discuss NBME form 2

7/25/2014 3:53:05 PM
Hello,
If anyone is available to discuss nbme from 2. please message me on skype id:exambuddy.
or i'll post my wrong q's first then we can form a thread and discuss them here.
thanks and good luck to you all for your prep

Regrads


7/26/2014 11:56:26 AM
how many nbmes are in step 3
post yor wrong question we will start to iscuss & answer


7/26/2014 6:00:42 PM
Thanks rekha500
there are 2 nbme in total form 2 and form 3.


7/26/2014 6:47:24 PM
Section 1
1)you are visiting a 78 year old woman with ischemic cardiomyopathy and chronic a.fib at her home for routine follow-up. 2 weeks ago she was d/c from the hosp following Tx for pulm.edema. she reports that she has had loss of appetite and has been SOB at rest during past few days despite increased use if O2.she had 3 hosp admissions during the past 8 mos for cardiac decompensation.On her last admission, her EJ was 18% and cardiac cath disclosed extensive multivessel disease not ammeable to stenting or bypass surgery. Her current meds include spironolactone,furosemide,lisinopril,atenolol,digoxin and nasal O2 as needed. she lives with her 50y.o daughter and has home health aide for 4 hrs per day. vital signs are temp 37.0(98.6F),pulse 78/min,and irregularly irregular,resp 24/min of oxygen and BP 108/68 mmHg. on physical exam she is alert and oriented. Auscultation of the lungs discloses bilateral basilar crackles. cardiac exam discloses S3 gallop and grade 3/6 holosystolic murmur at the cardiac apex. She has 2+ bipedal edema.The patient and her daughter are both upset by the possibillity of another hospitalization and they ask for advice. Which of the following is the most appropriate response to their condition?
A) disclose admitting the patient to ICU for short term but intensive Management to prevent the need for longer stay.
b)Discuss home hospice care as ab option for symptom management and avoidance of hospitalization
c)discuss referral to cardiac center with transplant capability for complete reevaluation of options
d)discuss the use of lorazepam to relieve her anxiety about the possibility of being hospitalized.
e)recommend staring amitriptyline therapy

2)35 y.0 AA man comes to the office becoz of weakness and numbness in his right arm and leg for the past week. he complains of blurred vision in the right eye and periods of seeing double. he also as poor bladder control. his deep tendon refleses are hyperactive on the right side and babinski sign is present. fundoscopic exam shows a pallor right optic disk. which of the following is the most likely diagnosis?
a) ALS
b)conversion disorder
c)GBS
d)MS
e)stroke
7)A 19 y.o woman comes to the office for the first time because of an increase frequency and urgency during the past 14 days. medical history is unremarkable. she has been sexually active with one male partner and they occasionally use condoms for contraception. She has not had menstrual period for the past 3 months;meses are typically irregular. she has never been pregnant. she is 157cm,weighs 55KG,BMI 22kg/m2. vital are norm. uterine consistent with 12 wks gestation; physical exam is otherwise unremarkable. urine pregnnacy test is positive. results of urinalysis are within the referance range. regarding the patient'c increase urinary frequency and urinary urgency,specific additional history to be obtained regarding which of the following?
a)daily fluid intake
b)family history of diabetes
c)medication use
d)previous history of UTI
e)no further history is necessary.

12) you are about to leave the office for 2 week vacation with your family when you recieve a telephone call from a 78 y.o long time patient. the patient had type 2 DM and has just been D/C fromt eh hospital following a debridement of foot ulcer. she is now having difficulty ambulating becoz of obesity and a inability to bear weight on the affected foot. she lives alone,and she says hse is having difficulty cooking for herself and caring for the wound. she is not scheduled to see the surgeon who performed the debridment for another week. she asks for your help. which of the following is the most appropriate intervention at this time?
a)admit the patient to the hospital
b)advise the patient to see the surgeon sooner.
c)arrange for home assessment by a visiting nurse
d)notify the patient's neighbor of her condition
e)schedule a home visit when you return from vacation

will add more soon


7/26/2014 11:43:33 PM
2). I know A is incorrect. I think the answer is MS, because its fits all the clinical features (i.e., unilateral UMN signs, ON, optic atrophy) as per Harrison's (19th edition, page. 3398). The only issue I see with this diagnosis is the race of the patient, has anyone read anything anywhere regarding how common the disease is in African American patients?


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