Genitalia are normal. Which of the following is the most appropriate initial step?

A) Determination of total serum bilirubin concentration
B) Discontinuation of breast-feeding
C) MRI of the brain
D) Ophthalmologic consultation
E) Paired TORCH titers

@lily white we would love your input on these questions if you like to join us!! its just a group discussion

q8)
Ans: D) Ophthalmologic consultation
nbme cert.


Retinoblastoma is a malignant tumor of the retina. Most common primary intraocular malignancy of childhood, with 90% occurring before the age of 3. Leukocoria (pupil with absence of red reflex) is the mc finding on physical exam, also often noted in a photographs.

*** Requires immediate referral to ophthalmologist if suspected.

Treatment options include systemic and/or local delivery of chemotherapy, brachytherapy, cryotherapy, laser photocoagulation, radiation, and enucleation. If diagnosed and treated early, prognosis is excellent. Involvement of the lamina cribrosa, and particularly the optic nerve, portends a bad prognosis.

9.
A 4-year-old girl who has been your patient since she was age 2 years is brought to the office by her mother because of burning on urination for the past 2 days. Her mother says, "She is going to the bathroom all the time and she has to go right away—all of a sudden." The mother notes that the child's urine has a strong odor. Her urinary stream has been normal. She has not had vomiting, bed-wetting, or daytime wetting or leaking. She has two siblings, neither of whom has had a urinary tract infection. She is 94 cm (3 ft 1 in; 10th percentile) tall and weighs 20 kg (45 lb; 95th percentile). Vital signs are temperature 37.0°C (98.6°F), pulse 80/min, respirations 20/min, and blood pressure 98/52 mm Hg. The child is well developed, pleasant, and cheerful. Abdominal examination discloses no masses, tenderness, or organomegaly. Genitourinary examination shows normal female genitalia. You suspect a urinary tract infection. A catheterized urine specimen is positive for nitrite and bacteria. The most likely cause of this infection is which of the following?
A) Neurogenic bladder
B) Poor toilet hygiene
C) Posterior urethral valves
D) Sexual abuse
E) Systemic bacteremia

q9)

Ans: B
nbme cert

From UTI in kids:

GIRLS are more at risk than boys

Kids with POOR TOILET HYGIENE, and especially girls who wipe back to front, are at increased risk, as are kids who tend to hold their urine for a long time

Kids who have certain structural or functional abnormalities of the urinary tract are certainly at risk

It's important to encourage proper wiping techniques and good hygiene, and to remind kids to empty their bladder and not "hold it" for long periods of time.
Avoiding bubble baths can also help prevent UTIs, because they can be irritating to the urethra.