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USMLE Step 3 Flashcards

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1
Q

Patient presents with acute onset le5ft foot pain, diminished pulses, pale cooler foot. Young patient (25) with murmur (apical diastolic murmur). Cause?

A

left atrial myxoma

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2
Q

inheritance of hemophilia A?

A

x linked recessive

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3
Q

Patient has decreased hearing and subq nodules. Fam hx: dad has bilateral deafness tx with surgery. Patient has hypopigmented spots on his back. MRI shows bilateral cerebellopontine angle masses. Cell type causes sx?

A

schwann cells - acoustic neuromas develop from proliferation of schwann cells

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4
Q

Rash with stuck on appearance, how do you diagnose? dx?

A

seborrheic keratosis

benign lesions, clinical exam only

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5
Q

tx of cryptococcal meningitis?

A

ampotericin B and flucytosine, if worsening mental status consider repeat LPs

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6
Q

HIV patient with lesions. Described as multiple small papules with central umbilication all over body and some have central necrosis. Dx?

A

cutaneous cryptococcosis

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7
Q

Side effect of TURP for resection of BPH?

A

dry ejaculate

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8
Q

what factors do you use to monitor lupus nephritis?

A

serum complement or anti ds DNA levels

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9
Q

trigger for hemodialysis based on lithium level?

A

greater than 4.0, 2.5-4 with severe neuro sx or AKI, fluids are not working

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10
Q

dx confirmation of urethral diverticulum?

A

MRI of pelvis or TVUS

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11
Q

length of time for tx of TB meningitis?

A

12 months

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12
Q

When are corticosteroids used in patient with HIV and PCP?

A

a-a oxygen gradient > 35, or arterial oxygen tension < 70

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13
Q

HTN agent that causes photosensitivity reactioN?

A

HCTZ

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14
Q

tx of ringworm of thescalp or tinea capitis?

A

oral griseofulvin

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15
Q

dx of patient with polyarticular arthropathy associated with hepatomegaly and diabetes?

A

hereditary hemochromatosis

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16
Q

patient’s with hereditary hemochromatosis are at increased risk for?

A

hepatocellular carcinoma

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17
Q

tx of seborrheic dermatitis?

A

selenium sulfide, ketoconazole

steroids

topical calcineurin inhibitors

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18
Q

best diagnostic test for lumbar spinal stenosis?

A

MRI of the spine

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19
Q

best next step for patient with unilateral painless scrotal mass?

A

US of the scrotum

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20
Q

most common complication to occur from bacterial conjunctivitis?

A

keratitis

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21
Q

tx of bacterial conjunctivitis in contact wearers? in non contact wearers?

A

cipro drops, erythromycin drops

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22
Q

dx of patient with elevated alk phosph and unexplained pruritus? after LFTs and hepatitis panel and US of RUQ what is the next best test?

A

PBC

antimitochondrial antibody levels

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23
Q

what tx can slow progression of PBC

A

ursodeoxycholic acid

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24
Q

6 contraindications to tPA?

A
  1. presence of active internal bleeding
  2. bleeding diathesis (pltl below 100,000)
  3. hypodensity in > 33% of arterial territory on CT scan
  4. ICH
  5. intracranial surgery in last 3 months
  6. BP > 185/110
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25
tx of one lesion of actinic keratitis? tx of multiple lesions?
cryosurgery or surgical excision 5-fluorouracil cream
26
2 ways to increase oxygenation of patient on vent?
increase PEEP increase FiO2
27
tx of gout in patient with renal failure and history of GI bleed? first line tx of gout in normal patient?
intra-art corticosteroids indomethacin
28
concern about thyroid nodule after ultrasound. Next step?
get TSH
29
concern about thyroid nodule if TSH is low. next step?
radionucleotide scan
30
concern about thyroid nodule if TSH is high. next step?
FNA
31
concerned about neuroendocrine tumor based on labs. Next step?
MRI of abdomen or CT scan
32
risk of colon cancer in patient by age of 45 if + colon polyps (FAP)
> 95%
33
3 year old with lump in armpit, fever, dogs and cats at home and attends daycare. next step in management? dx?
azithromycin cat scratch disease
34
how do you follow disease activity in SLE patients?
anti double stranded DNA abd
35
tx of anti-dsDNA abd in patient with arthralgias, serositis, and cutaneous sx?
prednisone and hydroxychloroquine
36
tx for mixed cryoglobulinemia associated with hep C infection in normal patient. In patient with impaired renal function?
alpha-interferon and ribaviron alpha interferon
37
risk of scaphoid fx in patient not treated?
nonunion and avascular necrosis
38
sx of infant botulism?
constipation, lethargy, poor sucking, weak crying, impaired gag reflex
39
difference in lab values of hypoPTH vs pseudohypoPTH?
hypoPTH - low ca, high phosph, low PTH pseudohypoPTH - low ca, high phosph, high PTH
40
young patient with DM, osteoporosis, HTN and hypokalemia...dx?
cushing syndrome
41
tx of tinea versicolor?
topical azole
42
best diagnostic test for concern for prostate bone mets? for MM bone mets? for mixed?
radioisotope bone scan plain xrays bone scans/PET
43
tx of pyloric stenosis?
correct electrolytes and then pyloromyotomy
44
abx associated with pyloric stenosis?
erythromycin
45
best tx for raynaud's?
nifedipine DHP
46
original tx for toxic megacolon? next tx?
iv steroids, surgery
47
extraarticular manifestations of ankylosing spondylitits?
eyes - acute anterior uveitis heart - aortic regurg lungs - restrictive lung disase, pulm fibrosis kidney - iga nephropathy
48
first screening test of patient with scrotal pain?
cremasteric reflex test, then scrotal elevation
49
patient with jerking movements an hour of waking up and generalized tonic-clonic seizures in a 16 year old dx and tx?
juvenile myoclonic epilepsy, valproic acid
50
patient with mild c diff tx? patient with moderate c diff? patient with severe c diff?
oral metro oral vanc iv metro and oral vanc
51
infant of mother with poorly controlled diabetes have what heart disease?
hypertrophic septum from glycogen deposits
52
tx of PML from JC virus in HIV positive patients?
highly active antiretroviral therapy
53
patient with asthma or CF who develops recurrent fever, malaise, cough with mucoid sputum, wheezing or bronchial obstruction dx? tx?
aspergillus steroids and itraconazol or voriconazole
54
tx of shingles?
valacyclovir
55
tx of post herpetic neuralgia?
TCAs, gabapentin, pregabalin
56
first line therapy of onychomycosis?
terbinafine
57
greatest sensitivity and negative predictive value for diagnosis or exclusion of osteo of the foot? how do you figure out best tx?
MRI with contrast bone biopsy to guide abx
58
single most important factor to determine prognosis of patient with COPD?
FEV1
59
patient who is immunocompromised who has painless red macules that progress rapidly to bullae and gangrenous ulcers dx? tx?
ecthyma gangrenosum from pseudomonoas, IV abx
60
tx of child with ITP?
steroids
61
findings of gastric endoscopy in patient with pernicious anemia?
absent rugae in fundus and body
62
tx of patients with rosacea and pustules? complications associated with rosacea?
topical metronidazole or azelaic acid ocular manifestations - test 14
63
old people diagnosed with depression are more likely to develop which type of depression?
alz or vascular dementia
64
patient's with celiac disease see what on GI endo?
villus atrophy with increased intraepi lymph
65
Patient on carvedilol, hydralazine, isosorbide dinitrate furosemide and spironolactone develops fatigue, night sweats, arthralgia, and pleuritis. Dx?
drug induced lupus from hydralazine
66
pt treated for syphilis develops HA and muscle pain with temp. dx? tx?
jarisch herxheimer reaction, no prevention/tx
67
most accurate test to confirm complete achilles tendon rupture
no plantar flexion on calf squeeze
68
side effects from sodium glucose cotransporter 2 medications which promote glucose reabsorption at the level of the proximal renal tubule
vulvovaginal candidiasis, UTIs from glucosuria
69
side effect of TURP in addition to retrograde ejaculation?
hyponatremia
70
patient with neutropenia presents with fever, eye pain, decreased visual acuity, white mound like lesion in vitreous. Dx? tx?
candida enophthalmitis vitrectomy and systemic amphotericin B
71
Tx of 8 mm small densely pigmented lesion with irregular borders in peripheral right choroid? Tx of >10 mm lesions?
repeat exam in 3 months radiation
72
what contraindications exist for DTaP vaccine?
anaphylaxis within 7 days of admin of vaccine encephalopathy within 7 days of admin
73
Most common extrarenal manifestation of ADPKD?
hepatic cysts
74
most common side effect of saw palmetto? what is it used to treat?
increased bleeding risk, BPH
75
most common complication associated with compartment syndrome?
acute renal failure
76
Preventive treatment for cluster headache?
verapamil
77
steps if patient positive for strep agalactiae at 14 weeks?
amox now, PCN prophylaxis during labor
78
best test to differentiate pancreatic malignancy from nonmalignant causes?
endoscopic ultrasound with aspiration
79
tx of patient with breast CA who has multiple brain mets?
whole brain radiation
80
patient's with tourette's are most at risk of developing what disease?
OCD - beginning of set #10
81
next step in patient who has resistant HTN?
renal duplex doppler US or CT/MR angio
82
SLE patients are at increased for what CV effect?
premature coronary atherosclerosis
83
how do you calculate odds ratio? meaning?
ad/bc <1 means exposure is associated with lower odds >1 exposure is higher odds of outcome
84
tx if patient has erosive joint disease in RA?
DMARDS (methotrexate)
85
Patient presents with fatigue, night sweats, arthralgia/arthritis, and pleuritis/pleural effusion who takes carvedilol, hydral, isosorbide, furosemide and spironolactone for heart failure?
drug induced lupus by hydralazine check anti-histone abd
86
specific abd in dermatomyositis?
anti-ro, anti-la, anti-sm, anti-RNP, anti-jo1
87
patient with RA does not respond to methotrexate and hydroxychlorine, next step in management?
add on another agent, infliximab
88
strongest known risk factor for male breast cancer?
klinefelters syndrome
89
calcium elevation, renal insuff, anemia, bone pain should make you think?
multiple myeloma CRAB
90
first line therapy for cluster headaches that last > 2 months?
verapamil
91
tx of thick plaques of plaque psoriasis?
topical fluocinonide

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