step 3 26

Question 1

how to tell people to take levothyroxine

Answer 1

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 (Levothyroxine has a narrow therapeutic index)

Question 2

comorbidities of late life depression

Answer 2

higher risk for developing Alzheimer disease and vascular dementia

Question 3

how to tell whether distribution is normal or positively or negatively skewed

Answer 3

normal = mean = median = mode
positive = mean greater than median greater than mode
negative = mode greater than median greater than mean

Question 4

ecythma gangrenosum presentation

Answer 4

immunocompromised patient + RAPID EVOLUTION of >1 skin lesion from an erythematous macule to a pustule or bullae and then into a nonpainful gangrenous ulcer. Fever and systemic signs of illness are common.

Question 5

Bacterial conjunctivitis management

Answer 5

erythromycin ointment or polymyxin-trimethoprim drops. However, fluoroquinolones are preferred for contact wearers due to higher risk for pseudomonal infection.

Question 6

keratitis presentation

Answer 6

photophobia, blurred or impaired vision, and a foreign body sensation with difficulty opening the affected eye

Question 7

test of choice to work up femoral head avascularnecrosis

Answer 7

MRI

Question 8

UC orders

Answer 8

1) mesalamine
2) antidiarrheals
3) antispasmodics
4) dietary consult

Question 9

IBD orders

Answer 9

ESR
CBC
CMP
Ova and parasites
Fecal leukocytes
stool culture
LFTS
PTT
PT/INR

Question 10

licorice effects

Answer 10

hypokalemia
hypotension
(suppresses RAAS. Looks like primary hyperaldosteronism but aldosterone is low due to RAAS suppression)

Question 11

patellofemoral pain syndrome

Answer 11

young woman with new pain + poorly localized + reproduced pain with extension of the knee with anterior pressure on the patella (patellofemoral compression test).

Question 12

pes anserine bursitis presentation

Answer 12

medial knee pain distal to the joint line.

Question 13

osgood schlatter presentation

Answer 13

pain at the insertion of the patellar tendon at the anterior tibial tubercle + adolescent and preadolescent patients + following a rapid growth spurt. Patients will have localized tenderness at the tibial tubercle.

Question 14

kava kava use

Answer 14

anxiety and insomnia

Question 15

st John’s wort use

Answer 15

depression

Question 16

gingko use

Answer 16

Memory enhancement

Question 17

black cohosh use

Answer 17

Postmenopausal symptoms (hot flashes & vaginal dryness)

Question 18

ginseng SE

Answer 18

Increased bleeding risk

Question 19

patients at increased risk for colon cancer

Answer 19

First-degree relative age <60 with colon cancer or adenomatous polyps
>2 first-degree relatives with colon cancer or adenomatous polyps at any age

Question 20

colon cancer screening for patients at increased risk

Answer 20

• Colonoscopy at age 40 or 10 years before the age of cancer diagnosis in a relative (whichever comes first)
• Repeat every 3-5 years

Question 21

FOOSH fracture and mechanism + comorbid condition

Answer 21

• distal radius fracture
• tripping and falling forward
• often fracture ulnar styloid too + risk for acute carpal tunnel syndrome

Question 22

other effects of endocarditis

Answer 22

• common in HIV patients
• pleuritic chest pain and cough due to septic pulmonary emboli (common complication of right sided IE)
• emboli appear on chest x-ray as multiple nodular opacities that may have evidence of cavitation

Question 23

amiodarone affect on thyroid metabolism

Answer 23

decreases the peripheral conversion of T4 to T3, causing increased serum T4 and decreased serum T3 levels with normal to borderline elevated TSH.

Question 24

propranolol affect on thyroid hormones

Answer 24

decreases conversion of T4 to T3 and is therefore useful in thyrotoxic emergencies.

Question 25

initial staging of thyroid cancer

Answer 25

Ultrasound of the neck and cervical lymph nodes

Question 26

uterine rupture treatment

Answer 26

emergency laparotomy

Question 27

uterine rupture presentation

Answer 27

Prior uterine surgery + acute severe abdominal pain with vaginal bleeding, loss of fetal station, and fetal heart rate tracing abnormalities.

Question 28

rectal prolapse management

Answer 28

surgery if full prolapse

medical if partial prolapse

Question 29

rheumatic heart disease presentation

Answer 29

dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Cardiac auscultation shows loud first heart sound (S1) and mid-diastolic rumble best heard at the cardiac apex.

Question 30

mitral stenosis murmur

Answer 30

low-pitched diastolic rumble most prominent at the apex.