Fam Med NBME Form 1 with correct questions and
answers.
,
, 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; cardiac
normal; trace pedal edema w/ no JVD or hepatojugular reflux
labs: Hgb 17.6
CXR: flattened diaphragms
ECG: RAD
next step in mgnt? - correct ans: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 cessation -
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 ans: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)
answers.
,
, 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; cardiac
normal; trace pedal edema w/ no JVD or hepatojugular reflux
labs: Hgb 17.6
CXR: flattened diaphragms
ECG: RAD
next step in mgnt? - correct ans: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 cessation -
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 ans: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)
