step 3 24

Question 1

acute rhinosinusitis management

Answer 1

*differentiate viral vs bacterial
Acute rhinosinusitis is most commonly due to viral pathogens and usually resolves within 10 days.
Patients with persistent symptoms >10 days, severe symptoms, or deterioration after several days of improvement often have acute bacterial rhinosinusitis, which is usually treated empirically with 5-7 days of oral amoxicillin-clavulanate.

Question 2

first line for heat stroke

Answer 2

augmentation of evaporative cooling, and the naked patient should be sprayed with a tepid water mist or covered with a wet sheet while large fans circulate air to maximize evaporative heat loss.

Question 3

cutting behavior management

Answer 3

• considered nonsuicidal self-injury
• screen for suicidal ideation and comprehensive psychiatric evaluation.
• no need to hospitilaze

Question 4

first line for tourette syndrome

Answer 4

• second-generation antipsychotics (eg, risperidone, aripiprazole)
• Habit reversal therapy (HRT), a form of cognitive-behavioral therapy, is the most effective nonpharmacological treatment.
• Other pharmacological treatments include alpha-2 adrenergic receptor agonists (eg, clonidine, guanfacine) and tetrabenazine (a dopamine depleter).

Question 5

serotonin syndrome presentation

Answer 5

fever, mental status changes, clonus, tremors and hyperreflexia.

Question 6

NMS vs serotonin syndrome

Answer 6

NO neuromuscular hyperactivity (eg, tremor, hyperreflexia, clonus).
- In addition, it is characterized by bradykinesia and generalized “lead pipe” muscular rigidity, which differs from the hyperkinesia of SS.

Question 7

HELLP syndrome management

Answer 7

magnesium sulfate for seizure prophylaxis + delivery.

Question 8

Indications of oseltamivir with influenza

Answer 8

1) patients who require hospitalization
2) severe or progressive illness
3) underlying high-risk medical conditions.
4) low-risk patients with mild disease who present <48 hours after symptom onset.

Question 9

name of liver lesion in women on OCPs + management

Answer 9

hepatic adenoma
- Asymptomatic lesions <5 cm are usually managed with discontinuation of oral contraception. Symptomatic patients and patients with larger lesions should undergo surgical resection.

Question 10

signs of respiratory fialure

Answer 10

Confusion and drowsiness
Depressed respiratory drive
Severe hypoxemia

Question 11

primary ovarian insufficiency treatment

Answer 11

oral or transdermal estrogen therapy until average age of menopause + progestin in women who have an intact uterus.

Question 12

treatment of dactylitis in SCD kids

Answer 12

pain control (eg, nonsteroidal anti-inflammatory drugs, oral opioids)
hydration
application of heat.

Question 13

protective factors

Answer 13

• high-fiber diet rich in fruits and vegetables
• regular nonsteroidal antiinflammatory drug use
• hormone replacement therapy
• regular exercise.

Question 14

race and colon cancer?

Answer 14

being black is an RF

Question 15

SAAG interpretation

Answer 15

A serum-ascites albumin gradient value of >1.1 g/dL indicates the presence of portal hypertension, while a value of <1.1 g/dL indicates the absence of portal hypertension.

Question 16

SAAG calculation

Answer 16

serum albumin value minus the ascitic fluid albumin value

Question 17

etiologies of ascites with low SAAG gradient

Answer 17

peritoneal carcinomatosis, peritoneal tuberculosis, nephrotic syndrome, pancreatitis, serositis

Question 18

DLB presentation

Answer 18

Fluctuating cognition (eg, alertness, attention), visual hallucinations, parkinsonism, and/or rapid eye movement sleep behavior disorder (ie, loss of normal rapid eye movement sleep atonia)

Question 19

TSH secreting adenoma presentation

Answer 19

Thyrotoxicosis
Diffuse goiter
Possible mass effect symptoms (eg, headache, visual field defects)

Question 20

vaccines for HIV patients

Answer 20

pneumococcal vaccination (13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine given in series). Most patients with HIV should also receive vaccination for hepatitis A and B if they do not have documented evidence of immunity.

Question 21

indications for FNA with thyroid nodule

Answer 21

• normal or high TSH and a confirmed nodule >1 cm

- suspicious ultrasound findings (eg, hypoechoic, microcalcifications, internal vascularity) or cancer risk factors

Question 22

subchorionic hematoma sequela

Answer 22

can result in placental dysfunction and therefore increase the risk for spontaneous abortion, abruptio placentae, preterm premature rupture of membranes, preeclampsia, preterm labor, fetal growth restriction, and intrauterine fetal demise

Question 23

child with high lead level at increased risk for..

Answer 23

cognitive impairment

Question 24

septic arthritis in infants

Answer 24

subtle findings such as irritability, poor feeding, aversion to being held, and pseudoparalysis (lack of movement). Although fever may be absent, elevated inflammatory markers are red flags for infection.
- effusion on US

Question 25

legg-calve perthes presentation

Answer 25

idiopathic avascular necrosis of the hip, presents in children age 3-12 with insidious-onset hip pain and limp. Deformity of the femoral head is seen on radiograph and MRI.

Question 26

CAP abx for toddlers

Answer 26

High-dose amoxicillin

Question 27

most frequent adverse events

Answer 27

adverse drug event

Question 28

complications of indirect inguinal hernias in kids

Answer 28

The irreducible hernia can compromise blood supply to the entrapped intestines (bowel ischemia) and testis (impaired fertility, testicular atrophy). Signs of incarceration include vomiting, abdominal distension, and scrotal pain.

Question 29

major problem that leads to difficulties finding cross-matched blood in patients with a history of multiple transfusions

Answer 29

alloantibodies (they develop antibodies to other blood group antigens from previous transfusions)

Question 30

use of radionuclide ventriculography (MUGA (multigated acquisition) scan,)

Answer 30

• high accuracy and reproducibility for measuring ejection fractions.
• thus used to measure drug side effect (cardiotoxic chemo like doxorubicin)

Question 31

treatment of tremor in PD patients

Answer 31

Consequently, some experts favor levodopa in patients age >65 who have severe symptoms affecting their quality of life. Dopamine agonists such as pramipexole can help to save levodopa treatment for a later time when the patient’s symptoms are more severe, and it might be preferred as the initial treatment in patients age <65.

Question 32

urethral diverticulum presentation

Answer 32

postvoid dribbling, dysuria, dyspareunia, and an anterior vaginal wall mass on pelvic examination

Question 33

urethral diverticulum diagnosis

Answer 33

MRI of the pelvis

OR transvaginal ultrasound.

Question 34

pellagra presentation

Answer 34

dementia, diarrhea, dermatitis, stomatitis and cheilosis.

Question 35

glucagonoma rash

Answer 35

Starts as small, elevated red area, gradually involved the surrounding skin, and became an erythematous, itchy, painful rash. Then starts clearing up from the center.

Question 36

use of Kleihauer-Betke test

Answer 36

determines the presence and quantity of fetomaternal hemorrhage so that the amount of Rho(D) immune globulin to be administered can be calculated.

Question 37

postpartum preeclampsia presentation

Answer 37

• new-onset hypertension with end-organ damage,
• can present up to 12 weeks postpartum and - can be complicated by pulmonary edema.
• lower extremity edema
• hyperreflexia

Question 38

lichen planus association

Answer 38

advanced liver disease due to hepatitis C v

Question 39

pseudoaneurysm from catheter access management

Answer 39

US

Question 40

pseudoaneurysm from catheter access presentation

Answer 40

pulsatile mass with a systolic bruit at the puncture site

Question 41

femoral AV fistula presentation

Answer 41

localized pain, no mass, and a continuous bruit

Question 42

management of renal mass consistent with RCC

Answer 42

If confined to renal capsule (stage I), partial nephrectomy.
If extending through the renal capsule but not beyond Gerota’s fascia (stage II), radical nephrectomy

Question 43

presentation of nonclassic adrenal hyperplasia

Answer 43

presents after the neonatal period with signs of androgen excess without salt-wasting. Clinical manifestations include early pubic and axillary hair growth and severe acne, but no evidence of pubertal testicular enlargement.

Question 44

first step in evaluation of palpable breast mass

Answer 44

If younger than 30 then US

If 30 or older then mammogram

Question 45

test of choice to evaluate for tension pneumo

Answer 45

if acute  (ie trauma), US
if nonacute, upright CXR

Question 46

acute bronchitis management

Answer 46

Symptomatic treatment (eg, NSAIDs &/or bronchodilators)
Antibiotics not recommended

Question 47

What is a mycotic aneurysm?

Answer 47

aneurysm arising from bacterial infection of the arterial wall. It can be a common complication of the hematogenous spread of bacterial infection

Question 48

Presentation of intracerebral mycotic aneurysm

Answer 48

Intracerebral mycotic aneurysms can present as an expanding mass with focal neurologic findings or with aneurysm rupture and subarachnoid hemorrhage.

Question 49

normal JVP

Answer 49

3-4 cm above the sternal angle

Question 50

other common cause of iron deficiency anemia

Answer 50

Breast-fed only infants (breast milk provides sufficient iron for the first few months of life, introducing iron-rich foods (eg, pureed meats) around age 6 months is necessary to prevent iron deficiency)