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* nbme 11 12 13
 #139125  
  angioplasty - 11/16/06 18:25
 
  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


 
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* Re:nbme 11 12 13
#561405
  santabanta - 11/16/06 18:51
 
  11)E

12)B

13)D
 
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* Re:nbme 11 12 13
#561417
  livelife - 11/16/06 19:03
 
  11) E
12)B
13)E
 
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* Re:nbme 11 12 13
#561434
  toxic - 11/16/06 19:18
 
  11) B
12)A
13)D
 
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* Re:nbme 11 12 13
#561438
  anand11anupa - 11/16/06 19:20
 
  11 e another name is Buergers disease.Counsel against smoking.
12.both ht and diabetes are risk factors so not very sure.Though in the list ht comes before diabetes but both the factors have score value -one.
13.e repeat she may have developed esophageal ca
 
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* Re:nbme 11 12 13
#561596
  pedres - 11/16/06 21:34
 
  11 E
12 B
132 D
 
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* Re:nbme 11 12 13
#562056
  dr_nuri - 11/17/06 09:25
 
  e/b/e for ques 1/2/3  
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* Re:nbme 11 12 13
#562090
  soujany - 11/17/06 09:50
 
  1. E
2. B
3. D since last endoscopy was 6 months ago. maybe unlikely to do a repeat one now again.
 
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* Re:nbme 11 12 13
#562925
  tea - 11/17/06 17:24
 
  b
d
d
 
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* Re:nbme 11 12 13
#562959
  joscohmd - 11/17/06 17:44
 
  e
a
d
 
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