08-29-2014, 08:15 PM
The DUB info is from UW CCS case #23
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Discuss NBME Form 2 Block 5/5 - grazie
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08-29-2014, 08:16 PM
@img87
I forgot! Thanks for giving me the idea to scan information, I got an App for my iphone, It was really fast to get that info up  Things we learn huh?
08-29-2014, 09:03 PM
13.
A 41-year-old married attorney comes to the office for an initial visit. She has just moved to the area. Medical history is significant for hypertension and panic disorder. Her panic disorder has been well controlled for 3 years with fluvoxamine. Medications also include atenolol. Blood pressure is 100/70 mm Hg. You are aware that fluvoxamine is not approved by the FDA for treatment of panic disorder. Which of the following is the most appropriate next step in pharmacotherapy? A) Notify the FDA of the inappropriate use of fluvoxamine B) Refer the patient to a psychiatrist to prescribe the fluvoxamine C) Review risks and benefits of continuing to prescribe fluvoxamine D) Switch fluvoxamine to alprazolam E) Switch fluvoxamine to sertraline I got this right and marked C
08-29-2014, 09:07 PM
14.
A 12-year-old girl is brought to the office by her parents because of a 6-month history of progressive blurring of vision in her right eye. Three months ago, an optometrist fitted her with corrective lenses, which improved but did not correct her visual acuity. Medical history is otherwise unremarkable. She takes no medications. She is at the 90th percentile for height and the 75th percentile for weight. Vital signs are normal. Physical examination discloses mild pallor of the right optic nerve head. Pupils measure 4 mm in diameter and constrict better to a bright light shone in the left eye than in the right eye. Visual acuity with corrective lenses is 20/20 in the left eye and 20/80 in the right eye. MRI of the brain discloses thickening of the right optic nerve. Examination of the skin is most likely to show which of the following? A) Facial angiofibromas B) Hemangioma C) Hyperpigmented macules D) Linear sebaceous nevi E) Telangiectasias
08-29-2014, 09:36 PM
Q14)
Ans: C C) Hyperpigmented macules Diagnostic criteria for type 1 neurofibromatosis (NF1) There are diagnostic criteria for NF1 that require at least 2 of 7 criteria. Some of these do not appear until later childhood or adolescence, and so confirmation of the diagnosis may be delayed and children should be followed up. ♦ At least six café au lait spots or hyperpigmented macules. They must be at least 5 mm wide in children younger than 10 years and 15 mm in adults. ♦ Axillary or inguinal freckles. ♦ Two or more typical neurofibromas or one plexiform neurofibroma. ♦ Optic nerve glioma. Tumours of the optic nerve (gliomas) occur in about 15% of children with NF1. They are often asymptomatic but, over time, tumours may cause visual acuity loss, abnormal colour vision, visual field loss, squint, pupillary abnormalities, pale optic disc, proptosis and hypothalamic dysfunction. ♦ Two or more iris hamartomas. They are called Lisch nodules and are seen by slit-lamp examination. ♦ Sphenoid dysplasia or typical long-bone abnormalities such as arthrosis. ♦ Having a first-degree relative with NF1.
08-29-2014, 09:37 PM
15.
A 20-year-old man sustained an inversion injury of his left ankle in a basketball game 2 weeks ago. At that time he had pain, swelling, and discoloration over the lateral malleolus and tenderness on palpation over the anterolateral corner of the ankle joint. Routine x-rays and stress views of the ankle were normal. He is now asymptomatic at this follow-up visit. This is his third such injury. Which of the following is the most appropriate management? A) A 3-week program of hydrotherapy B) Ankle strengthening exercise program C) Application of a short leg cast for 3 weeks D) Protected weight bearing E) Surgical repair of the ankle ligaments
08-29-2014, 09:59 PM
Q15)
Ans: B B) Ankle strengthening exercise program I marked this in my exam, it was right. Following an ankle sprain, strengthening exercises should be performed once you can bear weight comfortably and your range of motion is near full. There are several types of strengthening exercises. The easiest to begin with are isometric exercises that you do by pushing against a fixed object with your ankle.
08-29-2014, 10:03 PM
16.
A 24-year-old woman comes to the office because of a headache that began suddenly 1 day ago while she was exercising at the gym. She says the headache involves her entire head and was most severe at onset, rating the pain as a 9 on 10-point scale; she now rates the pain as an 8. She also notes mild photophobia and neck stiffness. She says she has had occasional headaches in the past, but that her current headache feels different. Aspirin and acetaminophen with codeine have provided no relief. Medical history is unremarkable and she takes no prescription medications. Vital signs are temperature 38.0°C (100.4°F), pulse 80/min, respirations 12/min, and blood pressure 120/80 mm Hg. On examination she is alert but appears in mild distress due to her headache. Funduscopic examination shows no abnormalities. There is pain and stiffness with passive neck flexion. The remainder of the physical examination, including neurologic examination, shows no abnormalities. Which of the following is the most likely initial working diagnosis? A) Acute bacterial meningitis B) Brain abscess C) Migraine D) Subarachnoid hemorrhage E) Vertebral artery dissection 17. A 38-year-old man comes to the office for the first time because he is concerned about his current state of health. He tells you that he is homosexual and has been in one relationship for the past 10 years. However, he admits to having receptive anal intercourse with new partners when visiting large cities on business trips. One year ago he had a negative serologic test for HIV. For the past 3 months he has noted intermittent diarrhea and night sweats. He has had no fever or weight loss. Currently he is taking no medications. Medical history is significant for PPD skin-test conversion as a teenager followed by 6 months of isoniazid therapy. He smokes one pack of cigarettes daily, and drinks a six-pack of beer weekly and an occasional glass of wine with dinner. He is allergic to penicillin. He is 188 cm (6 ft 2 in) tall and weighs 73 kg (160 lb); BMI is 21 kg/m2. Temperature is 37.2°C (99.0°F). Large lymph nodes are noted in the neck bilaterally, in the right axilla, and in the left inguinal area. There is no rash or hepatomegaly. The spleen is palpable 2 cm below the left costal margin and is tender. Which of the following is the most appropriate statement to the patient at this time? A) He has AIDS B) He has ARC (AIDS-related complex) C) He most likely has recurrent tuberculosis D) He should abstain from sexual intercourse pending clarification of his current health status E) He should have his steady sexual partner make arrangements to have serologic testing for HIV infection 18. A 6-year-old boy has had three upper respiratory tract infections in the past 9 months with fever, sore throat and once with an ear infection. Height and weight are at the 25th percentile. Physical examination is now normal. Tonsils are moderately enlarged. Examination of the ears shows no abnormalities; hearing is normal. There is no obstruction of the airway. Which of the following is the most appropriate next step? A) Arrange for an elective adenoidectomy B) Arrange for an elective tonsillectomy and adenoidectomy C) Arrange for placement of tubes into the middle ear D) Prescribe 6 months of prophylactic penicillin E) Reassure the family that nothing needs to be done at this time 19. A 36-year-old woman comes to the office 6 weeks after giving birth to a healthy male neonate via uncomplicated vaginal delivery. This was her first pregnancy. She reports no adjustment problems and says that she is breast-feeding without difficulty. However, she says, during the past 24 hours she has felt feverish and fatigued. She has no symptoms of ear discomfort, sore throat, lung congestion, or cough. She has no family history of breast or gynecologic cancer. On physical examination the right breast is larger than the left breast, and it is tender laterally. The right breast is firm, erythematous, and indurated over the upper outer quadrant. Milk is expressed from the nipple and is not bloody or foul-smelling. The left breast is normal. There are enlarged, tender lymph nodes in the right axilla. In addition to initiating warm soaks to the affected area, it is most appropriate to do which of the following? A) Aspirate the indurated area B) Initiate oral antibiotic therapy C) Obtain mammography D) Obtain ultrasonography of the right breast E) Refer the patient to a surgeon 20. A 35-year-old African American man comes to the office saying, "I'm tired all the time and I don't feel like doing anything." He has a history of hypertension for which he has been taking diuretics for 8 weeks. He tells you that a few days ago he developed weakness in the legs, which has progressively worsened. He has no recent history of febrile illness. Deep tendon reflexes are hypoactive and Babinski sign is absent. Sensory examination is normal. Which of the following is the most likely diagnosis? A) Amyotrophic lateral sclerosis B) Conversion disorder C) Guillain-Barré syndrome D) Hypokalemia E) Multiple sclerosis
08-30-2014, 09:06 AM
16.
A 24-year-old woman comes to the office because of a headache that began suddenly 1 day ago while she was exercising at the gym. She says the headache involves her entire head and was most severe at onset, rating the pain as a 9 on 10-point scale; she now rates the pain as an 8. She also notes mild photophobia and neck stiffness. She says she has had occasional headaches in the past, but that her current headache feels different. Aspirin and acetaminophen with codeine have provided no relief. Medical history is unremarkable and she takes no prescription medications. Vital signs are temperature 38.0°C (100.4°F), pulse 80/min, respirations 12/min, and blood pressure 120/80 mm Hg. On examination she is alert but appears in mild distress due to her headache. Funduscopic examination shows no abnormalities. There is pain and stiffness with passive neck flexion. The remainder of the physical examination, including neurologic examination, shows no abnormalities. Which of the following is the most likely initial working diagnosis? A) Acute bacterial meningitis B) Brain abscess – not seizures, no focal neurologic findings C) Migraine – not because meningismus. Basilar migraine is risk for stroke. D) Subarachnoid hemorrhage – there is not LOC E) Vertebral artery dissection (Young person, severe u/l posterior headache, cerebellar ischemia. Vertigo, severe vomiting, ataxia, diplopia, hemiparesis, unilateral facial weakness, and tinnitus) Ans: A) |
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