step 3 10

Question 1

acne management

Answer 1

Mild:
topical abx → clindamycin/erythromycin/sulfacetamide
benzoyl peroxide
if refractory → topical retinoid
Moderate:
benzoyl peroxide
retinoid – tazarotene/tretinoin/adapalene
Severe cystic:
oral abx → minocycline, tetracycline, clindamycin
oral retinoic acid → isotretinoin + check UPT

Question 2

how to intubate patient with c spine injury

Answer 2

flexible bronchoscope

Question 3

how to intubate patient with extensive facial trauma and bleeding

Answer 3

cricothyroidotomy

Question 4

blood pressure equals

Answer 4

cardiac output X total peripheral resistance

Question 5

total peripheral resistance equals

Answer 5

mean arterial pressure - mean venous pressure

Question 6

stroke volume equals

Answer 6

end-diastolic volume - end-systolic volume

Question 7

hemorrhagic shock first 6 steps

Answer 7

1) Intubate
2) 2 large bore IV’s
3) IVF + blood
4) type and screen
5) foley
6) IV abx

Question 8

Statin indications

Answer 8

Adults ≥ 21 years of age with a primary LDL-C ≥ 190 mg/dL should be treated with high-intensity statin therapy unless contraindicated.
Adults 40-75 years of age with an LDL-C 70-189 mg/dL without clinical ASCVD or diabetes and an estimated ten-year ASCVD risk ≥ 7.5% should be treated with moderate- to high-intensity statin therapy.
Adults 40-75 years of age with diabetes mellitus and an LDL-C 70-189 mg/dL should be treated with moderate-intensity statin therapy.
Individuals ≤ 75 years of age who have clinical ASCVD should be treated with high-intensity statin therapy unless contraindicated.
*all high intensity except diabetes

Question 9

CKD staging

Answer 9

*all increments of 15 starting at 15 except stage 1 and stage 2

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

Question 10

LUTS

Answer 10

lower urinary tract symptoms, refers to constellation of systems commonly associated with BPH

Question 11

earliest sign of hyperkalemia on ECG

Answer 11

all peaked T wave with a shortened QT interval is the earliest change (waveform 1), followed by progressive lengthening of the PR interval and QRS duration

Question 12

next step in management for patient with linear skull fracture + no LOC

Answer 12

clean laceration

Question 13

when surgery is indicated for skull fractures

Answer 13

comminuted or depressed skull fractures

Question 14

open skull fracture management

Answer 14

tetanus toxoid + ppx antibiotics

Question 15

management of head trauma with LOC

Answer 15

first step – noncon CT head, then can go home if someone can observe them for next 24 hours

Question 16

basal skull fracture management

Answer 16

CT head and neck

Question 17

CSF leak management with basal skull fracture

Answer 17

nothing, should heal on it’s own

Question 18

epidural hematoma management

Answer 18

emergency craniotomy (epidural hematoma is FATAL WITHIN HOURS)

Question 19

chronic subdural hematoma presentation

Answer 19

head trauma with fluctuating consciousness

Question 20

why do you order noncon CT’s for brain bleeds?

Answer 20

blood and contrast look the same on CTs, giving a false positive

Question 21

subdural hematoma management

Answer 21

craniotomy only if lateralizing signs and midline displacement

Question 22

presentation of diffuse axonal injury

Answer 22

deeply unconscious

Question 23

when you should absolutely never do an LP before head CT

Answer 23

elevated intracranial pressure (brain will herniate and patient will die)

Question 24

presentation of elevated intracranial pressure

Answer 24

headache, vomiting without nausea, ocular palsies, altered level of consciousness, back pain and papilledema

Question 25

what should always make you VERY CONCERNED about elevated ICP

Answer 25

vomiting without nausea

Question 26

why you use steroids for brain/spinal cord + when you should use them

Answer 26

they decrease edema, if there are no signs of edema on imaging, then they’re probably not doing anything

Question 27

first line measures for elevated ICP

Answer 27

head elevation, hyperventilation, avoid fluid overload

Question 28

second line measures for elevated ICP

Answer 28

mannitol (use very cautiously, can reduce cerebral perfusion)
sedation and/or hypothermia (lower oxygen demand)

Question 29

primary peritonitis

Answer 29

ascites and mild abdominal pain (even if fever and leukocytosis)

Question 30

acute abdomen management

Answer 30

rule out pancreatitis or ovarian cyst rupture → surgery eval if 1) peritonitis (excluding primary peritonitis) 2) abdominal pain/tenderness plus signs of sepsis 3) acute intestinal ischemia 4) penumoperitoneum

Question 31

classic pain pattern of peptic ulcers

Answer 31

wakes patient up at night

Question 32

most common causes of GI tract perforation

Answer 32

diverticulitis, perforated peptic ulcer, crohn’s

Question 33

GI perforation management

Answer 33

FIRST: Surgery consult
NPO
IVF
PPX ABX (metronidazole, cipro)

Question 34

first step if concern for esophageal perforation

Answer 34

gastrografin contrast esophagram

Question 35

volvulus management

Answer 35

proctosigmoidoscopy

Question 36

abdominal hernia management

Answer 36

elective repair

Question 37

diverticulitis management

Answer 37

Abdominal + pelvic CT scan with contrast (look for fat stranding around inflammed bowel)
→ if no peritoneal signs, manage with outpatient antibiotics (ciprofloxacin, metronidazole)
→ if peritoneal signs and abscess → admit
NPO
IVF
IV abx
CT guided percutaneous drainage
→ If generalized peritonitis or perforation → EMERGENCY SURGERY
→ IF RECURRENT → surgery

Question 38

diverticular abscess treatment

Answer 38

percutaneous or surgical drainage

Question 39

meds that can cause acute pancreatitis

Answer 39

didanosine, pentamidine, flagyl, tetracycline, thiazides, furosemide

Question 40

pancreatitis alarm features

Answer 40

hypotension, metabolic acidosis, leukocytosis >18,000, hyperglycemia, hypoxia, hypocalcemia, falling hematocrit

Question 41

chronic pancreatitis management

Answer 41

Pain management
Pregabalin x 3 weeks (RCT)
PO enzyme replacement
insulin

Question 42

appendicitis management system

Answer 42

IF peritoneal signs → surgery evaluation → IV abx before surgery
IF perforated → IV until fever and WBC count normalize

Question 43

how to perform murphy’s

Answer 43

breath all air out, palpate RUQ, ask patient to breath in

Question 44

primary postop concern for COPD patients

Answer 44

postop pneumonia

Question 45

pneumonic for post-op complications and timeframe

Answer 45

wind (atelectasis) – day 1, water (UTI) – day 3, walking (thrombophlebitis) – day 5 , wound (wound infection) – day 7

Question 46

first step with post-op disorientation

Answer 46

ABG (critical to rule out hypoxia)

Question 47

management of fecal fistula

Answer 47

If draining to outside, just observe.

If draining to inside, surgery

Question 48

high intensity statin

Answer 48

Atorvastatin 40-80

Rosuvastatin 20-40

Question 49

moderate intensity statin

Answer 49

atorvastatin 10

rosuvastatin 10