Board Simulator Series: Normal and Abnormal Processes in the Basic Sciences

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The patient has a year history of diabetes mellitus and takes glipizide and rosiglitazone. He first noticed the ulcer 2 months ago.

One month ago, a day course of oral amoxicillin-clavulanate therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. Today, vital signs are temperature Physical examination of the right great toe discloses a 1. Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in both feet.

Capillary refill time is 2 seconds in the right great toe. Which of the following historical factors or physical examination findings is most strongly associated with development of this patient's foot ulcer? Each question is associated with the initial patient vignette but is testing a different point. Questions are designed to be answered in sequential order. You must click "Proceed to Next Item" to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed previous item.

A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the girl's physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for approximately 45 seconds, after which she becomes relaxed and appears to fall asleep.

Vital signs at this time are temperature On physical examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose has a scant, clear discharge, and throat is mildly erythematous.

How to Check Vital Signs - Checking Vitals Nursing Assessment

Lungs are clear to auscultation except for transmitted upper airway sounds. Complete blood count, blood culture, lumbar puncture, and catheterized urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional history discloses that she was born at term, she had an uneventful neonatal course, she has normal growth and development, and vaccinations are up-to-date. She has never had an episode similar to this. Initial laboratory results are shown:.


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In addition to ampicillin for otitis media and acetaminophen, this child also should receive which of the following? Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that she is doing well and she has had no recurrence of her symptoms. Examination of the ears shows resolution of the otitis media.

Which of the following is the most important diagnostic step at this time?

Additional Assets

The drug ad item format includes a rich stimulus presented in a manner commonly encountered by a physician, eg, as a printed advertisement in a medical journal. Examinees must interpret the presented material in order to answer questions on various topics, including. The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, eg, as an abstract that accompanies a research report in a medical journal.

Examinees must interpret the abstract in order to answer questions on various topics, including. You will manage one case at a time. Free-text entry of patient orders is the primary means for interacting with the format. Buttons and check boxes are used for ordering a physical examination, advancing the clock, changing the patient's location, reviewing previously displayed information, and obtaining updates on the patient.

At the beginning of each case, you will see the clinical setting, simulated case time, and introductory patient information. Photographs and sounds will not be provided. Normal or reference laboratory values will be provided with each report; some tests will be accompanied by a clinical interpretation. To manage patients using the Primum CCS software, it is essential that you complete the Primum tutorial and sample cases provided. A brief description of the interface is provided in the Primum Tutorial. All rights reserved. United States Medical Licensing Examination.

Basic Science

Step 3 Announcements. Exam Format Step 3 is a two-day examination. Site of Care The physician-patient encounters described in Step 3 multiple-choice items are usually associated with a setting in which the encounter first occurs. Emergency Department Emergency Department includes emergency department and urgent treatment center.

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Phase I (Years 1 and 2) | VTCSOM | Virginia Tech

Clinical Encounter Frames Step 3 clinical encounter frames encompass several elements that are critical to the definition of a patient-physician encounter. These encounters may also include new problems arising in patients for whom a history is available. Patient encounters characterized by continuing management of previously diagnosed clinical problems among patients known to the physician and seen principally in ambulatory settings. Encounters focused on health maintenance are located in this frame. Also included are patient encounters characterized by acute exacerbations or complications, principally of chronic, progressive conditions among patients known to the physician.

Nursing strategies necessary for optimal birth experiences and safe quality nursing care of maternal-child patients and families will be emphasized. This course provides students with the opportunities to apply nursing theory in the care of childbearing and childrearing families. Nursing care for health and promotion and optimal patient and family wellness are the focus in the care of the childbearing women during the perinatal periods and in the care of the childrearing family from birth through adolescence.

An understanding of common, acute, and chronic health problems occurring in the childbearing process, and in infancy through adolescence will be demonstrated.


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  • Nursing strategies necessary for optimal birth experiences and safe quality nursing care of maternal-child patients and families will be implemented. This is a didactic course that prepares students to meet the nursing needs of children and families in the pediatric clinical setting. Students will have the opportunity to learn and apply principles of growth and development in relation to the nursing care of children from infancy through adolescence. Students will have the opportunity to learn and apply communication skills, critical thinking, the nursing process, and teaching and learning principles in meeting the nursing needs of children and their families in the acute care setting.

    Concepts explored include family theory, communication, safety, teaching, comfort, legal, ethical, and professional standards.


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    • Concurrent with N It is taken concurrently with N Students will have the opportunity to apply principles from N in relation to the nursing care of children from infancy through adolescence. Students will have the opportunity to apply communication skills, critical thinking, the nursing process, and teaching and learning principles in meeting the nursing needs of children and their families in an acute care setting.

      Students will explore additional topics in the companion course such as antepartum diagnostic testing, nursing care during obstetric procedures, intrapartum fetal surveillance, pain management during childbirth, and selected conditions of high-risk mothers and newborns. Prerequisite: N and N This course will provide students with guided clinical experiences in family-centered maternity care with an emphasis on family teaching and health promotion. Student activities will focus on the development of critical thinking integrated with the nursing process to differentiate between normal and abnormal findings during the antepartal, intrapartal, postpartal and neonatal periods.

      Phase I (Years 1 and 2)

      Additionally, students will have the opportunity to observe. Students apply their knowledge and experience in the development of a deeper understanding of pharmacological treatment modalities. This course prepares the nurse generalist for a leadership role in an ever-changing health care environment. The student is given the opportunity to critically evaluate and synthesize varying concepts of nursing management, conflict resolution, change theories, healthcare law and policy.