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| * Anyone interested in quick NBME discussion? |
| | #249024 |
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How abt we post qs n follow thru with answers , that way we'll be sure of whatever we choose..... No arguements, just plain this is what i think! U can support ur answer if u want, not if u don't! Anyone???? Right here! |
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| * Re:Anyone interested in quick NBME discussion? |
| #1082577 |
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16) C or D . What is differential follow-up btw?
18) B coz D/E are more like counselling than management, remember CS?
19) yup C he had that LCFA transferase deficieny moi thinks.
21) CuD be A..that was my first choice then i saw cor pumonale, I have aq. what abt that early diastolic murmur.....u think constrictive pericarditis wud have it? Plz. help with this one.
27) It can't be monospot in a 7 yr old rt?:O So maybe B sud be it...
30) yup lead.
FM u are good! Keep it up....
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| * Re:Anyone interested in quick NBME discussion? |
| #1082579 |
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31. A county health officer investigates an outbreak of illness among persons attending a church picnic. The illness is characterized by the onset of nausea and vomiting 3 to 4 hours after attending the picnic. All affected persons recover without specific therapy. The investigation implicates egg salad as the vehicle of transmission. This episode is consistent with a foodborne outbreak caused by which of the following?
A
) Clostridium perfringens
B
) Giardia lamblia
C
) Salmonella species
D
) Staphylococcus aureus
32. A 62-year-old woman comes to the physician because of generalized weakness for 2 weeks. She has a 20-year history of arthritis of the hands treated with aspirin and acetaminophen. She had two episodes of urinary tract infections 5 and 11 years ago, respectively. Examination shows no abnormalities except for Heberden's nodes on the hands. Laboratory studies show:
Erythrocyte sedimentation rate
15 mm/h
Serum
Na+
136 mEq/L
Cl–
100 mEq/L
K+
4.9 mEq/L
HCO3–
20 mEq/L
Urea nitrogen (BUN)
41 mg/dL
Creatinine
4 mg/dL
Urine
Protein
1+
WBC
2–4/hpf
RBC
none
Bacteria
none
Squamous epithelial cells
occasional
Granular casts
occasional
Renal ultrasonography shows no abnormalities. Which of the following is most likely to have prevented this condition?
A
) Periodic PPD skin testing
B
) Screening for autoimmune causes of glomerulonephritis
C
) Periodic renal ultrasonography
D
) Avoidance of analgesics
E
) Suppressive antibiotic therapy for treatment of urinary tract infections
33. A 60-year-old man comes to the physician because of increasing shortness of breath for 1 week; it occurs at rest and is exacerbated by exertion. He has not had chest pain. He has smoked two packs of cigarettes daily for 40 years. Between the ages of 18 and 30 years, he worked in a warehouse with exposed bare insulation; for the past 15 years, he has driven a taxi. Medications include ipratropium bromide and albuterol metered-dose inhalers. His temperature is 37 C (98.6 F), blood pressure is 170/95 mm Hg, pulse is 100/min, and respirations are 24/min. Anterior and posterior diffuse wheezes are heard. Cardiac examination shows no murmurs. There is mild pretibial edema. An x-ray film of the chest shows calcified pleural plaques on the right hemidiaphragm and a 2-cm pleural-based mass. With regard to the findings on the x-ray film, which of the following is most likely to have prevented this patient's condition?
A
) Appropriate immunizations
B
) Different occupation
C
) Different medications
D
) Hypertension screening
E
) Smoking cessation
34. A previously healthy 67-year-old man is admitted to the hospital because of lethargy, confusion, muscle cramps, and decreased appetite for 7 days. He appears ill. His temperature is 37 C (98.6 F), blood pressure is 120/70 mm Hg, pulse is 98/min, and respirations are 20/min. Breath sounds are diminished at the right lung base. Neurologic examination shows no abnormalities except for lethargy. Serum studies show:
Na+
114 mEq/L
K+
4.3 mEq/L
Creatinine
1 mg/dL
Thyroid-stimulating hormone
4.1 μU/mL
An x-ray film of the chest shows a 2-cm nodule in the right lower lobe and mediastinal adenopathy. A biopsy specimen of the nodule is most likely to show which of the following?
A
) Adenocarcinoma
B
) Clear cell carcinoma
C
) Mesothelioma
D
) Small cell carcinoma
E
) Squamous cell carcinoma
35. A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?
A
) Impaired intestinal motility
B
) Inflammatory process
C
) Malabsorption
D
) Secretory process
36. A 52-year-old woman comes to the physician because of a 3-month history of intermittent bloody discharge from the right breast. She does not perform regular monthly breast self-examinations. She has a 3-year history of major depressive disorder treated with fluoxetine. Examination of the breasts shows no abnormalities. No masses are noted on palpation. Serosanguineous fluid can be expressed from the nipple of the right breast by pressing on the left side of the areola. Which of the following is the most likely diagnosis?
A
) Cystosarcoma phyllodes
B
) Fat necrosis
C
) Fibroadenoma
D
) Fibrocystic changes of the breast
E
) Galactorrhea
F
) Hyperprolactinemia
G
) Intraductal papilloma
H
) Mastitis
I
) Paget's disease of the breast
37. A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the second left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse pressure. Which of the following is the most likely diagnosis?
A
) Atrial septal defect (ostium primum type)
B
) Atrial septal defect (ostium secundum type)
C
) Atrioventricular canal
D
) Coarctation of the aorta
E
) Hypoplastic left heart syndrome
F
) Patent ductus arteriosus
G
) Tetralogy of Fallot
H
) Transposition of the great arteries
I
) Tricuspid atresia
J
) Ventricular septal defect
38. A 70-year-old man comes to the physician because of urinary hesitancy and frequency for 9 months. His temperature is 37.5 C (99.5 F). Examination shows a circumcised penis with no urethral discharge. Testicular examination shows no abnormalities. Rectal examination shows an enlarged rubbery prostate that is nontender to palpation. Urinalysis shows many leukocytes and no erythrocytes. Gram's stain of urine shows gram-negative rods. Which of the following is the most likely cause of this patient's condition?
A
) Infection of the epididymis
B
) Infection of the prostate
C
) Infection of the urethra
D
) Neurogenic bladder
E
) Outflow obstruction of the bladder
39. A 32-year-old woman comes to the physician because of lethargy and boredom since the birth of her son 5 months ago. She worries about her ability to care for him and has had frequent palpitations. She is unable to fall back asleep after nighttime feedings. She stopped breast-feeding 1 month ago. Her son is healthy, and growth and development are normal for his age. Her blood pressure is 122/80 mm Hg, pulse is 58/min, and respirations are 18/min. Physical examination shows no abnormalities. She remembers one out of three objects after 5 minutes. Her serum cholesterol level is 265 mg/dL. The most appropriate next step in diagnosis is measurement of which of the following serum levels?
A
) Cortisol
B
) Estrogen
C
) Progesterone
D
) Prolactin
E
) Thyroid-stimulating hormone
40. The genetic disease institute at a university hospital has developed a rapid screening test for a serious but treatable inherited metabolic disorder. Although this disorder is predominantly found in a particular ethnic group, it is also found sporadically throughout the entire population. The screening test has a sensitivity of 95% and a specificity of 90%. When used in an ethnically prescreened population where the prevalence of this disorder is 30%, the positive predictive value is 80% and the negative predictive value is 96%. The institute proposes to use this screening test on the general population where the prevalence of this disease is 0.1%. Which of the following is the most likely result of this screening program?
A
) Negative predictive value decreases
B
) Positive predictive value decreases
C
) Sensitivity decreases
D
) Specificity decreases
41. A 32-year-old woman comes to the physician because of a 1-year history of increasingly severe dull pain in her lower back and buttocks. She also has had morning stiffness of the lower back that lasts for 1 to 2 hours. There is no history of trauma. Her job does not require heavy lifting. Her blood pressure is 110/70 mm Hg, pulse is 68/min and regular, and respirations are 16/min. Cardiopulmonary examination shows no abnormalities. There is tenderness to palpation over the sacroiliac joints bilaterally and decreased flexion and extension of the lumbar spine. An x-ray film of the lumbosacral spine shows sclerosis of the sacroiliac joints. Laboratory studies are most likely to show which of the following findings in this patient?
A
) Decreased erythrocyte sedimentation rate
B
) Histocompatibility human leukocyte antigen B27
C
) Increased serum antinuclear antibody titer
D
) Increased serum carcinoembryonic antigen (CEA) level
E
) Positive serum rheumatoid factor
42. A 6-month-old boy is brought to the physician because of respiratory distress for 1 day. He had a persistent dry cough 3 days ago. He has not had a fever or nasal discharge, but he has had chronic watery stools. He is at the 50th percentile for height and 10th percentile for weight. He appears ill and is in respiratory distress. His temperature is 37 C (98.6 F), pulse is 140/min, and respirations are 78/min. Pulse oximetry shows an oxygen saturation of 70% while breathing room air. Examination shows white plaques on the mucous membranes of his mouth and diffuse adenopathy. There are intercostal retractions, and diffuse crackles are heard throughout all lung fields. In addition to oxygen and antibiotic therapy, which of the following is the most appropriate next step in management?
A
) Stool culture for bacterial pathogens
B
) Urinalysis
C
) HIV testing
D
) Quantitative measurement of immunoglobulins
E
) Nitroblue tetrazolium testing
F
) Platelet morphology evaluation
G
) Tympanocentesis
43. A 42-year-old man is brought to the physician by his wife because of a 2-month history of staring spells that last 1 to 2 minutes each. During episodes, he also smacks his lips and picks at his shirt collar. Four years ago, he was comatose for 2 weeks after sustaining a head injury in a motorcycle collision; he required 6 months of rehabilitation. He reports that, over the past year, he has had intermittent episodes of smelling burnt rubber that occur approximately every 2 weeks. He hears an intense hissing sound during these episodes. Examination shows no abnormalities. Which of the following is the most likely diagnosis?
A
) Absence seizures
B
) Complex partial seizures
C
) Transient ischemic attack
D
) Tourette's disorder
E
) Limbic encephalopathy
44.
A 47-year-old woman is admitted to the hospital for evaluation of a 2-week history of increased irritability and racing thoughts. Her family reports that she argues with anyone who does not agree with her. She has been talking incessantly at a rapid rate and pacing around the house. She says that, for years, she has been hearing the voice of God telling her that she has been chosen for a special mission. She has barely slept for the past week, waiting to hear further messages from God. She is disheveled and dehydrated. Serum studies show:
Na+ 137 mEq/L
Cl– 96 mEq/L
K+ 3.8 mEq/L
HCO3– 22 mEq/L
Urea nitrogen (BUN) 30 mg/dL
Glucose 68 mg/dL
Creatinine 1.2 mg/dL
Mental status examination shows disorganized thoughts and flight of ideas. She is agitated and has difficulty staying seated. She is too distractible to perform cognitive tests. Toxicology screening is negative. Which of the following is the most likely diagnosis?
A
) Acute renal failure
B
) Borderline personality disorder
C
) Diabetes insipidus
D
) Narcissistic personality disorder
E
) Schizoaffective disorder
F
) Schizoid personality disorder
45. A 20-year-old man comes for a routine health maintenance examination. He has a 15-year history of difficulty relaxing his hands after tightly gripping objects or after shaking hands. His father has cataracts and frontal baldness. Examination shows thin forearms. There is moderate weakness of the hands and difficulty releasing after gripping with his hands. Which of the following is the most likely diagnosis?
A
) Amyotrophic lateral sclerosis
B
) Cervical spondylosis
C
) Multiple sclerosis
D
) Myasthenia gravis
E
) Myasthenic (Lambert-Eaton) syndrome
F
) Myotonic muscular dystrophy
G
) Polymyalgia rheumatica
H
) Polymyositis
I
) Progressive neuropathic (peroneal) muscular atrophy
46. A 47-year-old man is admitted to the hospital after threatening to harm a radio announcer he believed was broadcasting his thoughts. Over the past 20 years, he has had multiple psychiatric hospitalizations for threatening people who he believed were plotting against him, trying to control his mind, or causing him to hear voices by implanting devices in his head. Past symptoms improved with neuroleptic therapy; after discharge, he discontinued the medication and his symptoms worsened. Which of the following is the most appropriate pharmacotherapy to decrease this patient's risk for future hospitalization?
A
) Clozapine
B
) Fluphenazine hydrochloride
C
) Haloperidol decanoate
D
) Risperidone
E
) Trifluoperazine hydrochloride
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