NBME IFOM please help! - coke170

[ArchivalUser]

2. A 7-year-old girl is brought to the physician for a well-child examination. Her mother states that for the past 5 months, she has been making facial grimaces; the grimacing is worse when she is anxious. She has not had any other unusual motor movements or vocal sounds. Her teacher did not mention the facial grimaces during a recent parent-teacher conference. She is at the 60th percentile for height and the 55th percentile for weight. Her pulse is 76/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities except for occasional facial grimacing. Mental status examination shows a broad, appropriate affect and a neutral mood. She states that none of her friends have made any comments to her about the facial movements and that these movements do not bother her. Which of the following is the most appropriate next step in management?

O A) Schedule a follow-up examination in 3 months
O B) Behavior therapy
O C) Relaxation training
O D) Haloperidol therapy
O E) Sertraline therapy
23. A 72-year-old woman comes to the physician for a routine health maintenance examination. She has a 3-year history of waking up twice nightly to void. She has not had orthopnea, paroxysmal nocturnal dyspnea, or changes in appetite, weight, or fluid intake. She is 168 cm (5 ft 6 in) tall and weighs 69 kg (152 lb); BMI is 24 kg/m2. Her pulse is 80/min, and blood pressure is 142/82 mm Hg. Examination shows no other abnormalities for her age. Urinalysis shows no abnormalities. Which of the following is the most likely cause of this patient's nocturia?

O A) Congestive heart failure
O B) Interstitial nephritis
O C) Nephrotic syndrome
O D) Type 2 diabetes mellitus
O E) Normal aging
24. A previously healthy 67-year-old woman comes to the physician because of diffuse pain in her extremities for 3 months. She describes the pain as achiness in her shoulders, arms, and thighs. Examination shows mild tenderness (pain) to palpation over the shoulders and thighs. Muscle strength is full. Deep tendon reflexes are decreased bilaterally in the extremities. Sensation to pinprick and vibration is normal. Laboratory studies show:

Hemoglobin 12.9 g/dl (129 g/L)
Mean corpuscular volume 92 μm3 (92 fl)
Leukocyte count 7300/mm3 (7.3 x 10^9/L)
Erythrocyte sedimentation rate 94 mm/h
Serum Alkaline phosphatase 106 U/L
Creatine kinase 84 U/L
Which of the following is the most likely diagnosis?
O A) Ankylosing spondylitis
O B) Fibromyalgia
O C) Osteitis deformans (Paget disease)
O D) Polychondritis
O E) Polymyalgia rheumatica
O F) Polymyositis
O G) Rheumatoid arthritis
36. A 38-year-old man with a 6-week history of abdominal cramps and bloody diarrhea develops fever and generalized abdominal pain and distention. His temperature is 40°C (104 °F), pulse is 112/min, respirations are 20/min, and blood pressure is 122/76 mm Hg. The abdomen is distended and tympanitic; bowel sounds are absent, and there is no rebound tenderness (pain) to palpation. Which of the following is the most appropriate initial diagnostic study?

O A) X-ray of the abdomen
O B) Abdominal ultrasonography
O C) Barium enema
O D) Flexible sigmoidoscopy
O E) Peritoneal aspiration

[ArchivalUser]

2. C) Relaxation training ( mild tourette )
23 E) Normal aging
24 E) Polymyalgia rheumatica
36 A) X-ray of the abdomen

[ArchivalUser]

thank you monter.

here's more questions..

1. An 18-year-old woman comes to the emergency department because of fever, facial redness, and fluid weeping from her cheek for 2 days. Her 6-year-old sister has similar symptoms. She applies a hydrocortisone cream twice daily; she does not take other medications. Her temperature is 37.8°C (100°F), pulse is 78/min, and blood pressure is 110/70 mm Hg. There are numerous excoriations, heaped-up erythematous dermis, and a cloudy, yellow fluid draining from the skin of both antecubital fossae. Which of the following is the most appropriate next step in management?
O A) Open wet dressings
O B) Topical triamcinolone cream with occlusive dressings
O C) Oral dicloxacillin
O D) Oral fluconazole
O E) Oral prednisone

2. A 52-year-old woman with type 1 diabetes mellitus comes to the physician because of a 6-week history of abdominal bloating (distension) after meals and alternating diarrhea and constipation. She also has had loss of feeling in her feet over the past 12 months. Medications include enalapril, insulin, and pravastatin. Her temperature is 37°C (98.6°F). Her pulse is 80/min while supine, and blood pressure is 136/80 mm Hg; pulse is 80/min while standing, and blood pressure is 105/70 mm Hg; respirations are 12/min. Examination shows a healing ulcer on the left foot. The abdomen is nontender (painless) to palpation with no masses or rebound. Deep tendon reflexes and sensation to pinprick and vibration are decreased in the lower extremities. Test of the stool for occult blood is negative. Her hemoglobin A1c is 9%. Which of the following is the best explanation for this patient's diarrhea?
O A) Abnormal intestinal motility
O B) Intestinal inflammation
O C) Malabsorption
O D) Medication adverse effect
O E) Increased gastrointestinal secretion

4. A 20-year-old woman comes to the physician because of a 6-month history of diffuse joint pain, especially in her hips and knees. During this period, she occasionally has had a rash on her nose and cheeks. She has no history of serious illness and takes no medications. Her temperature is 38.1 °C (100.5°F). Examination shows warmth and swelling of the knees. Laboratory studies show:

Hemoglobin 10.5 g/dl (105 g/L)
Erythrocyte sedimentation rate 40 mm/h
Serum 30 mg/dl (10.7 mmol/L)
Urea nitrogen 1.8 mg/dl (159.1 μmol/L)
Creatinine 10.5 g/dl (105 g/L)

Which of the following is the most appropriate initial step in management?
O A) Observation only
O B) Oral colchicine therapy
O C) Oral prednisone therapy
O D) Intravenous vancomycin therapy
O E) Synovectomy

5. A 62-year-old man comes to the physician because of a painless bulge in his groin over the past month. The bulge is not enlarging; it disappears when he is supine. He has not had cough, difficulty urinating, or constipation. The abdomen is soft and is not distended or tender (not painful). Examination of the right groin shows a soft bulge along the spermatic cord at the pubic tubercle. Rectal examination shows no abnormalities. Which of the following is the most appropriate next step in management?

O A) Reexamination in 3 months
O B) Use of a groin support device
O C) CT scan of the abdomen and pelvis
O D) Colonoscopy
O E) Elective hernia repair

9. A 55-year-old man is brought to the emergency department 1 hour after the sudden onset of blurred vision in the left eye. There is no associated headache, strabismus, or eye pain. His temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 150/90 mm Hg. Funduscopy on the left shows a well visualized optic disc with sharp margins. The medial aspect of the retina appears out of focus and protrudes into the vitreous, and the lateral aspect of the retina appears normal. Which of the following is the most likely cause?

O A) Acute glaucoma
O B) Cholesterol embolism
O C) Detached retina
O D) lntraorbital hemorrhage
O E) Traumatic iritis

17. A 27-year-old man is brought to the physician by his parents because of increasingly bizarre behavior for 4 months. His parents state that he has been very "cold" with them, and they think he might be depressed. During this time, he has been talking to himself and has become withdrawn and isolated. He works at a library, and his manager has had to talk with him several times about ignoring the customers. He says that he does not have any problems and claims that his parents do not know what they are talking about. He states that he would like to be "left alone with just the books." One year ago, he became interested in Eastern philosophies, including reincarnation, afterlife, and mysticism; he recently changed religions. He reports no problems with sleep or appetite. He is 183 cm (6 ft) tall and weighs 63 kg (140 lb); BMI is 19 kg/m2. His pulse is 72/min, and blood pressure is 124/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he has a restricted affect. He states that he feels "okay." He is distant but cooperative. There is no evidence of hallucinations. Laboratory findings are within the reference range. Urine toxicology screening is negative. Over the next 10 years, this patient is at greatest risk for development of which of the following?
O A) Bipolar disorder
O B) Dysthymic disorder
O C) Major depressive disorder, recurrent
O D) Schizophrenia
O E) Somatization disorder

29. A 63-year-old man comes to the physician following a 10-hour episode of aphasia, blurred vision in the left eye, and numbness and tingling of the right upper extremity. The symptoms slowly resolved, and he is now asymptomatic. He has no history of similar symptoms, and medical history is unremarkable except for an appendectomy 40 years ago. His temperature is 37°C (98.6°F), pulse is 80/min and regular, and blood pressure is 170/96 mm Hg. Examination shows bilateral carotid bruits. A complete blood count and measurement of serum concentrations of electrolytes, urea nitrogen, and creatinine are within normal limits. Which of the following is the most likely cause of the symptoms?
O A) Embolus from a left carotid artery lesion
O B) Infarct of the optic chiasm
O C) Left anterior cerebral hypertensive infarct
O D) Right anterior cerebral aneurysm
O E) Right-sided vertebrobasilar insufficiency

[ArchivalUser]

first set:
correction : 2. B) Behavior therapy ( mild tourette ) habit reversal training
23 E) Normal aging
24 E) Polymyalgia rheumatica
36 A) X-ray of the abdomen

second set:
1. C) Oral dicloxacillin -- start antibiotics for infected atopic dermatitis
2 A) Abnormal intestinal motility
4 C) Oral prednisone therapy
5 E) Elective hernia repair
9 C) Detached retina
17 D) Schizophrenia
29 A) Embolus from a left carotid artery lesion