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6.
A 74-year-old man is brought to the office by his wife because of a progressive tremor of his right hand and mild stiffness of his right arm for the past 2 years. His wife also notes that he seems to have been walking more slowly during the past 6 months. Medical history is remarkable only for hypertension controlled with enalapril. Vital signs are temperature 37.0°C (98.6°F), pulse 64/min, respirations 12/min, and blood pressure 150/88 mm Hg. Physical examination shows diminished facial expression. Mental status examination shows no abnormalities. Strength is full throughout, but there is a prominent resting tremor of his right hand and bilateral cogwheel rigidity of the upper extremities that is more pronounced on the right side. Reflexes are 2+ and symmetric, and Babinski sign is absent bilaterally. He has a mild shuffling gait. Which of the following is the most appropriate diagnostic study?
A) Determination of serum thyroid-stimulating hormone concentration
B) Determination of serum vitamin B12 (cobalamin) concentration
C) MRI of the brain with contrast
D) PET scan
E) No diagnostic studies are indicated
ANS:
E) No diagnostic studies are indicated
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Yes, Parkinson dx can be done made based on clinic only.
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7.
A 28-year-old woman comes to the community-based health center because she noticed a tender, firm mass in her right breast in the same general location where she was hit by a softball 2 years ago. Vital signs are temperature 37.0°C (98.6°F), pulse 68/min, respirations 18/min, and blood pressure 118/64 mm Hg. She weighs 56 kg (123 lb) and is 155 cm (5 ft 1 in) tall; BMI is 23 kg/m2. Physical examination is normal except for an indurated and poorly defined mass in the right breast with local skin retraction. There is no palpable adenopathy. Mammogram shows fine, stippled calcification. Which of the following is the most likely diagnosis?
A) Fat necrosis
B) Fibroadenoma
C) Intraductal carcinoma
D) Lipoma
E) Phyllodes tumor
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kk sorry will do !! and those are all from Block 1 NBME form3!!
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q7)
Ans: A) Fat necrosis
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Nonproliferative benign breast lesions include
(1) Inflammatory Fat Necrosis, which follows surgical or blunt trauma, and generally resolves spontaneously; The calcification of fat necrosis is typically peripheral with a stippled curvilinear appearance creating the appearance of lucent "bubbles" in the breast parenchyma; Low density centres. Tumour formation is not a part of fat necrosis although it may be clinically palpable.
(2) lymphocytic mastitis, which may be seen in diabetic patients; and
(3) granulomatous mastitis, associated with foreign body reactions (e.g., Silicone and Paraffin for breast augmentation and reconstruction after cancer surgery), Sarcoid, or certain Infections.
Goldman's Cecil Medicine , Twenty-Fourth Edition
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8.
A 58-year-old white woman comes to the office to discuss results of a DEXA scan obtained 3 days ago that showed a T-score of −2.6 at the femoral neck and −2.0 at the lumbar spine (N> −0.1). She also has had a 1-month history of anhedonia, poor sleep with early morning awakening, decreased appetite, thoughts of death, and feelings of guilt. Medical history is significant for hypertension, hypercholesterolemia, osteoarthritis of the hips and knees, and gastric bypass surgery and cholecystectomy in her 30s. Medications include clonidine, amlodipine, atorvastatin, and daily ibuprofen. After her gastric bypass surgery, she developed deep venous thrombosis for which she took warfarin for 1 year. She does not smoke cigarettes or drink alcoholic beverages. The patient is 178 cm (5 ft 5 in) tall and weighs 73 kg (160 lb); BMI is 27 kg/m2. Vital signs are temperature 37.1°C (98.8°F), pulse 80/min, respirations 16/min, and blood pressure 148/76 mm Hg. The patient's affect is flat and she does not make eye contact. Physical examination discloses kyphosis, nontender enlargement of the distal interphalangeal joints of several fingers, and nontender bony prominences of the first metatarsophalangeal joints bilaterally. Results of fasting serum laboratory studies are shown:
Cholesterol
Total 161 mg/dL
HDL 52 mg/dL
LDL 79 mg/dL
Triglycerides 150 mg/dL
Glucose 98 mg/dL
In addition to initiating antidepressant therapy, which of the following is the most appropriate change to this patient's medication regimen at this time?
A) Add colchicine
B) Add ibandronate
C) Add lisinopril
D) Add raloxifene
E) Switch atorvastatin to pravastatin
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9.
A 5-year-old girl is brought to the health center by her parents because of a long-standing history of constipation. The father says, "This problem seemed to have started when she was 2 years old, after she was potty trained." The mother reports that in the early stages of the problem she had noticed a couple of blood drops in her daughter's stool in the toilet. She says that her daughter has a bowel movement only once or twice per week, usually after a suppository or an enema is given, and that her stools are large and occasionally "block" the toilet bowl. The child frequently soils her underwear. Which of the following is the most likely cause?
A) Cystic fibrosis
B) Gluten enteropathy
C) Habit constipation
D) Hirschsprung disease
E) Intestinal pseudo-obstruction
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8. B
9. C
Got them right on the NBME
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Question 8 BB is CORRECT per NBME feedback.
Question 9 CC is CORRECT per NBME feedback.
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