поиграем?

[FOLEY]

Донат и другие кто хочет...давайте играть!





1. A 45-year-old African-American man comes to the
office for the first time because he says, "I had blood in
my urine when I went to the bathroom this morning." He
reports no other symptoms. On physical examination his
kidneys are palpable bilaterally and he has mild
hypertension. Specific additional history should be
obtained regarding which of the following?


A. Chronic use of analgesics
B. Cigarette smoking
C. A family history of renal disease
D. Occupational exposure to carbon tetrachloride
E. Recent sore throats

[FOLEY]

2. A 24-year-old man comes to the office because of
intermittent chest pain that began a few weeks ago. You
have been his physician for the past 2 years and he has
been in otherwise good health. He says he is not having
pain currently. A review of his medical record shows
that his serum cholesterol concentration was normal at a
pre-employment physical examination 1 year ago. You
have not seen him since that visit and he says he has had
no other complaints or problems in the interim. He
reminds you that he smokes 1 pack of cigarettes per day.
When you question him further, he says that he does not
use any alcohol or illicit drugs. Although the details are
vague, he describes the chest pain as a substernal
tightness that is definitely not related to exertion.
Which of the following findings on physical

examination would be most consistent with
costochondritis as the cause of his chest pain?



A. Crepitance over the second and third ribs
anteriorly
B. Deep tenderness to hand pressure on the sternum
C. Localized point tenderness in the parasternal area
D. Pain on deep inspiration
E. Normal physical examination








3. In light of the patient’s original denial of drug use,
which of the following is the most appropriate next
step to confirm a diagnosis of cocaine use?



A. Ask the laboratory if serum is available for
toxicologic screening on a previous blood sample
B. Call his family to obtain corroborative history
C. Obtain a plasma catecholamine concentration
D. Obtain a urine sample for routine analysis but
also request toxicologic screening
E. Present your findings to the patient and confront
him with the suspected diagnosis

[Akela]

Донат и другие кто хочет...давайте играть!





A 45-year-old African-American man comes to the
office for the first time because he says, "I had blood in
my urine when I went to the bathroom this morning." He
reports no other symptoms. On physical examination his
kidneys are palpable bilaterally and he has mild
hypertension. Specific additional history should be
obtained regarding which of the following?


A. Chronic use of analgesics
B. Cigarette smoking
C. A family history of renal disease
D. Occupational exposure to carbon tetrachloride
E. Recent sore throats

D...

[FOLEY]

4. Cocaine use is confirmed. The patient admits a possible
temporal relationship between his cocaine use and his
chest pain and expresses concern about long-term health
risks.


The patient should be counseled regarding which of
the following?


A. Cocaine-induced myocardial ischemia can be
treated with blocking agents
B. Death can occur from cocaine-induced
myocardial infarction or arrhythmia
C. The presence of neuropsychiatric sequelae from
drug use indicates those at risk for sudden death
associated with cocaine use
D. Q wave myocardial infarction occurs only with
smoked "crack" or intravenous cocaine use
E. Underlying coronary artery disease is the
principal risk for sudden death associated with
cocaine use

[FOLEY]

D...

sorry. incorrect. (although Carbon Tetrachloride CAN cause kidney damage, this is not the BEST choice)

[elfy]

sorry. incorrect. (although Carbon Tetrachloride CAN cause kidney damage, this is not the BEST choice)
я знаю, я знаю :znaika: :lad:
C

[FOLEY]

когда кто-то угадает правильно с первого раза, получает плюс. только я рассчитываю на честность ваши и что вы не станете спрашивать у знакомых.

(врачи: отвечайте мне в личке...чтоб не выдавать ответ)

[FOLEY]

я знаю, я знаю :znaika: :lad:
C

Correct!

(can you explain your reasoning?)

[elfy]

Correct!

(can you explain your reasoning?)
just by means of elimination

[FOLEY]

just by means of elimination

actually, all of the choices in question 1 CAN give you the symptoms of blood in the urine...so you are one hell of an eliminator! good job!!!

(in that particular question they are trying to get you to pick up on the fact that the kidneys can be felt (palpable), which means they are larger than normal and probably the result of APKD - adult polycystic kidney disease. Of course in cancer the kidney could also be larger, but not on both sides!!!)

[elfy]

problem #2 - A?

[elfy]

actually, all of the choices in question 1 CAN give you the symptoms of blood in the urine...so you are one hell of an eliminator! good job!!!
:27: :oops:

[FOLEY]

problem #2 - A?
sorry. incorrect.

anyone else?

[Odinokiy_Ostrov]

Question 2 - C?

[elfy]

Foley, are you getting ready for some sort of exam?
(I just had 2 mid-terms today)

[FOLEY]

Question 2 - C?

good job!!!

(why did you choose that?)

[elfy]

good job!!!

(why did you choose that?)
that was my 2nd pick;)

[FOLEY]

Foley, are you getting ready for some sort of exam?
(I just had 2 mid-terms today)

no...i'm finished with all of my exams a very very long time ago. i had fun yesterday on the forum discussing a case with Donat...and it got me to start finding questions to answer. (it is just like doing puzzles!....for nerdy boys and girls like me)

[elfy]

problem#3 - A

[FOLEY]

that was my 2nd pick;)

also by elimination?

[FOLEY]

problem#3 - A

sorry. that would be illegal!

[elfy]

no...i'm finished with all of my exams a very very long time ago. i had fun yesterday on the forum discussing a case with Donat...and it got me to start finding questions to answer. (it is just like doing puzzles!....for nerdy boys and girls like me)
hmm, did I miss anything while I was away from the forum? ;) :cool:

[FOLEY]

hmm, did I miss anything while I was away from the forum? ;) :cool:

the key phrase was nerdy - like me ;)

[elfy]

sorry. that would be illegal!
then, it HAS to be C, all the rest are illegal, too

[Odinokiy_Ostrov]

no...i'm finished with all of my exams a very very long time ago. i had fun yesterday on the forum discussing a case with Donat...and it got me to start finding questions to answer. (it is just like doing puzzles!....for nerdy boys and girls like me)
Oh, sign me up for the nerdy club. I don't know much about medicine, but give me a legal puzzle...and you have me occupied for as long as you want.

My reasoning for Question 2 was (without any medical terminology, since I don't know much of it) that it would make sense that he'd have localized tenderness if it's a bone / muscular problem as opposed to an internal organ. I know it's a really lame way to explain this. This is the best I can do. :)

[FOLEY]

then, it HAS to be C, all the rest are illegal, too

C would not help you necessarily with confirming 100% the fact that the patient takes cocaine. sorry.

there is a correct answer there, trust me! (and one need not be a doctor to answer this...)

[Odinokiy_Ostrov]

C would not help you necessarily with confirming 100% the fact that the patient takes cocaine. sorry.

there is a correct answer there, trust me! (and one need not be a doctor to answer this...)
#3 - D. It seems like the only ethically correct choice.

[Odinokiy_Ostrov]

#4 - B?

[FOLEY]

Oh, sign me up for the nerdy club. I don't know much about medicine, but give me a legal puzzle...and you have me occupied for as long as you want.

My reasoning for Question 2 was (without any medical terminology, since I don't know much of it) that it would make sense that he'd have localized tenderness if it's a bone / muscular problem as opposed to an internal organ. I know it's a really lame way to explain this. This is the best I can do. :)

it is acually a great explanation! great job!

costochondritis - costo-condral junction is where the rib joins the sternum (the long flat bone in the middle of the chest). "itis" means inflammation...and usually pain. thus pressure around the are with finger would elicit the pain...confirming the diagnosis!

[FOLEY]

#3 - D. It seems like the only ethically correct choice.

unless the patient's life is in imminant danger if we don't test his urine for cocaine...we cannot do the test. (he litteraly has to be within minutes of dying unless we do the test)

so...the answer is E...all you can do is directly ask the patient again about cocaine use and if he denies, you can do nothing about it

[FOLEY]

#4 - B?

Exactly!!! (you smarty pants!)

[Odinokiy_Ostrov]

unless the patient's life is in imminant danger if we don't test his urine for cocaine...we cannot do the test. (he litteraly has to be within minutes of dying unless we do the test)

so...the answer is E...all you can do is directly ask the patient again about cocaine use and if he denies, you can do nothing about it
That makes sense. I guess I didn't choose E because I was a bit put off by the word "confront". Now that I've re-read the question, I realize that it was used in the non-threatening way.

[FOLEY]

5. A 47-year-old Italian-American man comes to the office for the first time for routine medical care. He has been referred to you by
his psychiatrist who has informed you that the patient has paranoid personality disorder. The patient has no other medical problems
at this time. He is unmarried, lives alone and has no close friends, but he occasionally attends family gatherings. He functions well
working alone in a technical position in an engineering firm. Which of the following is the best way to structure the
physician-patient relationship with this patient?



(A) Avoid giving him excessive details about possible, but infrequent, side effects and complications in order to avoid
triggering his paranoia
(B) Explain the rationale for any diagnostic procedures and treatment regimens in some detail, adopting a professional,
but not overly friendly stance
(C) Go out of your way to be warm and friendly so that he can develop trust in you
(D) Have his psychiatrist, with whom he has been working for several years, take the lead in presenting medical treatment
options
(E) Try to communicate with his family or medical personnel when he is not present in order to overcome his withholding

[FOLEY]

That makes sense. I guess I didn't choose E because I was a bit put off by the word "confront". Now that I've re-read the question, I realize that it was used in the non-threatening way.

logical things are so much fun, aren't they?

[Odinokiy_Ostrov]

B? ...

[Odinokiy_Ostrov]

logical things are so much fun, aren't they?
Yes, they are. I am actually enjoying this tremendously. :)

[FOLEY]

B? ...

you are on fire!


I think your legal kowledge is helping you with some of these!\


(this is a psychiatry question actually...which is fairly logical)

[Odinokiy_Ostrov]

you are on fire!

(this is a psychiatry question actually...which is fairly logical)
I had an advantage on this one. I've worked in social services for years before going to law school. So...I know a bit about psychiatric disorders.

[FOLEY]

http://forum.russianamerica.com/f/attachment.php?attachmentid=8534&stc=1&d=1174017063


6. The lesion shown is of a 1-year-old girl who is brought to the office by her parents because they want a second opinion regarding the
growth on her leg. The mother notes that it was small and flat at birth and has grown thicker in the past 6 months. The mother says,
"My usual physician seems unconcerned, but my mother-in-law says it looks awful and that something should be done." The child is
otherwise healthy. At this time it is most appropriate to tell the parents that the best cosmetic result will occur with which of the
following?



(A) Injection with a corticosteroid
(B) Observation only
(C) Radiation therapy
(D) Surgical excision
(E) Topical application of a corticosteroid

[FOLEY]

7. A 16-year-old Anglo-American girl comes to the office because she has missed a menstrual period and a home pregnancy test was
positive. Bimanual examination discloses an enlarged uterus, and a urine pregnancy test is positive. She is estimated to be
approximately 6 to 8 weeks pregnant. You have been the family's physician since she was born. She asks that you please not tell her
parents. Which of the following is the most appropriate immediate response?



(A) Attempt to persuade her to share the information with at least one adult member of her family
(B) Explain that by law you are unable to maintain confidentiality
(C) Explore with her the reasons for her not feeling comfortable sharing the information with her parents
(D) Point out that she will not be able to hide her pregnancy for very long
(E) Reassure her, but notify her mother after she leaves

[Odinokiy_Ostrov]

B, observation only. Everything else seems extreme for a 1-year-old if it is purely cosmetic.

[Odinokiy_Ostrov]

#7 - A?

[FOLEY]

8 A male colleague asks you to write a prescription for a narcotic analgesic for one of his female patients. You have noticed that this
patient frequently has been coming by the office to see your colleague, and that several of the visits have been marked "No Charge."
When you ask your colleague why he cannot write the prescription himself, he seems defensive and says, "Because I don't want
anybody to get the wrong idea." Which of the following is the most appropriate response to your colleague?



(A) "It sounds like there is more to this story than you are telling me; maybe we should talk about it."
(B) "I wish I could help you, but I never prescribe that medication for a patient unless I have seen the patient myself."
(C) "I will do this for you once, but I will need to see your patient in the office before I can write another prescription."
(D) "Maybe I should see your patient in the office myself, and then decide if she needs the medication."
(E) "You have seemed a little nervous lately. You aren't getting in over your head, are you?"

[FOLEY]

B, observation only. Everything else seems extreme for a 1-year-old if it is purely cosmetic.

but they are asking which option will give the BEST cosmetic result!

(p.s. you are right though!!! this lesion will eventualy resolve on its own...)

[Odinokiy_Ostrov]

#8 is probably B from the medical ethics standpoint. If the colleague is also a close personal friend of yours, you might also want to ask if he is getting in way over his head and if he wants to talk about it. :)

[FOLEY]

#7 - A?

seems like the "right" thing to do...but it is not allowed.

[Lakomka]

7c
8d

[Odinokiy_Ostrov]

but they are asking which option will give the BEST cosmetic result!

(p.s. you are right though!!! this lesion will eventualy resolve on its own...)
I guess one would have to have at least SOME knowledge of medicine to be able to figure out whether it would resolve on its own. I chose the answer based on the fact that I wouldn't subject a child to something so extreme for purely cosmetic reasons.

[FOLEY]

#8 is probably B from the medical ethics standpoint. If the colleague is also a close personal friend of yours, you might also want to ask if he is getting in way over his head and if he wants to talk about it. :)

also...seems reasonable, but not the correct answer here.

[FOLEY]

7c
8d

7 - correct. good job!!!

8 - incorrect

[FOLEY]

I guess one would have to have at least SOME knowledge of medicine to be able to figure out whether it would resolve on its own. I chose the answer based on the fact that I wouldn't subject a child to something so extreme for purely cosmetic reasons.

you are exactly right from this standpoint also...assuming that the lesion is not life-threatening!

[Odinokiy_Ostrov]

C was my second choice for #7.
I am curiously waiting for the correct answer to #8. If Lakomka's answer and mine were both wrong....I am lost. Everything else seems extremely unethical to me.

[FOLEY]

9. A 50-year-old African-American man with severe chronic obstructive pulmonary disease returns to the office following a recent
evaluation for possible lung transplantation in another city. He says he had been considered a suitable candidate, in all respects, but
was rejected by the transplant program when a random urine test was positive for a nicotine metabolite. He had previously told you
that he had stopped smoking 3 years ago. He stands by this and is at a loss to explain the positive urine test. He wants to know what
he should do now. Which of the following is the most appropriate next step?



(A) Advise him again to stop smoking and refer him to another transplant program
(B) Advise him that the transplant program cannot turn him down on this basis, according to the Americans with
Disabilities Act
(C) Contact the transplant program to learn their reasons for turning him down
(D) Explain to the patient that transplantation is out of the question as a result of what has occurred
(E) Write to the transplant program and insist that they give him another opportunity

[FOLEY]

C was my second choice for #7.
I am curiously waiting for the correct answer to #8. If Lakomka's answer and mine were both wrong....I am lost. Everything else seems extremely unethical to me.


it's actually A...weird, but it's the right thing to do from a medical ethics standpoint.

[FOLEY]

i am trying to find questions that require as little medical knowledge as possible...it is hard.

[Lakomka]

9.b or c

[FOLEY]

10. A 24-year-old woman comes to the office because of concerns about sexual function. The patient recently has remarried after being
divorced from an abusive partner. She is currently unable to complete intercourse with her new husband due to intense vaginal pain
on attempts at penetration. She was able to have intercourse successfully early in her first marriage. She is orgasmic with other
stimulation but cannot tolerate digital or other penetration. Vital signs are: temperature 37.0EC (98.6EF), pulse 72/min, respirations
18/min and blood pressure 118/64 mm Hg. Physical examination is normal; however, the patient is unable to tolerate the speculum
examination because of pain. Which of the following is the most likely mechanism for this condition?


(A) Change in vaginal flora because of a new partner
(B) Conversion disorder
(C) Inadequate lubrication
(D) Inflammation of vestibular glands
(E) Vaginal muscle spasm

[FOLEY]

9.b or c

pick one ;)

[Odinokiy_Ostrov]

9 - E?

[FOLEY]

11. A 6-year-old Mexican-American boy is brought to the office by his mother because of the gradual onset of abdominal pain. The visit
was prompted by the child's first grade teacher who sent him home from school because he appeared ill. The boy has been above the
recommended weight for his height at every visit since he became your patient 5 years ago. On physical examination today the child
does not appear to be in acute distress. Abdominal examination discloses normal bowel sounds and no tenderness, and is otherwise
inconclusive. Which of the following is the most appropriate next step?


(A) Ask the mother about problems separately from her son
(B) Call the school to check on details of the onset of pain
(C) Do rectal examination
(D) Obtain serum liver chemistry profile
(E) Order supine x-ray film of the abdomen

[elfy]

#6 - b?

[FOLEY]

9 - E?

молодец!

[Lakomka]

10. A 24-year-old woman comes to the office because of concerns about sexual function. The patient recently has remarried after being
divorced from an abusive partner. She is currently unable to complete intercourse with her new husband due to intense vaginal pain
on attempts at penetration. She was able to have intercourse successfully early in her first marriage. She is orgasmic with other
stimulation but cannot tolerate digital or other penetration. Vital signs are: temperature 37.0EC (98.6EF), pulse 72/min, respirations
18/min and blood pressure 118/64 mm Hg. Physical examination is normal; however, the patient is unable to tolerate the speculum
examination because of pain. Which of the following is the most likely mechanism for this condition?


(A) Change in vaginal flora because of a new partner
(B) Conversion disorder
(C) Inadequate lubrication
(D) Inflammation of vestibular glands
(E) Vaginal muscle spasm
b ...

[FOLEY]

#6 - b?

yep!

[FOLEY]

b ...

sorry. Ostrov had it right!

[Lakomka]

a 10?

[FOLEY]

12. A 44-year-old general surgeon is convicted of narcotic abuse. He successfully completes a 3-month drug rehabilitation program.
Following this treatment, his privilege to practice medicine will be determined by which of the following?


(A) American Board of Surgery
(B) Credentials committee of his hospital
(C) State medical board
(D) US Drug Enforcement Agency
(E) He will not be permitted to practice

[FOLEY]

a 10?

10 was E

[elfy]

10. A 24-year-old woman comes to the office because of concerns about sexual function. The patient recently has remarried after being
divorced from an abusive partner. She is currently unable to complete intercourse with her new husband due to intense vaginal pain
on attempts at penetration. She was able to have intercourse successfully early in her first marriage. She is orgasmic with other
stimulation but cannot tolerate digital or other penetration. Vital signs are: temperature 37.0EC (98.6EF), pulse 72/min, respirations
18/min and blood pressure 118/64 mm Hg. Physical examination is normal; however, the patient is unable to tolerate the speculum
examination because of pain. Which of the following is the most likely mechanism for this condition?


(A) Change in vaginal flora because of a new partner
(B) Conversion disorder
(C) Inadequate lubrication
(D) Inflammation of vestibular glands
(E) Vaginal muscle spasm
E???????

[Lakomka]

c...

[elfy]

12. A 44-year-old general surgeon is convicted of narcotic abuse. He successfully completes a 3-month drug rehabilitation program.
Following this treatment, his privilege to practice medicine will be determined by which of the following?


(A) American Board of Surgery
(B) Credentials committee of his hospital
(C) State medical board
(D) US Drug Enforcement Agency
(E) He will not be permitted to practice
C????????

[Odinokiy_Ostrov]

#12 - C? Or E. I am not sure what the guidelines are in terms of him ever being permitted to practice. But if he is, it will be determined by the State Medical Board.

[FOLEY]

13. An 84-year-old woman is brought to the office by her daughter, who is your patient. The mother has just moved in with the family
because she can no longer care for herself due to progressive, long-standing dementia. The daughter hopes you will help take care of
her mother. On physical examination the mother does not respond to your words or to the physical examination. You notice that she
smells of urine. On examination of the pelvis there is a diffuse erythematous rash extending over the perineum and the medial
thighs bilaterally. You suspect the rash relates to urinary incontinence. The daughter is present at the mother's examination. Which
of the following is the most appropriate statement to the daughter?


(A) "How long have you left your mother in this condition?"
(B) "His is a rash caused by urine. My nurse will insert a Foley catheter."
(C) "This rash should respond to cleansing with mild soap and drying with a clean towel three times a day."
(D) "You should take better care of your mother."
(E) "Your mother needs to wear diapers."

[Odinokiy_Ostrov]

# 13 - C?

[FOLEY]

E???????

exactly!

[FOLEY]

c...

yes

[elfy]

13. An 84-year-old woman is brought to the office by her daughter, who is your patient. The mother has just moved in with the family
because she can no longer care for herself due to progressive, long-standing dementia. The daughter hopes you will help take care of
her mother. On physical examination the mother does not respond to your words or to the physical examination. You notice that she
smells of urine. On examination of the pelvis there is a diffuse erythematous rash extending over the perineum and the medial
thighs bilaterally. You suspect the rash relates to urinary incontinence. The daughter is present at the mother's examination. Which
of the following is the most appropriate statement to the daughter?


(A) "How long have you left your mother in this condition?"
(B) "His is a rash caused by urine. My nurse will insert a Foley catheter."
(C) "This rash should respond to cleansing with mild soap and drying with a clean towel three times a day."
(D) "You should take better care of your mother."



(E) "Your mother needs to wear diapers."
definitely C

[Lakomka]

13. An 84-year-old woman is brought to the office by her daughter, who is your patient. The mother has just moved in with the family
because she can no longer care for herself due to progressive, long-standing dementia. The daughter hopes you will help take care of
her mother. On physical examination the mother does not respond to your words or to the physical examination. You notice that she
smells of urine. On examination of the pelvis there is a diffuse erythematous rash extending over the perineum and the medial
thighs bilaterally. You suspect the rash relates to urinary incontinence. The daughter is present at the mother's examination. Which
of the following is the most appropriate statement to the daughter?


(A) "How long have you left your mother in this condition?"
(B) "His is a rash caused by urine. My nurse will insert a Foley catheter."
(C) "This rash should respond to cleansing with mild soap and drying with a clean towel three times a day."
(D) "You should take better care of your mother."
(E) "Your mother needs to wear diapers."
c....

[FOLEY]

C????????

aga!

[FOLEY]

you are all correct...13 is C

[elfy]

по-моему тут собрались самые умные девочки форума :lol:
(сам себя не похвалишь... :grum:

[FOLEY]

A 34-year-old, white, married business executive who is a patient in your practice comes to the office because of low back pain. After you
enter the examining room and establish rapport, he appears embarrassed and says that back pain is not why he is here. Upon further
questioning, he admits to a sexual encounter on a recent business trip and says he now has a greenish urethral discharge. Tests for
gonorrhea are positive. He admits to having exposed his wife since returning from the trip. He does not want his wife told about this.



14. Because his wife is also a patient in your practice, which of the following is the most ethical approach?


(A) Report the case to the state health department and let them handle contacting his wife
(B) Request that he inform his wife of her exposure and the need for treatment and offer to assist as necessary
(C) Suggest that he bring his wife to the office tomorrow so that you can explain the situation and the need for treatment
for both of them
(D) Telephone his wife after he leaves, inform her of the problem and request that she come to the office for treatment
(E) Treat him now and treat his wife when she comes to the office for her next annual Pap smear 2 weeks from now





15. The patient decides he will personally tell his wife that night. He calls you the next day stating that his wife is angry and distraught,
and she is contemplating divorce. She is so upset she cannot even come to the office for treatment. He wants to know what to do
now. Which of the following is the most appropriate next step?

(A) Call the wife to ask her to come to the office to be treated and to talk about her reaction to this situation
(B) Have a member of your nursing staff call the wife to stress the importance of coming to the office for treatment
(C) Make a house call to treat her and assess the situation
(D) Refer them to a marriage counselor and ask her to come to the office next week for treatment
(E) Refer them to a psychiatrist skilled in crisis intervention and give her an antidepressant medication until the next
available appointment in 3 weeks

[FOLEY]

16. A 28-year-old man comes to the office because he is concerned about his relationship with his 9-year-old son. He is a single father
who has full custody of his son. The father says that they always have been very close, but recently he has not had much energy to
spend quality time with his son. He does not understand why he has had this change in behavior. He says he feels well, and to his
knowledge, is healthy. He says that he works daily in a job he likes and has had no occupational problems. History and physical
examination lead you to suspect substance abuse. Abuse of which of the following substances would most likely explain his
behavior?


(A) Amphetamine
(B) Cocaine
(C) Marijuana
(D) Phencyclidine
(E) Psilocybin

[FOLEY]

17. A 22-year-old college student calls your evening answering service because of an itchy, spreading rash over her right wrist and
lower arm for the past 2 days. You return her call, and she reports that she just returned from a weekend camping trip in the
mountains. She denies any fever, chest pain, dyspnea or red streaks up her arm. She states, "I'm feeling miserable and the itch is
killing me. I don't know if I was bitten by some insect or a tick. What should I do?" In counseling the patient over the telephone,
which of the following is the most appropriate response?

(A) "From what you describe I think you should go directly to a dermatologist. Please come to my office in the morning for
a referral."
(B) "Go to your pharmacist and ask for an over-the-counter antihistamine and Burow's solution, which you should apply
with wet compresses, and please come to my office in the morning."
(C) "I will call in antibiotics to the pharmacy so that you can begin treatment tonight. I would like to see you in my office
tomorrow."
(D) "Unfortunately I cannot prescribe any treatment without first examining you. Please call my office in the morning for
an appointment."
(E) "You should go to the nearest emergency department immediately for treatment and come to my office tomorrow
morning for follow-up."

[Lakomka]

14c
15a

[FOLEY]

18. During a sports physical examination, a 13-year-old boy expresses concern about his height. He was in the 10th percentile for
height throughout childhood and now is just above the 5th percentile. His sexual maturation rating is Tanner stage 2 for both
genitalia and pubic hair. He should be told which of the following?


(A) He is near his final height
(B) He probably has a slight deficiency of growth hormone
(C) He should increase his daily caloric intake
(D) He will grow several more inches
(E) He will need testosterone injections for several months

[FOLEY]

14c
15a

you're half right ;)

[Lakomka]

17. obvious posoin Ivy
b

[elfy]

#17 - b for sure

[FOLEY]

по-моему тут собрались самые умные девочки форума :lol:
(сам себя не похвалишь... :grum:

I'm proud of you!

(I will start to gently introduce some actual medical questions, if you don't mind...I have faith in you!)

[Lakomka]

16a

[elfy]

#18 - D?

[FOLEY]

17. obvious posoin Ivy
b

obviously!

[FOLEY]

#17 - b for sure

for sure!

[Lakomka]

18. During a sports physical examination, a 13-year-old boy expresses concern about his height. He was in the 10th percentile for
height throughout childhood and now is just above the 5th percentile. His sexual maturation rating is Tanner stage 2 for both
genitalia and pubic hair. He should be told which of the following?


(A) He is near his final height
(B) He probably has a slight deficiency of growth hormone
(C) He should increase his daily caloric intake
(D) He will grow several more inches
(E) He will need testosterone injections for several months
b....

[FOLEY]

16a

no, sorry.

[FOLEY]

#18 - D?

I am thoroughly impressed!

(what was your reasoning?)

[FOLEY]

b....

sorry. no.

[elfy]

I'm proud of you!

(I will start to gently introduce some actual medical questions, if you don't mind...I have faith in you!)
what do you mean "actual medical uqestions"? I thought those were the ones - I was already feeling like a doctor - you can't disappoint me like that :confused:
just kidding, go right ahead :lol: I am ready

[elfy]

I am thoroughly impressed!

(what was your reasoning?)
well, this way you are telling him the truth, but in a positive way (instead of saying, you are near your final hight, you say you will grow some more inches - just the same, but sounds so much better :)

[FOLEY]

19. A 14-year-old boy is brought to the walk-in clinic by his father late on Saturday afternoon because his left ear is swollen and
painful. The boy's ear has been black and blue since he injured it in a wrestling match 3 days ago. Symptoms have increased
significantly following a repeat injury 3 hours ago. On physical examination, his left ear is markedly swollen and tender to
palpation. Which of the following is the most appropriate next step?


(A) Reassure him and start aspirin therapy
(B) Reassure him and start codeine therapy
(C) Recommend that he apply cold packs to the ear for the next 12 hours
(D) Recommend that he apply hot packs to the ear for the next 12 hours
(E) Refer him to a surgeon for immediate drainage of the lesion

[FOLEY]

what do you mean "actual medical uqestions"? I thought those were the ones - I was already feeling like a doctor - you can't disappoint me like that :confused:
just kidding, go right ahead :lol: I am ready

19 is a bit more "medical"

[elfy]

#16 - c?

[Lakomka]

19c

[elfy]

#19 - e
something must be really wrong with that ear, I would not wait with the ice/hot packs

[FOLEY]

well, this way you are telling him the truth, but in a positive way (instead of saying, you are near your final hight, you say you will grow some more inches - just the same, but sounds so much better :)

well...there is a lot more to it than that (actual medical reasons) ;) but you have a gift for picking out the right answers!

[FOLEY]

#16 - c?

Yes!!!

[FOLEY]

19c

sorry.

[FOLEY]

#19 - e
something must be really wrong with that ear, I would not wait with the ice/hot packs

correct again!

[FOLEY]

14, 15 - still weren't answered.

[elfy]

well...there is a lot more to it than that (actual medical reasons) ;) but you have a gift for picking out the right answers!
I told you I had two mid-terms today, so I am still in that kinda mood :grum: :grum:

[elfy]

14 -B

[FOLEY]

20. A 75-year-old woman comes to the clinic because she has band-like burning pain in the right upper quadrant extending from
the epigastrium around to the midline of the back. On physical examination, there is no abdominal tenderness. Findings on
ultrasonography of the gallbladder are normal; serum amylase concentration is normal. Which of the following is the most
likely diagnosis?

(A) Acalculous cholecystitis
(B) Chronic relapsing pancreatitis
(C) Diverticulitis of the cecum
(D) Herpes zoster
(E) Penetrating duodenal ulcer

[elfy]

15- c

[FOLEY]

14 -B

yep.

[FOLEY]

15- c

no, sorry.

[elfy]

20. A 75-year-old woman comes to the clinic because she has band-like burning pain in the right upper quadrant extending from
the epigastrium around to the midline of the back. On physical examination, there is no abdominal tenderness. Findings on
ultrasonography of the gallbladder are normal; serum amylase concentration is normal. Which of the following is the most
likely diagnosis?

(A) Acalculous cholecystitis
(B) Chronic relapsing pancreatitis
(C) Diverticulitis of the cecum
(D) Herpes zoster
(E) Penetrating duodenal ulcer
I pick C

[FOLEY]

I told you I had two mid-terms today, so I am still in that kinda mood :grum: :grum:

well, you must've done great on your test...although I find sometimes on MCQs knowing the material can steer you away from the right answer by overthinking.

[FOLEY]

I pick C

before I tell you whether you are right or wrong...what is your reasoning?

[elfy]

no, sorry.
then, 15 - A

[elfy]

before I tell you whether you are right or wrong...what is your reasoning?
because the symptoms of Diverticulitis of the cecum are similar to appendicitis

[FOLEY]

then, 15 - A

you got it this time!

[elfy]

you got it this time!
:bis: maybe I should leave while I am the winner :lol: (I forgot I was not in the casino) - Foley, is there a prize?

[FOLEY]

because the symptoms of Diverticulitis of the cecum are similar to appendicitis

diverticulitis of the cecum would be very, very unusual and unlikely...

appendicitis in a 75yo woman is very unlikely

painless (remember what they give youin the question) diverticulitis and appendicitis is almost unheard off.

[FOLEY]

:bis: maybe I should leave while I am the winner :lol: (I forgot I was not in the casino) - Foley, is there a prize?

what would you like?

[elfy]

diverticulitis of the cecum would be very, very unusual and unlikely...

appendicitis in a 75yo woman is very unlikely

painless (remember what they give youin the question) diverticulitis and appendicitis is almost unheard off.
I am getting tired, not paying attention, excuses, escuses :lol:
time to go to bed :sleep:

[elfy]

what would you like?
ой, я сразу так даже и не знаю :27:
огласите, пожалуйста, весь список :lol:

[FOLEY]

21. A 2-year-old boy who has recently become one of your patients is brought to the clinic by his mother for a follow-up visit of a
chromosome analysis done 1 month ago. This child has minor dysmorphic features, and growth and developmental delay.
Chromosome analysis showed a small unbalanced chromosome translocation, with extra chromosomal material at the tip of
chromosome 3. The cytogenetics laboratory requested blood samples from both parents for follow-up studies. The parents are
divorced, and the mother has custody of the child. The relationship between the parents is hostile. The mother has been tested
and has normal chromosomes without evidence of translocation. At today's visit, she reacts angrily when the issue of
contacting the child's father for testing is raised. She states that he abandoned them, and that he has no interest in his child.
She refuses to cooperate in contacting the father, who could be a translocation carrier. You do not know the father, but an
office worker told you that he lives in a nearby town. The mother says that he is living with a new girlfriend. Which of the
following is the most appropriate next step?


(A) Attempt to identify the father's physician and work with that physician to obtain chromosome studies on the
father
(B) Contact the father by telephone and arrange for him to give a blood sample at a local hospital
(C) Document your attempts to work with the mother but proceed no further, since you have no physician-patient
relationship with the father
(D) Help the mother deal with her anger and educate her regarding the potential benefit to her son and others if the
father's chromosome studies are done
(E) Send the father a letter (expressing few details about the patient) and suggest that he contact your office for an
appointment and further discussion of his child

[FOLEY]

ой, я сразу так даже и не знаю :27:
огласите, пожалуйста, весь список :lol:

ну могу сейчас привести тебе Ben & Jerry's...actually, I am currently carless, so you'd have to drive.

[elfy]

I like Chunky Monkey
and Chubby Hubby is one of my favorites, too :lol:
you could take a cab;)

[Odinokiy_Ostrov]

21 - D?

[Malishka]

Goodness! i didn't know there were so many dorks here :evillaugh :evillaugh :evillaugh

(Me too, of course )

[FOLEY]

21 - D?

Correct!

[FOLEY]

22. An 18-month-old white infant is brought to the clinic because of pallor and irritability. Her mother says the infant's diet
consists almost exclusively of whole milk, approximately 40 oz per day. On physical examination, the infant has a pulse of
160/min, respirations of 50/min, and normal heart sounds with a grade 2/6 systolic ejection murmur. Liver is palpable 3 cm
below the right costal margin. Laboratory studies show:
Blood
Hematocrit 13%
Hemoglobin 3 g/dL
Mean corpuscular volume 48 μm3
Platelet count 400,000/mm3
Reticulocyte count 0.8% (N=0.5-1.5% of red cells)
WBC 12,000/mm3
Following appropriate evaluation, which of the following is the most appropriate treatment?


(A) Administration of oral folate therapy
(B) Administration of parenteral iron therapy
(C) Administration of parenteral vitamin B12 (cyanocobalamin) therapy
(D) Transfusion with packed erythrocytes
(E) Transfusion with whole blood

[FOLEY]

23. A 3-year-old boy is brought to the office by his father because of a 3-month history of decreased activity, poor appetite,
sporadic vomiting, clumsiness and speech regression. Since his birth his family has lived in an old area of the city where
there is demolition of old buildings. Examination of a peripheral blood smear is likely to show which of the following?


(A) Basophilic stippling of erythrocytes
(B) Degranulation of eosinophils
(C) Diminished numbers of platelets
(D) Howell-Jolly bodies
(E) Macrocytic erythrocytes

[FOLEY]

24. A 32-year-old man and his 29-year-old wife are being evaluated for infertility. The woman's gynecologist reports that the
woman had a normal anatomic and physiologic evaluation and suggests the need for assessment of potential male factors.
On examination, the man is 188 cm (6 ft 3 in) tall with fair skin and little facial hair. His testicles are small and firm, and he
has mild gynecomastia. No sperm are seen on analysis of his semen. Which of the following tests is most likely to establish
the underlying cause of the infertility?


(A) Karyotype from peripheral leukocytes
(B) Serum estrogen and testosterone concentrations
(C) Serum gonadotropin concentrations (follicle-stimulating hormone and luteinizing hormone)
(D) Serum prolactin concentration
(E) Testicular ultrasonography

[FOLEY]

25. A 5-year-old boy is brought to the office by his mother because of recurrence of bed-wetting at night. He has a 3-month-old
sister who is healthy. Physical examination is normal. Urinalysis shows:
Specific gravity 1.010
Glucose Negative
Protein Negative
Microscopic 0-1 WBC/hpf, 0 RBC/hpf
Which of the following is the most important information to share with his parents?


(A) This condition will cease if they reprimand him for deliberately wetting the bed
(B) The condition is self-limiting, and they should take care to lessen the emotional impact on their child
(C) This is a potentially serious problem and could represent chronic inflammation of the kidneys
(D) This may be a precursor of diabetes mellitus
(E) This signifies a serious underlying emotional disorder

[FOLEY]

26. A 67-year-old man is admitted to the hospital because of fever, malaise and weight loss for the past 6 weeks. Night sweats
began 4 weeks ago. His medical records show that he has had a tonsillectomy, adenoidectomy, mitral valve
commissurotomy and sigmoid colon resection for diverticulitis. His temperature has been as high as 38.3°C (101.0°F) daily.
Today, vital signs are: temperature is 38.8°C (101.8°F), pulse 100/min and respirations 14/min. The patient appears
chronically ill but is in no acute distress. Other physical findings include a cotton-wool exudate in the right eye, crackling
rales at the lung bases and a moderate blowing grade 2/6 pansystolic murmur. There is moderate left lower quadrant
abdominal tenderness. Leukocyte count is 11,500/mm3 with normal differential and hematocrit is 35%. Urinalysis shows
4 WBC/hpf and 10 RBC/hpf. Chest and abdominal x-ray films are normal except for slight left ventricular enlargement. At
this which of the following is the most likely diagnosis?



(A) Bacterial endocarditis
(B) Diverticulitis
(C) Hodgkin disease
(D) Pyelonephritis
(E) Vivax malaria

[FOLEY]

A 25-year-old man has been on life support systems for the past 48 hours following blunt head trauma.


27. Which of the following is the most important criterion to declare the patient brain dead and to permit removal of life support
systems?

(A) Bedside EEG showing no electrical activity
(B) Decorticate and decerebrate posturing
(C) Failure to respond to electroconvulsive stimuli
(D) Glasgow coma score of 3 or less
(E) Unenhanced MRI of the brain showing dilated ventricles


28. Brain death cannot be established in this patient if there is the presence of which of the following?

(A) Carotid blood flow
(B) Cremasteric reflexes
(C) Elevated serum aminoglycoside concentrations
(D) Hypothermia
(E) Marked cerebral edema

[elfy]

27 - E?

[elfy]

28 - b

[Odinokiy_Ostrov]

24 - B?

[FOLEY]

27 - E?

no, sorry

[FOLEY]

28 - b

nope.

what happened to your great guessing streak?!

[FOLEY]

24 - B?

no. sorry.

[MEV]

А вопросики Kaplan Q-bank step 2 CK чтоли? Или UW :-) Жалко игра ваша закончилась уже, я б тоже поиграла с вами, а то мне скоро 9 часов подряд так развлекаться :-)

[Malishka]

А вопросики Kaplan Q-bank step 2 CK чтоли? Или UW :-) Жалко игра ваша закончилась уже, я б тоже поиграла с вами, а то мне скоро 9 часов подряд так развлекаться :-)
Good luck, stud muffin :34:

[FOLEY]

А вопросики Kaplan Q-bank step 2 CK чтоли? Или UW :-) Жалко игра ваша закончилась уже, я б тоже поиграла с вами, а то мне скоро 9 часов подряд так развлекаться :-)

i think closer to step 3...but after a while they all blend into one.

p.s. good luck!

[MEV]

спасибо, только на гуд лак и приходится надеяться.:(

[elfy]

спасибо, только на гуд лак и приходится надеяться.:(
что так? не готовились?:(

[MEV]

да готовилась... только вот готовься-не готовься - а полностью готовым себя все равно никогда не почуствуешь. слишком много всего. ну да ладно, с первым также было, проходили мы уже. это я так просто, плакаю:rolleyes:

[Malishka]

да готовилась... только вот готовься-не готовься - а полностью готовым себя все равно никогда не почуствуешь. слишком много всего. ну да ладно, с первым также было, проходили мы уже. это я так просто, плакаю:роллеыес:

вздохни и напейся

[Whoever]

да готовилась... только вот готовься-не готовься - а полностью готовым себя все равно никогда не почуствуешь. слишком много всего. ну да ладно, с первым также было, проходили мы уже. это я так просто, плакаю:роллеыес:


вздохни и напейся

А потом сразу готовься к Step 3, пока воспоминания от Step2- CK не стёрлись-они похожие экзамены. Иначе потом времени больше уйдёт.

Удачи, и чтоб с хорошим баллом:)

[elfy]

А потом сразу готовься к Step 3, пока воспоминания от Step2- CK не стёрлись-они похожие экзамены. Иначе потом времени больше уйдёт.

Удачи, и чтоб с хорошим баллом:)
Whoever, вы тоже врач?

[Whoever]

Whoever, вы тоже врач?

в своём роде.
a multiple-choice physician:)

[Malishka]

А потом сразу готовься к Степ 3, пока воспоминания от Степ2- ЦК не стёрлись-они похожие экзамены. Иначе потом времени больше уйдёт.

Удачи, и чтоб с хорошим баллом:)

Нет, не обязательно. Иногда лучше клинически попрактиковатьса. Степ 3 забирает уикенд что бы подготовитьса

[Whoever]

Нет, не обязательно. Иногда лучше клинически попрактиковатьса. Степ 3 забирает уикенд что бы подготовитьса

Да нет, побольше одного уикенда будет.
Хотя от специальности зависит. И ещё, он для иностраных выпускников сложнее:

http://www.usmle.org/scores/2006perf.htm

[Malishka]

Да нет, побольше одного уикенда будет.
Хотя от специальности зависит. И ещё, он для иностраных выпускников сложнее:

хттп://щщщ.усмле.орг/сцорес/2006перф.хтм

Кому как. Больше у меня не было времени заниматьса

[Whoever]

Иногда лучше клинически попрактиковатьса.

В узких специальностях (Ob/Gyn, Psychiatry, Anesthesiology) бывают даже случаи проблемы с получением лицензии после резидентур из-за отсутствия этого экзамена. Несмотря на клиническую практику:) А если идёшь в Family Practice или Medicine, то шанс сдать за годы резидентуры близок к 100 процентам. Особо одарённым даже за один уикенд удаётся подготовиться:)

[Malishka]

В узких специальностях (Об/Гын, Псычиатры, Анестхесиологы) бывают даже случаи проблемы с получением лицензии после резидентур из-за отсутствия этого экзамена. Несмотря на клиническую практику:) А если идёшь в Фамилы Працтице или Медицине, то шанс сдать за годы резидентуры близок к 100 процентам. Особо одарённым даже за один уикенд удаётся подготовиться:)

Первый год, практически ВСЕ специальности делают подобие общей медицины. Хирурги, OB/GYN, анестесиологи, офтальмологи, психиаторы, урологи и т.д. It's really not that bad

[Whoever]

Первый год, практически ВСЕ специальности делают подобие общей медицины. Хирурги, OB/GYN, анестесиологи, офтальмологи, психиаторы, урологи и т.д. It's really not that bad

Ну, в Ob/Gyn у них нет Medicine rotation , насколько я понимаю.
В Psychiatry-4 месяца.
В Anesthesiology, действительно, год.

В основном на первом году занимаются scut work или замещением калия при низком уровне такового. А Step 3 всё же сложнее:)

[FOLEY]

чтоб просто сдать его - не сложно. вот чтоб хороший бал получить, тогда сложней.

и таки да, лучше набраться опыта клинического (любого, так как тест и на гинекологию и на хирургию и на психиатрию) чем сидеть и зубрить.

[Malishka]

Ну, в Ob/Gyn у них нет Medicine rotation , насколько я понимаю.
В Psychiatry-4 месяца.
В Anesthesiology, действительно, год.

В основном на первом году занимаются scut work или замещением калия при низком уровне такового. А Step 3 всё же сложнее:)
Must be shitty residency. I enjoy my ancillary staff.

PS I didn't even have scut work as a med student. Never wheeled pt to Xray, never had to do blood cultures/put in IVs. NMJ, baby :evillaugh :34:

PS One doesn't have to manage MIs, diverticulitis, infections, pneumonias, UTIs, thyroid storm, etc in the first year???? Just replace potassium???? I don't believe that

[Whoever]

Must be shitty residency...

You forgot one thing. For a foreign medical grad, the likelihood of getting into "shitty" (even though I disagree) residency is pretty high. Likewise, the likelihood of getting no residency position at all is high enough. Do not apply American standards for foreign grads.

[Whoever]

... Just replace potassium????

Do not take it literally:)

[Malishka]

You forgot one thing. For a foreign medical grad, the likelihood of getting into "shitty" (even though I disagree) residency is pretty high. Likewise, the likelihood of getting no residency position at all is high enough. Do not apply American standards for foreign grads.

Yes, dad, please forgive me

[Whoever]

Yes, dad, please forgive me

That's O.K. Just consider the audience-I believe majority of them are IMGs.

[Lakomka]

That's O.K. Just consider the audience-I believe majority of them are IMGs.
and IMG stands for?

[Whoever]

and IMG stands for?

International medical graduate.

[MEV]

IMG - International Medical Graduates

[MEV]

А потом сразу готовься к Step 3, пока воспоминания от Step2- CK не стёрлись-они похожие экзамены. Иначе потом времени больше уйдёт.

Удачи, и чтоб с хорошим баллом:)

Спасибо! План минимум - не меньше 90 :)

[Lakomka]

удачи!:34:

я кстати, последнее время сталкиваюсь с таким количеством народа который едет учиться на врача домой, с тем что бы сюда потом вернуться

[MEV]

ну кому как наверное удобней. Здесь дорого учиться на врача. Там - бесплатно (или практически бесплатно). Качество образования там значительно хуже, хотя экзамены те же самые потом сдавать. ( но многие тем не менее сдают на более высокие баллы чем средний AMG )
У IMG потом геморрой с резидентурой. AMG многим лоаны выплачивать. Индивидуально все в общем. Но был бы выбор - я б здесь училась.