NBME FORM 4 SECTION 2eee eee ee red et Comprehensive Clinical Science Self-Assessment 4. A 24-year-old woman comes to the physician because of mouth sores for 3 days. She has a 2-year history of hypertension and a 6.m ‘She has several clean ulcers of the oral mucosa. There is symmetric swelling ofthe proximal interphalangeal and matacarpoohalange deviation. Laboratory studies show: Hematoent| 29% Leukocyte count 3100imm' Platelet count 199,000 urine Protein 3 Bloos a ‘Serum antinuclear antibody bter is 1.512, and anti-double-stranded DNA assay is positive. Which of the following is te most likely die © A) Behcet syndrome © 8) Rheumatoid arthritis © C) Scleroderma © 0) Sjogren syndrome © E) Systemic lupus erythematosuseee fee eet Comprehensive Clinical Science Self-Assessment ‘A.52.year-old woman is brought to the emergency department because of a 1-hourhistory of nausea, voriting, and epigastiic pain w has a history of similar episodes of epigastric pain after eating or witn exertion. She has type 2 diabetes melitus treated with metforrr cigarettes daily for 30 years. Her pulse is 104/min, respirations are 76imin, and blood pressure is 8/60 mm Ha, Examination snows clear to auscultation. Cardiac examination shows a normal S1 and S2, a grade 2/6, apical systolic murmur is heard. The point of maxi remainder of the examination shows no abnormalities. An ECGis shown. Which of the folowing is the most ikely diagnosis? © A) Cholaithiasis © By itral valve prolapse © C) Myocardial infarction © D) Pepiicuicer disease © E) Pulmonary embolism