NBME 3 block 2 questions with answer key needed. - docfoofoo

[ArchivalUser]

Hi there exam is in a few weeks......can someone please post NBME 3 section 2 q and a's
thanks in advance.
docfoofoo

[ArchivalUser]

c'mon people......someone has to have it!!! please

[ArchivalUser]

stilll nobody????

[ArchivalUser]

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* nbme3 sec2
#223301
quansar - 09/25/07 00:43

here you go the section 2, I will work on the sec3/4 in next few days




1. For the past 10 years, a 28-year-old woman has followed a strict diet that prohibits dairy products, meat, fish, and fowl. On routine examination, her hematocrit is 30%, and mean corpuscular volume is 122 pm3. Which of the following is the most
appropriate next step in diagnosis?

O A) Erythrocyte folate determination
O B) Serum iron and total iron-binding capacity determinations
O C) Serum thyroid hormone determination
O D) Serum urea nitrogen (BUN) determination
O E) Serum vitamin B12 (cyanocobalamin) determination

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2. A 47-year-old man comes to the physician because of a persistent nonproductive cough for 3 months. He has not had fever, rhinorrhea, or nasal congestion. He was seen by a physician 3 months ago for the cough and treated with amoxicillin and an over-the-counter cough medication. He has a 3-month history of hypertension well controlled with lisinopril. He is in no distress. He weighs 79 kg (175 lb) and is 178 cm (70 in) tall. His temperature is 37.1°C (98.8°F), blood pressure is 130178 mm Hg, pulse is 721min and regular, and respirations are 161min. Examination shows no abnormalities. A complete blood count and x-ray films of the chest show no abnormalities. Which of the following is the most appropriate next step in management?

O A) X-ray films of the sinuses
O B) Discontinue lisinopril therapy
O Q Add a beclomethasone inhaler to the medication regimen
O D) Add ciprofloxacin to the medication regimen
O E) Add hydrocodone to the medication regimen


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3. A 12-year-old girl is brought to the physician by her mother because she is concerned about her daughter's difficulty making friends and socializing. Her development and adjustment had been normal until 6 months ago when she began to refuse to use restrooms at school or eat in the cafeteria. Her mother describes her as a quiet, serious child who does not readily interact with other people. Her teachers report that her concentration varies. at times, she appears to be daydreaming. On examination, she is reserved but pleasant and appears to be of normal intelligence. Her speech is normal in rate and rhythm. She says that she is concerned that her voice will fail her if she has to read aloud in class. Which of the following is the most likely diagnosis?

O A) Attention-deficitthyperactivity disorder, inattentive type
O B) Autistic disorder
O C) Expressive language disorder
O D) Oppositional defiant disorder
O E) Selective mutism
O F) Social phobia
O G) Age-appropriate behavior

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A picture here for q4

4. A 25-year-old woman is brought to the emergency department 45 minutes after being hit in the right eye with a tennis ball. She has severe pain and decreased vision in the injured eye. Visual acuity is 201400 on the right. A photograph of the eye is shown. Which of the following is the most likely diagnosis?
O A) Acute angle-closure glaucoma
O B) Anterior iritis
O C) Cataract
O D) Hyphema
O E) Hypopyon

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5. A 44-year-old woman is brought to the emergency department 40 minutes after being stabbed in the left groin. Her blood pressure is 128/84 mm Hg, pulse is 100/min, and respirations are 16/min. Examination of the wound shows a small hematoma and no external bleeding. Popliteal and pedal pulses are palpable in the left lower extremity below the injury. Lacerations of the femoral artery and vein are found and repaired. Two days postoperatively, she has progressively severe pain of the left lower extremity and swelling of the leg from the knee down. Which of the following is the most likely cause of her new symptoms?

O A) Arterial embolism
O B) Compartment syndrome
O C) Lymphatic disruption from the injury
O D) Thrombosis of the femoral vein
0 E) Wound hemorrhage

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6. The crude mortality rate for coronary artery disease in Community A is twice the crude mortality rate for coronary artery disease in Community B. The age-standardized mortality rates for coronary artery disease in the two communities are the same. These findings are most consistent with which of the following inferences?

A) Coronary artery disease mortality in the elderly is higher in Community A than Community B
B) Coronary artery disease mortality in young adults is higher in Community A than Community B
C) The population of Community B is younger than the population of Community A
D) The proportionate mortality from coronary artery disease is higher in Community A than Community B
E) The two communities have similar age distributions

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7. An otherwise healthy 28-year-old man comes to the physician because of a dry hacking cough for 3 months. A routine examination 6 months ago showed no abnormalities. His paternal grandfather had colon cancer. Examination today shows normal findings. An x-ray film of the chest shows a large anterior mediastinal mass. Which of the following is the most likely origin of this neoplasm?
O A) Colon
O B) Kidney
O C) Prostate
O D) Stomach
0 E) Testicle

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A testis tumor may become metastatic and manifest with large retroperitoneal and/or chest lesions, while the primary tumor is nonpalpable. Scrotal ultrasonography may locate the primary tumor. Histopathology of the primary testis often shows a focus of tumor surrounded by fibrous scar, termed burned-out testis cancer.

8. A 50-year-old man has a cardiac arrest during sexual intercourse. He is promptly resuscitated and recovers uneventfully from an acute anterior wall myocardial infarction. At discharge from the hospital, he and his wife inquire about the safety of future sexual intercourse. Which of the following is the most appropriate advice?
O A) Psychiatric consultation is necessary
O B) Sexual intercourse should be performed while wearing an ambulatory ECG monitor
O C) Sexual intercourse will be safe when exercise tolerance improves
O D) They should wait 3 months before having sexual intercourse
O E) They should have sexual intercourse as soon as possible to overcome the fear of another event



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9. A 68-year-old woman with terminal metastatic breast cancer is living at home with her son. She has a living will requesting that she be allowed to "die in peace." She is unresponsive to voice and has not had any food or liquids for 3 days. Her son disagrees with her decision not to accept further therapy, including chemotherapy, antibiotics, hospitalization, and enteral or parenteral nutrition. Which of the following is the most appropriate next step in management?
p A) Abide by the decisions of the next of kin
p B) Obtain a court order to allow additional therapy to be given
O C) Start enteral feedings
p D) Admit her to the hospital
0 E) No further intervention


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10. A 57-year-old woman comes to the physician for a follow-up examination. She has a 5-year history of hypercalcemia, which was diagnosed with routine laboratory studies, and her serum calcium levels have ranged from 10.8 mg/dL to 11.5 mg/dL. She declined further evaluation in the past because she "felt well." She takes no medications. Her last menstrual period was 7 years ago. She maintains a weight of 67 kg (148 lb) and is 170 cm (67 in) tall, BMI is 23 kg/m2. Her blood pressure is 126/80 mm Hg, and pulse is 66/min. Examination shows no abnormalities. Which of the following is the most appropriate next step to assess her risk for fracture?

O A) 24-Hour urine collection for measurement of collagen cross-links excretion
O B) Bone densitometry
O C) Bone-specific measurement of serum alkaline phosphatase activity
O D) Posteroanterior and lateral x-ray films of the thoracic spine and hips
O E) Biopsy of the iliac crest


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11. A 30-year-old woman, gravida 4, para 3, is admitted to the hospital in labor at 38 weeks' gestation. The cervix is 4 cm dilated. Contractions occur every4 minutes. The fundal height is 40 cm. The membranes are intact. The fetal lie cannot be determined by abdominal examination, and no presenting part is palpable in the pelvis. Which of the following is the most appropriate next step in management?

O A) Ultrasonography
O B) Administration of oxytocin
O C) Administration of tocolytic drugs
O D) Amniotomy
O E) Cesarean delivery


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12. Six days after undergoing a laparoscopic cholecystectomy for acute cholecystitis, a 35-year-old woman comes to the physician because of fever and abdominal pain for 3 days. She is jaundiced. Her temperature is 38°C (100.4°F). Abdominal examination shows distention and incisions that are healing normally. Leukocyte count is 12,000/mm3, and total serum bilirubin level is 7.9 mg/dL. Which of the following is the most likely cause of the jaundice?

O A) Anesthetic-related hepatitis
O B) Common bile duct injury
O C) Fulminant hepatic failure
O D) Reaction to perioperative antibiotics
O E) Subhepatic abscess

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13. A 9-year-old boy is brought to the physician because of progressive weakness and a purple-red discoloration over his cheeks and upper eyelids over the past 8 weeks. His symptoms began shortly after a camping trip, and he now is unable to climb stairs, walk long distances, comb his hair, or dress himself. His mother says that she was careful to apply his sunscreen on the trip and can recall no tick bites or exposure to poisonous plants. His only medication is a topical corticosteroid for several dry, scaly patches of the skin. He appears weak and lethargic. He is at the 75th percentile for height and 25th percentile for weight, he has had no change in his weight since his last examination 9 months ago. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. Examination of the skin shows a purple-red discoloration over the cheeks and eyelids, periorbital edema, erythematous plaques and scales over the elbows and knees, and flat-topped red papules over all knuckles. There is generalized weakness and atrophy of the proximal muscles. Which of the following is the most likely diagnosis2

O A) Dermatomyositis
O B) Duchenne's muscular dystrophy
O C) Eczema
O D) Lyme disease
O E) Psoriasis
O F) Rocky Mountain spotted fever
O G) Seborrhea
0 H) Systemic lupus erythematosus


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14. An 82-year-old man is brought to the emergency department because of the sudden onset of confusion 48 hours ago. His family says that he previously had been functional and independent. His temperature is 37.5°C (99.5°F), blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 12/min. The skin is warm and clammy. Bowel sounds are hypoactive, and there is guarding and tenderness in the right lower quadrant of the abdomen. Examination of the heart, lungs, and extremities shows no abnormalities. He is drowsy but arousable and oriented to person but not place or time. There are no focal deficits. Which of the following is the most likely
diagnosis?
O A) Appendicitis
O B) Colon cancer
O C) Meningitis
O D) Pneumonia
0 E) Urinary tract infection

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15. Two hours after emergency cholecystectomy, a 48-year-old woman has an oxygen saturation of 84% and a PO2 of 56 mm Hg on 2 Lfmin of oxygen via nasal cannula. Her blood pressure is 120180 mm Hg, and respirations are 16/min. Decreased breath sounds are heard on the right, and there is decreased excursion on inspiration bilaterally. There is minimal dullness over the right base. Examination shows no jugular venous distention or pedal edema. An x-ray film of the chest shows increased density over the right lower lung field, the tracheal, mediastinal, and cardiac silhouettes are shifted to the right. The right lung field appears considerably smaller than the left lung field. Which of the following is the most likely cause of these findings?
O A) Atelectasis
O B) Pleural effusion
O C) Pneumonia
O D) Pneumothorax
0 E) Pulmonary embolism

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16. A 47-year-old man comes to the physician because of low-grade fever and malaise for 3 months. He was infected with hepatitis B 25 years ago. He appears well nourished but ill. His temperature is 37.7°C (99.8°F), blood pressure is 110170 mm Hg, pulse is 801min, and respirations are 121min. Examination shows slight jaundice and hepatomegaly. The spleen is not palpable, and there is no ascites or dependent edema. Serum studies show:

Total bilirubin 3 mg1dL
Alkaline phosphatase 160 U!L
Aspartate aminotransferase (AST, GOT) 230 U!L
Alanine aminotransferase (ALT, GPT) 275 U!L

Serum a-fetoprotein level is markedly increased. Ultrasonography of the right upper quadrant of the abdomen shows a 5-cm, solid lesion in the right lobe of the liver. Biopsy is most likely to show which of the following?
O A) Focal nodular hyperplasia
O B) Hepatic adenoma
O C) Hepatocellular carcinoma
O D) Metastatic adenocarcinoma
0 E) Regenerating liver nodule


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17. A previously healthy 30-year-old woman has had a painless lump in her neck for 2 days. Her mother was treated for a thyroid tumor at the age of 35 years. Her 28-year-old sister has an increased serum calcitonin level but no thyroid mass. Examination shows a palpable thyroid nodule. Her serum calcitonin level is increased. Which of the following diagnoses should be excluded prior to surgical treatment of the thyroid gland?
O A) Adrenocortical carcinoma
O B) Lung carcinoma
O C) Ovarian carcinoma
O D) Parathyroid carcinoma
O E) Pheochromocytoma

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18. A 67-year-old man comes to the physician because of a 1-month history of shortness of breath with exertion, easy fatigability, and mild ankle swelling. Five years ago, he underwent successful chemotherapy with doxorubicin for lymphoma. Moist crackles are heard throughout both lungs. An S3 is heard. The liver edge is palpated 4 cm below the right costal margin. There is 2+ pitting edema of the pretibial region, ankles, and feet. Which of the following is the most likely underlying cause of this patient's symptoms?
O A) Aortic sclerosis
O B) Cardiotoxicity
O C) Cirrhosis
O D) Mediastinal obstruction
0 E) Pneumonitis

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The response options for the next two items are the same. You will be required to select one answer for each item in the set.

For each patient with vaginal bleeding during pregnancy, select the most likely diagnosis.

O A)Abortion of a blighted twin
O B)Cervicitis
O C)Ectopic pregnancy
O D)Focal decidual necrosis
O E) Gestational trophoblastic disease
0 F) Incomplete abortion
0 G) Ovarian torsion
0 H) Ruptured ovarian cyst
0 I) Threatened abortion


19. A 23-year-old woman, gravida 2, para 0, has had vaginal spotting and abdominal cramps for 2 days. Her last menstrual period was 8 weeks ago. A home pregnancy test was positive 2 weeks ago. She underwent a salpingectomy4 years ago following an ectopic pregnancy. Examination shows a closed cervix, an enlarged uterus, and no adnexal masses. Transvaginal ultrasonography shows an empty uterus. Serum 3-hCG level is 8000 mIU1mL.

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For each patient with vaginal bleeding during pregnancy, select the most likely diagnosis.

C A) Abortion of a blighted twin 0 F) Incomplete abortion
C B) Cervicitis ) Ovarian torsion
0 C) Ectopic pregnancy H) Ruptured ovarian cyst
0 D) Focal decidual necrosis I) Threatened abortion
0 E) Gestational trophoblastic disease


20. A 25-year-old woman has had painless vaginal postcoital bleeding for 2 hours. Her last menstrual period was 10 weeks ago. A pregnancy test is positive. There is a small amount of dark blood in the vaginal canal. She has a reddened, friable cervical os.


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21. A previously healthy 62-year-old man comes to the physician because of a 1-year history of numbness and weakness of the right hand. He is a carpenter and has no history of injury to his hand. Examination shows wasting of muscle mass in the first web space. Sensation to touch is decreased along the ring and little fingers. There is weakness of abduction and adduction of the fingers. Which of the following is the most likely site of nerve injury?
O A) Axillary nerve
O B) Long thoracic nerve
O C) Median nerve above the elbow
O D) Median nerve at the elbow
O E) Median nerve at the wrist
O F) Musculocutaneous nerve above the elbow O G) Musculocutaneous nerve at the elbow
O H) Musculocutaneous nerve at the wrist
O I) Radial nerve above the elbow
O J) Radial nerve at the elbow
O K) Radial nerve at the wrist
O L) Suprascapular nerve
O M) Thoracodorsal nerve
0 N) Ulnar nerve at the elbow

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22. A 45-year-old man comes to the physician for a follow-up visit. He has had recurrent ulcer disease for 8 years, his symptoms are currently relieved with antacid therapy. He had one episode of bleeding 1 year ago that required a blood transfusion. He appears pale. His hemoglobin level is 10.6 g/dL, mean corpuscular volume is 78 pm3, and reticulocyte count is 0.8%. Which of the following additional laboratory findings is most likely?

Serum Iron Iron-binding Capacity (TIBC) Saturation of Serum Ferritin
(pg/dL) (pg/dL) (N=250-400) TIBC (%) (ng/mL)
O A) 30 120 25 50
O B) 40 360 11 10
O C) 60 180 33 80
O D) 80 200 40 120
0 E) 100 150 67 600

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23. A 6-year-old girl is brought to the physician because of a 1-day history of vomiting, headache, and weakness. One month ago, she underwent resection of an astrocytoma and placement of a ventriculoatrial shunt for residual hydrocephalus, her postoperative course had been uncomplicated. Currently, she is drowsy and irritable. Her temperature is 37.5°C (99.5°F), blood pressure is 126/54 mm Hg, pulse is 82/min, and respirations are 24/min. Funduscopic examination shows papilledema. Reflexes are brisk with hypertonia in the lower extremities.

Which of the following is the most likely underlying mechanism for these symptoms?

O A) Carcinomatous infiltration of cerebrospinal fluid
O B) Malfunction of ventriculoatrial shunt
O C) Overproduction of cerebrospinal fluid from a choroid plexus papilloma
O D) Recurrence and extension of the astrocytoma
O E) Thrombosis of the superior sagittal sinus



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The response options for the next three items are the same. You will be required to select one answer for each item in the set.

For each patient with a respiratory problem, select the most appropriate next step in management.

O A)Administration of BCG vaccine
O B)Administration of an inhaled bronchodilator
O C)Administration of oxygen
O D)Arterial blood gas analysis
O E)Bronchoscopy
O F)Culture of the pharynx for bacteria
O G)Direct laryngoscopy
O H) Gastric washings for acid-fast bacteria
O I) Intravenous infusion of saline
O J) Isoniazid and rifampin therapy O K) Lumbar puncture
O L) Measurement of serum aspirin level
O M) Subcutaneous administration of epinephrine.
N) Viral culture of respiratory secretions
00) X-ray films of the chest
O P) X-ray films of the neck


24. A previously healthy 8-year-old boy is brought to the emergency department because of swelling of the lips and difficulty breathing for 20 minutes. The symptoms began when he was helping his father clean the gutters on their house. He appears anxious. His temperature is 37.2°C (99°F), pulse is 1201min, and respirations are 50/min. Pulse oximetry shows an oxygen saturation of 96%. His lips and eyes appear puffy. He has subcostal and intercostal retractions. Auscultation of the chest shows diffuse bilateral wheezing.


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For each patient with a respiratory problem, select the most appropriate next step in management.

O A)Administration of BCG vaccine 0 I) Intravenous infusion of saline
O B)Administration of an inhaled bronchodilator O J) Isoniazid and rifampin therapy
Oc)Administration of oxygen O K) Lumbar puncture
O D)Arterial blood gas analysis O L) Measurement of serum aspirin level
O E)Bronchoscopy O M) Subcutaneous administration of epinephrine
O F)Culture of the pharynx for bacteria O N) Viral culture of respiratory secretions
O G)Direct laryngoscopy 00) X-ray films of the chest
O H)Gastric washings for acid-fast bacteria O P) X-ray films of the neck


25. A 16-year-old girl is brought to the emergency department because of heavy breathing for 8 hours, and vomiting and ringing in the ears for 1 hour. She recently broke up with her boyfriend and has been threatening to hurt herself. She appears somnolent but is arousable and answers questions appropriately. Her temperature is 37.5°C (99.5°F), pulse is 88/min, and respirations are 50/min. Pulse oximetry shows an oxygen saturation of 96%. She has no retractions, nasal flaring, or cough. The lungs are clear to auscultation.


L) Measurement of serum aspirin level



For each patient with a respiratory problem, select the most appropriate next step in management.

0 A)Administration of BCG vaccine 0 I) Intravenous infusion of saline
0 B)Administration of an inhaled bronchodilator 0 J) Isoniazid and rifampin therapy
0 C)Administration of oxygen 0 K) Lumbar puncture
0 D)Arterial blood gas analysis O L) Measurement of serum aspirin level
0 E)Bronchoscopy 0 M) Subcutaneous administration of epinephrine
0 F)Culture of the pharynx for bacteria 0 N) Viral culture of respiratory secretions
O G)Direct laryngoscopy O) X-ray films of the chest
O H)Gastric washings for acid-fast bacteria 0 P) X-ray films of the neck


26. A previously healthy 6-year-old boy is brought to the physician for a follow-up examination after a PPD skin test produced an induration greater than 15 mm. He has had no cough or fever. He has a good appetite and is at the 50th percentile for height and weight. He appears well. His temperature is 37.2°C (99°F), pulse is 88/min, and respirations are 18/min. The lungs are clear to
auscultation.

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27. A 25-year-old nulligravid woman comes to the emergency department because of severe pain in the right lower quadrant of the abdomen for 4 hours. She has had no nausea, vomiting, fever, or chills. Three weeks ago, a right adnexal mass was found on routine examination. Her last menstrual period was 3 days ago. Her temperature is 37.2°C (99°F), blood pressure is 110/70 mm Hg, and pulse is 92/min. Pelvic examination shows right adnexal tenderness. Hemoglobin level is 13 g/dL, and leukocyte count is 9000/mm3. Pelvic ultrasonography shows a small amount of free fluid in the cul-de-sac. Which of the following is the most likely cause of the pain?
O A) Appendicitis
O B) Endometriosis
O C) Ovarian hemorrhage
O D) Ruptured ovarian cyst
O E) Torsion of the adnexa
0 F) Tubal obstruction

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28. A 15-year-old boy comes to the physician because of acne over his face for 1 year. He prefers not to use any oral medications. Examination shows 10 to 15 pustules. Which of the following is the most effective treatment for this patient's symptoms?

p A) Avoidance of chocolate, fatty foods, and caffeine
p B) Use of benzoyl peroxide soap
O C) Vigorous scrubbing of affected areas
p D) Application of vitamin A and vitamin E to affected areas
p E) Ultraviolet light therapy

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29. A 3-year-old boy with acute lymphoblastic leukemia has had fever for 3 days. He completed his last course of chemotherapy 6 days ago. He has had no malaise, rash, or anorexia and has had no known contact with sick children in preschool. He appears well. His temperature is 38.6°C (101.5°F), blood pressure is 75160 mm Hg, pulse is 100/min, and respirations are 22/min. Examination shows normal findings. Laboratory studies show:
Hemoglobin 10.1 g/dL (N=11.5-15.5)
Leukocyte count 2200/mm3
Segmented neutrophils 5%
Bands 1%
Lymphocytes 65%
Atypical lymphocytes 11%
Monocytes 18%
Platelet count 35,000/mm3

Which of the following is the most appropriate next step in management?

O A) Schedule a follow-up visit and discharge without medication
O B) Observe him in the office for 3 hours, discharge without medication if examination remains unchanged
O C) Discharge him with oral broad-spectrum antibiotic therapy
O D) Admit him to the hospital for observation
O E) Admit him to the hospital for intravenous broad-spectrum antibiotic therapy

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30. A 72-year-old woman is brought to the emergency department 1 hour after the sudden onset of right facial droop and weakness of the right arm and leg. She takes captopril for hypertension and daily aspirin. Her blood pressure is 150/90 mm Hg, pulse is 80/min, and respirations are 161min. Examination shows a left carotid bruit and right central facial paralysis. There is moderate expressive aphasia. A CT scan of the head shows no abnormalities. Which of the following is the most appropriate initial pharmacotherapy?
O A) Oral ticlopidine
O B) Oral warfarin
O C) Sublingual nifedipine
O D) Intravenous nitroprusside
O E) Intravenous tissue plasminogen activator




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31. A previously healthy 37-year-old woman comes to the physician because of a 3-month history of episodes of severe anxiety, shortness of breath, palpitations, and numbness in her hands and feet. Her vital signs are within normal limits. Physical examination shows no abnormalities. Thyroid function studies and an ECG show no abnormalities. Which of the following is the most appropriate pharmacotherapy?
A) Lithium carbonate
B) Methylphenidate
O C) Olanzapine
p D) Paroxetine
0 E) Valproic acid

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32. A 37-year-old nulligravid woman comes to the physician because she has not been able to conceive for 2 years. Her 40-year-old husband has a child by a previous marriage. Her last menstrual period was 6 weeks ago, menses have occurred at increasingly infrequent intervals over the past year. Fifteen years ago, she was treated for one episode of Chlamydia trachomatis infection. She weighs 59 kg (130 lb) and is 170 cm (67 in) tall. Examination shows no abnormalities. Serum studies show:

R-hCG <5 mlUfmL
Follicle-stimulating hormone 50 mlU1mL
Luteinizing hormone 45 mlUfmL
Prolactin 13 ngfmL
Thyroid-stimulating hormone 3 pU/mL

Which of the following is the most likely cause of this patient's infertility?

O A) Hypothalamic amenorrhea
O B) Hypothyroidism
O C) Pituitary adenoma
O D) Polycystic ovarian disease
O E) Premature ovarian failure
0 F) Tubal factor


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33. A 47-year-old woman comes to the physician because of a 2-day history of fever and joint pain. Six days ago, she completed a 10-day course of dicloxacillin for folliculitis. She appears comfortable. Her temperature is 38.6°C (101.5°E), pulse is 721min and regular, respirations are 161min, and blood pressure is 120176 mm Hg. Examination shows an urticarial rash over the trunk and extremities. There is moderate generalized lymphadenopathy and diffuse joint tenderness. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these symptoms?
O A) Epstein-Barr virus infection
O B) IgE-mediated allergic reaction
O C) Mycobacterium haemophilum infection
O D) Serum sickness
0 E) Staphylococcal sepsis

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34. A 34-year-old man is brought to the emergency department by his family because of a decreased need for sleep, increased goal-directed activity, increasingly irritable and unstable mood, and uncharacteristic sexual promiscuity over the past week. Yesterday, he quit his long-standing job at a hardware store and plans to move to Washington, DC, to become the "Senator-in-Chief." He says that this position is being created especially for him by the president. He believes that he has developed supersensitive hearing and is now able to hear conversations of people hundreds of miles away. He has no history of drug use, and there is no personal or family history of psychiatric illness. On examination, he is extremely irritable and agitated, threatening to "punch out anyone who tries to mess with me." Which of the following is the most likely diagnosis?
O A) Bipolar disorder
O B) Cyclothymic disorder
O C) Delusional disorder
O D) Schizophrenia
O E) Schizophreniform disorder

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35. A 17-year-old girl has had flu-like symptoms, low-grade fever, and malaise for 3 days and mild jaundice for 2 days. Serum studies show an aspartate aminotransferase (AST, GOT) activity of 670 UIL and an alanine aminotransferase (ALT. GPT) activity of 860 U/L. Serum IgM antibody to hepatitis A is positive. Which of the following is most likely to minimize the risk for this disease in family members?
O A) Acyclovir therapy for family members
O B) Hepatitis B vaccination for family members
O C) Immune globulin therapy for family members
OD) Interferon alfa-2b therapy for family members
0 E) Use of separate toilet facilities by the patient

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36. One day after missing her dialysis treatment, a 27-year-old woman comes to the physician because of generalized weakness. Her blood pressure is 95172 mm Hg, and pulse is 45/min and regular. Examination shows a well-functioning arteriovenous fistula in the left upper extremity. Muscle strength is 315 in all extremities. An ECG shows third-degree atrioventricular block. Laboratory studies are ordered. Which of the following is the most appropriate next step in management?
O A) Kayexalate-sorbitol enema
O B) Intravenous administration of calcium gluconate
O C) Oral administration of sodium polystyrene sulfonate (Kayexalate)
O D) Immediate placement of a pacemaker
O E) No treatment pending laboratory results


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37. A previously healthy 2-year-old boy is brought to the physician because of fever and abdominal pain for 24 hours. His developmental milestones are appropriate for age. He is fully alert and responsive. His temperature is 38.6°C (101.5°F), blood pressure is 85/60 mm Hg, pulse is 1001min, and respirations are 20/min. Examination shows suprapubic tenderness to deep palpation but no guarding or rebound. There are no palpable abdominal masses or costovertebral angle tenderness. The penis is circumcised, there is no urethral discharge. Urinalysis shows 20-30 leukocytes/hpf, 5-6 erythrocytes/hpf, and nitrites. A urine culture grows 100,000 colonies/mL of Escherichia coli sensitive to all tested antibiotics. Amoxicillin therapy is initiated. Five days later, he is afebrile and asymptomatic. Ultrasonography of the kidneys shows no abnormalities. Which of the following is the most appropriate next step in management?

O A) Discontinue the antibiotic in 2 days and reexamine only if symptoms recur
O B) Voiding cystourethrography
O C) Intravenous pyelography
O D) Cystoscopy
O E) No further testing


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38. A 62-year-old woman comes to the physician because of increasingly severe low back pain over the past month. Prolonged periods of rest have not relieved her symptoms. Sensorimotor examination of the lower extremities shows no abnormalities. Her hematocrit is 32%, and serum calcium level is 12 mgfdL. An x-ray film of the chest shows no abnormalities. An x-ray film of the spine is shown. Which of the following is the most likely diagnosis?
O A) Herniated nucleus pulposus
O B) Mechanical low back pain
O C) Metastatic carcinoma
O D) Osteopetrosis
0 E) Spinal stenosis


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39. A 43-year-old man comes to the physician for evaluation and management of cardiac risk factors 8 weeks after sustaining a myocardial infarction. He takes aspirin and metoprolol daily, and he does not smoke cigarettes. His father and brother both had myocardial infarctions before the age of 50 years, their serum cholesterol levels are unknown. There is no family history of diabetes mellitus. He weighs 86 kg (190 lb) and is 180 cm (71 in) tall. His blood pressure is 130170 mm Hg, pulse is 68/min, and respirations are 14/min. Two years ago, his serum cholesterol level was 245 mg/dL. Fasting serum glucose level is 88 mg/dL. Which of the following is the most appropriate next step to evaluate his cardiac risk factors?


O A) Random measurements of serum cholesterol level
O B) Measurement of fasting serum cholesterol level only
O C) Fasting serum lipid studies only
O D) Oral glucose tolerance test and fasting serum lipid studies
O E) Oral glucose tolerance test and measurement of fasting serum cholesterol level

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40. A 47-year-old man comes to the physician because of a 3-week history of increasing facial swelling and a 1-week history of morning headaches and mild shortness of breath. He had previously felt well. He completed a course of chemotherapy 4 months ago for small cell carcinoma of the lung. His temperature is 37.2°C (98.9°F), blood pressure is 142180 mm Hg with an 8-mm Hg paradoxical pulse, pulse is 84/min, and respirations are 18/min. Examination shows significant diffuse facial and periorbital edema. The optic discs are sharp, and ocular movements are intact. The lungs are hyperresonant bilaterally with a moderately prolonged expiratory phase. Mild rhonchi are heard on inspiration and expiration. An x-ray film of the chest shows a 10-cm mass in the right upper lobe and apex. Which
of the following is the most likely explanation for these findings?
O A) Chemotherapy-induced bone marrow toxicity
O B) Chemotherapy-related cardiac toxicity
O C) Hypercoagulable state secondary to malignancy
O D) Interstitial metastatic pulmonary disease
O E) Intracranial metastases
O F) Lymphatic obstruction
O G) Malignant pericarditis
O H) Paraneoplastic syndrome
O I) Pleural metastases
O J) Soft tissue metastases
0 K) Vascular obstruction


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41. A 13-month-old girl is brought for a well-child examination. There is no history of prenatal or perinatal problems. Her diet consists of breast milk, juice, legumes, cooked vegetables, and fruit. She has had three ear infections treated successfully with amoxicillin and two episodes of diarrhea since birth. She will pull to a stand and stand alone for 1 minute but has not begun to walk. She is able to pick up raisins with her thumb and forefinger but is unable to feed herself with a spoon. Which of the following is the most appropriate
assessment of fine and gross motor development?

`` Fine Motor Gross Motor
Development Development
O A) Normal normal
O B) Normal delayed
O C) Delayed normal
O D) Delayed delayed

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42. An 18-month-old girl is brought to the physician because of intermittent shortness of breath over the past 6 months. Her mother notes that her daughter often squats to relieve her symptoms. Examination shows cyanosis and clubbing of the fingers. A prominent right ventricular impulse with a grade 3/6, systolic ejection murmur is heard best in the third left intercostal space. An ECG shows right ventricular hypertrophy. An x-ray film of the chest shows a small-sized heart and decreased pulmonary blood flow. Which of the following is the most likely diagnosis?
O A) Atrial septal defect (ostium primum type)
O B) Atrial septal defect (ostium secundum type)
O C) Atrioventricular canal
O D) Coarctation of the aorta
O E) Hypoplastic left heart syndrome
O F) Patent ductus arteriosus
O G) Tetralogy of Fallot
O H) Transposition of the great arteries
O I) Tricuspid atresia
0 J) Ventricular septal defect

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43. A 5-day-old girl has been feeding poorly since birth. She weighed 2900 g (6 lb 7 oz) at birth and now weighs 2600 g (5 lb 12 oz). Physical examination shows an enlarged clitoris and labial fusion. A sibling born 5 years ago died at 1 week of age. A life-threatening complication of this syndrome results from failure to produce which of the following?
O A) Aldosterone
O B) Cholesterol
O C) Estrogen
O D) Insulin
0 E) Testosterone


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44. A 57-year-old hospitalized man undergoes right subclavian venous catheterization for hyperalimentation. He is currently being treated for a small bowel fistula. While the results of an x-ray film of the chest to check the catheter position are pending, the patient suddenly becomes agitated. His blood pressure is 70150 mm Hg, and pulse is 1101min. Examination shows jugular venous distention. The lungs are clear to auscultation. Breath sounds are equal bilaterally. The trachea is midline. An x-ray film of the chest shows a catheter in the superior vena cava, transversing the right ventricle and crossing to the left of the midline. Which of the following is the most likely cause of this patient's hypotension?
O A) Air embolism
O B) Pericardial tamponade
O C) Pulmonary artery perforation
O D) Staphylococcal bacteremia
O E) Tension pneumothorax

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45. Twenty-four hours after hospitalization for fixation of a femoral fracture, a 35-year-old construction worker has nausea, agitation, and insomnia. His blood pressure is 1501100 mm Hg. He is oriented but anxious. Which of the following is the most appropriate next step in diagnosis?
O A) Inquire about recent alcohol intake
O B) Examination of a urine specimen for fat bodies
O C) Leukocyte count with differential
O D) ECG
0 E) Pulmonary arteriography

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46. A previously healthy 27-year-old woman comes to the physician because of a 3-month history of moderate abdominal pain that improves for a short time after she eats. She has not had any rectal bleeding. Her temperature is 36.4°C (97.5°F), blood pressure is 110170 mm Hg, and pulse is 80/min. Abdominal examination shows midepigastric tenderness. Her hemoglobin level is 12 gfdL, and leukocyte count is 80001mm3. Serum Helicobacterpylori antibody assay is positive. Which of the following is the most appropriate next step in management?
O A) HIDA scan
O B) Amoxicillin, clarithromycin, and omeprazole therapy
O C) Ciprofloxacin therapy
O D) Omeprazole, magnesium hydroxide, and metoclopramide therapy O E) Ranitidine therapy


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* Re:nbme3 sec2
#945453
resident07 - 09/25/07 00:46

thank you!
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* Re:nbme3 sec2
#945759
multivit - 09/25/07 09:37

thanks a lot !!
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* Re:nbme3 sec2
#946378
cutierp - 09/25/07 13:48

amazing..thanks a lot mate..
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* Re:nbme3 sec2
#946432
jjliu - 09/25/07 14:08

thanks, quansar!
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