12-12-2008, 10:59 AM
rey3liles did u get my email....i did not get urs
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NBME question - rey3liles
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12-12-2008, 11:01 AM
First C
Second B Third B Fourth B FiFth C- to rule out cancer, though unusual at this age but ulcerative lesion and obesity favours What are the answers rey3liles?
12-12-2008, 11:33 AM
26. A 27-year-old woman comes to the office because she recently noted a copious vaginal discharge requiring showering or bathing two or three times daily. She states that despite bathing frequently, she never feels clean. She has had no other medical problems. Results of her last Pap smear 1 year ago were normal. She is not sexually active at this time and is taking no medications. She has never been pregnant. She works as a respiratory therapist at a local community hospital and recently broke up with a boyfriend of several months. Physical examination shows no abnormalities. Pelvic examination demonstrates no vaginal discharge, bleeding, or mucosal lesions. Uterus is normal-sized and nontender. Adnexa are palpable and there are no masses. In addition to obtaining cultures for gonorrhea and chlamydia, which of the following is the most appropriate next step?
A) Determine serum estrogen concentration B) Order antibody studies for syphilis and HIV C) Prescribe an oral anti-trichomonal medication and antifungal cream D) Question the patient regarding the circumstances surrounding her recent break-up E) Tell the patient you will wait for the Pap smear results before prescribing anything for the discharge
12-12-2008, 11:35 AM
A 28-year-old African-American woman comes to the office because of low back pain and decreased urine output. She is a semiprofessional basketball player and she is married. She had one pregnancy 12 years ago that was uncomplicated and resulted in vaginal delivery of a term female neonate. Medications include oral contraceptive pills and a corticosteroid inhaler for asthma. She is 182 cm (6 ft) tall and weighs 88 kg (195 lb). Physical examination is normal except for a palpable lower abdominal mass that extends to the umbilicus. Speculum examination discloses a 3-cm ulcerative lesion circumferentially around the external cervical os. Bimanual examination shows a firm, nodular, central pelvic mass filling the pelvis and extending cephalad to the umbilicus. Rectovaginal examination confirms these findings. Stool is negative for occult blood. Which of the following is the most appropriate recommendation?
A) Arrange for laparoscopy B) Do a cervical biopsy C) Do an endometrial biopsy D) Increase Pap smear screening to every 3 months E) Obtain pelvic ultrasonography
12-12-2008, 11:36 AM
A 46-year-old man with diabetes mellitus well controlled by diet alone returns to the office for a follow-up visit for migraines. You have been seeing him for the past year for the migraines, and about 2 months ago you prescribed a calcium-channel-blocking medication. His previous medications included ergotamine and propranolol, but they were discontinued because of lack of full effect. At today's visit he complains of ankle swelling. Physical examination is normal except for 2+ pitting edema. Which of the following is the most appropriate step at this time?
A) Determine serum albumin concentration B) Discontinue his calcium-channel-blocking medication C) Order determination of protein excretion in a 24-hour urine sample D) Order echocardiography E) Prescribe a diuretic agent
12-12-2008, 12:33 PM
A 10-year-old boy is brought to the emergency department because he developed hives and shortness of breath 10 minutes after being stung by an insect. His father tells you that he had a similar episode of dyspnea and urticaria 2 years ago. Physical examination now shows a frightened child who appears out of breath, has generalized urticaria and asks for help in a hoarse voice. Vital signs are: temperature 37.0°C (98.6°F), pulse 120/min, respirations 36/min and blood pressure 70/40 mm Hg.
Item 1 of 3 19. Which of the following is the most important first step in managing this patient? A) Administer diphenhydramine, orally B) Administer epinephrine, subcutaneously C) Administer oxygen via face mask D) Establish intravenous access E) Obtain arterial blood gas values Item 2 of 3 20. After 10 minutes there is no change in his condition. At this time, the most appropriate next step is to administer which of the following? A) Diphenhydramine, orally B) Dopamine, intravenously C) Epinephrine, subcutaneously D) Prednisone, orally E) Ranitidine, orally Item 3 of 3 21. The patient improves with treatment. In 30 minutes his urticaria, dyspnea and hoarseness are resolved and his vital signs are normal. As you prepare to discharge the patient you recommend that he be evaluated by an allergist. The patient's mother asks you what should be done until he can be seen by the allergist. Which of the following is the most appropriate recommendation? A) Avoid all outdoor activity B) Take diphenhydramine, orally, every 4 hours while awake C) Take oral prednisone once daily D) Use an albuterol metered-dose inhaler after any insect sting E) Use an epinephrine autoinjector if he is stung again |
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