step 3 17

Question 1

systemic sclerosis vs. CREST syndrome

Answer 1

Systemic sclerosis can manifest as limited cutaneous systemic sclerosis (CREST syndrome, which includes calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias) - Diffuse cutaneous systemic scleroderma (which includes more diffuse skin involvement as well as involvement of the lungs, kidneys, and gastrointestinal tract).

Question 2

management of congenital adrenal hyperplasia

Answer 2

chronic glucocorticoid and mineralocorticoid replacement to maintain blood pressure and growth and to suppress adrenal androgens.

Question 3

chlamydia treatment

Answer 3

Z-PACK, azithromycin

Question 4

dysuria not responding to z-pac probably due to…

Answer 4

M genitalium infection, which usually requires treatment with moxifloxacin.

Question 5

pathophys of diastolic HF

Answer 5

prolonged systemic hypertension causes left ventricular hypertrophy and impaired diastolic filling, eventually leading to decompensated volume overload despite normal left ventricular ejection fraction >50%

Question 6

contraindications to pregnancy, when to recommend terminating pregnancy

Answer 6

Left ventricular ejection fraction <40%
NYHA class III-IV heart failure
Prior peripartum cardiomyopathy
Severe obstructive cardiac lesions
Severe pulmonary HTN (Eisenmenger syndrome)
Unstable aortic dilation >40 mm

Question 7

management of varicella vaccination for someone who has immunocompromised housemate

Answer 7

varicella-zoster virus (VZV) vaccine can be administered safely to immunocompetent patients with household contacts who are immunocompromised. Although transmission of VZV by a vaccine-related rash is rare, vaccinated individuals should be monitored for a rash and isolated if one develops.

Question 8

use of ANOVA

Answer 8

difference in mean values among several groups.

Question 9

late-life depression confers increase risk for developing

Answer 9

AD

vascular dementia

Question 10

plan B name

Answer 10

ulipristal, may be taken up to 5 days after unprotected intercourse.

Question 11

postexposure prophylaxis for sexual assault victims

Answer 11

• treat empirically for chlamydia, gonorrhea, and trichomoniasis.
• Post-exposure prophylaxis for hepatitis B depends on immunity.
• HIV prophylaxis is offered up to 72 hours after the assault.

Question 12

empiric antibiotics for pediatric sepsis

Answer 12

ampicillin plus gentamicin or cefotaxime.

Question 13

management of infant born to mother who did not receive ppx for GBS

Answer 13

observe for 48 hours

Question 14

CF clinical features

Answer 14

Recurrent sinopulmonary infections
Intestinal obstruction (eg, meconium ileus)
Pancreatic insufficiency & diabetes
Male infertility

Question 15

clinical significance of anti-thyroid peroxidase antibodies

Answer 15

associated with increased risk for pregnancy loss, even in women who are biochemically euthyroid

Question 16

alternatives to hormone therapy for management of hot flashes

Answer 16

SSRIs/SNRIs

Question 17

gestational diabetes management after delivery

Answer 17

• discontinue anti-hyperglycemic therapy after delivery.
• screen at 6-12 weeks postpartum with a 2-hour oral glucose tolerance test due to the association between GDM and type 2 diabetes mellitus.

Question 18

hawthorne effect

Answer 18

impact on behavior from awareness of being observed

Question 19

quality-adjusted life year

Answer 19

value between 0 and 1 suggesting equivalence of life value with disability

Question 20

complications and management of bicuspid aortic valve

Answer 20

at risk for developing aortic dilation, aortic aneurysm, and aortic dissection, and should be screened with imaging of the aortic root and proximal aorta.

Question 21

comorbidities of turner syndrome

Answer 21

hypothyroidism and celiac disease should occur due to an increased risk of these autoimmune conditions. In addition, because of an increased risk of learning disabilities, neuropsychological testing is performed prior to school entry to ensure that appropriate therapies can be provided if needed.

Question 22

meralgia paresthetica management

Answer 22

weight loss (in obese patients) and avoidance of tight-fitting garments to reduce the pressure on the nerve entrapment area.

Question 23

low GGT means

Answer 23

bone disease

Question 24

lung cancer screening recommendation

Answer 24

low-dose chest CT is recommended for patients age 55-80 with a >30-pack-year smoking history and who currently smoke or quit within the last 15 years

Question 25

test characteristics of CT

Answer 25

Screening is associated with a 20% relative reduction in mortality risk but a false positive rate of nearly 96%.
- PPV very low, if positive still very low likelihood of cancer

Question 26

preeclampsia management

Answer 26

• stabilization with blood pressure control (eg, hydralazine, labetalol) and magnesium sulfate for seizure prophylaxis.
• THEN DELIVERY (stabilize mother first). At >34 weeks gestation, delivery is initiated after maternal stabilization is established.

Question 27

prolonged steroid management

Answer 27

calcium and vitamin d

Question 28

how to prevent febrile nonhemolytic transfusion reaction

Answer 28

leukoreduction

Question 29

management of suicidal ideation

Answer 29

IF no intent or plan, don’t necessarily need hospitalization (passive vs. active SI)

Question 30

management of genital warts

Answer 30

trichloroacetic acid

Question 31

cephalohematoma vs caput succadenaum

Answer 31

caput doesn’t cross suture lines

Question 32

when angiodysplasia bleeds occur (with what comorbid conditions)

Answer 32

ESRD (uremic platelet dysfunction), aortic stenosis (which leads to acquired vWD), and von Willebrand disease (vWD)

Question 33

vertebrobasilar insufficiency meaning

Answer 33

reduced blood flow in the base of the brain, typically secondary to emboli, thrombi, or arterial dissection.

Question 34

presentation of imperforate hymen

Answer 34

cyclic pelvic pain, bulk symptoms (eg, constipation), primary amenorrhea, and hematocolpos (accumulation of blood and fluid behind the intact hymen).

Question 35

biggest predictor of return to work with chronic back pain

Answer 35

Recovery expectation

Question 36

impaired fasting glucose is a RF for what

Answer 36

coronary artery disease

Question 37

period during which false negatives can occur with HIV

Answer 37

4 weeks

Question 38

testing required before starting HAART

Answer 38

hep b (some regimens target both)

Question 39

treatment of acute uterine bleeding

Answer 39

combination oral contraceptives containing high-dose estrogen

Question 40

causes of abnormal uterine bleeding

Answer 40

PALMCOEIN
Structural
Polyp (eg, endometrial polyp)
Adenomyosis
Leiomyoma (submucosal & other)
Malignancy & hyperplasia
Nonstructural
Coagulopathy
Ovulatory dysfunction
Endometrial (eg, infection, inflammation)
Iatrogenic (eg, anticoagulants)
Not yet classified

Question 41

why benzos should be avoided in elderly

Answer 41

increased fall risk

Question 42

best intervention for reducing fall risk

Answer 42

discontinue benzos and other meds associated with increased fall risk

Question 43

most common complication of cat-scratch disease

Answer 43

lymph node suppuration

Question 44

other manifestation of cat-scratch disease

Answer 44

oculoglandular syndrome

- adenopathy of the preauricular or cervical nodes is seen. Involvement of the conjunctivae (as in this case)

Question 45

management of negative symptoms in schizophrenia

Answer 45

• referral for social skills training

Question 46

desmoid tumors presentation

Answer 46

deeply seated painless or sometimes painful masses in the trunk/extremity, intraabdominal bowel and mesentery, and abdominal wall. They can cause intestinal obstruction and bowel ischemia and have a high rate of recurrence, even after aggressive surgery (as in this patient).

Question 47

management of bleeding related to menopause

Answer 47

endometrial biopsy is indicated in women age >45 with anovulatory bleeding to evaluate for endometrial hyperplasia or cancer.

Question 48

management of histrionic patient

Answer 48

Best response is to calmly set limits and establish firm boundaries to maintain the professional physician-patient relationship

Question 49

synovial fluid analysis with reiter’s

Answer 49

high white blood cell count but is culture negative

Question 50

levo interactions and instructions on taking

Answer 50

Take on an empty stomach with water 30-60 minutes before breakfast. Common medications, such as calcium and iron supplements, can impair the absorption of levothyroxine and should be separated from it by 3-4 hours.