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+--- Thread: nbme 11-20 - sanket4in (/showthread.php?tid=518620)
nbme 11-20 - sanket4in - ArchivalUser - 07-13-2010
11. A 48-year-old man who smokes cigarettes has had progressive claudication in the left calf for the past month. He says the pain lasts about 5 minutes and then subsides. Physical examination shows absent pulses in the left foot and normal pulses in the right foot. Atrophic changes are noted in both legs. Doppler examination shows a 0.40 left ankle/brachial ratio; there is no change with exercise. Which of the following is the most likely diagnosis?
A
) Aortic occlusive disease
B
) Femoral popliteal occlusive disease
C
) Leriche syndrome
D
) Peripheral small-vessel occlusive disease
E
) Thromboangiitis obliterans
12. A 52-year-old Hispanic computer technician comes to the office because of a 3-week history of substernal chest discomfort when she climbs stairs or eats a heavy meal. She first noticed the discomfort after climbing two flights of stairs. The discomfort is nonradiating and sometimes only involves the left side of the chest. She has hypertension and type 2 diabetes mellitus. Current medications include metformin and an ACE inhibitor. She has recently had increased stress because her company is experiencing financial difficulty. Her husband receives medical disability benefits, and they are dependent on her income. Physical examination shows no abnormalities. Which of the following risk factors is most important to consider when assessing her chest pain?
A
) Age
B
) Diabetes mellitus
C
) Gender
D
) Hypertension
E
) Stress level
13. A 47-year-old woman returns to the office because of gastrointestinal symptoms. She says, "I still have burning pain in my stomach that travels up my chest to my neck after I eat." During the past 5 years she has been treated with antacids, H2-blocking medications, proton pump inhibitors and motility agents, with only mild relief. She smokes one pack of cigarettes per day and drinks one cup of coffee in the morning. There is no family history of peptic ulcer disease. Previous endoscopies, the last of which was 6 months ago, have shown lower esophagitis secondary to reflux with healing ulcers and scarring. Gastric and duodenal cultures for Helicobacter pylori have been negative. Vital signs today are normal. Physical examination, including rectal examination, is normal. Which of the following is the most appropriate next step?
A
) Consider an alternative pharmacotherapeutic regimen
B
) Continue current treatment
C
) Do esophageal pH monitoring
D
) Obtain surgical consultation
E
) Repeat endoscopy
14. A 38-year-old woman with systemic lupus erythematosus but no evidence of nephritis comes to the office because of a 3-week history of mood swings with crying spells, irritability and insomnia. She is especially upset because she has been yelling at her children "over small, everyday things." One month ago she started corticosteroid therapy. She is currently taking prednisone, 60 mg/day. Her other medications include an oral contraceptive (the same one for the past 6 years) and ibuprofen. She smokes one-half pack of cigarettes daily, drinks one to two beers 5 nights weekly and three cups of coffee each morning. Which of the following is the most appropriate intervention for her mood disturbance?
A
) Add amitriptyline at bedtime
B
) Discontinue the oral contraceptive
C
) Reduce the prednisone dosage
D
) Replace ibuprofen with acetaminophen
E
) Urge her to stop smoking and to reduce her alcohol and caffeine intake
15. A 76-year-old retired pharmacist is brought to the health center by his wife, who says, "He's afraid to go to sleep, Doctor. Tell him, Henry." He tells you that he was mugged and assaulted 1 week ago while he was out for a walk early in the morning. The patient proceeds to tell you that he has been having nightmares, not about the assault, but of being in vulnerable situations. He also feels anxious during the day but he is able to leave the house without difficulty. In addition to supportive therapy, which of the following pharmacotherapies is most appropriate to prescribe?
A
) Amitriptyline
B
) Clonazepam
C
) Diphenhydramine
D
) Gabapentin
E
) Risperidone
16. A 58-year-old white store manager comes to the office for a periodic health evaluation. You have been treating both the patient and his wife for the past 15 years. Today the patient is tearful and agitated. He says that he is having difficulty with his son, who is age 32 years and has schizophrenia. The son has been living intermittently in a group home or on the streets. The patient says that his son is noncompliant with his antipsychotic medications. Recently, the son has been calling the patient's house asking for money, which the patient suspects his son uses to buy alcohol and illicit drugs. It is most appropriate to advise the patient to do which of the following?
A
) Arrange an involuntary commitment to a psychiatric hospital for his son
B
) Ask his son's psychiatrist to adjust his medication
C
) Change his phone number
D
) Contact the local chapter of the National Alliance for the Mentally Ill for support and advice
E
) Obtain a restraining order against his son
17. A 20-year-old man comes to the health center because of ankle pain. Two days ago he sustained an inversion injury of his left ankle in a basketball game. He has been able to walk unassisted since the injury. Today he has pain and moderate swelling and discoloration over the lateral malleolus. Physical examination shows tenderness on palpation over the anterolateral corner of the ankle joint. He has had two similar injuries in the past. Which of the following is the most appropriate initial management?
A
) An ankle-strengthening exercise program
B
) Application of a long-leg cast for 3 weeks
C
) Application of a short-leg cast for 3 weeks
D
) Protected weight bearing
E
) Surgical repair of the ankle ligaments
18. A 52-year-old woman comes to the office because of a 4-day history of increasing pain of the right hip and thigh. The pain is exacerbated by lying on her right side while sleeping. She says the pain often awakens her and is accompanied by a burning sensation along the right side of her posterior thigh that radiates to her knee. She usually has stiffness and pain in the hip during the following morning that gradually diminishes as she walks around her house and does house chores. She says the pain is also triggered by sitting with her right leg crossed over the left leg. The patient is otherwise healthy and takes no medications. She is 168 cm (5 ft 6 in) tall and weighs 63 kg (140 lb); BMI is 23 kg/m2. Vital signs are normal. Physical examination discloses tenderness on deep palpation of the right trochanter. Which of the following is the most likely diagnosis?
A
) Arthritis of the hip
B
) Aseptic necrosis of the femoral head
C
) Bursitis
D
) Gout
E
) Osteosarcoma of the femoral head
19. An 18-year-old man comes to the health center because he has had pain in his right leg for the past 5 days. He says that he recently added jogging to his weight-lifting workouts, and he started running 5 miles per day 2 weeks ago. He is 180 cm (5 ft 11 in) tall and weighs 83 kg (185 lb). On physical examination he has moderate tenderness over the midtibia. X-ray of the leg will most likely show which of the following?
A
) A bone cyst
B
) Displaced fracture
C
) Metastatic disease
D
) Soft-tissue calcification
E
) Normal findings
20. A 58-year-old woman comes to the office for follow-up of fibromyalgia. You had been treating her for the past several years for nonspecific muscular aches and pains. In the past you noted that occasionally the pain could be reproduced on physical examination by applying pressure to certain muscles; however, these trigger points seemed to change on each physical examination. Fibromyalgia was diagnosed 3 months ago and amitriptyline therapy was started at that time. At a follow-up visit 3 weeks ago she showed little response to the amitriptyline therapy, and naproxen was added to her regimen. Today she returns to the office complaining that "every time I get the least little bump on my hands the skin seems to tear." Her physical examination is unchanged except for the lesions shown. Which of the following is the most appropriate management?
A
) Discontinue the amitriptyline
B
) Discontinue the naproxen
C
) Prescribe oral corticosteroids
D
) Prescribe topical corticosteroids
E
) Prescribe topical 5-fluorouracil
0 - ArchivalUser - 07-13-2010
e,b,d,e,c,d or e, c, c, e, c.....my answers
0 - ArchivalUser - 07-13-2010
d/b,b,d,c,c,d,d/e,c,e,c
0 - ArchivalUser - 07-13-2010
Thanks Chinni17...Can you please explain ?
Q 11 ...why not e ?
Q 14 ...why c ?
Q 17 ...what would be correct answer?
0 - ArchivalUser - 07-16-2010
For Q17, the answer is A. In most cases of talofibular ligament injury, early surgical intervention is rarely indicated. Early rehabilitation is recommended.
0 - ArchivalUser - 07-16-2010
For Q20, the answer would be B because SJS developed after adding naproxen. Early withdrawal of suspected drugs is more important. Symptomatic treatment is usually performed for SJS. Systemic corticosteroid treatment for SJS is controversial.
0 - ArchivalUser - 04-17-2011
THESE ARE NOT NBME 11, I DID IT TODAY. I DIDN'T RECOGNIZE ANY OF THEM!!!
0 - ArchivalUser - 04-18-2011
my guess as follows
e
b
not sure whether c or d
c
e or b, sanket and chinni can u pls explain why c ??
d looks like the most appropriate ans, not sure of the correct one though
c, cruciate can u pls provide the source to ur ans, thx
c
b, sanket and chinni why not b ??
c
thx
0 - ArchivalUser - 04-18-2011
b
b DM is coronary equivalent
d may be need some nissen fundoplication refractory GERD
c
B will help with anxiety and sleep
d
c
b
e
c