08-25-2014, 01:39 PM
Okay, this is Block 3 from Form 2 NBME for Step 3
If you haven't taken it yet, I don't recommend you check this but if I you took it already, come here to discuss the questions. Please provide some small explanation to your answers.
Here we go....
Form 2 Block 3
1.
A 60-year-old man comes to the office because of a 4-week history of generalized muscle weakness that has made it difficult to rise from a low chair or raise his arms above his head. He also has noted postural dizziness, dry mouth, difficulty emptying his bladder, and erectile dysfunction during this time. He has not had pain or sensory loss. Medical history is otherwise unremarkable and he takes no medications. Vital signs are temperature 37.0°C (98.6°F), pulse 80/min, respirations 18/min, and blood pressure 130/80 mm Hg supine and 105/60 mm Hg standing. Muscle bulk and tone are normal. There are no fasciculations. Muscle strength is 4/5 bilaterally in the proximal muscles of all four extremities; muscle strength improves with repeated testing of the deltoid and iliopsoas muscles. Deep tendon reflexes are absent diffusely and Babinski sign is absent. The remainder of the neurologic examination shows no abnormalities. Which of the following additional disorders is most likely present in this patient?
A) Diabetes mellitus
B) Hypothyroidism
C) Monoclonal gammopathy
D) Small cell lung cancer
E) Vitamin B12 (cobalamin) deficiency
2.
A 45-year-old Hispanic woman, gravida 4, para 4, comes to the office for an annual gynecologic examination. She says her menstrual periods have been occurring at 3- to 4-month intervals during the past year. When her menstrual periods do occur, they are heavy. She has also gained 4.5 kg (10 lb) since last year. Medical history is unremarkable and she takes no medications. She is 162 cm (5 ft 4 in) tall and weighs 76 kg (167 lb); BMI is 29 kg/m2. Examination of the breasts discloses no masses or galactorrhea. Pelvic examination discloses a slightly enlarged, globular uterus with no adnexal masses. Pelvic ultrasonography shows a thickened endometrial lining measuring approximately 14 mm. Without treatment, which of the following is most likely to develop in this patient?
A) Adenocarcinoma of the ovary
B) Endometrial hyperplasia
C) Endometrial polyps
D) Ovarian cysts
E) Uterine myomata
3.
A 10-year-old Hispanic boy is brought to the office by his mother because of an itchy rash on his right ankle and leg that he noticed this morning while putting on his socks. Small blisters have formed from scratching the rash. Vital signs are temperature 36.7°C (98.0°F), pulse 70/min, respirations 16/min, and blood pressure 90/70 mm Hg. Examination of the skin shows a linear erythematous rash over the right lower extremity with clear oozing transudate; there is no edema. A photograph of the rash is shown. The remainder of the physical examination discloses no abnormalities. Which of the following is the most appropriate topical pharmacotherapy at this time?
A) Acyclovir
B) Clotrimazole
C) Erythromycin
D) Hydrocortisone
E) Mupirocin
4.
A 24-year-old European American woman calls the office because, she says, "I feel lousy." She has come to the office repeatedly in the past year for various symptoms including headaches, chest tightness, abdominal pain, and nerve tingling. Work-ups have been normal. She takes no medication. She often calls for an urgent appointment; the symptoms that she describes always seem more severe than the physical examinations reflect. The patient is polite but ends each visit by saying, "Doctor, I forgot to tell you about...", and lists another symptom. Which of the following is the most effective management of this patient?
A) Arrange psychiatric evaluation
B) Evaluate the patient for substance abuse
C) Prescribe fluoxetine
D) Prescribe lorazepam
E) Schedule frequent visits and provide reassurance
5.
A 2-month-old infant is brought to the office by his mother for a well-child visit. The infant's mother says he seems to have very bowed legs. She thinks that the infant's grandmother had to wear special shoes for the same reason. Otherwise the infant is doing well and is breast-feeding six to eight times daily. Weight is 5549 g (12 lb 4 oz) and length is 57.5 cm (23 in). On physical examination both legs appear to bow outward symmetrically such that the knees are far apart. The femurs and tibias appear to be symmetrical. The hips, knees, and ankles have equal movement. The infant smiles and pumps his legs vigorously during the examination. He also seems to enjoy bearing weight on his legs. Which of the following is the most likely explanation for the patient's bowed legs?
A) Congenital chondrodysplasia
B) External tibial torsion
C) Internal tibial torsion
D) Normal growth
E) Rickets
If you haven't taken it yet, I don't recommend you check this but if I you took it already, come here to discuss the questions. Please provide some small explanation to your answers.
Here we go....
Form 2 Block 3
1.
A 60-year-old man comes to the office because of a 4-week history of generalized muscle weakness that has made it difficult to rise from a low chair or raise his arms above his head. He also has noted postural dizziness, dry mouth, difficulty emptying his bladder, and erectile dysfunction during this time. He has not had pain or sensory loss. Medical history is otherwise unremarkable and he takes no medications. Vital signs are temperature 37.0°C (98.6°F), pulse 80/min, respirations 18/min, and blood pressure 130/80 mm Hg supine and 105/60 mm Hg standing. Muscle bulk and tone are normal. There are no fasciculations. Muscle strength is 4/5 bilaterally in the proximal muscles of all four extremities; muscle strength improves with repeated testing of the deltoid and iliopsoas muscles. Deep tendon reflexes are absent diffusely and Babinski sign is absent. The remainder of the neurologic examination shows no abnormalities. Which of the following additional disorders is most likely present in this patient?
A) Diabetes mellitus
B) Hypothyroidism
C) Monoclonal gammopathy
D) Small cell lung cancer
E) Vitamin B12 (cobalamin) deficiency
2.
A 45-year-old Hispanic woman, gravida 4, para 4, comes to the office for an annual gynecologic examination. She says her menstrual periods have been occurring at 3- to 4-month intervals during the past year. When her menstrual periods do occur, they are heavy. She has also gained 4.5 kg (10 lb) since last year. Medical history is unremarkable and she takes no medications. She is 162 cm (5 ft 4 in) tall and weighs 76 kg (167 lb); BMI is 29 kg/m2. Examination of the breasts discloses no masses or galactorrhea. Pelvic examination discloses a slightly enlarged, globular uterus with no adnexal masses. Pelvic ultrasonography shows a thickened endometrial lining measuring approximately 14 mm. Without treatment, which of the following is most likely to develop in this patient?
A) Adenocarcinoma of the ovary
B) Endometrial hyperplasia
C) Endometrial polyps
D) Ovarian cysts
E) Uterine myomata
3.
A 10-year-old Hispanic boy is brought to the office by his mother because of an itchy rash on his right ankle and leg that he noticed this morning while putting on his socks. Small blisters have formed from scratching the rash. Vital signs are temperature 36.7°C (98.0°F), pulse 70/min, respirations 16/min, and blood pressure 90/70 mm Hg. Examination of the skin shows a linear erythematous rash over the right lower extremity with clear oozing transudate; there is no edema. A photograph of the rash is shown. The remainder of the physical examination discloses no abnormalities. Which of the following is the most appropriate topical pharmacotherapy at this time?
A) Acyclovir
B) Clotrimazole
C) Erythromycin
D) Hydrocortisone
E) Mupirocin
4.
A 24-year-old European American woman calls the office because, she says, "I feel lousy." She has come to the office repeatedly in the past year for various symptoms including headaches, chest tightness, abdominal pain, and nerve tingling. Work-ups have been normal. She takes no medication. She often calls for an urgent appointment; the symptoms that she describes always seem more severe than the physical examinations reflect. The patient is polite but ends each visit by saying, "Doctor, I forgot to tell you about...", and lists another symptom. Which of the following is the most effective management of this patient?
A) Arrange psychiatric evaluation
B) Evaluate the patient for substance abuse
C) Prescribe fluoxetine
D) Prescribe lorazepam
E) Schedule frequent visits and provide reassurance
5.
A 2-month-old infant is brought to the office by his mother for a well-child visit. The infant's mother says he seems to have very bowed legs. She thinks that the infant's grandmother had to wear special shoes for the same reason. Otherwise the infant is doing well and is breast-feeding six to eight times daily. Weight is 5549 g (12 lb 4 oz) and length is 57.5 cm (23 in). On physical examination both legs appear to bow outward symmetrically such that the knees are far apart. The femurs and tibias appear to be symmetrical. The hips, knees, and ankles have equal movement. The infant smiles and pumps his legs vigorously during the examination. He also seems to enjoy bearing weight on his legs. Which of the following is the most likely explanation for the patient's bowed legs?
A) Congenital chondrodysplasia
B) External tibial torsion
C) Internal tibial torsion
D) Normal growth
E) Rickets