Step3 15

Question 1

Characteristic of brain metastasis on imaging studies

Answer 1

Multiple

Well circumscribed

Significant size of edema compared to the size of the lesion

Question 2

Heart conditions seen in SLE

Answer 2

CAD: chronic inflammation increases risk for cardiovascular disease (accelerated atherosclerosis)

Pericarditis (due to serositis). Usually associates with other serositis (dyspnea due to pleural efusion)

Question 3

Risk factors for spontaneous abortions

Answer 3

Advanced maternal age

Previous abortion

Substance abuse disorder

Question 4

Follow up intervals for colonoscopy after polypectomy (6)

Answer 4

> 10 polyps: <3years

1-2 adenomatous (<1cm): every 5 years

Any > 1cm or villous or 3-10: every 3 years

Small hyperplastic: every 10 years

Adenocarcinoma (minimal invasion and >2mm of margin): 2-3 months

Large sessile polyp (>2cm) removed by piecemeal excision: 2-6 months

Question 5

Neuroleptic malignant sd. vs Serotonin sd

Answer 5

NMS: antipsychotic
Serotonin sd.: SSRI, SNRI

both can cause fever, diaphoresis, tachycardia, rhabdomyolysis, renal failure

NMS: rigidity (Treat with dantrolene)
Serotonin sd.: myoclonus, hyperreflexia

Question 6

Antibiotics of meningococcal prophylaxis

Answer 6

rifampin: 4 doses orally
cefuroxime: IM one dose, safe in pregnancy
ciprofloxacin: one oral dose, not in kids

Question 7

Who needs prophylaxis against meningococcus?

Answer 7

Super close contacts

Anyone in contact with patients fluids

> 8hr sitting together (airplane)

Question 8

Inclusion criteria for thrombolytic in stroke

Answer 8

3-4.5 hrs since onset of symptoms

Ischemic stroke with measurable neuro deficits

Question 9

Absolute contraindication for thrombolytic in stroke (8)

Answer 9

Hemorrhage or multifocal >33% of the hemisphere
Arterial puncture on a noncompressible site (<7 days)
Recent head trauma <3 months
BP >185/110
Hx. of intracranial hemorrhage, neoplasia, or vascular malformation
Recent spinal/intracranial surgery
Patient on anticoagulation. INR >1.7 PT>12 PTT elevated, PLT <100.000
Glucose <50

Question 10

Relative exclusion criteria for stroke (6)

Answer 10

Rapid improving neurological symptoms
Pregnancy
MI in the past 3 months
GI or GU bleed un the past 21 days
Major surgery/trauma in the past 14 days
Seizure at onset of stroke

Question 11

Main cause of death after stroke

Answer 11

DVT - Pulmonary embolism

Especially on hemiparetic side

Question 12

Permissive hypertension

Answer 12

Up to 220/120 mmHg

If anticoagulation… do no let it go over 185/105

Question 13

Myocardial infarction EKG criteria

Answer 13

New ST elevation in 2 consecutive leads

• > 1mm in all leads
• > 1.5mm in women, >2mm in man >40 or >2.5mm in man <40 in lead V2 and V3

New LBBB with symptoms of acute coronary sd

+/- reciprocal st depresion

Question 14

Timing of diagnosis of ADHD

Answer 14

<12 years of age

symptoms going for >6 months

Question 15

UFH vs LMWH in DVT

When do you use them?

Answer 15

Full dose UfH in DVT

LMWH in prevention

Question 16

Medications given to a patient with an MI

Answer 16

Nitrates: except if right heart failure. Watch out for hypotension

Double antiplatelet: aspirin + P2Y receptor blocker
Statins

Beta-Blocker: cardioselective. Except if patient is in Heart Failure

Anticoagulation: warfarin, heparin

Statins: atorvastatin, sinvastatin

Coronary reperfusion

Question 17

Effects of statin therapy after an MI

Answer 17

Plaque stabilization

Reduce inflammation

Atherosclerosis regression

Question 18

Risk factors and clinical manifestation of Malignant Otitis external.

Answer 18

Risk Factors:
Advanced age
Diabetes
HIV and other immunodeficiencies

Clinical presentation
Pain
Erythema
Granulation tissue
Purulent discharge

Question 19

Etiology of Malignant Otitis externa and treatment

How do you follow response to treatment?

Answer 19

Pseudomna >95%

IV Antipsudomonal antibiotics first
Fluoroquinolones
Penicillins (piperacillin)
Ceftazdime

Use CRP/ESR as reference for disease activity

Switch to oral once they have normalized

Question 20

Ramsay Hut Sd.

Answer 20

Varicella-zoster uticus

Question 21

Diagnosis and treatment of scabies

Answer 21

Scraping and light microscopy

5% permethrin cream

Question 22

Most reliable method for confirmation of proper endotracheal tube placement

Answer 22

Capnography:

1) Rectangular waveform with 4 phases
2) Litmus paper that changes color when exposed to CO2 (from purple to yellow)