Step 3

Question 1

Step 3 IBS workup

Answer 1

• stool guiac, fecal leukocytes, culture, ova, parasite
• colonoscopy
• abdominal CT

Question 2

diverticulitis diagnosis

Answer 2

abdominal and pelvic CT scan

Question 3

volume loss in GI bleeder that’s tachy and has low pressure

Answer 3

30 percent

Question 4

orthostatic definition

Answer 4

drop in systolic of 20 or more OR rise in pulse of 10 BPM or more

Question 5

transfusion thresholds on step 3

Answer 5

Less than 30 in older person

20-25 in younger person

Question 6

platelet transfusion threshold

Answer 6

Below 50,000

Question 7

problem with PPI’s

Answer 7

increased risk of pneumonia and c diff colitis

Question 8

most common complication of TIPS

Answer 8

hepatic encephalopathy

Question 9

use of MRCP

Answer 9

detects causes of biliary and pancreatic duct obstruction not found on CT

Question 10

hep A treatment

Answer 10

• give vaccine if healthy, immune globulin also if young and old or chronically sick with liver disease or HIV

Question 11

management of hep B vaccinated person with needle stick?

Answer 11

Check for surface antibody and if present, then NTD

Question 12

hepatic encephalopathy treatment

Answer 12

lactulose or rifaximin

Question 13

paracentesis indications

Answer 13

1) New ascites
2) pain, fever, or tenderness
3) therapeutic

Question 14

Wilson’s diagnosis

Answer 14

Slit lamp + ceruloplasmin

Question 15

hemochromatosis DDX

Answer 15

MRI of liver + HFe gene mutation

Question 16

AIHA demographic

Answer 16

young woman with atopy

Question 17

best test for AIHA

Answer 17

ANA + antismooth muscle antibody test

Question 18

AIHA treatment

Answer 18

prednisone

Question 19

NASH RF’s

Answer 19

obesity + DM + HLD

Question 20

cutoff for change in FEV after inhaled bronchodilaters with asthma and reactive airway disease

Answer 20

greater than 12% increase in FEV1

Question 21

when you need methacholine stimulation test

Answer 21

patient needs RAD/asthma eval but is not currently SOB

Question 22

caveat about steroids

Answer 22

take 4-6 hours to be effective

Question 23

orders for asthma treatment

Answer 23

albuterol
methyl pred bolus 
inhaled ipratropium
O2
magnesium

Question 24

long acting beta agonists

Answer 24

Salmeterol

Formeterol

Question 25

home O2 indication

Answer 25

pO2 less than 55, or O2 sat less than 88

Question 26

ILD management

Answer 26

Steroids → if no response → azathioprine for long term treatment → if no response trial cyclophosphamide

Question 27

drugs for IPF

Answer 27

perfenidone and nintedanib

Question 28

BOOP

Answer 28

bronchiolitis obliterans organizing pneumonia, also known as COP, cryptogenic organizing pneumonia

Question 29

BOOP/COP presentation

Answer 29

cough, rales, SOB, fever, malaise, myalgias

Question 30

BOOP/COP workup

Answer 30

CXR + CT + open lung biopsy

Question 31

BOOP/COP treatment

Answer 31

steroids

Question 32

BOOP/COP vs. ILD

Answer 32

shorter onset, fever/myalgias/malaise

Question 33

pulmonary HTN meds

Answer 33

Bosentan Epoprostenol Sildenafil Riociguat

Question 34

CXR in PE

Answer 34

most commonly normal but can see atelectasis

Question 35

EKG in PE

Answer 35

most commonly sinus tach, most common abnormality is nonspecific ST-T wave changes

Question 36

ABG in PE

Answer 36

hypoxia + increased AA gradient + mild respiratory alkalosis

Question 37

management of high concern for PE

Answer 37

STAT CXR + ABG + assess contraindications to anticoagulation --> START HEPARIN → if hypotensive --> start tPA

Question 38

pleural exudate features

Answer 38

``` high protein (greater than 40 percent of serum level) LDH high (greater than 60 percent of serum level) ```

Question 39

transudative pleural fluid features

Answer 39

low protein, low LDH

Question 40

decortication

Answer 40

- treatment for recurrent effusions that fail pleurodesis | - you strip off pleura from the lung so it will stick to the interior chest wall.

Question 41

other potential OSA options

Answer 41

``` Consider acetazolamide (causes a metabolic acidosis to encourage respiration) Consider medroxyprogesterone (central respiratory stimulant) ```

Question 42

ABPA treatment

Answer 42

oral steroids + itraconazole in refractory cases

Question 43

ABPA diagnosis

Answer 43

aspergillus skin testing IgE Circulating precipitins A fumigatus specific antibodies

Question 44

ABPA classic patient

Answer 44

asthmatic with worsenign symptoms who is coughing up brownish mucous plugs with recurrent infiltrates, peripheral eosinophilia + high serum IgE + central bronchiectasis.

Question 45

ARDS diagnosis

Answer 45

1) bilateral pulmonary interstitial infiltrates on CXR 2) normal wedge pressure 3) pO2/FIO2 less than 200

Question 46

cardiac output in septic shock

Answer 46

High

Question 47

wedge pressure in septic shock

Answer 47

low

Question 48

TB demographics

Answer 48

HIV-positive homeless prisoners alcoholics

Question 49

TB presentation

Answer 49

Fever, cough, sputum production, weight loss, night sweats

Question 50

5 mm PPD group

Answer 50

close contacts, steroid users, HIV-positive

Question 51

10 mm PPD group

Answer 51

homeless, immigrants, alcoholics, health care workers, prisoners

Question 52

15 mm PPD group

Answer 52

everyone else