Step3 25

Question 1

Compartment syndrome diagnosis

Answer 1

Compartment pressure >30

OR

Delta pressure < 20-30 (Systolic - compartment)

Question 2

Scombroid poisoning presentation

Answer 2

Flushing
Throbbing headache
Palpitation
Abdominal cramps
Diarrhea
Oral burning

Question 3

Pufferfish intoxication

Answer 3

Tetrodotoxin 15-40 after ingestion

Tingling of the lips and mouth, followed by dizziness, tingling in the extremities.

Problems with speaking, balance, muscle weakness and paralysis, vomiting, and diarrhea.

In severe intoxications, death can result from respiratory paralysis.

Question 4

Lead-time bias vs. length time bias

Answer 4

Lead time diagnoses earlier

Lenght time: diagnoses more benign, asymptomatic cases

They both show an apparent increase in survival

Question 5

Adrenal insufficiency vs. hypoaldosteronism

Answer 5

Hypoaldosteronism;
Only cortisol is low
Na normal or mildly low 
K normal because aldosterone is present 
No skin changes

Question 6

Clinical presentation of acute HIV infection

Answer 6

2-4 weeks after contact

Mononucleosis-like symptoms
Generalized macular rash
GI symptoms

Distinctive features:
painful mucocutaneous ulcers
Maculopapular rash (includes palms and soles)

Viral load: >100000
Antibodies might be negative
CD4 count: maybe normal

Question 7

HEMOCHROMATOSIS

Skin
M/E
GI
Endocrine
Cardiac
Infections

Answer 7

Skin: hyperpigmentation (bronze diabetes)

M/E: arthralgia, arthropathy, chondrocalcinosis

GI: Elevated LFTs, hepatomegaly (first), cirrhosis (late)

Endocrine: DM, hypogonadism, hypothyroidism

Cardiac: restrictive or dilated cardiomyopathy

Infections: Listeria, Vibrio, Yersinia

Question 8

Arthropathy in Hemochromatosis

Answer 8

2nd/3rd metacarpophalangeal joints commonly affected
Also, elbows, knees

Xray: sclerosis, osteopenia, cyst, hook-like osteophyte

Joint aspiration:
Inflammatory
Calcium pyrophosphate crystals

Question 9

Management of spinal epidural abscess

Answer 9

CBC
ESR/CRP
Culture
MRI
Biopsy
Antibiotics
Surgical decompression

Question 10

Where do you do a biopsy on a patient with metastatic disease

Answer 10

Wherever is easiest

Question 11

Predictors of pancreatitis severity

Answer 11

BUN >20 or uptrend during hospitalization

Hematocrit >40% (shows hemoconcentration due to thrid spacing)

CRP>140

Older age
Obesity

Question 12

REMEMBER

Answer 12

No overlapping in Confidence intervals means there is statistical significance between two groups

Question 13

Sarcoma botryoides

Answer 13

Bloody, mucoid vaginal discharge

Grape-like mass protruding from the vagina

Question 14

Classification and management of lupus nephritis

Answer 14

Renal biopsy ALWAYS

Treat with corticosteroids
I: Mesangial: usually asymptomatic
II: Mesangial proliferative: microscopic hematuria, proteinuria

Treat with corticosteroids and cyclophosphamide/mycophenolate
III: Focal: hematuria, proteinuria, hypertension (possible nephrotic SD)
IV: Segmental: most common, poor prognosis, similar to focal

V: Membranous: nephrotic sd

VI: Sclerosing: progressive CKD with bland urinary sediment (do not treat with immunosuppresion)

Question 15

How do you monitor renal disease in Lupus

Answer 15

Anti-dsDNA and complement levels

Question 16

Vibrio vulnificus infection
Dxx with mycobacterium marinum

Mechanism
Presentation

Answer 16

Mechanism:
Ingestion or wound infection

Presentation: rapidly progressive <12 hrs.
Septicemia: septic shock, bullous lesion
Cellulitis with hemorrhagic bulla or necrosis

Treat with IV ceftriaxone + doxycycline (highly fatal)

Mycobacterium marinum
Ulcers and papules and it is more subacute in progression

Question 17

Keratosis pilaris

Answer 17

Rough skin
Keratin plugs

Treat with keratolytic
Urea
Salicylic acid

Question 18

Pretest probability for type 2 Heparin induced thrombocytopenia

Answer 18

Thrombocytopenia:

2: Drop >50% or nadir >20k
1: Drop 30-50% or nadir 10-20k
0: Drop <30% or nadir <10k

Timing

2: 5-10 days since heparin or <1 if heparin in the last 30 days
1: 5-10 days in consistent drop in platelets or <1 day if heparin the last 30-100
0: <4 days

Thrombosis

2: Confirmed
1: Suspicious/recurrent
0: Absent

alTernate

2: Not apparent
1: Possible
0: Definite

0-3= low probability
4-5= moderate
6-8= high

Question 19

Management of Heparin induce thrombocytopenia

Answer 19

Stop heparin

Initiate direct thrombin inhibitors:
argatrovan
bivalidurin

Warfarin worsens thrombophilic state and can worsen the situation. It can be started after the thrombin inhibitors

Avoid as much as possible. List this complication as an “allergy”

Question 20

Management of localized vocal cord tumors

Answer 20

If no invasion.. radiation can help preserve the cord

Question 21

Treating strep infection prevents what?

Answer 21

Rheumatic fever

Peritonsilar abscess
Cervical lymphadenitis

Antibiotic has no effect in prevention of Glomerulonephritis

Question 22

Medications that increase warfarin effect

Answer 22

Metronidazole, fluoroquinolone: reduce intestinal flora

Inhibition of CYP450 2C9: amiodarone, azoles

Acetaminophen: decreases vit. K recycling

NSAIDs: inhibit platelet function
Ginkgo biloba: increase bleeding (unknown)

Question 23

Medications that lower warfarin effect

Answer 23

Increase coagulation factors: birth control

Induction of CYP450 2C9: SJW, rifampin, phenytoin

Vitamin ingestion; green leaf diet (excess vitamin K)

Question 24

Indication for antibiotics in patients with anal abscess

Answer 24

Patients with:

Diabetes
Immunosuppression
Extensive cellulitis
Valvular heart disease

Question 25

Management of Borderline personality disorder

Answer 25

Dialectical psychotherapy:

+/- Antipsychotics or mood stabilizers for mood instability and transient psychosis

+/- Antidepressant if mood disorder

Question 26

Test of choice for diagnosis Chronic pancreatitis

Answer 26

Magnetic resonance cholangiopancreatopgraphy

Question 27

Management of chronic pancreatitis

Answer 27

Trial of life style modifications first (stop alcohol, smoking, initiate smaller and more frequent meals, low fat)

Enzymes

Pain control (TCAs, NSAIDs, pregabaline)