nbme form 2 b1 2/2 - grazie

[ArchivalUser]

29.
A 46-year-old African American computer programmer comes to the office for a follow-up visit. He has had high blood pressure for the past 6 months. Results of routine blood tests and physical examinations have been normal. His blood pressure has not responded to a low-sodium diet and other lifestyle modifications, and you are contemplating initiating pharmacotherapy. At today's visit the patient shows you information he obtained from the Internet about the use of calcium supplementation to control blood pressure. Regarding this information it is most appropriate to tell him which of the following?

A) The benefits are offset by the risk for kidney stone formation
B) Most of the benefits have been seen in patients with stage IV hypertension
C) Their efficacy is largely unproven in randomized trials
D) They are more effective when taken with vitamin D
E) They are most effective in patients with lactase deficiency

[ArchivalUser]

30.
A 35-year-old woman whom you follow for periodic examinations and who has no significant previous medical problems requests referral for mammography. She has three children. She is worried because her mother died of breast cancer last year at age 72 years, and she has been reading about the increased risk in women whose mothers have had breast cancer. Her insurance plan only covers screening mammography starting at age 50 years. On physical examination today, her breasts have mild fibrocystic changes, not significantly different from previous examinations. Which of the following is the most appropriate next step?

A) Call the insurance company and request that an exception be made to cover her mammography
B) Explain the expected benefits of mammography given her age and history
C) Find out what type of breast cancer her mother had
D) Stretch your interpretation of the fibrocystic changes and order mammography to evaluate "a suspicious mass"
E) Suggest that she obtain a second opinion

[ArchivalUser]

D.

[ArchivalUser]

28 D.

[ArchivalUser]

30 B.

[ArchivalUser]

q28)

D) Nodules on the distal interphalangeal joints
(right by NBME)


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A little review...

OSTEOARTHRITIS
Essentials of diagnosis

1. Joint pain (monoarticular, insidious, deep, dull ache) and crepitation mainly involving Wt-bearing joints (#1 is the knee; then the hip, and lumbar spine),
and finger joints (PIPs and DIPs), worsened with exercise and relieved by rest; morning stiffness < 30 min; limited range of motion (late stage).

2. Joint lesions are asymmetric and monoarticular, and progressive slowly and irreversibly. Usually there are no systemic manifestations, erythema, warmth, or swelling. Other findings include sclerosis of subchondral bony end-plates adjacent to diseased cartilage, subchondral cysts, etc.

3. X-ray:
(1) Joint space narrowing;
(2) Osteophytes (in PIPs are Bouchard’s nodes; in DIPs are Heberden’s nodes; Image 83).
Synovial fluid is mostly Nl (straw color, WBC < 2000/ uL).

Abnormal results indicate possible complications.
MRI of the spine may be indicated if neurologic signs are found.

Treatment --Aimed at reducing pain and maintaining mobility.

1. Supportive therapies: They all help reduce weight and correct poor posture to decrease joint loading. Physical therapy and exercise programs are effective (swimming is the best ). Advice patient to lose weight, rest, and avoid overuse of the joint.

2. Palliative medicines: NSAIDs (acetaminophen as the first choice) can relieve symptoms, but cannot stop the disease progression. If NSAIDs is not effective or intolerant, it can be replaced by a COX2 inhibitor. Intra-articular injection of corticosteroids is helpful but should not be used frequently.

3. Surgical joint replacement and arthroplasty: Reserved for advanced cases with poor life quality. It should be delayed as long as possible because a revision may be needed 10-15 yrs after the surgery.

Gong MD, Yale (2013-02-05). Yale-G's Refined Clinical Review for USMLE Step 2 & 3 (New Edition) (Kindle Locations 4353-4359). www.usmle-yaleg.com. Kindle Edition.

[ArchivalUser]

29.
A 46-year-old African American computer programmer comes to the office for a follow-up visit. He has had high blood pressure for the past 6 months. Results of routine blood tests and physical examinations have been normal. His blood pressure has not responded to a low-sodium diet and other lifestyle modifications, and you are contemplating initiating pharmacotherapy. At today's visit the patient shows you information he obtained from the Internet about the use of calcium supplementation to control blood pressure. Regarding this information it is most appropriate to tell him which of the following?

A) The benefits are offset by the risk for kidney stone formation
B) Most of the benefits have been seen in patients with stage IV hypertension
C) Their efficacy is largely unproven in randomized trials
D) They are more effective when taken with vitamin D
E) They are most effective in patients with lactase deficiency


I have no clue. But it's not A

[ArchivalUser]

I go with C for 29.

[ArchivalUser]

i think, 29 is C

[ArchivalUser]

ok found it on the web, somebody got it right.

q29)
C) Their efficacy is largely unproven in randomized trials

"Answer: C - got this Rt. B/c we're talking about using Ca for HTN and that's not well shown in the lit"