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Discuss NBME Form 2 Block 5/5 - grazie
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08-30-2014, 11:35 AM
21.BB
EMS can get to the patient in matter of minutes. EMS can provide the required immediate supportive treatment.
08-30-2014, 11:57 AM
Q23 I think A,( if not improvement by carbamazepine , phenytoin, baclofen, or gabapentin can be tried).
Kaplan
08-30-2014, 12:24 PM
q22)
Ans: B We have this pt 3 months post MI, we only know he went through cardiac rehabilitation program for 2 months, his medicines, but other than that we don't really know how bad his CAD is. I marked Echo before but thinking twice, I think an Angiogram would be a good study to order since medical records are not available, and we need to assess his actual cardiac function. Please correct me if I am wrong.
08-30-2014, 12:45 PM
23.
A 56-year-old African American man whom you have been treating for tic douloureux of the left trigeminal nerve comes to the office for a follow-up visit. He has been your patient for many years, and you have treated him for his current condition for the past 6 months. He is currently taking carbamazepine. Today he tells you that the episodes of tic activity have become more frequent, especially at night, and they seem to be more severe than when he was first diagnosed. The patient also reports that his face now feels numb and that he is having trouble hearing with the left ear. He is otherwise healthy. Vital signs are normal. There is decreased sensation over the left side of the face and decreased hearing on the left. Which of the following is the most appropriate next step? A) Change his medication to phenytoin B) Increase the carbamazepine dosage C) Obtain consultation with an audiologist D) Obtain MRI of the temporal bones E) Refer him to a surgeon
08-30-2014, 12:51 PM
@jenan
Yes I saw it in Kaplan Step 3, so we choose A Carbamazepine is the Std of care for Tx. In those not controlled with Carbamazepine; Phenytoin, Baclofen and gabapentin can de tried. In those not responding to any form of medical therapy, surgery or alcohol injection into the affected nerve may work. Kaplan, Step 3, p569
08-30-2014, 01:10 PM
24.
A 26-year-old white woman returns to the office for a follow-up visit because of oligomenorrhea and questions about her ability to conceive a child. Her menstrual periods are irregular, often occurring only every 4 to 6 months. She is 163 cm (5 ft 4 in) tall and weighs 85 kg (187 lb); BMI is 32 kg/m2. Blood pressure is 140/88 mm Hg. Skin examination shows facial acne, acanthosis nigricans, and excess hair on her face, around her nipples, and in a line from her umbilicus to pubis. External genitalia are normal. Pelvic ultrasonography shows slightly enlarged ovaries bilaterally. Pap smear at her last visit obtained 1 week ago was normal. Results of laboratory studies obtained 1 week ago are shown: Serum ……………………… Blood TSH 2.0 μU/mL Hematocrit 38% Glucose, random 210 mg/dL ……. Urine Testosterone 96 ng/dL (N=20–75) Pregnancy test Negative Serum 17-hydroxyprogesterone concentration obtained 1 hour after injection of adrenocorticotropic hormone is normal. Today, random fingerstick blood glucose concentration is 230 mg/dL. After discussing your findings with the patient she says that she would like to have children in the future but does not want to get pregnant now. In addition to oral contraceptives, which of the following is the most appropriate pharmacotherapy? A) Acarbose B) Glyburide C) Insulin D) Metformin E) Repaglinide Ans: D Treatment Oral contraceptive pill treats irregular bleeding and hirsutism. The progestin component prevents endometrial hyperplasia. Spironolactone may also be used to suppress hair follicles. Clomiphene citrate or human menopausal gonadotropin (HMG) is the treatment of choice for infertility. Metformin enhances ovulation and manages insulin resistance. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 11235-11239). Kaplan Publishing. Kindle Edition.
08-30-2014, 01:37 PM
25.
An 81-year-old African American woman who has diabetes mellitus comes to the office for a routine appointment. The patient follows a prescribed diet and exercise regimen, and she takes metformin, enalapril, simvastatin, and aspirin. She says she feels well and has been active in her church and community. Vital signs are temperature 37.0°C (98.6°F), pulse 82/min, and blood pressure 145/78 mm Hg. Physical examination discloses a 2 × 2-cm, firm, mobile nodule in the upper outer quadrant of her left breast. The patient asks, "If I have cancer, what therapy is normally recommended for patients of my age?" Which of the following is the most appropriate recommendation? A) Chemotherapy and radiation therapy B) Lumpectomy and chemotherapy C) Lumpectomy with radiation therapy D) Radical mastectomy with radiation therapy E) Observation only Ans: A) Chemotherapy and radiation therapy I marked A in my exam and it was correct. Breast irradiation should be recommended to older women with a life expectancy >5 years. Adjuvant hormone therapy remains a reasonable therapeutic option in elderly women with positive hormone receptor tumours. Aromatase inhibitors have demonstrated a better toxicity profile and effectiveness as adjuvant therapy than tamoxifen in young postmenopausal women but have not been specifically studied in the elderly population. The efficacy of adjuvant chemotherapy for breast cancer has been also established.
08-30-2014, 01:40 PM
26.
A 45-year-old Hispanic woman, gravida 2, para 2, comes to the office for an annual health maintenance examination. She has been a patient of yours for the past 15 years. Medical history is unremarkable and she takes no medications. When you first saw her at age 30 years, she was 160 cm (5 ft 3 in) tall and weighed 54 kg (120 lb); BMI was 21 kg/m2. Since that time, she has been gradually gaining weight, and at last year's physical examination she weighed 68 kg (150 lb). Today she weighs 73 kg (160 lb); BMI is 28 kg/m2. Physical examination discloses no abnormalities. The patient says she wishes to lose weight. Which of the following is the most appropriate initial step? A) Obtain history regarding which foods and exercise the patient enjoys B) Order thyroid function tests C) Prescribe a low-carbohydrate diet D) Prescribe orlistat to assist with weight loss E) Refer the patient to a self-help weight loss group 27. A 67-year-old woman comes to the office because of increasing constipation for the past 3 months. She has a history of hypertension treated with hydrochlorothiazide. For the past 2 weeks, she notes that "my belly has gotten big and my bowel movements have become very thin." Blood pressure is 140/85 mm Hg. Abdomen is moderately distended and tympanitic to percussion. There is no hepatomegaly or evidence of ascites. Rectal examination shows a small amount of brown stool that tests negative for occult blood. Hemoglobin concentration is now 11.2 g/dL, decreased from 12.8 g/dL last year. Which of the following is the most likely diagnosis? A) Colon cancer B) Diverticulosis C) Inflammatory bowel disease D) Irritable bowel syndrome E) Leiomyomata uteri The following vignette applies to the next 2 items. A 67-year-old African American man comes to the office for a follow-up visit for hypertension. It has been 1 year since his last visit. He has had hypertension for the past 12 years and prostatism for the past 6 years. Serum prostate-specific antigen (PSA) concentrations during this time have ranged from 4.6 ng/mL to 5.2 ng/mL (N |
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