Step3 40

Question 1

Approach to a TB patient (CCS)

Answer 1

CBC, Creat, BUN UA, Chest Xray, sputum gram, and AFB, ESR, EKG

AFB positive for Bacilli

Admit to ward
LFTs
Uric acid (pyrazinamide increases uric acid)
Ophthalmology consult (before ethambutol)

Initiate treatment
Isoniazid (6m)
Piridoxine(6m)
Rifampin (6m)
Ethambutol (2m)
Pirzainamide (2m)

Continue treatment until 3 consecutive negative AFB
Routinely check LFTs
X-ray after 1 month

Question 2

Empiric treatment for acute prostatitis

Answer 2

For septic patients or vomiting: ampicillin + gentamycin

First aid says: oral TMP-SMX or Fluoroquinolone

Question 3

Treatment for Turner Sd

Answer 3

Growth hormone: if < P5%

Estrogen replacement <13. Strogen/Progesterone therapy after 13

Vitamin D

Calcium

Dietary consult

Question 4

Workup for turner

Answer 4

LH and FSH + Karyotype

After the diagnosis is confirmed, order everything
Echocardiogram
TSH
UA
Lipid panel
Abdominal, Renal, and Pelvic US
Skeletal survey
Hearing test
Psychiatric test: to determine IQ
Gynecologic consult: fertility
Ophthalmology consult: screen for anomalies

Question 5

Primary amenorrhea algorithm

Answer 5

pg 360

Question 6

What do you need to do before performing a Thoracocentesis

Answer 6

Order
PT/PTT
INR
Creat (>6 increases the risk of bleeding)

Question 7

Exudate with low pH

Answer 7

if pH <7.2

EPYEMA

Drain

Question 8

Lab workup and pharmacological treatment for primary hypertension

Answer 8

ROUTINE:
CBC, BMP, UA, lipid panel, EKG

MEDICATIONS:
ARA, ACEI, or CCB (first line)

Elderly or Black people
CCB or diuretics first

Need at least 3 different elevated BP for diagnosis

140-160:
Lifestyle modification first.
Medication after >6 months of fail lifestyle changes

> 160
2 medications right away with lifestyle modifications

Question 9

Ecthyma vs. Pyoderma gangrenosum

Answer 9

Ecthyma:
Immunocompromised patient
Pseudomonas infection
Painless
Systemic symptoms (fever)
Treat with antibiotics

Pyoderma:
Patient with Inflammatory bowel disease
Inflammatory nodule-papule-pustule-ulcer
Painful
No systemic symptoms

Question 10

Wernicke encephalopathy presentation and management

Answer 10

Ataxia

Encephalopathy: confusion, disorientation

Oculomotor dysfunction: lateral rectus palsy

ONLY 10-20% HAVE ALL 3
Give thiamine to those in whom the diagnosis is possible.
Oculomotor symptoms get better in hours, ataxia and encephalopathy may take weeks to months or never get better

Question 11

Korsakoff syndrome

Answer 11

Amnesia (retrograde and anterogade)
Confabulation

Lesion in the mamillary bodies

Cognition, behavior, long term memory are usually preserved

Question 12

Empiric antibiotics for patients in acute chest syndrome

Answer 12

Coverage for: S. pneumonia, H. influenzae, Mycoplasma, Chlamydia pneumonia

Cefuroxime + Azithromycin

Question 13

Treatment of acute gout

Answer 13

1. Kidney disease (acute or chronic), CHF
   NSAID sensitivity, peptic ulcer, taking anticoagulation?
   -no: Indomethacin
   -yes: go to step 2
2. Severe renal or kidney disease, taking another CYP450 inhibitor?
   - no: colchicine
   - yes: go to step 3
3. Is there more than 1 joint involved?
   - no: local steroids (injection) or systemic steroids (oral or IM)
   - yes: systemic steroids (oral or IM)

Question 14

Criteria for imaging in a patient with macrocephaly

Answer 14

Rapidly expanding: >2cm/month in an infant <6months

Neurologic symptoms

Developmental delay