Step3 46

Question 1

Criteria for medical management of ectopic pregnancy

Answer 1

B-hCG <5000

Size: <3.5 cm

Stable

Non-fetal cardiac activity

Question 2

Approach to untreated hypothyroidism before surgery

Answer 2

Is surgery urgent?
Yes: Perform surgery unless severe (myxedema coma, other server symptoms) , then start treatment

No: treat hypothyroidism before

Remember: Patients with CAD or elderly, need to be started on a lower dose

Question 3

Localize cord lesions

Absent cremasteric reflex and hip flexion

Answer 3

L1-L2

Question 4

Localize cord lesions

Foot dorsiflexion and plantar flexion

Answer 4

L5-S2

Question 5

Localize cord lesions

Absence of anal sphincter tone

Answer 5

S2-S4

Question 6

Acute sickle cell hepatic crisis

Answer 6

Looks like cholecystitis but also presents with ane anemia

Vaso-occlusive crisis become more common in pregnancy

Question 7

Management of Gallstone pancreatitis

Answer 7

Regular management + cholecystectomy within 7 days of clinical improvement for patients with mild/moderate disease.

Check for stones on the biliary system:
Intraoperative for patients with low risk
CPRE: for patients with evidence of obstructive gallstone

Severe pancreatitis: wait until the resolution of symptoms

Question 8

Variceal hemorrhage algorithm

Answer 8

pg. 172

Question 9

How to assess the respiratory status of a patient with Guillain-barre

Answer 9

Vital capacity, tidal volume

Negative respiratory force

Question 10

Riluzole is the treatment for what?

Answer 10

ALS

Question 11

Treatment of Guillian-Barre

Answer 11

IVIG or Plasma exchange if:
Patient is immobile
and
Within 4 weeks of symptoms onset

This reduces the need for mechanical ventilation

Question 12

Treatment of Multiple sclerosis

Answer 12

Acute vs. Chronic: steroids vs. beta interferon

Depression: SSRI, SNRI
Spasticity: PT, massage, baclofen
Neuropathic pain: gabapentin, duloxetine
Urge urinary incontinance:
Fatigue: amantadine, stimulants

Question 13

Gillian-Barre evolution and prognosis

Answer 13

Weakness: 2 weeks
Plateau:2-4 weeks
Recovery: lasts for months

By 1 year, 65% have recovered.

If symptoms were severe or trigger was an infection with Campylobacter, prognosis is worse

Question 14

SAAG and conditions associated with each

Answer 14

> 1.1 (Portal hypertension)
CHF
Alcoholic hepatitis
Cirrhosis

<1.1 (No portal hypertension)
Cancer
Nephrotic syndrome
TB
Pancreatitis
Serositis

Question 15

Management of peripheral artery disease

Answer 15

1A: Aspirin, statin, smoking cessation
1B: exercise program. (30-35 min, 3x/w for 3m until patter establish, then progression)

2: Cilostazol > pentoxiphilin

3: Surgery
Stent or bypass

Question 16

REMEMBER

Patients taking antipsychotics

Answer 16

Can develop extrapyramidal symptoms