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nbme 4 step 3 practice exam questions and answers
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nbme 4 step 3 practice exam questions and answers
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nbme 4 step 3 practice exam questionsand answers
65 iiyo iiF iihas iia ii3 iimonth iihx iiof ii*increasing iilow iiback iipain*. iiHad iilow iiback iipain iifor
iipast ii3 iiyrs iithat's iibeen iitreated iiw/NSAIDs iiand iicodeine. iiNow iirated iias ii7/10 iiin
iiseverity. iiPain iiradiates iito iiboth iilegs, iiworsens iiwhen iiwalking iior iistanding ii& iiRelieved
iiwhen iisitting. ii1 iiYEAR iiAGO: iiX iiray iilumbosacral iispine: iimild iiosteoarthritis. iiExam:
ii4/5 iimm iistrength iiLE, iihyporeflexia iiof iiknees&ankles iib/, iiunsteady iigait iib/c iiof iipain.
iiNo iiother iiabnormalities. iiMost iiappropriate iidiagnostic iistudy iiof iilumbosacral iispine iito
iiorder iiat iithis iitime? ii- iiAnswers ii-*MRI*
-prly iib/c iithis iipain iiis iiworse iithan iithe iiusual iipain ii& iineuro iisx iiof iihyporeflexia,
iidecreased iimm iistrength, iiand iiunsteady iigait
A iicouple iicomes iito iidiscuss iithe iiresults iiof iiprenatal iitesting iiin iicurrent iipregnancy.
iiScreening iitest iishowed iiincreased iirisk iifor iihaving iia iichild iiw/Down iisyndrome.
iiAmniocentesis iiis iisuggested iifor iiher. iiHusband iiasks ii"When iican iiwe iischedule iithe
iiamniocentesis? iiI iithink iithat iiwe iishould iijust iiget iion iiw/it." iiWife iiresponds iiangrily,
ii"That's iieasy iifor iiu iito iisay. iiU iihaven't iibeen iicarrying iithis iibaby iifor ii4 iimonths ii& iiu
iihaven't iifelt iiit iimove iilike iiI iihave. iiAppropriate iiresponse? ii- iiAnswers ii-"I iiknow iithis iiis
iidifficult iinews iifor iiboth iiof iiu. iiI iiwould iilike iito iiknow iiwhat iiboth iiof iiu iiare iithinking iinow"
3 iiy.o. iiboy iiis iiat ii50th ii%tile iifor iiheight&weight. iiExam: iihemihypertrophy iiof iileft iiside
iiof iibody iiwhen iicompared iito iiright. iiPalpable iimass iiin iiLLQ. iiLabs: iiHgb ii12, iiHct ii36%,
iiUrine: iiSG ii1.020, iiWBC ii0-1/hpf, iiRBC ii10-20/hpf. iiU/S: iileft iikidney iimass. iiDx? ii-
iiAnswers ii-*Wilms iitumor*
-most iicommon iiRENAL iimalignancy iiin iikids
-age ii<5
-*Unilateral, iiPAINFUL, iiabdominal iimass*
-HTN, iihematuria
neuroblastoma ii- iiAnswers ii-most iicommon iiextracranial iisolid iitumors iiin iikids
-painLESS iiabdominal iimass
-may iihave iiHTN iiDue iito iimass iicompressing iirenal iiartery iiand iiactivating iirenin-
angiotensin iisystem ii
-FLUSHING ii&SWEATING iidue iito iicatecholamine iihypersecretion
-neural iicrest iiorigin
-involves iiadrenal iimedulla, iisympathetic iichain
-median iiage ii<2
-*periorbital iiecchymoses(orbital iiMETASTASES)*
-spinal iicord iicompression iifrom iiepidural iiinvasion("dumbbell iitumor")
-opsoclonus-myoclonus iisyndrome
, DX: iielevated iicatecholamine iimetabolites, iismall&round iiblue iicells iion iihistology, iiN-
myc iigene iiamplification
58 iiyear iiold iiF iihas iiheavy iisubsternal iichest iipain iirelieved iiby iinitroglycerin ii& iirest.
iiPain iioccurs iiw/exertion&accompanied iiby iisome iiSOB&sweating. ii6 iimonths iiago:
iiCABG. iiVSS. iiECG: iiNSR iiw/*inverted iiT iiwaves iiNEW iiin iileads iiV4-V6.* iinext iistep iiin
iievaluation iiis iito iido iiwhich? ii- iiAnswers ii-*Repeat iicoronary iiartery iicatheterization*-
>NOT iiorder iiecho iior iiMUGA iiscan
-maybe iib/c iiof iiNEW iiinverted iiT iiwaves?
70 iiyo iihas ii1 iiwk iihx iileft iieyelid iidroop. iiPMG iiCOPD&Quit iismoking ii5 iiyrs iiago.
iiTroublesome iipain iiradiating iidown iileft iiarm. iiLeft iiptosis iiw/small iipupil iion iiexam.
iiDiagnostic iistudy? ii- iiAnswers ii-*CT iiscan iithorax*
-prly iipancoast iitumor
65 iiyo iiF iihad ii2 iimin iigeneralized iitonic-clonic iiseizure iithat iioccured iiwhen iiasleep.
iiPMH: iiHTN, iibreast iicancer ii2 iiyrs iiago iis/p iilumpectomy, iiradiation iitherapy, iiadjuvant
iichemo ii1 iiyr iiago. iiMeds: iilisinopril, iitamoxifen.Pt iiis iidrowsy, iinot iioriented iito
iiperson,place,time. iiBP ii160/95. iiPulse iiox ii95%.Exam: iiright iilower iiface iidrooping.
iiEyes iiconjugately iideviated iito iileft. iiBriskly iiwithdraws iiLUE ii& iiboth iiLE iito iinoxious
iistimuli; iithere's iino iimovement iiof iiRUE. iiFingerstick iiBG ii70, iiserum iisodium
iiconcentration ii130. iiCAUSE iiof iiseizure? ii- iiAnswers ii-*Brain iimetastasis* iiprly iifrom
iibreast iicancer
-looks iilike iishe iigot iia iistroke
strongest iipredisposing iifactor iifor iiprostate iicancer ii- iiAnswers ii-age ii(old)
32 iiyo iiF ii6 iiday iif/u iifor ii12 iicm iilipoma iiremoval iifrom iileft iilateral iithigh. iiFor iipast ii2
iidays, iishe iihad iiswelling ii&mild iiincrease iiin iitenderness iion iiand iiaround iiincision iisite.
iiExam iiof iiincision iisite: iibubble-like iiswelling iiunderneath iiincision iiw/o iierythema,
iidrainage iior iilymphadenopathy. iiArea iiis iiballotable ii& iifluid iiwave iion iipalpation.DX? ii-
iiAnswers ii-*Seroma*=pocket iiof iiclear iiserous iiFLUID ii-common iiafter iisurgery
-ballotable iimeans iisignificant iieffusion
28 iiyo iiF iiG1P1 iiat ii33 iiwks iigestation iiin iiactive iilabor. iiRR ii22. iiExam: iinontender
iiabdomen. iifundal iiheight ii36 iicm. iipelvic iiultrasound iishows iipocket iiof iiamniotic iifluid
ii91.5 iimm. iiUnderlying iicause? ii- iiAnswers ii-*Fetal iiesophageal iiatresia* ii(not iifetal
iipolycystic iikidneys)
66 iiyo iiIrish iiAmerican iiman iihas iiSOB iion iiexertion iifor iipast ii6 iimonths, iibut iinow
iipresent iiwhen iiclimbing ii1 iiflight iiof iistairs. ii+Dry iicough. iiRetired ii1 iiyr iiago iifrom iijob iiin
ii*Stone* iiquarry. iiExam: iifinger ii*Clubbing," iiend-expiratory iicrackles. iiCXR: iifibronodular
iiinfiltrate iiin iiUPPER iiLOBES. iiDx? ii- iiAnswers ii-*Silicosis*
asbestosis ii- iiAnswers ii--construction ii& iishipyard iiworkers
-20 iiyrs iiafter iiinitial iiexposure
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