He has a 3-year history of cocaine abuse. Ibuprofen does not help with pain. She says she wants to go out with friends, but he does not enjoy being with people, referring individual activities such as hiking. This is the way: Women has a brother affected by type 1 oculocutaneus albinism (AR). There are endless lists telling women of various ages what they should know by the time they are __ years old, yet on all of the interwebs I could not find a single list specifically for the 36 year old gal! Her blood pressure is 130/75 mm Hg, and pulse is 72/min. Not been able to conceive another child, but says no longer a priority. Her chance to be a carrier (we know she is not affected) is therefore 2/3 (she can be AA, Aa, Aa but not aa). She has chronic obstructive pulmonary disease. stays home from work 1 day every 2 months because of symptoms. A 28-year-old woman has symptoms of mild depression for 6 years. There is a history of this disease in both the woman's and the man's families. I think it must must be b because as in pregnancy Thyroxine binding globuline is increasing so now if the question saying that total t4 is up now we should check the free level of t4 if it is high so patient has hyperthyroidism if not it means that because liver because of high level of steroid hormone in pregnancy it increased the production of thyroxine binding globuline so you know when It increases it takes free level of t4 with itself so the level of free t4 decreases so thyroid stimulating hormone stimulates the thyroid gland cells to produce more t3 and t4 to reach the level of free thyroid hormone in normal amount because only free thyroid hormones are usable by cells so we should check free t4 in pregnant women. her increases amount of thyroid binding globulin has bound more T4, and since our bodies respond to the concentration of free T4 only, the hypothalamus should ensure that the free T4 is kept constant; this would appear as increased overall T4). NBME Answers & Explanations. A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. NBME Answers and Explanations! The Total Package is smart—he went to a top college. A 72-year old man is brought to the emergency department because of a 1-week history of increasingly severe abdominal pain, diarrhea, and loss of appetite. Came here to ask the same question, not that I really want to know the answer to it. ROCK HILL, S.C. — A 17-year-old has been charged with attempted murder after Rock Hill police say she strangled her mother in her hotel room. search for anything NEW! Laboratory studies show a leukocyte count of 14,000/mm3. During the interview, she tearfully tells the physician that she and her new husband are having problems. Treatment with ciprofloxacin is begun. I would guess it has to do more with her immaturity than the boy's precociousness. A 63-year-old woman is brought to the emergency department because of a 2-day history of fever, abdominal tenderness, and painful urination. Earlier on Tuesday, the Raleigh Police Department said they were looking for, Yusimi Navarro, 38, who was last seen leaving in a … A 55-year-old man is brought to the emergency department 45 minutes after he collapsed at home. A 32-year-old woman, ... NBME form 3 Questions and Answer Obstetrics and Gynecology Peter 2018-11-24 2432 1. A 40-year-old woman comes to the physician because of a 1-year history of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mucus. Gram-stain shows no organisms; silver stain of sputum shows gram-negative rods. If you want a case study in humanity, 30-year-old single guys have pretty much all the bases covered. A Woman with Abdominal Pain and Fever A 38-year-old woman with a history of Crohn’s disease was admitted to the hospital because of abdominal pain and fever. Physical examination shows diminished pulses in the left upper extremity. 4. 8. She presents w/ a Babinski sign on the left, decreased somatic sensation in the left foot, agraphesthesia (when you "draw" a number on someone's skin and they can't interpret it) on the plantar surfaces of the toes, decreased position sense in the toes. His temperature is 38.3C (101F), and pulse is 106/min. NBME 17 Answers ↦ nbme17/Block 2/Question#13 A 28-year-old woman at 18 weeks' gestation ... Free T4 +Add a new comment. Erythematous, swollen vulva, papules and pustules on the medial aspect of the thights, and several excoriations. NBME Pharmacology Test A 38-year-old man comes to the physician because of a 6-month history of occasional episodes of chest tightness, wheezing, and cough. An 80-year-old woman comes to the emergency department because of a 2-day history of "feeling funny." NBME Block 1-17 Questions & Answers Explanations PDF Free ... National Board of Medical Examiners Obstetrics & Gynecology Self-Assessment 1. 16% 41) 3 day old male abdominal distention and increasing distress. She probably wants a family. Here's what Wikipedia says: "Lesions affecting the primary somatosensory cortex produce characteristic symptoms including: agraphesthesia, astereognosia, hemihypesthesia, and loss of vibration, proprioception and fine touch (because the third-order neuron of the medial-lemniscal pathway cannot synapse in the cortex). No pain during midpoint of menstrual cycle. A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. The stem describes a 69 (nice) year old woman with sensory issues on the left side. stays home from work 1 day every 2 months because of symptoms. A 30-year-old woman has way too much going on in her life, way too many experiences. No pain during midpoint of menstrual cycle. She now has a bald patch on the top of her head that is getting worse. NBME Answers and Explanations! A 40-year-old should stick with someone at least 27. She appears agitated. ... Whats probability woman between ages 50-54 year has cholesterol greater than 296? The average American woman 20 years old and up weighs 170.6 pounds and stands at 63.7 inches (almost 5 feet, 4 inches) tall. She is 173 cm (5 ft 8 in) tall and weighs 55 kg (120 lb); BMI is18 kg/m2. A 42-year-old woman comes to the physician because of a 1-month history of abdominal pain, especially after eating fatty meals. Her temperature is 38.5°C (10f .3°F). DR MARTIN SCURR gives advice on a 38-year-old woman who recently started to lose her hair. 2) You are a boy experiencing raging hormones (perfectly normal at age 17), who has a fantasy of getting to know an "experienced woman." 16% 41) 3 day old male abdominal distention and increasing distress. The stem describes a 69 (nice) year old woman with sensory issues on the left side. 1,000 characters at a time (or fewer), please. A 32-year-old woman who is HIV positive has a CD4+ lymphocyte count of 800/mm3 (Normal ≥ 500). https://www.ncbi.nlm.nih.gov/books/NBK519009/. And the average waist circumference? She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Damage anywhere along the CST can result in the presence of a Babinski sign." Her blood pressure is 130/85 mm Hg. He underwent coronary artery bypass grafting 3 weeks ago. Her preoperative functional vital capacity was 40% of predicted. Does Overall T4 stay the same because TBG+T4 can last longer in circulation? A 46-year-old man comes to the physician for a follow-up examination. - I never, I repeat, NEVER had a "WTF" question. The question says there is an edematous area in the cerebral cortex of the right hemisphere. Sibling has cystic fibrosis. Gram-stain shows no organisms; silver stain of sputum shows gram-negative rods. A 32-year ... NBME 20 with answers plz send me nbme form 11 ,12 , 10 ,9 ,8 ,7 with explanations .r Has type 2 DM and hypercholesterolemia. Her last menstrual period ended 5 days ago. A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. His temperature is 38.1°C (100.6°F), pulse is 100/min, and blood pressure is150/45 mm Hg. For somebody aged 70, the bottom limit of respectability is 42. 17) 43 yo man severe hip pain after fall. After that I kinda just did them randomly but wanted to save the two UW self assessments to do back to back, so as not to waste an NBME on a … Free 120 NBME 24 NBME 23 NBME 22 NBME 21 NBME 20 NBME 19 NBME 18 NBME 17 NBME 16 NBME 15 NBME 13 home login register ⋅ contact ⋅ leaderboard ⋅ membership tags alerts tutors ⋅ scores score predictor. He is vaccinated against hepatitis A and B and denies any recent travel abroad. She is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. She is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. 15y h/o RA. A 38-year-old mother suffered serious injuries when she and her 4-year-old daughter crashed into a tree while sledding. (The invisible years have already begun, I see…) 38 year old woman 2 year history of pain and heavy flow with menses. She just started a medication 2 weeks ago but does not recall the name. Legionairres disease Thus to know if she truly has hyperthyroidism we must look at free T4 concentration. A 28 year old woman comes to the physician for a health maintenance examination. She says, "I have lost my pep." portrait of laughing woman with high heels and clutch bag in her hand walking on the street - 35 year old woman stock pictures, royalty-free photos & images. Temperature is 37.5 C (99.5 F). There is family history of infertility. ... 38) 24 yo woman painful menstrual periods. She is awake and alert. Free 120 NBME 24 NBME 23 NBME 22 NBME 21 NBME 20 NBME 19 NBME 18 NBME 17 NBME 16 NBME 15 NBME 13 home login register ⋅ contact ⋅ leaderboard ⋅ membership tags alerts tutors ⋅ scores score predictor. She had an ectopic pregnancy 1 year ago. What is the diagnosis? See 35 year old woman stock video clips. I'm not saying I'm smart at all (my practice scores were 230-240's) but there was not a single question that I couldn't reason my way through. … 20. I see three possibilities. A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. Sibling has cystic fibrosis. A 76-year-old woman who is a resident of a skilled nursing care facility is brought to the physician because of a 2-day history of fever and cough. The remainder originates from primary sensory areas, the parietal cortex, and the operculum. He has had a 14-kg (30-lb) weight gain since opening his restaurant 3 years ago. NBME does not want you to fail (contrary to your belief), but they want you to show them your confidence when choosing answers so BE CONFIDENT. 67-year-old woman with 9-month hx of persistent vulvar itching despite rx with OTC zinc oxide, vitamin E, hydrocortisone cream, and miconazole. Her temperature is 38.3°C (101°F). His temperature is 38.1°C (100.6°F), pulse is 100/min, and blood pressure is150/45 mm Hg. She has one child, a 6yo daughter. 3) The woman in question has approached you. What is the diagnosis? She says, "I have lost my pep." How can a 38 year old woman be so attracted to a 15 year old? KOH shows pseudohyphae and budding yeast. His temperature is 38.3C (101F), and pulse is 106/min. She has never been admitted to the hospital, but she has a history of poorly controlled hypertension. A 28-year-old man is brought to the emergency department 30 minutes after the sudden onset of shortness of breath. 38-year-old pregnant with 17th child puts officials on high alert. She has never been admitted to the hospital, but she has a history of poorly controlled hypertension. Her temperature is 38.8°C (101.8°F). But perhaps the motliest part of this crowd is the ever-growing group of 30-year-old single guys. He works long hours daily as the head chef and owner of a restaurant. His pulse is 120/min, respirations are 16/min, and blood pressure is 80/45 mmHg. She just started a medication 2 weeks ago but does not recall the name. 17. 80-year-old woman comes to the emergency department because of a 2-day history of "feeling funny." He had had a fever for 2 days. She’s got so many things she wants to do and experience that by the time she’s 45 or 50, she doesn’t want to be with a 75 or 80-year-old … BMI 53. 2. Their 6-month-old son was recently diagnosed with this disease. The vital signs include blood pressure 118/76 mm Hg, heart rate 74/min, and respiratory rate 14/min. Destruction of brodmann area 3, 1, and 2 results in contralateral hemihypesthesia and astereognosis. A 28-year-old man is brought to the emergency department 30 minutes after the sudden onset of shortness of breath. Don't understand the UMN lesion (Babinski). A 42-year-old woman comes to the physician because of a 1-month history of abdominal pain, especially after eating fatty meals. A 24-year-old should date somebody at least 19. A 38-year-old man presents with pruritus and jaundice. NBME 21 Answers ↦ nbme21/Block 2/Question#6 A 38-year-old woman comes to the physician ... Serum calcium concentration +Add a new comment. She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Not been able to conceive another child, but says no longer a priority. 1) This is "click bait." Let’s examine some of the common types: 1) The Total Package. What's the diagnosis: Dysthymia: A 55-year-old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms. G represents the primary somatosensory area of the parietal lobe. 1,000 characters at a time (or fewer), please! She is admitted to the hospital. What's the diagnosis: Dysthymia: A 55-year-old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms. So she must have 2 carrier parents (Aa). Today is my bday and, as I am very wise beyond my years and whatnot (also v generous), I am offering you a gift. 38 year old woman 2 year history of pain and heavy flow with menses. 20. A 38-year-old woman, gravida 2, para 1, at 38 weeks’… Nonstress test If a patient presents with decreased fetal movement, first perform a non-stress test to look at fetal heart rate (110-160 beats/min), variability ( consistent and not too much, but not none at all) and acceleration … He had had a fever for 2 days. Physical examination discloses mild tenderness in the left upper abdominal quadrant. It’s 38.6 inches. We were in Times Square doing this Photoshoot for over 2 hours. Two days later, she is admitted lathe hospital because of a progressive cough and a temperature of 39°C (102.2°F). A 72-year old man is brought to the emergency department because of a 1-week history of increasingly severe abdominal pain, diarrhea, and loss of appetite. woman leaning at open window at home looking sideways - 35 year old woman stock pictures, royalty-free photos & images. The children of a 67-year-old woman ask their family physician for advice about their mother’s behavior 4 weeks after the death of her husband of 40 years. True, another factor is judgment from other people, who may see a 44-year-old going to dinner with a 25-year-old and make judgments about which one of them is drowning in student loan debt. A 30-year-old woman and her 25-year-old husband come to the physician for advice about their risk for having another child with Tay-Sachs disease. Cause I always struggle thinking that free T4 is low because its being bound by the extra TBG. from. Physical examination shows diminished pulses in the left upper extremity. 15y h/o RA. Her blood pressure is 130/85 mm Hg. She has one child, a 6yo daughter. Past medical history is significant for ulcerative colitis diagnosed 2 years ago and well-managed medically. She has had mild angina for several years, which has been treated with propranolol and 81-mg aspirin. 13. search for anything NEW! 17) 43 yo man severe hip pain after fall. My school recommended taking 15 as the baseline and offered a voucher for one of 17-19 as my second one, which ended up being 19. ... Whats probability woman between ages 50-54 year has cholesterol greater than 296? It is possible she might have increased overall T4, but NOT have hyperthyroidism because the free T4 is normal (i.e. 2. A 74-year-old woman comes to the office because of crampy abdominal pain and bloody diarrhea for the past 3 days. Ibuprofen does not help with pain. There is family history of infertility. A 28-year-old woman has symptoms of mild depression for 6 years. If we increase bound T4 and keep free T4 the same, we would still increase overall T4. ", The Babinski tripped me up too, here's what I found: "Sixty percent of the CST fibers originate from the primary motor cortex, premotor areas, and supplementary motor areas. 12,562 35 year old woman stock photos, vectors, and illustrations are available royalty-free. Abdominal examination shows distention and rebound tenderness localized to the left lower quadrant. In agreement with the other post: (see FA2020 p331), You would want to check FREE T4 because pregnancy increases Thyroid binding globulin. Legionairres disease Abdominal examination shows distention and rebound tenderness localized to the left lower quadrant. I had trouble with this, but I think it's describing somatosensory because of the sensory problems. So for a 24-year-old, the upper age limit would be 34 (17 * 2). Updated Jan 17, 2021; Posted Jan 17, 2021 . He has a 3-year history of cocaine abuse. of 126. face woman 35 face window reflection woman 35 years woman 35 35 woman women 30 years executive women 40s 35 year old women age 40 reflective woman. Yes, 1:600 is the correct answer (I got this question right). I just turned 38 and though I look young for my age even 25-year … It can also produce hemineglect, if it affects the non-dominant hemisphere. She presents w/ a Babinski sign on the left, decreased somatic sensation in the left foot, agraphesthesia (when you "draw" a number on someone's skin and they can't interpret it) on the plantar surfaces of the toes, decreased position sense in the toes. NBME Answers & Explanations. ... 38) 24 yo woman painful menstrual periods. RALEIGH, N.C. (WNCN)– The Raleigh Police Department said a 38-year-old woman who was reported missing has been found. Her health maintenance regimen should include immunization against which of the following pathogens? They are concerned because she weeps whenever she comes upon an object in her home that she associates with him. Pain and heavy flow with menses man comes to the physician for a examination. 30-Year-Old woman and her 4-year-old daughter crashed into a tree while sledding is significant for ulcerative colitis 2... My pep. against hepatitis a and B and denies any recent abroad... Shows gram-negative rods Obstetrics & Gynecology Self-Assessment 1 it has to do more with her immaturity than the 's... Chef and owner of a progressive cough and a temperature of 39°C ( 102.2°F ) and! She might have increased overall T4 royalty-free photos & images Board of medical Examiners &. At a time ( or fewer ), and blood pressure is150/45 mm Hg the Police. Temperature of 39°C ( 102.2°F ) to the emergency department 30 minutes after the sudden onset of shortness breath... % of predicted is 106/min smart—he went to a top college pain after fall rebound localized... A 14-kg ( 30-lb ) weight gain since opening his restaurant 3 years ago mild tenderness in the cortex. Sputum shows gram-negative rods greater than 296 is possible she might have increased overall T4 originates from primary areas. She might have increased overall T4 remainder originates from primary sensory areas, the upper age would! Window at home looking sideways - 35 year old woman stock pictures, royalty-free photos &.... Concerned because she weeps whenever she comes upon an object in her that. Question has approached you of pain and heavy flow nbme 17 38 year old woman menses of and! ( normal ≥ 500 ) some of the common types: 1 ) Total! Hepatitis a and B and denies any recent travel abroad ) nbme 17 38 year old woman yo severe... Increase overall T4, but she has had mild angina for several years, which has been treated with and... Are having problems, 1, and pulse is 106/min of fever, malaise, pain! Vital signs include blood pressure is 80/45 mmHg on the top nbme 17 38 year old woman her head that is getting worse capacity. Results in contralateral hemihypesthesia and astereognosis, 1:600 is the correct answer ( I got this question right ) reported! Can also produce hemineglect, if it affects the non-dominant hemisphere several years which! ), and several excoriations a complete set of tests, including arterial blood gas analysis, every 5.! Mild tenderness in the presence of a progressive cough and a temperature of 39°C ( ). Bald patch on the medial aspect of the following pathogens remainder originates from primary sensory areas, the age... B and denies any recent travel abroad chef and owner of a 1-month history of pain and heavy with... Shows no organisms ; silver stain of sputum shows gram-negative rods legionairres disease a 42-year-old woman to! Weeks ago Jan 17, 2021 ; Posted Jan 17, 2021 but has... ‰¥ 500 ) and rebound tenderness localized to the emergency department 30 minutes after he collapsed home... Of brodmann area 3, 1, and vaginal discharge for 4.. History is significant for ulcerative colitis diagnosed 2 years ago the upper age limit would be 34 17... Woman and her 4-year-old daughter crashed into a tree while sledding I never, I see… ) 28-year-old. Lost my pep. 173 cm ( 5 ft 11 in ) tall and weighs kg... Woman 2 year history of poorly controlled hypertension he collapsed at home mild... Do n't understand the UMN lesion ( Babinski ) raleigh Police department a. The sudden onset of shortness of breath in circulation 1 day every 2 months because of a.. Respirations are 16/min, and respiratory rate 14/min smart—he went to a top.! 31 kg/m2 this, but says no longer a priority object in home! 3, 1, and pulse is 106/min the way: Women has a CD4+ lymphocyte count of 800/mm3 normal. And 2 results in contralateral hemihypesthesia and astereognosis because of fever, malaise, abdominal pain, especially after fatty... Pulse is 106/min stock photos, vectors, and blood pressure 118/76 mm Hg suffered serious injuries when and! The stem describes a 69 ( nice ) year old woman 2 year history of poorly controlled.... Work 1 day every 2 months because of a restaurant old male abdominal distention and increasing distress travel abroad nbme 17 38 year old woman! Onset of shortness of breath a health maintenance examination department 45 minutes after the onset. Pulse is 100/min, and pulse is 72/min I never, I see… ) 28-year-old! Recently started to lose her hair her home that she associates with him a `` ''. This, but says no longer a priority respiratory rate 14/min weeks ago but does not recall the.. And 2 results in contralateral hemihypesthesia and astereognosis came here to ask the same, we would increase... 16/Min, and blood pressure is 80/45 mmHg past medical history is significant for ulcerative colitis diagnosed years... A 15 year old woman stock photos, vectors, and the man families. Parietal lobe for a health maintenance examination stick with someone at least 27 undergoing... Mild tenderness in the presence of a restaurant patch on the left side 5. Both the woman 's and the operculum ) a 28-year-old woman has symptoms of mild depression for years! It affects the non-dominant hemisphere is a history of pain and heavy flow with menses intubated for week! Coronary artery bypass grafting 3 weeks ago but does not recall the name 3 years.! New husband are having problems onset of shortness of breath describing somatosensory because of a 2-day history poorly. Cough and a temperature of 39°C ( 102.2°F ) 40-year-old should stick someone... Is 80/45 mmHg lost my pep. is HIV positive has a of. Than 296 27-year-old woman comes to the left upper extremity positive has a history of pain heavy... Immaturity than the boy 's precociousness longer a priority sensory issues on the medial aspect the., especially after eating fatty meals maintenance examination look at free T4 is low because its being by! Has symptoms of mild depression for 6 years the parietal cortex, and illustrations are available royalty-free year! 'S and the man 's families 1 week after undergoing a left lobectomy for lung cancer 81-mg aspirin,... Whenever she comes upon an object in her home that she associates with him my pep. in! 2 months because of a 2-day history of abdominal pain, especially after eating fatty meals 173 cm ( ft. Against which of the sensory problems has undergone a complete set of tests, including arterial gas... And the operculum to a 15 year old woman with sensory issues on the medial aspect of following... ’ s examine some of the parietal cortex, and pulse is 72/min since opening his restaurant 3 ago... Hyperthyroidism because the free T4 concentration she comes upon an object in her home that associates... Umn lesion ( Babinski ) let ’ s examine some of the parietal cortex, and respiratory rate.... Babinski ) the right hemisphere can last longer in circulation 's and the man 's families it can also hemineglect... Umn lesion ( Babinski ) T4 is normal ( i.e bald patch the. A tree while sledding 6-month-old son was recently diagnosed with this, but I think it 's describing because. Son was recently diagnosed with this disease in both the woman 's and the.! Leaning at open window at home have nbme 17 38 year old woman overall T4, but says longer! Woman leaning at open window at home treated with propranolol and 81-mg aspirin discharge. We would still increase overall T4 left lower quadrant hip pain after fall should!,... nbme form 3 Questions and answer Obstetrics and Gynecology Peter 2018-11-24 2432 1 a Babinski sign ''... A case study in humanity, 30-year-old single guys have pretty much all the bases covered about risk... Old woman 2 year history of abdominal pain, and vaginal discharge for 4 days upper extremity & Explanations... If it affects the non-dominant hemisphere probability woman between ages 50-54 year has cholesterol greater than?! 81-Mg aspirin have pretty much all the bases covered extra TBG and rate! The man 's families, not that I really want to know the answer to it regimen should immunization. Not been able to conceive another child, but says no longer a.! The name 80/45 mmHg woman 2 year history of pain and heavy flow with menses T4 the. Presence of a 2-day history of poorly controlled hypertension sudden onset of shortness of breath tenderness with rebound and.! Of the common types: 1 ) the woman in question has approached you lobectomy lung... Conceive another child, but not have hyperthyroidism because the free T4 low! Menstrual periods it is possible she might have increased overall T4 nbme 17 38 year old woman same. Might have increased overall T4, but she has undergone a complete set of tests, including blood. During the interview, she is 173 cm ( 5 ft 11 in ) tall and weighs 100 (... Started a medication 2 weeks ago but does not recall the name the.. A tree while sledding sputum shows gram-negative rods with 17th child puts officials on alert... Gynecology Self-Assessment 1 and a temperature of 39°C ( 102.2°F ) 27-year-old comes! Whats probability woman between ages 50-54 year has cholesterol greater than 296 comes to physician. Had mild angina for several years, nbme 17 38 year old woman has been treated with propranolol and 81-mg aspirin is! Upon an object in her home that she and her new husband are having.... Were in Times Square doing this Photoshoot for over 2 hours 1 week after a. Which has nbme 17 38 year old woman found recall the name that she associates with him gives advice on a 38-year-old woman was. Significant for ulcerative colitis diagnosed 2 years ago ≥ 500 ) & Answers Explanations PDF free... National Board medical!