Hey guys these are the questions i got wrong when i did NBME Clinical Science Mastery Series - FORM 1. I appreciate it if you can provide me the correct answers and why you picked them! thank you
1. A previously healthy 32-year-old woman comes to the physician because of a 2-month history of dull right-sided pelvic pain. The pain is most severe during menses. Her last menstrual period was 3 weeks ago. She takes no medication. Examination shows fullness in the right adnexa and tenderness to palpation. Urine Beta-hCG test is negative. Pelvic ultrasonography shows a 5-cm simple cyst in the right adnexa. She says she is anxious about paying for treatment because her medical insurance expires in 2 weeks. Which of the following is the most appropriate next step in management?
A) Reassurance and schedule a follow up visit in 1 year
B) OCP therapy and a second pelvic examination in 6 weeks
C) Ultrasonography-guided drainage of the cyst
D) Laparoscopy and oophorectomy
E) Laparotomy and oophorectomy
F) Total abdominal hysterectomy and bilateral salpingo oophorectomy
2. A 23-year-old woman comes for a follow-up examination 3 weeks after being diagnosed with urinary tract infection. Treatment with trimethoprim-sulfamethoxazole has relieved her symptoms. This is her third urinary tract infection over the past year. She has no history of serious illness. She was married 3 months ago. Her temperature is 37C (98.6F). Examination shows no abdominal or flank tenderness. Urinalysis is within normal limits. Daily administration of which of the following is most appropriate prophylaxis agains recurrence of this condition?
3. A healthy 18-year-old nulligravid woman comes to the physician for a routine health maintenance examination. She states that she typically has pain in one of the adnexal region that occurs during days 13 and 14 of her menstrual cycle. She describes the pain as brief and sharp. Menarche was at the age of 13 years, and menses occur at regular 28-day intervals with moderate flow for the next 2 days. She has never been sexually active. Physical and pelvic examination show no abnormalities. Which of the following is the most appropriate next step in management?
B) Testing for Neisseria gonorrhea and Chlamydia trachomatis
C) Pelvic ultrasonography
D) Leuprolide therapy
4. A 67-year-old woman comes to the physician because of a 9-month history of persistent vulvar itching despite treatment with over-the-counter zinc oxide, vitamin E, hydrocortisone cream, and miconazole. She has type 2 diabetes mellitus and hypercholesterolemia. She is 155 cm (5 ft 1 in) tall and weights 127 kg (280 lb); BMI is 53 kg/m2. Examination shows an erythematous swollen vulva, papules and pustules on the medial aspect of the thighs, and several excoriations. A KOH preparation of a scraping of a pustule shows pseudohyphae and budding yeast. Which of the following is the most likely underlying cause of this patient's failure to respond to treatment?
A) contact dermatitis
C) Self-induced excoriations
D) Type 2 diabetes mellitus
E) Vulvar malignancy
5. A 27-year-old primigravid woman at 33 weeks gestation comes to the physician for a routine prenatal visit. She has had systemic lupus erythematosus for 8 years but has been in remission for the past year. Her pregnancy has been uncomplicated except for a fundal heigh that began to lag 2 months ago. Ultrasonography at 20 weeks gestation showed a fetus that had a normal anatomy and was consistent in size with gestational age. The patients blood pressure today is 100/62 mmHg. Pelvic examination shows no abnormalities. The fundal height is 26 cm. There is no ferning on light microscopy of vaginal secretion. Ultrasonography shows oligohydramnios and a fetus consistent in size with a 30-week gestation. Urinalysis shows no protein. Which of the following is the most likely cause of the oligohydramnios?
A) Fetal renal agenesis
B) Fetal urinary obstruction
C) Intrauterine fetal infection
D) Ruptured membranes
E) Uteroplacental insufficiency
6. A 27-year-old Filipino woman at 10 weeks gestation comes for her first prenatal visit. Her pregnancy has been complicated by fatigue and nausea. She has not had fever, bleeding, or rashes. She has a 15-year history of anemia. Her hematocrit has remained 28% to 29% during the past 7 years despite iron supplementation She has never been hospitalized. Menarche was at age 13 years. Menses occur at 28-day intervals, last 5 days, and diminish in flow after the first day. Five years ago, she visited her family in Manila and remembers becoming ill with flu-like symptoms during that visit. Examination shows a uterus consistent in size with a 10-week gestation. Which of the following is the most appropriate next step in management?
A) Test of the stool for occult blood
B) Hemoglobin electrophoresis
C) Triple screening
D) Erythropoietin therapy
E) Interferon alfa therapy
F) chorionic villus sampling
7. A 20-year old primigravid woman at 40 weeks gestation is admitted to the hospital in labor. The cervix is 4 cm dilated; the vertex is at 0 station. Two liters of lactated Ringer solution are administered. An epidural catheter is placed, and a test dose of lidocaine and epinephrine is injected. She immediately has tinnitus and a metallic taste in her mouth. Her pulse now is 110/min, and blood presentation is 140/100 mm Hg. Which of the following is the most likely cause of these findings?
A) Anesthetic induced anaphylactic reaction
B) Epidural administration of anesthetic
C) Intravascular injection of anesthetic
D) Mislabeling of the anesthetic agent
8. A 57 year-old woman comes to the physician for a routine health maintenance examination. She has hypertension type 2 diabetes mellitus, and generalized anxiety disorder. Her great aunt has a history of breast cancer. The patient has been receiving hormone therapy with conjugated estrogen and medroxyprogesterone daily since menopause 5 years ago. Additional medication include hydrochlorothiazide, metfomin, and various herbal medication. Her BP is 136/84 mm Hg. Examination of the breasts shows no masses or nipple discharge. Which of the following historical finding is the greatest risk factor for breast cancer in this patient?
A) Family history of breast cancer
B) Herbal medication
C) Hormone therapy
E) Type 2 diabetes mellitus
9. A 23-year-old primigravid woman at 30 weeks gestation is brought to the emergency department because of headache, blurred vision, and constant right upper quadrant abdominal pain for 12 hours. Her pulse is 92/min, respiration are 14/min, and blood pressure is 138/95 mm Hg. Examination shows moderate edema of the face and fingers. Deep tendon reflexes are 3+. Labratory studies show:
Platelet count 40,000/mm3Which of the following is most likely diagnosis?
Serum AST 1200 U/L
Serum ALT 365 U/L
Lactate dehydrogenase 1954 U/L
A) Abruptio placentae
C) Idiopathic cholestasis of pregnancy
D) Immune thrombocytopenia purpura
E) Severe preeclampsia
10. Prior to discharge from the hospital following an uncomplicated delivery, a 30-year-old woman, gravida 1, Para 1, states that she would like to resume the combination oral contraceptive she took prior to pregnancy. She plans to breast-feed for 6 months. In considering the combination of breast-feeding and this method of contraception, the physician should counsel the patient about which of the following potential problems?
A) Decreased effectiveness in preventing pregnancy
B) Decreased protein content in breast milk
C) Delayed uterine involution
D) Increased incidence of urinary tract infection
E) Increased incidence of mastitis
11. A 22-year-old woman comes to the physician because of a second episode of painful vesicular genital lesions. She says that her new sexual partner has similar lesions on his penis. If left untreated, which of the following is most likely clinical course?
A) Development of severe systemic illness over the next 3 days
B) Development of an exfoliative dermatitis within 1 week
C) increasing symptoms for 3 weeks, then a gradual decrease
D) persistence of the lesions for 3 months or more
E) Spontaneous disappearance of the lesions within 1 week