Fam,./Med,./NBME,./Form,./1
57,./yo,./-
,./6,./month,./hx,./of,./cough,./(gray,./to,./light,./yellow,./sputum),,./SOB,./on,./exertion,
,./and,./wheezing
no,./chest,./pain,./
smokes,./1.5,./packs,./of,./cigs,./qd,./for,./38,./yrs
PE:,./dec,./breath,./sounds,,./occasional,./wheezing,,./fine,./scattered,./crackles;,./c
ardiac,./normal;,./trace,./pedal,./edema,./w/,./no,./JVD,./or,./hepatojugular,./reflux,./
labs:,./Hgb,./17.6,./
CXR:,./flattened,./diaphragms
ECG:,./RAD
next,./step,./in,./mgnt?,./-,./correct,./answer,./✔ ✔
recommend,./participation,./in,./a,./smoking,./cessation,./program,./
pt,./has,./developed,./COPD,./and,./is,./on,./his,./way,./to,./CHF
only,./intervention,./that,./changes,./the,./course,./of,./COPD,./is,./smoking,./cessati
on,./-,./slows,./dz,./progression,./
smoking,./cessation,./programs,./-
,./most,./effective,./intervention,./to,./reduce,./risk,./of,./COPD,./
results,./in,./dec,./symptom,./freq,./
maintaining,./cessation,./-,./dec,./mortality,./and,./dec,./rates,./of,./decline,./in,./FEV1
62,./yo,./-,./concerned,./for,./risk,./of,./T2DM
,mom,./and,./2,./sisters,./received,./this,./dx,./in,./their,./50s,./
BMI:,./30
BP:,./130/70,./mmHg
labs:,./HgA1C,./8.4%;,./dec,./Cl-;,./inc,./HCO3-
,,./BUN,./(30),,./glucose,./(200),,./Cr,./(1.8)
what,./med,./is,./CI,./in,./this,./pt?,./-,./correct,./answer,./✔ ✔ metformin
major,./SE,./of,./this,./drug,./is,./lactic,./acidosis,./
CI,./in,./pts,./who,./have,./renal,./failure
FDA,./suggests,./to,./not,./use,./in,./pts,./w/,./mild,./renal,./impairment,./(Cr,./>,./1.4,./for
,./women,./and,./>,./1.5,./for,./men)
bc,./it's,./excreted,./by,./the,./kidneys
52,./yo,./-,./2,./wks,./after,./inf,./wall,./MI
echo,./before,./d/c:,./EF,./of,./33%
recovery:,./dec,./exercise,./tolerance
PE:,./gucci
most,./appropriate,./drug,./to,./prolong,./pt's,./life?,./-,./correct,./answer,./✔ ✔
lisinopril,./
ACEi,./-,./cornerstone,./of,./tx,./for,./chronic,./systolic,./HF,./
improve,./symptoms,,./reduce,./mortality,,./dec,./hospitalizations,,./and,./improv
e,./quality,./of,./life,./
,in,./pts,./who,./have,./had,./MIs,./-
,./BBs,./and,./ACEi,./have,./been,./shown,./to,./reduce,./morbidity,./and,./mortality
ACEi,./-
,./reduce,./preload/afterload,,./improve,./cardiac,./output,,./and,./inhibit,./RAAS
25,./yo,./-,./pos,./PPD,./skin,./test
exposed,./to,./person,./w/,./active,./TB,./when,./she,./was,./a,./child
all,./previous,./PPD,./tests,./neg,./-,./last,./one,./5,./yrs,./ago
CXR:,./gucci
next,./step,./in,./mgnt?,./-,./correct,./answer,./✔ ✔
treatment,./of,./latent,./tuberculosis,./now,./
dx:,./pos,./skin,./test,./+,./neg,./CXR,./+,./lack,./of,./symptoms,./
tx:,./INH,./for,./9,./months,./+,./B6,./or,./rifampin,./for,./4,./months
42,./yo,./w/,./T2DM,./-,./lesion,./on,./perineum,./for,./3,./months,./
PE:,./ulcerated,./plaque,./on,./perineal,./body,./
biopsy:,./invasive,./squamous,./cell,./carcinoma;,./extensive,./intraepi,./dz,./on,./pe
rineum,./
most,./likely,./underlying,./cause?,./-,./correct,./answer,./✔ ✔
exposure,./to,./human,./papillomavirus,./
perineum,./=,./area,./between,./anus,./and,./scrotum/vulva
genital,./wart,./>,./CIN,./or,./carcinoma,./
, diabetics,./are,./more,./prone,./to,./ulcers,./(esp,./on,./their,./feet),./due,./to,./neuropath
y
47,./yo,./-,./2,./month,./hx,./of,./severe,./HAs
qNight,./-,./wakes,./up,./at,./3AM,./bc,./severe,./pain,./behind,./L.eye,./-
,./feels,./like,./he's,./being,./"stabbed,./by,./an,./ice,./pick",./
L.pupil,./smaller,./than,./R;,./L.eyelid,./droops
smokes,./2,./packs,./of,./cigs,./for,./25,./yrs
drinks,./6,./beers,./qNight
P:,./110/min
BP:,./145/90,./mmHg
PE:,./deep,./facial,./wrinkles,./
fundo:,./no,./papilledema,./
most,./likely,./cause?,./-,./correct,./answer,./✔ ✔ cluster,./headache
more,./prevalent,./in,./males
series,./of,./HAs,./occurring,./close,./together,./for,./6-12,./wks,./
severe,,./intense,,./UL,./pain,./lasting,./sec,./to,./min
tx:,./high-flow,./O2;,./can,./be,./used,./w/,./sumatriptan;,./verapamil,./as,./ppx
37,./yo,./-,./hx,./of,./rheumatic,./fever,./as,./kid
cardiac,./exam:,./L.parasternal,./lift;,./diastolic,./murmur,./at,./apex,./and,./lower,./L.
sternal,./border;,./S4,./
57,./yo,./-
,./6,./month,./hx,./of,./cough,./(gray,./to,./light,./yellow,./sputum),,./SOB,./on,./exertion,
,./and,./wheezing
no,./chest,./pain,./
smokes,./1.5,./packs,./of,./cigs,./qd,./for,./38,./yrs
PE:,./dec,./breath,./sounds,,./occasional,./wheezing,,./fine,./scattered,./crackles;,./c
ardiac,./normal;,./trace,./pedal,./edema,./w/,./no,./JVD,./or,./hepatojugular,./reflux,./
labs:,./Hgb,./17.6,./
CXR:,./flattened,./diaphragms
ECG:,./RAD
next,./step,./in,./mgnt?,./-,./correct,./answer,./✔ ✔
recommend,./participation,./in,./a,./smoking,./cessation,./program,./
pt,./has,./developed,./COPD,./and,./is,./on,./his,./way,./to,./CHF
only,./intervention,./that,./changes,./the,./course,./of,./COPD,./is,./smoking,./cessati
on,./-,./slows,./dz,./progression,./
smoking,./cessation,./programs,./-
,./most,./effective,./intervention,./to,./reduce,./risk,./of,./COPD,./
results,./in,./dec,./symptom,./freq,./
maintaining,./cessation,./-,./dec,./mortality,./and,./dec,./rates,./of,./decline,./in,./FEV1
62,./yo,./-,./concerned,./for,./risk,./of,./T2DM
,mom,./and,./2,./sisters,./received,./this,./dx,./in,./their,./50s,./
BMI:,./30
BP:,./130/70,./mmHg
labs:,./HgA1C,./8.4%;,./dec,./Cl-;,./inc,./HCO3-
,,./BUN,./(30),,./glucose,./(200),,./Cr,./(1.8)
what,./med,./is,./CI,./in,./this,./pt?,./-,./correct,./answer,./✔ ✔ metformin
major,./SE,./of,./this,./drug,./is,./lactic,./acidosis,./
CI,./in,./pts,./who,./have,./renal,./failure
FDA,./suggests,./to,./not,./use,./in,./pts,./w/,./mild,./renal,./impairment,./(Cr,./>,./1.4,./for
,./women,./and,./>,./1.5,./for,./men)
bc,./it's,./excreted,./by,./the,./kidneys
52,./yo,./-,./2,./wks,./after,./inf,./wall,./MI
echo,./before,./d/c:,./EF,./of,./33%
recovery:,./dec,./exercise,./tolerance
PE:,./gucci
most,./appropriate,./drug,./to,./prolong,./pt's,./life?,./-,./correct,./answer,./✔ ✔
lisinopril,./
ACEi,./-,./cornerstone,./of,./tx,./for,./chronic,./systolic,./HF,./
improve,./symptoms,,./reduce,./mortality,,./dec,./hospitalizations,,./and,./improv
e,./quality,./of,./life,./
,in,./pts,./who,./have,./had,./MIs,./-
,./BBs,./and,./ACEi,./have,./been,./shown,./to,./reduce,./morbidity,./and,./mortality
ACEi,./-
,./reduce,./preload/afterload,,./improve,./cardiac,./output,,./and,./inhibit,./RAAS
25,./yo,./-,./pos,./PPD,./skin,./test
exposed,./to,./person,./w/,./active,./TB,./when,./she,./was,./a,./child
all,./previous,./PPD,./tests,./neg,./-,./last,./one,./5,./yrs,./ago
CXR:,./gucci
next,./step,./in,./mgnt?,./-,./correct,./answer,./✔ ✔
treatment,./of,./latent,./tuberculosis,./now,./
dx:,./pos,./skin,./test,./+,./neg,./CXR,./+,./lack,./of,./symptoms,./
tx:,./INH,./for,./9,./months,./+,./B6,./or,./rifampin,./for,./4,./months
42,./yo,./w/,./T2DM,./-,./lesion,./on,./perineum,./for,./3,./months,./
PE:,./ulcerated,./plaque,./on,./perineal,./body,./
biopsy:,./invasive,./squamous,./cell,./carcinoma;,./extensive,./intraepi,./dz,./on,./pe
rineum,./
most,./likely,./underlying,./cause?,./-,./correct,./answer,./✔ ✔
exposure,./to,./human,./papillomavirus,./
perineum,./=,./area,./between,./anus,./and,./scrotum/vulva
genital,./wart,./>,./CIN,./or,./carcinoma,./
, diabetics,./are,./more,./prone,./to,./ulcers,./(esp,./on,./their,./feet),./due,./to,./neuropath
y
47,./yo,./-,./2,./month,./hx,./of,./severe,./HAs
qNight,./-,./wakes,./up,./at,./3AM,./bc,./severe,./pain,./behind,./L.eye,./-
,./feels,./like,./he's,./being,./"stabbed,./by,./an,./ice,./pick",./
L.pupil,./smaller,./than,./R;,./L.eyelid,./droops
smokes,./2,./packs,./of,./cigs,./for,./25,./yrs
drinks,./6,./beers,./qNight
P:,./110/min
BP:,./145/90,./mmHg
PE:,./deep,./facial,./wrinkles,./
fundo:,./no,./papilledema,./
most,./likely,./cause?,./-,./correct,./answer,./✔ ✔ cluster,./headache
more,./prevalent,./in,./males
series,./of,./HAs,./occurring,./close,./together,./for,./6-12,./wks,./
severe,,./intense,,./UL,./pain,./lasting,./sec,./to,./min
tx:,./high-flow,./O2;,./can,./be,./used,./w/,./sumatriptan;,./verapamil,./as,./ppx
37,./yo,./-,./hx,./of,./rheumatic,./fever,./as,./kid
cardiac,./exam:,./L.parasternal,./lift;,./diastolic,./murmur,./at,./apex,./and,./lower,./L.
sternal,./border;,./S4,./
