09-07-2014, 12:35 PM
Oh wow ok !! interesting fact!! thanks 
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Discuss NBME F3 B1 - grazie
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09-07-2014, 12:38 PM
q17
Ans: E E) Serum parathyroid hormone concentration nbme cert! Pt with fam hx of neck surgeries and thyroid cancer. His Calcium 10.4 mg/dL and Phosphorus 2.0 mg/dL, we better check that Parathyroid gland.
09-07-2014, 12:39 PM
18.
A 35-year-old woman with rheumatoid arthritis returns to the office for a follow-up examination. Treatment has consisted of ibuprofen, intermittent prednisone for the past 5 years, and therapy with methotrexate initiated 1 year ago for continued multijoint involvement. The methotrexate has provided some relief, but she continues to have 1 hour of morning stiffness daily and several actively inflamed joints. She is 168 cm (5 ft 6 in) tall and weighs 66 kg (145 lb); BMI is 23 kg/m2. Vital signs are temperature 37.2°C (99.0°F), pulse 78/min, respirations 13/min, and blood pressure 138/82 mm Hg. Physical examination discloses warmth, erythema, tenderness, and sponginess of the metacarpophalangeal and proximal interphalangeal joints and wrists bilaterally and in the right elbow and left knee. The remainder of the physical examination shows no abnormalities. You are considering beginning tumor necrosis factor-alpha inhibitor therapy. Which of the following is the most appropriate next step prior to modifying the patient's therapy? A) Order echocardiography B) Order a 24-hour urine protein concentration C) Order an MRI of the brain D) Order serum rheumatoid factor assay E) Place a PPD skin test
09-07-2014, 12:39 PM
No matter what the question states!! According to UW if you have a high CA you must do PTH first
09-07-2014, 12:42 PM
Yes E
q18) E) Place a PPD skin test nbme cert! In order to decrease the risk of developing TB, prior to the introduction of the anti-TNF alpha therapy, all patients should undergo screening for TB.
09-07-2014, 12:47 PM
19.
An 88-year-old widower is brought to the office by his 61-year-old daughter for a periodic health evaluation. He is a retired machinist. He lives with his daughter and her family. The patient has a history of dementia and he has been your patient for the past 15 years. During the visit the daughter tells you that her father is having increasing difficulty with his basic activities of daily living. He needs assistance with bathing and dressing. He has difficulty transferring, has problems toileting, and frequently is incontinent. Recently he has become suspicious and paranoid of family members. He still can walk and feed himself independently. On Mini-Mental State Examination, he has difficulty with recall, concentration, language skills, and orientation; his total score is 13/30. The patient has a valid directive to physicians and had previously assigned a power of attorney for health care to his daughter. Which of the following is the most appropriate question to the daughter regarding long-term planning for this patient? A) "Did you care for your mother before she passed away?" B) "Does your father have long-term care insurance?" C) "Do you know the contents of your father's will?" D) "Have there been any changes in his medication regimen lately?" E) "What support systems are available to you to assist with your father's needs?" 20. A 63-year-old white woman comes to the office because of a worsening cough during the past 2 months that has become productive of white sputum during the past week. She says, "It started off as an irritating dry cough that would occur randomly and unexpectedly throughout the day. Last week, I started coughing up whitish phlegm, and now during the past few days it has contained flecks of blood." She has not had fever, chills, sweats, or shortness of breath. She has never smoked cigarettes and does not drink alcoholic beverages. Medical history is remarkable for hypertension treated with hydrochlorothiazide and hypothyroidism treated with levothyroxine. She is 162 cm (5 ft 4 in) tall and weighs 60 kg (132 lb); BMI is 23 kg/m2. Vital signs are temperature 37.1°C (98.8°F), pulse 68/min, respirations 16/min, and blood pressure 122/78 mm Hg. Examination of the sinuses, nares, tympanic membranes, and throat shows no abnormalities. Neck is supple without thyromegaly. Breath sounds are decreased at the right mid-lung field. Chest x-rays are shown. Which of the following is the best indication for antibiotic therapy in this patient? A) Chest x-ray findings B) Enlarged lymph node C) History of sweats D) White sputum production with blood flecks E) No antibiotic therapy is indicated 21. A 14-year-old white boy comes to the office with his mother because he "physically collapsed" for a few seconds, yesterday evening; he did not lose consciousness. The patient says, "It was scary. I was sitting down, watching a funny movie, and it was like my muscles just gave out for a minute. Also, my basketball coach has asked me to leave the team because he doesn't think I've been alert during the last few games." His mother notes that for the past 2 months he has been increasingly sleepy during the day despite going to bed at a reasonable time. Both the patient and his mother do not understand why he is drowsy during the day. He has also been nodding off frequently in class. He has been generally healthy and has had no recent infectious illnesses. Past medical history is unremarkable except for a febrile seizure at 8 months. He does not use illicit drugs or drink alcoholic beverages. He is an A/B student. Family history is significant for two maternal aunts with similar daytime sleep episodes. The patient's mother requests a sleep test. He is 165 cm (5 ft 5 in) tall and weighs 52 kg (115 lb). Vital signs are pulse 85/min, respirations 18/min, and blood pressure 128/78 mm Hg. Physical examination is normal. This patient is most likely to have a history of which of the following? A) Early morning awakening B) Frequent nightmares C) Hypnagogic hallucinations D) Night terrors E) Nighttime insomnia 22. A 32-year-old white veterinary technician comes to the office saying, "I've had trouble swallowing during the past 4 or 5 months." He reports that the symptoms developed slowly and are becoming worse, and he occasionally regurgitates food. Initially he had some associated pain with swallowing, but this no longer occurs. The symptoms are worse when he eats rapidly and when he is stressed. Symptoms are induced about equally by intake of solids and liquids and are sometimes relieved if he stands up straight. Antacids have had no effect. The patient has been otherwise healthy. He reports drinking one or two cans of beer about four nights per week, and has smoked four to five cigarettes daily for the past 6 years. Physical examination shows no abnormalities. Barium swallow shows a dilated esophagus with an air-fluid level. Which of the following is the most likely diagnosis? A) Achalasia B) Early esophageal carcinoma C) Esophageal diverticulum D) Esophageal ring E) Reflux esophagitis 23. A 58-year-old woman comes to the office for a follow-up visit 4 weeks after being discharged from the hospital. She was treated in the hospital for 4 days following myocardial infarction. She has a 3-year history of hypercholesterolemia treated with simvastatin. Metoprolol and aspirin were added to her regimen during her hospitalization. She has no history of hypertension or diabetes mellitus. She smoked one pack of cigarettes daily for 25 years but quit 1 year ago. She has one gin cocktail about five times weekly with dinner. Her father had coronary artery disease and had a myocardial infarction at age 53 years. There is no family history of alcohol abuse. She is 168 cm (5 ft 6 in) tall and weighs 60 kg (132 lb); BMI is 21 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 54/min, respirations 18/min, and blood pressure 123/80 mm Hg. Physical examination shows no abnormalities. Results of laboratory studies are shown: Serum AST 23 U/L Glucose, fasting 95 mg/dL Cholesterol, total 160 mg/dL HDL 50 mg/dL LDL 92 mg/dL Triglycerides 89 mg/dL The patient asks, "Is it okay if I continue drinking gin?" Which of the following statements is the most appropriate response? A) "Because of your heart attack, I cannot recommend any alcohol intake." B) "Continuing your current intake may reduce your risk for another heart attack." C) "For ethical reasons I cannot advise you on drinking alcohol." D) "I cannot recommend resuming your consumption of alcohol because it will probably lead to alcohol dependence." E) "To realize any benefit from alcohol consumption, you would need to increase the amount you consume to one to two drinks every day." 24. A 2-month-old infant is brought to the office for a periodic health evaluation. He was born at full term, is healthy, and is developing normally. Physical examination shows a small, reducible inguinal hernia on the right side. Both testes are descended and of normal size. You inform the parents that the infant has a congenital inguinal hernia and explain that the boy will need operative treatment. Which of the following is the most appropriate plan for scheduling this procedure? A) Admit the infant to the hospital for surgical repair on the following morning B) Schedule the operation within the next 2 weeks C) Wait until the infant is 1 year of age because the congenital inguinal hernia may close spontaneously D) Wait until the infant is 1 year of age because the risk for incarceration is minimal E) Wait until the infant is 6 months of age because general anesthesia is safer after that age 25. A 55-year-old African American woman, gravida 4, para 4, comes to the office because of a rash across both breasts that first appeared approximately 2 months ago. The patient says that initially she was not concerned about the rash because it appeared after she became sunburned during a trip to the Caribbean. She has tried treating the rash with over-the-counter moisturizers without success. Medical history is remarkable for hypothyroidism, for which she takes levothyroxine. She underwent tubal ligation 10 years ago. Menopause occurred 4 years ago. She has smoked two packs of cigarettes daily for the past 40 years. Vital signs are normal. Physical examination discloses mild bilateral breast tenderness and the findings shown. Mammogram obtained 2 weeks ago discloses no abnormalities. Which of the following is the most appropriate next step? A) Bilateral breast ultrasonography B) Potassium hydroxide scraping for yeast C) Punch biopsy of the nipple D) Repeat mammography
09-07-2014, 12:47 PM
Would love your feedback on these 6 questions
1.55 year old woman who has just joined your health plan comes to the office for her periodic health evaluation. She is postmenopausal and she has had screening mammo yearly for the past 5 years. The mammo done last week shows a solitary cluster of micro calcification measuring approximately .8cm in the lower out quadrant of the left breast. PE , including breast exam is normal. Which of the following is the most important initial step? a. determine if she is taking estrogen b. inquire regarding family history of breast cancer c. Obtain CXR d. Order stereotactic core biopsy e. Order US of the breast 2. 52 year old teacher returns to the office for a periodic health evaluation. Three years ago, you diagnose menopause and discuss estrogen replacement therapy with the patint. She declined therapy and said “ I prefer more natural approach. Ill deal with menopause when i need to. her last menstrual period occurred when she was age49. Today she says that she has begun using dong quay pills and vit E supplements, and has increase her intake of soy protein in an attempt to reduce menopausal symptoms. Within 3 months of beginning this regimen she's says ‘ I began to feel like my old self again and haven’t had any more of those hot flashes and had started after my periods stopped. Why i even have a period every 2 to 3 months now. The patient is 160cm and weight 104 BMI 18. Vital signed are normal. Pelvic examination discloses pink vagina mucosa with normal rugae. The cervic is normal the uterus is small and non tender.Pap smear and cholesterol are pending. At this time which of the following the most appropriate conclusion regarding this patient? She has prolactin secreting tumor she has a source of unopposed estrogen she has adequate estrogen levels to proven osteoporosis she has developed endometrial carcinoma she is not postmenopasual 3. An 81 year old man comes to the office with his son of 2 months after dx of adenocarcinoma. The pt has been losing weight since being dx. at this visit his son tells you that the pt gathered his family and told them all that he did not want further eval or tx of the cancer , and he never wanted to returen to the hospital under any circumstance. “ just take care of me at home as best you can” He told the family. 3 days late the son calls u because they found the pt unresponsive but breathing. He is not sure what to do. You suspect Stroke. What do you respond? are you sure he meant what he said about not going back to the hospital are u prepared to cont caring for him at home now ill arrange for admission to chronic care tell me about his condition so i can decide whether he should go to the hospital you must take him to the hospital call 911 NOW 4. The breast question with the scales bilateral breast US KOH scrape for yeast Punch biopsy of the nipple repeat mamma 5. 31 year old bodybuilder comes to the office because of frequent headaches for the past 8 weeks . He tells you that the heads aches extend from his temples to the back of his head. The patient is 183 cm 6 ft and weights 88kg 195lb . BMI27. VS now are temp 98.4 pulse 88 respirations 14 BP 190.105. PE normal. In addition to obtaining a social history and information about alcohol use it is most important to obtain information regarding which of the following? a. intake of creatine b. his intake of vitamin supplements c. smoke history WRONG d. training routine e. anabolic steriods 6. 63 year old white woman comes to the office because of a worsening cough during the past 2 months that has become productive of white sputum during the past week. She says " it started off as an irritating dry cough that would occur randomly and un expectedly throughout the day. Last week I started coughing up whitish phlegm and now during the past few days it has contained flecks of blood. she denies chills fever and sweats and SOB. blah blah lol and PHOTO which of the following is the best indication for antibiotic therapy in this pt. a. CXR findings b. Enlarged lymph node c. history of sweats d. white sputum with blood e. no antibiotic therapy indicated.
09-07-2014, 12:47 PM
OH you have more lol Nevermind
u covered mine whoops
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