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+--- Thread: nbme mcq - gumin1009 (/showthread.php?tid=364356)
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nbme mcq - gumin1009 - ArchivalUser - 11-27-2008
25. A 25-year-old woman returns to the office because of intermenstrual spotting since beginning oral contraceptive therapy 6 months ago. This is her first attempt at oral contraceptive therapy; she and her partner primarily used condoms for contraception in the past. Before this current therapy her menstrual periods had always been regular. Which of the following is the most appropriate management?
A) Advise her to take two pills daily until the bleeding stops
B) Discontinue the oral contraceptive therapy and have her resume use of condoms for birth control
C) Reassure her that the bleeding problem will resolve in a few months
[D) Switch the current oral contraceptive pill to one containing a higher estrogen dose]
E) Switch to a progestin-only oral contraceptive pill
24. A 56-year-old Native American man returns to the office to discuss results of studies obtained during a previous visit 8 weeks ago. The patient has a 19-year history of diabetes mellitus treated with sulfonylurea. He checks his serum glucose concentration approximately once daily. He does not smoke cigarettes and rarely drinks alcoholic beverages. He is 183 cm (6 ft) tall and weighs 76 kg (168 lb); BMI is 23 kg/m2. Vital signs during the previous visit were temperature 36.9°C (98.4°F), pulse 82/min, and blood pressure 130/85 mm Hg. Physical examination of the neck disclosed a right-sided carotid bruit. Examination of the extremities disclosed diminished pulses with associated hair loss over both legs. Hemoglobin A1c was 7.2%. Urine albumin-creatine ratio was 62 mg/g/24 h (NAnkle-brachial index (ABI) was 0.89 on the left and 0.98 on the right; duplex carotid ultrasonography showed nonulcerated plaque with 70% stenosis in the right internal carotid artery. The patient was referred to an ophthalmologist, who diagnosed him with nonproliferative background diabetic retinopathy. Which of the following findings in this patient is of most concern?
[A) 70% stenosis of the right carotid artery]
B) Hemoglobin A1c of 7.2%
C) Left ABI of 0.89
D) Nonproliferative diabetic retinopathy
E) Urine albumin-creatine ratio of 62 mg/g/24 h
0 - ArchivalUser - 11-27-2008
1 c
2 d
0 - ArchivalUser - 11-28-2008
1.C
2.D
0 - ArchivalUser - 11-28-2008
1.D
2.B
0 - ArchivalUser - 11-28-2008
1) e
2)D
0 - ArchivalUser - 11-28-2008
C
A
0 - ArchivalUser - 11-28-2008
1. c
2. c
0 - ArchivalUser - 11-28-2008
Can each of us explain our choices for q 2?
For me it is the 70% stenosis of carotid he is at high risk of stroke or TIA.Stenosis of 70-99% needs surgery by CEA.
HBA1c should be below 7 so he is not so bad with his control but he needs stricter control of his sugar.
For retinopathy,note that it is background nonproliferative.Only severe nonprolif or prolif retinopathy is urgent.
For ABPI,he has ischemia but not critical.If it were below 6 then yes.
For E, Microalbuminuria: 30-300 mg albumin/g Creatinine.This can be controlled on ACEI and it takes several yrs b4 ESRD.
0 - ArchivalUser - 11-28-2008
Sorry,a mistake in my explanation for ABPI.It should be If ABPI was
0 - ArchivalUser - 11-28-2008
0.6 not 6