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* nbme-4
 #141307  
  tea - 11/25/06 16:45
 
  1. A 76-year-old retired plumber comes to the office with his wife because he has had progressive memory loss during the past year. His wife tells you that he has recently gotten lost in his home at night. He has also had urinary incontinence, about which he says, "It must be because of my big prostate." The patient's wife is concerned that he walks differently and often staggers, but he has not fallen. He now uses a cane. He tells you that he has recently used his wife's lorazepam for insomnia. One of his four siblings has significant memory loss. Vital signs are normal. Physical examination shows good orientation. During the mental status examination, he recalls only one of three items after 3 minutes, he is unable to do serial threes or sevens, and there is evidence of impaired judgment. He has mild ataxia with a tendency to fall to the left if he does not have support. Which of the following is the most likely presumptive diagnosis?

A

) Dementia, Alzheimer type

B

) Normal-pressure hydrocephalus

C

) Parkinson dementia

D

) Pseudodementia due to depression

E

) Reversible drug-induced dementia

2. A 52-year-old woman comes to the office because of difficulty falling asleep. She says that she retires to her bedroom at 7:00 PM and watches television while lying on her bed. She turns out the light and the TV at 11:00 PM but lies awake until at least 2:00 AM. She then sleeps soundly until 7:00 AM when she gets up to go to work. She is divorced and lives alone. She takes no medications. Her physical examination is normal. Which of the following is the most appropriate management?

A

) Advise her to avoid watching TV in bed

B

) Advise her to drink a warm beverage before going to bed

C

) Advise her to exercise lightly at 9:00 PM

D

) Prescribe flurazepam

E

) Prescribe temazepam

3. A 7-year-old girl is brought to the office by her mother because the girl has been awakening regularly at night in considerable distress about 1 hour after falling asleep. The mother describes her as being extremely fearful and inconsolable during these episodes. Her mother says, "She cries out something about a figure in a dark cape who is chasing after her and wants to turn her into stone. A few minutes later, she is able to go back to sleep and remembers little of what has happened the next morning." She has been in excellent health and has achieved appropriate developmental milestones. She is doing well in school and has a number of friends and playmates. She is 121 cm (4 ft) tall and weighs 22 kg (48 lb). Vital signs are: temperature 37.0°C (98.6°F), pulse 60/min, respirations 18/min and blood pressure 100/70 mm Hg. Physical examination shows a normally developed and well-nourished girl. Physical and neurologic examinations are normal. Which of the following is the most likely diagnosis?

A

) Cataplexy

B

) Central sleep apnea

C

) Major depressive disorder

D

) Nightmares

E

) Night terrors

4. An 8-year-old boy is brought to the health center by his parents because of a 2-day history of sore throat and fever. Temperature is 38.3°C (101.0°F) and pulse is 88/min; other vital signs are normal. Physical examination shows erythema of the posterior pharynx; the tonsils are enlarged and there are a few spots of whitish exudate on the left tonsil. A few small, nontender posterior cervical lymph nodes are palpable. There is no rash. Rapid streptococcal test is negative. Which of the following is the most appropriate next step?

A

) Administer intramuscular penicillin

B

) Obtain a throat culture

C

) Obtain acute-phase serum for antistreptolysin-O titer

D

) Prescribe azithromycin

E

) Reassure the patient's parents that he has a viral illness

5. A 16-year-old Latino boy comes to the health center because of ear pain for the past 2 days. He has been working at a local restaurant 30 to 40 hours per week through a school-sponsored vocational education program. His father left his family when the patient was a young child, and his mother died 1 year ago of breast cancer. He was declared an emancipated minor by the court after his mother's death, and he now rents a room in a home in his neighborhood. He has received care at the health center in the past for episodic illnesses and vaccinations before his mother died. Which of the following is the most accurate statement regarding obtaining consent for treatment today?

A

) Can be seen because he is likely to have an infectious disease and signed consent is not necessary

B

) Can be seen because his deceased mother gave signed consent for services in the past

C

) Can be seen if he signs a consent for services

D

) Cannot be seen because he has a living parent whose signed consent is required

E

) Cannot be seen without consent of the court that awarded emancipated minor status

6. A 67-year-old man comes to the office because of a 1-week history of increasing cough productive of small amounts of clear sputum and shortness of breath on exertion. He has smoked one and one-half packs of cigarettes per day for the past 40 years. He quit smoking 14 months ago when he was told that he had severe lung disease. He appears to be in no acute distress. He cannot speak in full sentences without taking a breath, and he purses his lips when exhaling. The patient is 170 cm (5 ft 7 in) tall and weighs 57 kg (125 lb); BMI is 20 kg/m2. The physical examination is most likely to show which of the following?

A

) Accessory muscle use

B

) An audible, right-sided S3

C

) Cyanosis of the extremities

D

) Lower extremity edema

E

) Wide splitting of S2

7. A 32-year-old African-American woman with a history of major depressive disorder comes to the health center because of palpitations and dizziness for the past week. She has been taking fluoxetine for the past 3 years and had been doing well until her mother died several months ago. At that time she became despondent with frequent crying and inability to sleep at night. Six weeks ago her psychiatrist increased the dose of fluoxetine but she did not think it helped. A friend recommended St. John's wort, which she began taking several weeks ago. She also takes calcium carbonate daily, occasional antihistamines for seasonal allergies, and amoxicillin-clavulanate, which was prescribed 10 days ago by another physician for a sinus infection. Vital signs now are: temperature 37.2°C (99.0°F), pulse 90/min, respirations 18/min and blood pressure 140/90 mm Hg. On physical examination she is somewhat tremulous. Thyroid is normal and chest is clear. Cardiovascular examination discloses a regular rhythm with slight tachycardia. Abdominal and neurologic examinations are normal. Which of the following is the most likely cause of her symptoms?

A

) Anxiety reaction due to her mother's death

B

) Hyperthyroidism

C

) Interaction between fluoxetine and amoxicillin-clavulanate

D

) Interaction between fluoxetine and antihistamines

E

) Interaction between fluoxetine and St. John's wort

8. A 54-year-old African-American dispatcher comes to the office because of hip and leg pain. You have treated the patient for diabetes mellitus, emphysema and obesity. His diabetes is controlled with diet and insulin therapy and is managed by his wife who is a registered nurse. He has a 30-year history of smoking two packs of cigarettes per day and he does not want to stop. For the past 4 months he has been taking aspirin with each meal to relieve his hip and leg pain. His wife drops him off at work in the morning; he walks to the hospital to ride home with his wife. He states he has no pain at rest but walking for a few blocks causes his whole left leg to ache. Which of the following is the most likely cause of his symptoms?

A

) Osteoarthritis

B

) Peripheral neuropathy

C

) Peripheral vascular insufficiency

D

) Sciatic nerve radiculopathy

E

) Spinal stenosis

9. A 74-year-old woman comes to the office because of constipation and blood-streaked stools for the past 3 days. She has had a 4.5-kg (10-lb) weight loss and anorexia for the past few months. She has a temperature of 37.0°C (98.6°F). Abdominal examination is normal. Rectal examination is normal except for the presence of occult blood on examination of the stool. Leukocyte count is 9000/mm3. Which of the following is the most likely diagnosis?

A

) Carcinoma of the cecum

B

) Carcinoma of the sigmoid colon

C

) Ischemic colitis

D

) Pseudomembranous enterocolitis

E

) Ulcerative colitis

10. A 46-year-old white woman returns to the office for follow-up of abdominal pain. Two weeks ago, she came to the office because of constipation and passing two to three loose stools with mucus per day. Physical examination at that time was normal. Her weight has remained the same and temperature has been normal. She has never had an abdominal operation. Lower gastrointestinal barium study and flexible sigmoidoscopy are normal. Complete blood count is normal. Today, you review the results with the patient. Which of the following is the most appropriate recommendation to the patient?

A

) Antianxiety medication

B

) Antispasmodic medication

C

) Consultation with a gastroenterologist

D

) Consultation with a psychiatrist

E

) Fiber supplementation
 
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* Re:nbme-4
#571243
  pk007 - 11/25/06 18:15
 
  1.b
2.a
3.e
4.b
5.c
6.c
7.e
8.c
9.a
10.e
 
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* Re:nbme-4
#571283
  tea - 11/25/06 18:46
 
  1b
2a
3e
4b
5a
6c
7e
8c
9b
10e
 
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* Re:nbme-4
#571702
  rich - 11/26/06 10:34
 
  let me try:
1 B
2 A
3 E
4 B
5C
6C
7E
8C
9 B
10 E
 
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* Re:nbme-4
#571705
  tea - 11/26/06 10:51
 
  goody goody...thank you Pk and Richy

q5, if this is an adult, does the patient need to sign a consent to Tx regular diseases? I know procedures yes, what do you think the board wants us to do? This 16yo should be Tx equally as adult

appreciate all comments.
 
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* Re:nbme-4
#571775
  chirkut - 11/26/06 12:57
 
  6???a
could u plz giv me explanation for "c"
 
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* Re:nbme-4
#571796
  tea - 11/26/06 13:23
 
  I do not think this patient has acute exacerbation-no significant productive cough, sputum is not yellow-a sign of infection, no acute stress...most consistent findings in chronic severe lung disease is clubbing.

let see what other people say.
 
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* Re:nbme-4
#571827
  chirkut - 11/26/06 14:01
 
  option c is ?clubbing
?cyanosis
 
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* Re:nbme-4
#571854
  captopril - 11/26/06 14:25
 
  y not
6:a
7:d

 
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* Re:nbme-4
#571866
  turtle - 11/26/06 14:32
 
  For 6, he cannot finish his sentences without taking a breath and purses lips while exhaling so answer is most probably use of accessory muscles. also, cyanosis and clubbing are two different things.

the 16 yr old doesnot need consent for ear pain management.
 
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