nbme form 2 b1 2/2 - grazie

[ArchivalUser]

34.. BB

[ArchivalUser]

q34)

B) Diabetes mellitus
(correct by NBME)

Acanthosis nigricans is conventionally divided into benign and malignant forms.

Benign: This may include obesity-related, hereditary, and endocrine forms of acanthosis nigricans like Hypothyroidism, acromegaly, polycystic ovary disease, insulin-resistant DIABETES, or Cushing's disease.

Malignant: Associated with tumor products and insulin-like activity, or tumour necrosis factor. Occurring as a Paraneoplastic Syndrome associated with cancer. MC associated with GI Adenocarcinomas, as well as GU cancer such as prostate, breast, and ovary. Other cancers, such as those of the lung, stomach, and lymphoma, are occasionally associated with acanthosis nigricans.

[ArchivalUser]

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

I think I would go also with A, the “SIG-E-CAPS” comes negative so no depression. It's not D (by nbme feedback) , not dysthymic cause this is recently and is not depression.

A) would be correct
Good img87

[ArchivalUser]

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


Answer:
B) Discuss home hospice care as an option for symptom management and avoidance of hospitalization
This kind of medical care is common for terminal patients.

B came right in my exam

Okay, tomorrow I hope to do 2nd block and more if I can. Thanks for your answers, posts and explanations

Nighty night *-* ZZZZZZZ