NBME 15- Block 3

A 2½-year-old girl is brought to the physician for a well-child examination. She was born at term following an uncomplicated pregnancy and has no history of serious illness. She can climb steps, throw a ball overhand, and build a tower of six blocks. She is beginning to dress herself. She uses two-word sentences. She is shy around strangers. She participates in interactive play in day care. Examination shows no abnormalities. Which of the following is the most accurate assessment of this child’s development?

A 32-year-old nulligravid woman comes to the physician with her husband because she has been unable to conceive for 2 years. The couple has sexual intercourse without contraception approximately three times weekly. Menses occur at irregular 25- to 35-day intervals. Her last menstrual period was 3 weeks ago. She is otherwise healthy and takes no medications. Physical examination, including pelvic examination, shows no abnormalities. Serum studies show:

Semen analysis shows:

Hysterosalpingography shows bilateral tubal patency. Which of the following is the most likely cause of this patient’s infertility?

A previously healthy 4-month-old boy is brought to the physician because of a 2-day history of fever and episodes of vomiting and crying. He is fussy but consolable. His temperature is 39.1°C (102.4°F), pulse is 142/min, respirations are 28/min, and blood pressure is 88/54 mm Hg. On examination, the left testicle is not palpable in the scrotal sac. Laboratory studies show:

A Gram stain of a catheterized urine sample shows gram-negative rods. Urine and blood cultures are pending. Which of the following is the most likely underlying cause of these abnormal laboratory findings?

A 17-year-old primigravid patient at 38 weeks’ gestation is admitted to the hospital in labor. Contractions have occurred for 2 hours every 2 to 3 minutes. Her pregnancy has been uncomplicated. A fetal heart tracing is shown. The cervix is 4 cm dilated and 90% effaced; the vertex is at 0 station. In addition to continued fetal monitoring, which of the following is the most appropriate next step in management?

A 77-year-old man comes to the physician 24 hours after the gradual onset of mild shortness of breath. He has alcohol-induced cirrhosis treated with furosemide, spironolactone, and a potassium supplement, but he says that he ran out of his medications last week. Since then, he has noticed progressive swelling of his feet and increased abdominal girth. There is no other history of serious illness. He is uncomfortable and in mild respiratory distress. He appears cachectic. His pulse is 82/min, respirations are 14/min, and blood pressure is 102/74 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows severe distention. The liver is not palpated. There is 2+ pedal edema bilaterally. Serum studies show:

Which of the following is most likely to be decreased in this patient?

A 37-year-old man comes to the physician for a routine examination. He has no history of serious illness, has no known allergies, and takes no medications. His mother died of a brain neoplasm at the age of 60 years. His father is 86 years old and healthy. During the past 4 years, the patient has volunteered at a homeless shelter and has donated blood once every 2 months. He appears healthy. He is 178 cm (5 ft 10 in) tall and weighs 75 kg (165 lb); BMI is 24 kg/m2. Vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies show:

Results of fasting serum lipid studies are within the reference ranges. Which of the following is the most appropriate next step in management?