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l******g
发帖数: 278 | 1 NBME form 4
1. A 22-year-old woman with asthma comes to the physician for a follow-up
examination. She feels well. She has been treated for six acute episodes of
wheezing and nonproductive cough during the past year; her last episode was
1 month ago. Her symptoms are exacerbated when she is outside during the
spring and fall. Current medications include an albuterol inhaler and
echinacea. She has smoked one-half pack of cigarettes daily for 5 years and
does not drink alcohol. She is employed in a jewelry factory. Her
temperature is 37.2°C (99°F), pulse is 80/min, respirations are 12/min,
and blood pressure is 120/80 mm Hg. Examination and an x-ray of the chest
show no abnormalities. In addition to counseling about smoking cessation,
which of the following measures is most likely to reduce the frequency of
asthma exacerbations?
A ) Change in work environment
B ) Desensitization to animal dander
C ) Fluticasone inhaler therapy
D ) Haemophilus influenzae type b vaccine
E ) Influenza vaccine
F ) 23-Valent pneumococcal vaccine
2 An 82-year-old woman comes to the physician because of a 9-month history
of progressive urinary incontinence. At least once daily, she has a strong
urge to void, is unable to reach a bathroom in time, and spontaneously
passes a large amount of urine. She had a mild cerebral infarction 2 years
ago with no residual weakness. She has severe arthritis of her knees and
hips, which severely limits her mobility. Current medications include
lovastatin and aspirin. Examination, including pelvic examination, shows no
abnormalities. Which of the following is the most likely explanation for
this patient's incontinence?
A ) Detrusor hyperactivity
B ) Intrinsic weakness of the urethral sphincter
C ) Outflow obstruction
D ) Poor pelvic support
E ) Upper motoneuron disease
3 A 32-year-old woman comes to the physician because of a 1-month history of
diarrhea, abdominal bloating, and loss of appetite resulting in a 3.6-kg (8
-lb) weight loss. She reports three to four semiliquid stools daily. She has
not had fever, abdominal pain, or rectal bleeding. She returned from a
scuba diving vacation in Mexico 6 weeks ago; her boyfriend who accompanied
her has not had similar symptoms. Abdominal and rectal examinations show no
abnormalities. Which of the following is the most likely causal organism?
A ) Escherichia coli O157:H7
B ) Giardia lamblia
C ) Rotavirus
D ) Vibrio cholerae
E ) Yersinia enterocolitica
4 A previously healthy 32-year-old woman comes to the physician because of a
2-day history of fever and an area of swelling and redness on her right
forearm. Six hours ago, she noticed red streaks extending from her forearm
to her elbow. She has not traveled, and there is no history of trauma. Her
temperature is 37.8°C (100°F). Epitrochlear lymph nodes are enlarged.
Examination of the distal radial aspect of the right upper extremity shows
an 8 x 13-cm warm, erythematous area of edema that is tender to palpation;
there is a warm, tender red streak extending from this area to the elbow.
Which of the following is the most likely causal organism?
A ) Haemophilus influenzae
B ) β-Hemolytic streptococcus
C ) Pseudomonas aeruginosa
D ) Salmonella choleraesuis
E ) Staphylococcus epidermidis
5 A 57-year-old woman comes to the physician because of a 2-year history of
progressive cough productive of 2 to 3 tablespoons of yellow sputum daily;
it is worse in the mornings and now lasts all day. She cannot walk more than
one block without becoming short of breath. She has not had fever,
hemoptysis, night sweats, or weight loss. She has smoked two packs of
cigarettes daily for 40 years. She is 160 cm (5 ft 3 in) tall and weighs 82
kg (180 lb); BMI is 32 kg/m2. Her pulse is 96/min, respirations are 20/min,
and blood pressure is 150/90 mm Hg. Pulse oximetry on room air shows an
oxygen saturation of 90%. Breath sounds are decreased in all lung fields,
and rhonchi are heard at the bases. The expiratory phase is prolonged. An
ECG shows sinus tachycardia and P pulmonale. Pulmonary function tests show
an FEV1 of greater than 80% of predicted, an FEV1:FVC ratio of 70% of
predicted, and a diffusing capacity of the lung for carbon monoxide greater
than 60% of predicted. Which of the following is the most likely diagnosis?
A ) Chronic bronchitis
B ) Cystic fibrosis
C ) Emphysema
D ) Kartagener syndrome
E ) Postnasal drip syndrome\
6 The patient's oldest daughter calls the physician to discuss her mother's
care. She says, "We want my mother to receive hospice care at home, but no
one wants her to die at home. Can she still have hospice services?" Which of
the following is the most appropriate response?
A
) "No, but we can try to arrange for some other type of home service."
B
) "No. It is important that hospice patients die at home."
C
) "No. The patient cannot be enrolled in the hospice program if the
patient or family prefer that death not take place at home."
D
) "Yes, but we would have to transfer her to a nursing home to enroll
her in the hospice program."
E
) "Yes. Hospice can provide home-based care and attempt to transfer the
patient to another site before death."
7 A 32-year-old woman comes to the physician because of a 1-month history
of diarrhea, abdominal bloating, and loss of appetite resulting in a 3.6-kg
(8-lb) weight loss. She reports three to four semiliquid stools daily. She
has not had fever, abdominal pain, or rectal bleeding. She returned from a
scuba diving vacation in Mexico 6 weeks ago; her boyfriend who accompanied
her has not had similar symptoms. Abdominal and rectal examinations show no
abnormalities. Which of the following is the most likely causal organism?
A
) Escherichia coli O157:H7
B
) Giardia lamblia
C
) Rotavirus
D
) Vibrio cholerae
E
) Yersinia enterocolitica
8 An 87-year-old woman who is a resident of a skilled nursing care
facility is brought to the physician by staff because of fever for 1 day. A
urinary catheter was placed 2 weeks ago because of urinary incontinence. She
has dementia, Alzheimer type, and is unable to communicate verbally. Her
temperature is 37.8°C (100°F), pulse is 86/min, respirations are 14/min,
and blood pressure is 120/74 mm Hg. Mucous membranes are moist and pink.
Urinalysis shows:
Color
cloudy brown
pH
8.8
Blood
2+
Glucose
negative
Protein
2+
RBC
too numerous to count
WBC
20–25/hpf
Nitrites
3+
Leukocyte esterase
3+
Bacteria
many
9 A Gram stain of urine shows gram-negative bacilli. Which of the following
measures is most likely to have prevented this patient's current condition?
A
) Use of incontinence briefs instead of the catheter
B
) Changing the catheter daily
C
) Cleaning the urethral orifice with povidone-iodine daily
D
) Flushing the catheter with an antibiotic solution daily
E
) Oral antibiotic prophylaxis
F
) Oral oxybutynin therapy
10 A 17-year-old girl comes to the physician because of fatigue,
increased thirst, and increased urination over the past 2 weeks; she has had
a 4.5-kg (10-lb) weight loss during this period despite an increased
appetite. She has not had dysuria. At the onset of her symptoms, she had a
mild upper respiratory tract infection that resolved without treatment. Her
temperature is 36.8°C (98.2°F), pulse is 86/min, respirations are 14/min,
and blood pressure is 100/50 mm Hg. Cranial nerves are intact. Muscle
strength is 5/5, and deep tendon reflexes are symmetric. Serum studies show:
Na+
132 mEq/L
Cl−
96 mEq/L
K+
3.7 mEq/L
HCO3−
26 mEq/L
Creatinine
1.2 mg/dL
11 Which of the following is the most likely location of the primary disease
process?
A
) Adrenal gland
B
) Bone marrow
C
) Central nervous system
D
) Kidney
E
) Liver
F
) Muscle
G
) Pancreas
H
) Parathyroid gland
I
) Pituitary gland
J
) Thyroid gland
12 A 67-year-old man with alcoholism comes to the physician for a routine
examination. He has a 15-year history of poorly controlled hypertension; he
takes hydrochlorothiazide and admits that he is not compliant with his drug
regimen. His blood pressure is 170/102 mm Hg, unchanged from his last three
office visits. Funduscopic examination shows arteriovenous nicking and
tortuosity of the arteries. This patient is at greatest risk for which of
the following?
A
) Aortic aneurysm
B
) Glaucoma
C
) Myocardial infarction
D
) Pulmonary hypertension
E
) Subarachnoid hemorrhage
13 A 57-year-old woman comes to the physician because of a 2-year history
of progressive cough productive of 2 to 3 tablespoons of yellow sputum
daily; it is worse in the mornings and now lasts all day. She cannot walk
more than one block without becoming short of breath. She has not had fever,
hemoptysis, night sweats, or weight loss. She has smoked two packs of
cigarettes daily for 40 years. She is 160 cm (5 ft 3 in) tall and weighs 82
kg (180 lb); BMI is 32 kg/m2. Her pulse is 96/min, respirations are 20/min,
and blood pressure is 150/90 mm Hg. Pulse oximetry on room air shows an
oxygen saturation of 90%. Breath sounds are decreased in all lung fields,
and rhonchi are heard at the bases. The expiratory phase is prolonged. An
ECG shows sinus tachycardia and P pulmonale. Pulmonary function tests show
an FEV1 of greater than 80% of predicted, an FEV1:FVC ratio of 70% of
predicted, and a diffusing capacity of the lung for carbon monoxide greater
than 60% of predicted. Which of the following is the most likely diagnosis?
A
) Chronic bronchitis
B
) Cystic fibrosis
C
) Emphysema
D
) Kartagener syndrome
E
) Postnasal drip syndrome | j*****o
发帖数: 137 | | J*********4
发帖数: 1274 | 3 Just guessing
1. C
2. B
3. B
4. B
5. C
6. E
7. B
8-9. A
10-11.G
12.C | j**********0
发帖数: 391 | 4 my guess
1 c
2 b
3 e
4 d
5 c
6 d
7 e
8-9 e
10-11 j
12 d | J*********4
发帖数: 1274 | 5 My understanding
3. healthy adult drink contaminated water while scuba diving; bloating,
diarrhea; Y. E should have right side pain, most commonly in children after
eating contaminated pork
http://www.cdc.gov/parasites/giardia/epi.html
4. The most common cause of lymphangitis in humans is Streptococcus pyogenes
(Group A strep), although it can also be caused by the fungus Sporothrix
schenckii. from Wiki
http://en.wikipedia.org/wiki/Lymphangitis
10. Hyponatrimia secondary due to hyperglycemia of DM type I. |
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