NBME FORM 3 QS

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NBME FORM 3 QS

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will try my best
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07/08/08 - 11:26 AM

11. A 57-year-old man with a 10-year history of type 2 diabetes mellitus comes to the physician fora routine examination. His last office visit was 6 months ago. He feels well. Current medications include enalapril and glyburide. He is 168 cm (5 ft 6 in) tall and weighs 84 kg (185 Ib), BMI is 30 kg/mZ. His pulse is 60/min, and blood pressure is 100/70 mm Hg. Funduscopic examination shows soft and hard exudates. Laboratory studies show
Hemoglobin Al. 12%
Serum
Urea nitrogen (BUN) 23 mg/dL
Creatinine 1.4 mg/dL
Urine protein 1+
Which of the following is the most appropriate additional pharmacotherapy?

O A) Atenolol
O B) Captopril
O C) Hydrochlorothiazide
O D) Metformin
0 E) Verapamil

43. A previously healthy 72-year-old man is brought to the physician because of two episodes of transient paresis in the left arm during the past 2 days; each episode lasted for 3 to 4 minutes. No bruits are heard over the carotid arteries, and there are no cardiac murmurs. Carotid duplex ultrasonography and confirmatory arteriography show a 30% stenosis of the internal carotid arteries bilaterally. Which of the following is the most appropriate next step in management?
A) Aspirin therapy
B) Heparin therapy
C) Nifedipine therapy
D) Placement of a carotid endovascular stent
E) Carotid endarterectomy

20. A 25-year-old woman has had painless vaginal postcoital bleeding for 2 hours. Her last menstrual period was 10 weeks ago. A pregnancy test is positive. There is a small amount of dark blood in the vaginal canal. She has a reddened, friable cervical os.

O A)Abortion of a blighted twin
O B)Cervicitis
O C)Ectopic pregnancy
O D)Focal decidual necrosis
O E) Gestational trophoblastic disease
0 F) Incomplete abortion
0 G) Ovarian torsion
0 H) Ruptured ovarian cyst
0 I) Threatened abortion

can anybody explain the importance of reddened friable cervical os?

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will try my best
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07/08/08 - 11:28 AM

Also if you say metformin for the first qs please explain whether you can give it for decreased renal function pts.

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hero
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07/08/08 - 12:34 PM

will try my best wrote:
Also if you say metformin for the first qs please explain whether you can give it for decreased renal function pts.

just monitor his renal function, be aware of possible lactic acidosis and discontinue if contrast study planned, lots of pts with impaired renal function taking metformin.

liliaeliz
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07/08/08 - 01:09 PM

1 d
2 A
3 B FRIABE CERVIX AND POSCOITAL BLEEDINGIS

liliaeliz
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07/08/08 - 01:12 PM

Do not mention anything about OS IS COSED OR OPEN

mikky
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07/08/08 - 01:36 PM

regarding first q...the patient has a 10 year h/o DM and also urine protein +1...indicating diabetic nephropathy...should not we start ACE inhibitor here???so y not b???

and 2nd one A

and third one i guess B...cervix is soft in normal pregnancy...friable and red cervix...looks like cervicitis....

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hero
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07/08/08 - 01:38 PM

liliaeliz wrote:
Do not mention anything about OS IS COSED OR OPEN

2h is too long and too much blood for cervicitis, also painless, i think threatened abortion

hero
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07/08/08 - 01:40 PM

cervicitis usually comes with complains, not bleeding

hero
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07/08/08 - 01:47 PM

Threatened abortion: Vaginal bleeding of any degree during early pregnancy is considered to represent a threatened abortion...

...On vaginal examination, the cervical os is closed, and no cervical motion tenderness or tissue is found

http://www.emedicine.com/EMERG/topic11.htm

Cervicitis is suspected if the cervix is erythematous, edematous, or easily friable.

Edited by hero on 07/08/08 - 01:57 PM

drms
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07/08/08 - 03:12 PM

#10

11-D
43-A
20-I

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liliaeliz
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07/08/08 - 03:41 PM

#11

YOU ARE RIGHT HERO 2 HS IS TOO LONG TIME ,BUT YOU HAVE PAINLESS POSCOITAL BLEE DING IN CERVICITIS
WHAT ABOUT erythematous, edematous, or easily friable. OS ?

liliaeliz
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07/08/08 - 03:44 PM

#12

MIKKY Current medications include enalapril and glyburide.

will try my best
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07/08/08 - 04:06 PM

#13

Thanks guys and glas for your feedback.Thanks Hero about Metformin.

About the carotid stenosis, I had read that recurrent episodes of TIA"s is an indication for surgey.Does anyone think so.

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liliaeliz
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07/08/08 - 04:33 PM

#14

If TIA is recurrent after aspirin treatment,you give the combination of aspirin and dipirydamole

mikky
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07/09/08 - 01:23 AM

#15

thanx lileliz.....very often i dont read Q properly disapproval

....so the ans is metformin nod

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