Step3 14

Question 1

MRI findings in spinal stenosis

Answer 1

Osteophytes at facet joints

Hypertrophy of the ligamentum flavum

Protrusion of intervertebral disc

Question 2

Management of neonatal clavicle fracture

Answer 2

Reassurance
Pain control
Long sleeve shirt pin to a 90 degree angle

Question 3

Mechanism of infection in toxoplasmosis

Answer 3

Undercook meat
Unwashed produce (contaminated soil)
Cat feces

Question 4

Clinical features of congenital toxoplasmosis

Answer 4

Triad:
Chorioretinitis
Diffuse intracraneal calcification
Hydrocephalus

Microcephaly or macro (severe hydrocephalus)
Nonspecific: jaundice, hepatosplenomegaly, rash, growth restriction

Question 5

Treatment for congenital toxoplasmosis

Answer 5

Pirymethamine
Sulfadiazine
Folinic acid

Question 6

ToRCHeSZ

CNS manifestations

Answer 6

Toxoplasma: intracranial calcifications, hydrocephalus, microcephalus (unless severe hydrocephalus)

Rubella: deafness, encephalitis

CMV: periventricular calcification, microcephaly

Herpes: severe CNS infection

HIV: recurrent infections

Syphilis: non?

Zika: microcephaly, ventriculomegaly, intracranial calcifications

Question 7

Management of inguinal hernia

Answer 7

Surgery

1-2 weeks after birth

Question 8

Causes of osteonecrosis (2 main, 9 other)

Answer 8

Steroids
Alcohol

Others:
SLE, Sickle cell, antiphospholipid sd., chronic renal insufficiency and hemodialysis, Gaucher’s disease, HIV infection, following renal transplant, Caisson disease

Question 9

Avascular necrosis clasification and management

Answer 9

Stage 1: normal Xray, MRI: dead bone
Stage 2: dead bone on Xray
Stage 3: femoral head collapse
Stage 4: stage 3 + cartilage damage

Treatment:
Core decompression for stage 1 and 2
Total hip replacement

Question 10

Labs findings in PSGN

Answer 10

Urine:
+ protein, +blood, +RBC cast

Blood:
Elevated creatinine
Low C3
Positive ASO titter

Question 11

Prenatal testing (timing, advantage, disadvantage)

First trimester combine test

Answer 11

10-14

Nuchal translucienty
B-HCG
Protein A (pregnancy associated protein

9-13 weeks
Early screening
Not diagnostic

Question 12

Prenatal testing (timing, advantage, disadvantage)

Cell free fetal DNA

Answer 12

> 10 weeks

High sensitivity and specificity for aneuploidy
Not diagnostic

Question 13

Prenatal testing (timing, advantage, disadvantage)

Chorionic villus sampling

Answer 13

10-13 weeks

Diagnostic for Karyotyping
Invasive, increase risk of spontaneous abortion

Question 14

Prenatal testing (timing, advantage, disadvantage)

Second trimester quadruple screening

Answer 14

B-hCG, Inhibin, AFP, striol

15-25

Screening for neural tube defects and aneuploidy
Not diagnostic

Question 15

Prenatal testing (timing, advantage, disadvantage)

Amniocentesis

Answer 15

15-20

Diagnostic for karyotype
Increase risk of fetal injury, rupture of membrane, pregnancy loss

Question 16

Prenatal testing (timing, advantage, disadvantage)

Second trimester US

Answer 16

15-20

Evaluates fetal growth, fetal anatomy and confirms placental position
Not sensitive for all defects, some findings have no significance

Question 17

Diagnostic test for Pheochromocytoma

Answer 17

24hr urine metanephrines and catecholamines
Plasma fractionated metanephrines (less specific)

24hr urine vanimandelic acid (less sensitive/specific)

Decongestionants and TCAs need to be stopped 2 weeks before test

Question 18

Sd associated with pheochromocytoma

Answer 18

Fx of Pheochromocytoma
MEN2
NF1
VHL

Question 19

Pheochromocytoma workup

Answer 19

Suspicious=> Urine and plasma metanephrines and cathecholamines

Negative: Recheck during spell
Positive==> MRI/CT abdominal
=== Positive==> Alpha and beta block, genetic testing, surgical evaluation, MIBG scan if tumor >5Cm
=== Negative ==> MIBG scan, whole body scan, PETscan, octreotide scan

Question 20

Quad study prenatal screening

Answer 20

Trisomy 18
AFP: low
B-hCG: low
Estriol: low
Inhibin: normal
H-hCG: low

Trisomy 21
AFP: low
Estriol: low
hCG: high
Inhibin: high
H-hCg: high

Neural tube defect
AFP: elevated
Estriol: espina bifida normal, anencephaly low
hCG: normal
Inhibin: normal
H-hCg: not used

Question 21

Elevated AFP in pregnancy

Answer 21

Neural tube defect
Abdominal wall defect
Incorrect dating (most common)
Fetal death or distress
Multiple gestation

Question 22

What is MIBG scan

Answer 22

Metiliodinebenzilguanidine scan it is a functional scan

Used in diagnosis of neuroendocrine tumors because MIBG resembles norepinephrine and is taken up by tumors that secrete this

Use to diagnosed malignant tumors (usually >5cm) or tumors that are not seen in regular MRI or CT

Younger patients and those with family hx need this scan do to increase risk of malignancy

Question 23

Chromogranin A

Answer 23

Secreted by 80% of neuroendocrine tumors

Not specific for pheochromocytoma

Question 24

4 complications during adrenalectomy for pheochromocytoma and treatment

Answer 24

Hypertensive crisis: treat with IV nitroprusside, phentolamine, nicardipine

Hypotension: treat with bolus of normal saline

Hypoglycemia: intravenous dextrose

Cardiac arrhythmias: lidocaine of esmolol

Question 25

Metoclopramide MOA and side effect

Answer 25

D2 receptor blocker

Use for nausea

Causes extrapyramidal symptoms
(akathisia, parkinsonism, dystonia)

Question 26

Absolute contraindication of combined hormonal contraceptive (12)

Answer 26

Migraines with aura
Hypertension (160/110)
Heart disease
Hx. Stroke
Hx. of thromboembolic disease
Diabetes with end organ damage
Post partum <3 weeks
Smoking >15/day + >35 years
Recent surgery/immobilization
Antiphospholipid antibody sd.
Breast cancer
Cirrhosis and liver disease