09-07-2014, 06:37 AM
Please post your answer and some little explanation why you choose that answer, I will review them all but some inputs are always welcome and it can only benefits us all.
Thank you!
Thank you!
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Discuss NBME F3 B1 - grazie
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09-07-2014, 06:40 AM
1.
A 35-year-old woman comes to the office because of a 5-day history of worsening left lower quadrant abdominal pain and a 3-day history of vaginal spotting. Her last menstrual period was 6 weeks ago and a recent home pregnancy test was positive. She has had two previous pregnancies, both of which resulted in cesarean delivery for fetal distress. The patient previously used an intrauterine device for contraception but discontinued use last year when her periods became heavy; she now uses condoms and the rhythm method for contraception. Medical history is significant for treatment for an infection caused by Chlamydia trachomatis at age 28 years. She has smoked one pack of cigarettes daily for the past 15 years. She is 168 cm (5 ft 6 in) tall and weighs 57 kg (125 lb). Vital signs are temperature 37.1°C (98.9°F), pulse 110/min, respirations 16/min, and blood pressure 108/76 mm Hg. Abdominal examination discloses mild lower quadrant tenderness that is greater on the left side; there is no guarding or rebound. Pelvic examination discloses a small amount of brown discharge in the vagina, mild cervical motion tenderness, and a closed cervical os. Results of laboratory studies are shown: Serum Blood β-hCG 1848 mU/mL Hematocrit 34.3% Hemoglobin 11.9 g/dL Pelvic ultrasonography shows no intrauterine gestational sac. Which of the following is the most significant risk factor for development of this patient's condition? A) Age B) Cigarette smoking history C) Gravid status D) Previous infection caused by Chlamydia trachomatis E) Prior use of intrauterine device
09-07-2014, 06:57 AM
q1)
Ans: D nbme cert Chlamydia trachomatis is the most common STD in the U.S. Most women with Endocervical or Urethral infections are asymptomatic. Up to 45% of cases of gonococcal infection may have concomitant chlamydial infection. Infertility or Ectopic pregnancy can result as a complication from symptomatic or asymptomatic chronic infections of the endometrium and fallopian tubes. Ferri's Clinical Advisor 2015.
09-07-2014, 06:58 AM
Q2 & Q3
The following vignette applies to the next 2 items. A 37-year-old newspaper delivery truck driver, whom you have known for 2 years, comes to the office because of neck pain. Three days ago, his pickup truck was hit in the rear by a larger truck. The patient was dazed but not unconscious. He had acute pain in his posterior neck and right shoulder area. He was transported to a nearby emergency department by ambulance where x-rays were normal. He was observed in the emergency department for 6 hours, fitted with a cervical collar, and given ibuprofen for pain. Prior to this accident he had been healthy, although he came to the office every few months with minor complaints, such as tinnitus and dyspepsia. No physical abnormalities were found at any of these past visits, and he responded to reassurance and symptomatic treatment. Today he is wearing the cervical collar and seems in distress. On physical examination, the nuchal area is diffusely tender to palpation, and the patient self-limits neck movements. Neurologic examination is normal. He tells you that he has already seen his attorney who believes that he has a good case against the other driver. Item 1 of 2 2. Which of the following is the most appropriate initial management to maximize this patient's recovery? A) Declare him unable to work until his symptoms have ceased B) Encourage him to forgo litigation C) Increase the pain medication D) Reassure him and continue the collar and ibuprofen therapy E) Refer him for physical rehabilitation Item 2 of 2 3. Based upon the medical literature and this patient's history, which of the following is a correct statement about his recovery? A) He will develop dependency on pain medication B) He will need long-term care with visits every few months C) He will only improve if he receives psychotherapy D) Litigation may delay symptomatic recovery E) Secondary gain will lead to malingering
09-07-2014, 07:21 AM
Q2-
Ans: E) Refer him for physical rehabilitation A,B and C are out, D is wrong by nbme. Patient is kind of hypochondriac, was always coming for minor problems. Now he has an excuse but PE is ok except for some tenderness on the nuchal area due to the accident. Sending him to Physical Rehab will give him that reassurance he needs to feel better. Ans: E Q-3 Ans: C) He will only improve if he receives psychotherapy B, D and E are wrong, by nbme. So, between A and C, I would pick C because he is only receiving Ibuprofen, no dependence on this one. Please correct me if I am wrong or if you got this right on the nbme feedback.
09-07-2014, 07:25 AM
2..xray is normal, already on pain killer for existing complaint. E may help him.
3..Due to his litigation interest, D is a possibility i guess
09-07-2014, 07:26 AM
4.
A 17-year-old girl comes to the office for a physical examination prior to attending camp. She has been generally healthy. Physical examination shows a roughness on her arms, which is shown. She states, "I've tried all sorts of lotions, but this just stays the same." Which of the following is the most likely diagnosis? A) Eczema B) Keratosis pilaris C) Lichen planus D) Pityriasis rosea E) Psoriasis Answer: B NBME cert Keratosis pilaris is very common and presents as tiny (
09-07-2014, 07:30 AM
5.
A 42-year-old Ecuadorian man who recently immigrated to the USA comes to the office for an initial visit. He tells you that for the past several months he has been having episodes of uncontrollable crying, difficulty sleeping, and loss of sex drive and appetite. He is not taking any medications. His family is in Ecuador. He has no other medical problems. Physical examination discloses no abnormalities. Which of the following is the most appropriate step prior to initiating therapeutic intervention? A) Ask the patient about his beliefs regarding the cause of his illness B) Ask the patient if he has any history of medication allergy C) Inform the patient about the benefits of medication in his condition D) Inform the patient about the nature of depression E) Inform the patient about the relationship between the patient's mind and body D is wrong  now what? C? A? Please! I need help with this qs
09-07-2014, 07:49 AM
5 is A!!! Thank you by the way for number 4 had no clue and took the exam and couldn't figure it out
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