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B) Explain the expected benefits of mammography given her age and history
At 35yo and mother with BC at 70. She should start screening at 40 yo, not earlier.
Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
(American Cancer Society Guidelines for the Early Detection of Cancer, April 2013)
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31.
A 62-year-old white woman comes to the office because of a 2-day history of poor appetite with nausea, vomiting, and chills. She also has left lower abdominal pain that she describes as an almost constant, gripping ache. Although she is usually constipated, she has been having non-bloody, loose stools two to three times daily. Medical history is remarkable for hysterectomy and oophorectomy for leiomyomata uteri 10 years ago, after which she began hormone replacement therapy. Vital signs today are temperature 38.8°C (101.8°F), pulse 100/min, and blood pressure 142/85 mm Hg. The patient appears to be in moderate discomfort and she cannot find a comfortable resting position. Abdominal examination discloses left lower quadrant tenderness, guarding, and rebound; there is a palpable tender mass. Rectal examination shows exquisite left-sided tenderness. Test of the stool for occult blood is positive. Pelvic examination shows no vaginal discharge and a normal vaginal cuff. There is left adnexal tenderness. Which of the following is the most appropriate next step?
A) Admit her to the hospital for immediate laparotomy and partial colectomy
B) Admit her to the hospital for intravenous antibiotic therapy and do lower gastrointestinal barium series
C) Admit her to the hospital for intravenous antibiotic therapy and obtain CT scan of the abdomen
D) Place her on clear liquids, prescribe amoxicillin-clavulanic acid and reevaluate her tomorrow
E) Place her on clear liquids, prescribe trimethoprim-sulfamethoxazole and metronidazole and reevaluate her tomorrow
32.
A 52-year-old man comes to the office accompanied by his wife. She says that she is worried her husband is going to die because she has noticed during the past 6 months that he snores loudly and occasionally stops breathing. The patient has snored for many years. He says he knows his sleep is restless and he is tired during the day. He has a history of hypertension treated with atenolol and diabetes mellitus controlled with diet. He does not smoke cigarettes and he seldom drinks alcoholic beverages. The patient is 173 cm (5 ft 8 in) tall and weighs 104 kg (230 lb); BMI is 35 kg/m2. Vital signs are temperature 37.2°C (99.0°F), pulse 54/min and regular, respirations 16/min, and blood pressure 136/82 mm Hg. Physical examination discloses no abnormalities. If the condition is left untreated, the patient is most likely to develop which of the following?
A) Chronic obstructive pulmonary disease
B) Narcolepsy
C) Pneumothorax
D) Right heart failure
E) Seizure disorder
33.
A 17-year-old African American high school senior comes to the office accompanied by her mother for a follow-up visit. You have been treating the girl for severe menstrual cramps for the past 2 years. She says her cramps and the associated nausea, vomiting, and diarrhea are well controlled with the nonsteroidal anti-inflammatory drug (NSAID) that you prescribed for her. Her last period was 3 weeks ago and it was normal. When you speak privately with her, she denies any history of sexual activity. On physical examination the abdomen is soft and nontender, without a palpable mass. Speculum examination is well tolerated and discloses no abnormalities. Bimanual examination shows a 5-cm, mobile, nontender cystic left ovary. Urine pregnancy test is negative. Which of the following is the most likely explanation for the ovarian mass?
A) Benign cystic teratoma (dermoid cyst)
B) Ectopic pregnancy
C) Endometriosis
D) Functional cyst
E) Ovarian cancer
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C) Admit her to the hospital for intravenous antibiotic therapy and obtain CT scan of the abdomen
This is an acute abdomen, she has fever and mod-sev LLQ pain, which can be a Diverticulitis, but that left adnexal tenderness'? anyway we need further imagen studies but let's start covering the pt on ATB and get some picture of that belly  an abd CT scan
Oh, beside, this qsn was right on my exam 
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D) Right heart failure
(correct by NBME)
Obstructive sleep apnea (OSA)/hypopnea syndrome occurs in approximately 10% of adult men and 5% of middleaged women. It is becoming increasingly clear that, in addition to excessive daytime sleepiness and snoring, OSA is associated with a variety of chronic cardiovascular sequelae, including hypertension, stroke, coronary artery disease, and sudden death.
Pulmonary hypertension is a less appreciated complication of the physiologic changes associated with OSA. Patients with OSA have been shown to have transient, sometimes severe, elevations in pulmonary arterial pressures (PAP) during sleep. Several factors associated with OSA lead to chronic hypoxia and subsequent right heart failure.
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33.
A 17-year-old African American high school senior comes to the office accompanied by her mother for a follow-up visit. You have been treating the girl for severe menstrual cramps for the past 2 years. She says her cramps and the associated nausea, vomiting, and diarrhea are well controlled with the nonsteroidal anti-inflammatory drug (NSAID) that you prescribed for her. Her last period was 3 weeks ago and it was normal. When you speak privately with her, she denies any history of sexual activity. On physical examination the abdomen is soft and nontender, without a palpable mass. Speculum examination is well tolerated and discloses no abnormalities. Bimanual examination shows a 5-cm, mobile, nontender cystic left ovary. Urine pregnancy test is negative. Which of the following is the most likely explanation for the ovarian mass?
A) Benign cystic teratoma (dermoid cyst)
B) Ectopic pregnancy
C) Endometriosis
D) Functional cyst
E) Ovarian cancer
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33)
D) Functional cyst
Painless, mobile mass.
1st step: B-hCG
Ultrasound: fluid filled simple cyst
7cm: Laparoscopic removal
If multiple cysts: Do biopsy of 3 layers and do Cystectomy or OOphorectomy depending on preserving or not fertility
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34.
A 15-year-old African American girl comes to the office because of the lesion shown, which has increased in size and become darker and thicker during the past 6 months. She takes no medications and is not sexually active. She is 152 cm (5 ft) tall and weighs 115 kg (252 lb); BMI is 49 kg/m2. Vital signs are temperature 36.0°C (96.8°F), pulse 88/min, respirations 20/min, and blood pressure 110/78 mm Hg. At this time it is most appropriate to inquire about a family history of which of the following?
A) Addison disease
B) Diabetes mellitus
C) Hypercholesterolemia
D) Hyperparathyroidism
E) Polycystic kidney disease
35.
A 46-year-old woman comes to the office because she has become increasingly depressed during the past 6 weeks and cannot stop worrying about the future. She underwent lumpectomy with axillary lymph node dissection and radiation therapy for localized (stage I) breast cancer 3 months ago. She says she still enjoys pleasurable activities but cannot always motivate herself to participate. Her friends have noticed this and commented that she "just does not seem like herself." She also reports difficulty concentrating for the past month. She has not had decreased energy, loss of appetite, or difficulty sleeping. She reports no significant feelings of worthlessness or guilt and has not had suicidal thoughts. Vital signs are normal. Physical examination shows a healed surgical site and is otherwise unremarkable. Which of the following is the most likely explanation for her emotional distress?
A) Adjustment disorder with depressed mood
B) Depression secondary to a medical condition
C) Dysthymic disorder
D) Generalized anxiety disorder
E) Major depressive disorder
36.
You are visiting a 78-year-old woman with ischemic cardiomyopathy and chronic atrial fibrillation at her home for routine follow-up. Two weeks ago she was discharged from the hospital following treatment for pulmonary edema. She reports that she has had loss of appetite and has been short of breath at rest during the past few days despite increased use of oxygen. She has had three hospital admissions during the past 8 months for cardiac decompensation. On her last admission, her ejection fraction was 18% and cardiac catheterization disclosed extensive multivessel disease not amenable to stenting or bypass surgery. Her current medications include spironolactone, furosemide, lisinopril, atenolol, digoxin, warfarin, and nasal oxygen as needed. She lives with her 50-year-old daughter and has a home health aide for 4 hours per day. Vital signs are temperature 37.0°C (98.6°F), pulse 78/min and irregularly irregular, respirations 24/min off oxygen, and blood pressure 108/68 mm Hg. On physical examination she is alert and oriented. Auscultation of the lungs discloses bilateral basilar crackles. Cardiac examination discloses an S3 gallop and a grade 3/6 holosystolic murmur at the cardiac apex. She has 2+ bipedal edema. The patient and her daughter are both upset by the possibility of another hospitalization and they ask for advice. Which of the following is the most appropriate response to their concern?
A) Discuss admitting the patient to the intensive care unit for short-term but intensive management to prevent the need for a longer stay
B) Discuss home hospice care as an option for symptom management and avoidance of hospitalization
C) Discuss referral to a cardiac center with transplant capability for a complete reevaluation of options
D) Discuss the use of lorazepam to relieve her anxiety about the possibility of being hospitalized
E) Recommend starting amitriptyline therapy
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34.
A 15-year-old African American girl comes to the office because of the lesion shown, which has increased in size and become darker and thicker during the past 6 months. She takes no medications and is not sexually active. She is 152 cm (5 ft) tall and weighs 115 kg (252 lb); BMI is 49 kg/m2. Vital signs are temperature 36.0°C (96.8°F), pulse 88/min, respirations 20/min, and blood pressure 110/78 mm Hg. At this time it is most appropriate to inquire about a family history of which of the following?
http://www.consultant360.com/sites/defau...thosis.jpg
A) Addison disease
B) Diabetes mellitus
C) Hypercholesterolemia
D) Hyperparathyroidism
E) Polycystic kidney disease
PD: the picture is not the actual pic, I forgot to save the pic, sorry , but it was just one like this
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34 ...need picture
35..AA
36.. BB
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