Step3 4

Question 1

Treatment for Multifocal ventricular tachycardia

Answer 1

Treat underlying condition first. Do not initiate treatment until underlying causes have been addressed

Then: use an AV nodal blocker (eg. verapamil, beta-blockers)

Question 2

Target electrolyte value when replacing K and Mg

Answer 2

K: replace until 4mEq/L

Mg: keep or replace until 2 mEq/L

Question 3

A study statistical significance is equal to:

Answer 3

Alpha value

Defined by the researchers. Usually 0.05

Question 4

Normal platelet count

Answer 4

150,000 to 450,000

Question 5

Normal serum bicarbonate

Answer 5

22-28

Question 6

Differential diagnosis for fever in returning travelers

early incubation period

Answer 6

<10 days:

Dengue, Chikungunya, Typhoid fever, influenza, legionellosis

Question 7

Differential diagnosis for fever in returning travelers

medium incubation period

Answer 7

1 week-3weeks

Typhoid fever, malaria, leptospirosis, schistosomiasis, rickettsia infections

Question 8

The differential diagnosis for fever in returning travelers

longer incubation period

Answer 8

> 3 weeks
Tuberculosis
Leishmaniasis
Enteric parasitic infections

Question 9

How to return to sports after a concussion

Answer 9

Rest >24hrs. Close monitoring (outpatient)

Light aerobic exercise… increase every 24hrs… can go back to contact sports >7days

If symptomatic: return to the level of activity where the patient is asymptomatic

Limit screen time, frequent breaks at school, shorter days

Question 10

Malaria prophylaxis for P. falciparum areas

Answer 10

Chloroquine-resistant: Subsaharan region, southern and Southeast Asia)

• Doxycycline: cheap, GI disturbances
• Atovanquone: expensive, GI disturbances, can affect liver function
• Mefloquine: preferred in pregnancy. Neuropsych effects

Chloroquine sensitive:
Chloroquine/hydroxyclhoroquiene and

Question 11

Malaria prophylaxis for no P. falciparum areas

Answer 11

South America, Mexico, Corea

Primaquine: teratogenic, hemolysis in G6PD deficiecy

Question 12

ADHD prognosis in adolescents and adulthood.

Risks

Answer 12

Up to 1/3 continue to have symptoms

If left untreated:
Risk for academic underachievement, drug use, car accidents, antisocial behavior, underemployment

Question 13

Treatment for ADHD

Answer 13

< 6yoa: therapy

Stimulant medication: first-line

Non-stimulants (atomoxetine): in patients with Hx. of substance abuse (more than occasional use)

Question 14

Dilatated cardiomyopathy mnemonic

Answer 14

Alcohol
Beri Beri
Chagas
Coxsackie
Cocaine
Doxorubicin
hEmochromatosis

Question 15

Chagas cardiac manifestations

Answer 15

Dilatated cardiomyopathy

Affects mostly right heart (JVD, peripheral edema)

Embolic complication of mural thrombus

Fibrosis leading to arrhythmias: av block, ventricular tachy, nodal dysfunction

Left ventricular aneurism

Question 16

Etiology of neonatal sepsis and treatment

Answer 16

<28 days:
E. coli, GBS, Listeria

Ampicilin + Cefotaxime or Gentamicin

> 28 days:
N. meningitidis
S. pneumonia

Ceftriaxone or Cefotaxime +/- Vancomycin (if meningeal involvement is suspected)

Question 17

Criteria to recommend atb prophylaxis and tube placement for otitis media

Answer 17

> 3 episodes in 6 months
4 in 12 months

Patients with cranial-facial deformities or high risk for speech/hearing disorders

Question 18

When do you order these studies for hypercortisolism?

MRI of the head

CT of the chest

CT/MRI abdomen

Inferior petrosal sinus sampling

Answer 18

MRI of the head: elevated HCTH

CT of the chest: Looking for ectopic sources of HCTH

CT/MRI abdomen: Low HCTH, maybe adrenal origin

Inferior petrosal sinus sampling: trying to locate the source of HCTH

Question 19

Etiology of immune thrombocytopenia

Answer 19

Antibodies against platelets

Usually precipitated by a viral infection

Question 20

Laboratory findings in immune thrombocytopenia

Answer 20

Platelets <100,000
Few platelets (normal or bigger) on peripheral smear

(Isolated thrombocytopenia)