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+--- Thread: Discuss NBME F3 B1 - grazie (/showthread.php?tid=787769)
Discuss NBME F3 B1 - grazie - ArchivalUser - 09-06-2014
NBME FORM 3 BLOCK 1
STEP 3
This thread is for discussion of Form 3 Block 1 only. Please share why you pick your choice, we are all going to be benefit from it.
Thank you!
0 - ArchivalUser - 09-06-2014
NBME FORM 3 BLOCK 1
1.
A 35-year-old woman comes to the office because of a 5-day history of worsening left lower quadrant abdominal pain and a 3-day history of vaginal spotting. Her last menstrual period was 6 weeks ago and a recent home pregnancy test was positive. She has had two previous pregnancies, both of which resulted in cesarean delivery for fetal distress. The patient previously used an intrauterine device for contraception but discontinued use last year when her periods became heavy; she now uses condoms and the rhythm method for contraception. Medical history is significant for treatment for an infection caused by Chlamydia trachomatis at age 28 years. She has smoked one pack of cigarettes daily for the past 15 years. She is 168 cm (5 ft 6 in) tall and weighs 57 kg (125 lb). Vital signs are temperature 37.1°C (98.9°F), pulse 110/min, respirations 16/min, and blood pressure 108/76 mm Hg. Abdominal examination discloses mild lower quadrant tenderness that is greater on the left side; there is no guarding or rebound. Pelvic examination discloses a small amount of brown discharge in the vagina, mild cervical motion tenderness, and a closed cervical os. Results of laboratory studies are shown:
Serum Blood
β-hCG 1848 mU/mL Hematocrit 34.3%
Hemoglobin 11.9 g/dL
Pelvic ultrasonography shows no intrauterine gestational sac. Which of the following is the most significant risk factor for development of this patient's condition?
A) Age
B) Cigarette smoking history
C) Gravid status
D) Previous infection caused by Chlamydia trachomatis
E) Prior use of intrauterine device
The following vignette applies to the next 2 items.
A 37-year-old newspaper delivery truck driver, whom you have known for 2 years, comes to the office because of neck pain. Three days ago, his pickup truck was hit in the rear by a larger truck. The patient was dazed but not unconscious. He had acute pain in his posterior neck and right shoulder area. He was transported to a nearby emergency department by ambulance where x-rays were normal. He was observed in the emergency department for 6 hours, fitted with a cervical collar, and given ibuprofen for pain. Prior to this accident he had been healthy, although he came to the office every few months with minor complaints, such as tinnitus and dyspepsia. No physical abnormalities were found at any of these past visits, and he responded to reassurance and symptomatic treatment. Today he is wearing the cervical collar and seems in distress. On physical examination, the nuchal area is diffusely tender to palpation, and the patient self-limits neck movements. Neurologic examination is normal. He tells you that he has already seen his attorney who believes that he has a good case against the other driver.
Item 1 of 2
2.
Which of the following is the most appropriate initial management to maximize this patient's recovery?
A) Declare him unable to work until his symptoms have ceased
B) Encourage him to forgo litigation
C) Increase the pain medication
D) Reassure him and continue the collar and ibuprofen therapy
E) Refer him for physical rehabilitation
Item 2 of 2
3.
Based upon the medical literature and this patient's history, which of the following is a correct statement about his recovery?
A) He will develop dependency on pain medication
B) He will need long-term care with visits every few months
C) He will only improve if he receives psychotherapy
D) Litigation may delay symptomatic recovery
E) Secondary gain will lead to malingering
End of Set
4.
A 17-year-old girl comes to the office for a physical examination prior to attending camp. She has been generally healthy. Physical examination shows a roughness on her arms, which is shown. She states, "I've tried all sorts of lotions, but this just stays the same." Which of the following is the most likely diagnosis?
A) Eczema
B) Keratosis pilaris
C) Lichen planus
D) Pityriasis rosea
E) Psoriasis
5.
A 42-year-old Ecuadorian man who recently immigrated to the USA comes to the office for an initial visit. He tells you that for the past several months he has been having episodes of uncontrollable crying, difficulty sleeping, and loss of sex drive and appetite. He is not taking any medications. His family is in Ecuador. He has no other medical problems. Physical examination discloses no abnormalities. Which of the following is the most appropriate step prior to initiating therapeutic intervention?
A) Ask the patient about his beliefs regarding the cause of his illness
B) Ask the patient if he has any history of medication allergy
C) Inform the patient about the benefits of medication in his condition
D) Inform the patient about the nature of depression
E) Inform the patient about the relationship between the patient's mind and body
6.
A 74-year-old man is brought to the office by his wife because of a progressive tremor of his right hand and mild stiffness of his right arm for the past 2 years. His wife also notes that he seems to have been walking more slowly during the past 6 months. Medical history is remarkable only for hypertension controlled with enalapril. Vital signs are temperature 37.0°C (98.6°F), pulse 64/min, respirations 12/min, and blood pressure 150/88 mm Hg. Physical examination shows diminished facial expression. Mental status examination shows no abnormalities. Strength is full throughout, but there is a prominent resting tremor of his right hand and bilateral cogwheel rigidity of the upper extremities that is more pronounced on the right side. Reflexes are 2+ and symmetric, and Babinski sign is absent bilaterally. He has a mild shuffling gait. Which of the following is the most appropriate diagnostic study?
A) Determination of serum thyroid-stimulating hormone concentration
B) Determination of serum vitamin B12 (cobalamin) concentration
C) MRI of the brain with contrast
D) PET scan
E) No diagnostic studies are indicated
7.
A 28-year-old woman comes to the community-based health center because she noticed a tender, firm mass in her right breast in the same general location where she was hit by a softball 2 years ago. Vital signs are temperature 37.0°C (98.6°F), pulse 68/min, respirations 18/min, and blood pressure 118/64 mm Hg. She weighs 56 kg (123 lb) and is 155 cm (5 ft 1 in) tall; BMI is 23 kg/m2. Physical examination is normal except for an indurated and poorly defined mass in the right breast with local skin retraction. There is no palpable adenopathy. Mammogram shows fine, stippled calcification. Which of the following is the most likely diagnosis?
A) Fat necrosis
B) Fibroadenoma
C) Intraductal carcinoma
D) Lipoma
E) Phyllodes tumor
8.
A 58-year-old white woman comes to the office to discuss results of a DEXA scan obtained 3 days ago that showed a T-score of −2.6 at the femoral neck and −2.0 at the lumbar spine (N> −0.1). She also has had a 1-month history of anhedonia, poor sleep with early morning awakening, decreased appetite, thoughts of death, and feelings of guilt. Medical history is significant for hypertension, hypercholesterolemia, osteoarthritis of the hips and knees, and gastric bypass surgery and cholecystectomy in her 30s. Medications include clonidine, amlodipine, atorvastatin, and daily ibuprofen. After her gastric bypass surgery, she developed deep venous thrombosis for which she took warfarin for 1 year. She does not smoke cigarettes or drink alcoholic beverages. The patient is 178 cm (5 ft 5 in) tall and weighs 73 kg (160 lb); BMI is 27 kg/m2. Vital signs are temperature 37.1°C (98.8°F), pulse 80/min, respirations 16/min, and blood pressure 148/76 mm Hg. The patient's affect is flat and she does not make eye contact. Physical examination discloses kyphosis, nontender enlargement of the distal interphalangeal joints of several fingers, and nontender bony prominences of the first metatarsophalangeal joints bilaterally. Results of fasting serum laboratory studies are shown:
Cholesterol
Total 161 mg/dL
HDL 52 mg/dL
LDL 79 mg/dL
Triglycerides 150 mg/dL
Glucose 98 mg/dL
In addition to initiating antidepressant therapy, which of the following is the most appropriate change to this patient's medication regimen at this time?
A) Add colchicine
B) Add ibandronate
C) Add lisinopril
D) Add raloxifene
E) Switch atorvastatin to pravastatin
9.
A 5-year-old girl is brought to the health center by her parents because of a long-standing history of constipation. The father says, "This problem seemed to have started when she was 2 years old, after she was potty trained." The mother reports that in the early stages of the problem she had noticed a couple of blood drops in her daughter's stool in the toilet. She says that her daughter has a bowel movement only once or twice per week, usually after a suppository or an enema is given, and that her stools are large and occasionally "block" the toilet bowl. The child frequently soils her underwear. Which of the following is the most likely cause?
A) Cystic fibrosis
B) Gluten enteropathy
C) Habit constipation
D) Hirschsprung disease
E) Intestinal pseudo-obstruction
10.
A 76-year-old woman who has been your patient for the past 10 years comes to the office because of fatigue. She has had health evaluations on an irregular basis; her last visit was 2 years ago. At that visit she was healthy and results of laboratory studies were normal. Today she tells you that she has noted a 4.5-kg (10-lb) weight loss during the past 6 months, although she has followed no special diet or exercise regimens. Past history is remarkable for borderline hypertension and osteoarthritis. She had herpes zoster 6 months ago that was treated conservatively. The patient was previously a physical therapist. She was divorced 15 years ago and has three grown children by that marriage. She remarried 10 years ago. She reports that she had sexual intercourse several times with a long-term friend during the interim between her marriages. The friend has subsequently died of pneumonia. Vital signs today are normal. Physical examination shows a tired-appearing, elderly woman. There is candidiasis of the oral mucosa. Lung, cardiac, and abdominal examinations are normal. Results of laboratory studies are shown:
Blood
Hemoglobin 8 g/dL
WBC 1200/mm3
Platelet count 100,000/mm3
Which of the following is the most likely diagnosis?
A) Epstein-Barr virus (EBV) infection
B) HIV infection
C) Iron deficiency anemia
D) Mycobacterial infection
E) Pernicious anemia
11.
A 16-year-old African American boy who has been your patient since birth comes to the office because of back pain. He has sickle cell disease, and he has a history of multiple hospital admissions for vaso-occlusive crises, fever, and suspected sepsis. Current medications include daily penicillin and folic acid. Today he states that he is seldom free of discomfort, that the pain is worse in the morning, and that it is exacerbated by long periods of inactivity. He rates his pain as a 3 on a 10-point scale. He says the pain does not limit his daily activities but it is almost always present and is causing him to be short-tempered with family and peers. Vital signs are temperature 37.0°C (98.6°F), pulse 70/min and regular, respirations 14/min, and blood pressure 118/74 mm Hg. Physical examination is remarkable for tenderness over the back at approximately the level of T8 and there is some limitation of flexion. Which of the following is the most appropriate pharmacotherapy at this time?
A) Amitriptyline
B) Carbamazepine
C) Codeine
D) Ibuprofen
E) Meperidine
12.
A 28-year-old woman who is 16 weeks pregnant with her first pregnancy returns to the office for a prenatal visit. This is a planned pregnancy. She is not married and is in a stable relationship with the father of the baby. Pap smear obtained at her first visit 2 weeks ago shows high-grade squamous intraepithelial lesion (HGSIL). In discussing her Pap smear results, she says she has chosen to terminate the pregnancy so that a full evaluation of her cervix can be done immediately, and that she is considering hysterectomy. Which of the following is the best response to this patient?
A) "How do your boyfriend and family feel about your decision?"
B) "I thought you wanted to have a child."
C) "It is very unlikely that you currently have cancer."
D) "Tell me more about your concerns."
E) "There is no indication for you to terminate your pregnancy."
13.
A 40-year-old Latina woman who has been your patient for 10 years comes to the office for a periodic health evaluation. She says, "Doctor, I just can't seem to sleep at night. I work all day and I'm tired, but I just can't sleep. And the heat. I want to put on the air conditioning when everyone else is complaining how cold it is." She says her menstrual periods have become irregular. Vital signs are shown:
Today 1 Year ago
Pulse 110/min 80/min
Respirations 14/min 14/min
Blood pressure 130/86 mm Hg 110/70 mm Hg
Weight 54 kg (120 lb) 59 kg (130 lb)
She is 165 cm (5 ft 5 in) tall and her BMI today is 20 kg/m2. Her appearance is unchanged from last year. Physical examination, including pelvic examination, is normal. The appropriate studies confirm the suspected diagnosis. This patient is at increased risk for which of the following?
A) Osteoporosis
B) Ovarian cancer
C) Premature menopause
D) Thyroid cancer
E) Uterine cancer
14.
A 3-year-old white boy is bought to the office by his mother after referral by his day-care center because they have been concerned about his language development. The mother says the boy has a vocabulary greater than 100 words and that he can put two words together, yet he speaks in few intelligible sentences. The mother was told she had gestational diabetes while she was pregnant with him. The patient was a full-term normal neonate and delivery was normal. He sat up at age 5 months, crawled at age 10 months, and walked at age 13 months. He is not yet toilet trained. The teachers describe him as an active boy who is easily distractible and has a difficult time following directions. Medical history is significant for chronic otitis media with effusions in both ears since age 1 year, for which he has been treated with multiple antibiotics. The boy is 91.5 cm (36 in; 10th percentile) tall and weighs 17 kg (38 lb; 90th percentile). Vital signs and physical examination are normal except for retracted, scarred tympanic membranes. Which of the following is the most likely underlying cause for the patient's speech and language delay?
A) Attention-deficit/hyperactivity disorder
B) Autism
C) Chronic antibiotic use
D) Chronic otitis media
E) Maternal gestational diabetes
15.
A 59-year-old white man comes to the office because of generalized itching. He has been your patient since he had colon resection for carcinoma 5 years ago. His current medications include occasional use of an albuterol inhaler for pollen allergies. Medical history is otherwise unremarkable. Physical examination today discloses icterus and dry skin. The right upper quadrant is mildly tender and there is hepatomegaly. Results of laboratory studies are shown:
Serum
Alkaline phosphatase 800 U/L
AST 118 U/L
Bilirubin
Total 7.0 mg/dL
Direct 5.5 mg/dL
Lactate dehydrogenase 82 U/L
Proteins, total 7.0 g/dL
Results of hepatitis serology tests are all negative. CT scan shows multiple liver metastases. Bile ducts are not visibly dilated. Which of the following is the most appropriate next step in the management of his itching?
A) Arrange for radiation therapy of the abdomen
B) Initiate oral cholestyramine therapy
C) Initiate oral codeine therapy
D) Initiate oral methotrexate therapy
E) Place the patient on a low-fat diet
16.
A 73-year-old woman returns to the office for follow-up of hypertension. She has tried lowering her blood pressure with lifestyle modification, but blood pressure measurements checked regularly at home during the past 3 months have averaged 150/82 mm Hg. She is otherwise healthy and takes no medications. She has a family history of hypertension in her mother, who had a stroke at age 71 years. The patient's vital signs today are temperature 36.8°C (98.2°F), pulse 74/min, respirations 18/min, and blood pressure 154/84 mm Hg. Physical examination, including funduscopic examination, shows no abnormalities. Results of laboratory studies are shown:
Serum
Creatinine 1.0 mg/dL
Na+ 141 mEq/L
K+ 3.9 mEq/L
ECG is obtained and is normal. Echocardiogram shows an ejection fraction of 0.60 but is otherwise normal. In assessing this patient's need for pharmacotherapy, which of the following factors is most compelling?
A) Diastolic blood pressure measurement
B) Family history of stroke
C) The lack of end-organ damage
D) The patient's age
E) Systolic blood pressure measurement
17.
A 32-year-old man comes to the office for an annual health maintenance examination. He says he generally has felt well. Medical history is remarkable only for an episode of renal calculi 4 years ago. The patient works in construction, is married, and has no children. He does not smoke cigarettes or use illicit drugs. He drinks three to four beers daily. Family history is remarkable for diabetes mellitus in his mother and myocardial infarction at age 53 years. His father died of thyroid cancer at age 44 years. A paternal uncle also has a history of renal calculi and had recent neck surgery. The patient is 180 cm (5 ft 11 in) tall and weighs 109 kg (240 lb); BMI is 34 kg/m2. Vital signs are temperature 37.2°C (99.0°F), pulse 96/min, respirations 14/min, and blood pressure 130/80 mm Hg. Physical examination discloses no abnormalities. Results of fasting laboratory studies are shown:
Serum
ALT 28 U/L
AST 26 U/L
Urea nitrogen 9 mg/dL
Creatinine 0.9 mg/dL
Na+ 144 mEq/L
K+ 3.9 mEq/L
Cl− 100 mEq/L
HCO3− 23 mEq/L
Calcium 10.4 mg/dL
Glucose 154 mg/dL
Phosphorus 2.0 mg/dL
TSH 3.6 μU/mL
Which of the following is the most appropriate next test to order?
A) CT scan of the neck
B) Exercise stress test
C) Renal ultrasonography
D) Serum calcitonin concentration
E) Serum parathyroid hormone concentration
18.
A 35-year-old woman with rheumatoid arthritis returns to the office for a follow-up examination. Treatment has consisted of ibuprofen, intermittent prednisone for the past 5 years, and therapy with methotrexate initiated 1 year ago for continued multijoint involvement. The methotrexate has provided some relief, but she continues to have 1 hour of morning stiffness daily and several actively inflamed joints. She is 168 cm (5 ft 6 in) tall and weighs 66 kg (145 lb); BMI is 23 kg/m2. Vital signs are temperature 37.2°C (99.0°F), pulse 78/min, respirations 13/min, and blood pressure 138/82 mm Hg. Physical examination discloses warmth, erythema, tenderness, and sponginess of the metacarpophalangeal and proximal interphalangeal joints and wrists bilaterally and in the right elbow and left knee. The remainder of the physical examination shows no abnormalities. You are considering beginning tumor necrosis factor-alpha inhibitor therapy. Which of the following is the most appropriate next step prior to modifying the patient's therapy?
A) Order echocardiography
B) Order a 24-hour urine protein concentration
C) Order an MRI of the brain
D) Order serum rheumatoid factor assay
E) Place a PPD skin test
0 - ArchivalUser - 09-06-2014
any photo? no 4
0 - ArchivalUser - 09-06-2014
q4 pic
http://i42.photobucket.com/albums/e338/Graziedoc/STEP%203%20PICS/q4_zps51db9b36.png
0 - ArchivalUser - 09-06-2014
1 d
2 e
3 d
4 a, no pic
5 a
6 e
7 e
8 b
9 c
10 b
11 d
12 d
13 d or a
14 a
15 b
16 e
17 e
18 e
0 - ArchivalUser - 09-06-2014
I am taking my exam in 2 days. I don't know what to revise in these 2 days. I have not taken any NBME do you think it is wise to take it this late. MY UWSA 5 days back was 217.
0 - ArchivalUser - 09-06-2014
Can you guys put up some more of the NBME q's so that people like me can discuss and have some exposure to them.
0 - ArchivalUser - 09-06-2014
I will be back tonight to discuss the qs, really busy right now, but we will discuss them all
0 - ArchivalUser - 09-06-2014
If you haven't check qs from NBME Form 2, here are the links:
Block 1
1/2
http://www.usmleforum.com/showthread.php?tid=786025
2/2
http://www.usmleforum.com/showthread.php?tid=786144
Block 2
http://www.usmleforum.com/showthread.php?tid=786192
Block 3
http://www.usmleforum.com/showthread.php?tid=786701
Block4
http://www.usmleforum.com/showthread.php?tid=786891
Block5:
http://www.usmleforum.com/showthread.php?tid=787045
0 - ArchivalUser - 09-06-2014
Thanks grazie