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Hi there,
I took NBME form 2, it was ok. I want to solve all the qs, anybody who took the exam already and wants to solve it now?
Please let me know. I wont send the complete exam, I want to solve it one by one and discuss the questions. Anybody?
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Q-1
A 28-year-old man with schizoaffective disorder comes to the office because of restlessness and nervousness since being discharged from the hospital 2 weeks ago following a 6-day admission for treatment of a manic episode. He says, "I'm not really worried but I just can't sit still. The only time I get any rest is when I sleep. I haven't had a cigarette or a drink since I left the hospital, but I'm thinking I need to have one soon!" He forgot to bring a list of his discharge medications, but he says, "I'm back on lithium and they gave me a shot they said would last a month." Vital signs are normal. During the physical examination he moves around on the examination table and occasionally stands up, shuffles his feet, and sits down again. At this time which of the following is the most likely explanation for this patient's symptoms?
A) Adverse effect of medication
B) Dysthymia
C) Nicotine withdrawal
D) Prolonged alcohol withdrawal
E) Residual hypomania
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Can u explain it when you reply please? and yes it's right, I got it right in my exam. I took the one with feedback
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Patient is experiencing akatisia - side of anti psychotics
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pt is having akathisia(motor restlessness -inability to remain still) cozed by typical antipsychotic, that was given by shot
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Nice!
I want to use these NBME questions to focus my reading on those high yield questions, just now I read all antipsychotics and side effects.
In my feedback, A was the answer, so we are cool with this 
This pt most likely received Haloperidol shot (High potency antipsychotic) and is currently having EPS like Akathisia, feelings of restlessness, alternating sitting positions, unable to sit still.
When patients present these symptoms, the next step is to lower the antipsychotic and add beta blockers or benzodiazepine.
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2.
A 53-year-old African American schoolteacher with hypertension comes to the office with his wife because of increasing sexual dysfunction. You last saw him for a periodic health evaluation 1 year ago. He describes decreasing firmness of his erections which are now inadequate for vaginal penetration. He dates the onset of these symptoms to approximately 7 to 8 months ago, but he cannot pinpoint any precipitating factors. He now has decreased early-morning erections. He has been taking a long-acting calcium-channel-blocking medication for the past 6 years. He denies any significant alcohol intake or psychosocial problems, describes his work situation as very rewarding, and feels his wife has been very supportive with regard to his sexual problems. The patient is 178 cm (5 ft 10 in) tall and weighs 95 kg (210 lb); BMI is 30 kg/m2. Blood pressure is 136/82 mm Hg. Physical, neurologic, peripheral vascular, and genital examinations are normal. Complete blood count and screening laboratory studies for liver and renal disease are normal. Fasting plasma glucose concentration is 86 mg/dL. Which of the following is the most appropriate next step?
A) Determination of serum testosterone concentration
B) Initiation of an exercise and weight-reducing program
C) Lower extremity and penile arterial Doppler studies
D) MRI of the pituitary gland
E) Referral of the couple to a sex therapist
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In my exam, the correct answer was A (from feedback, got it right)
Erectile dysfuntion
First rule out organic causes. Laboratory studies should include hormonal evaluation to exclude a diagnosis of HYPOGONADISM (TESTOSTERONE and PROLACTIN levels) and testing to screen for Diabetes if the patient is not known to be diabetic (hemoglobin A1c or glucose tolerance testing). Most patients usually have had a general survey, but this is certainly appropriate if it has not been done to assess for kidney or liver disease.
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