Step3 48

Question 1

What will be the easiest way to find the test with the hights PPV or NNV when you are giving a bunch of options

Answer 1

For PPV: look for the test with the highest specifity

Question 2

Rule in or out a disease with a Sensitivity or Specificity

Answer 2

SnNOUT: sensitivity rules out. A negative result on a highly sensitive test: rules out

SpIN: specificity rules in. A positive result on highly specific test: rules in

Question 3

Approach to dysentery

Answer 3

Stool culture, Shiga toxin, fecal leukocyte

CT if suspicious for ischemic colitis

Endoscopy if IBD is suspected

Question 4

Treatment for Urogenital gonorrhea

Answer 4

Ceftriaxone only

Before it was cef + azy.. new guidelines recommend cef only

Question 5

Empiric treatment for Urethritis

Answer 5

Ceftriaxone + doxycycline

Question 6

Treatment for Legionella

Answer 6

Fluoroquinolone or azithromycin

Question 7

Patient with hematuria and eosinophiluria

Answer 7

Think parasitic infection (schistosomiasis) if the patient comes from 3rd world country

Question 8

Management of a pregnant patient with a GBS + culture during 1st trimester`

Answer 8

Treat now: amoxicillin or cephalexin

Culture 1 week after treatment is finished

Prophylactic penicillin during labor

Question 9

Metabolic disorders that cause prolonged QT

Answer 9

Hypothyroidism

Starvation

Low K, Mg, Ca

Question 10

Cardiovascular causes of long QT

Answer 10

Ischemia

AV block

Sinus node dysfunction

Question 11

Other causes of long QT

not medications, metabolic or cardiovascular

Answer 11

Hypothermia

Intracranial disease

HIV

Question 12

Antiarrhythmics causes of long QT

Answer 12

Sotalol, amiodarone, flecainade

Question 13

Pressures in the atria and ventricle in cardiac tamponade

Answer 13

They tend to equalize

Question 14

Solid breast mass evaluation

Answer 14

pg. 385 and 386

Question 15

Patient with 2 months of psychotics symptoms and drug use

Diagnosis?

Answer 15

Discontinue drugs to see if they are the cause of the psychosis

Question 16

Fetal fibronectin

Answer 16

If positive in a patient <34weeks, it means an increased risk of preterm delivery

Question 17

Presentation of amniotic fluid embolism

Answer 17

Cardiogenic shock

Hypoxemic respiratory failure

CID

Coma or seizures

Question 18

Shoulder pain with passive and active motion

Answer 18

Adhesive capsulitis, usually related to stiffness

Treat with “range of motion” exercises

Question 19

Clinical presentation and management of chronic urticaria

Answer 19

Pruritic, round, serpentiginous plaques
>6 weeks
Individual lesions last <24 hrs
80-90% Idiopathic
50% presents with angioedema

Diagnosis:
Clinical
Lab workup to rule out any other association: CBC, BMP, ESR, LFTs, UA
Skin biopsy if systemic symptoms, rash >24hr

Treat with:
Second generation antihistamine: eg, cetirizine
Avoid aggravating conditions: NSAIDs, heat

Question 20

Treatment of acute vs. chronic urticaria

Answer 20

Acute:
Mild: 2nd gen antihistamine (cetirizine, loratadine)
Moderate: add 1st generation (hidroxixine)
Severe: add oral glucorticoids

Chronic: (>6 months)
Step1: 2nd gen antihistamine (cetirizine, loratadine)

Step2: try any of the following
increase dose
add  1st generation (hydroxyzine)
add leukotriene inhibitor
add oral glucocorticoids

Step3:
Change the medication
Hydroxychloroquine, tacrolimus, omalizumab

Most patients have spontaneous resolution in 2-5 years

Question 21

Diabetes diagnosis

Answer 21

Symptomatic patients with: (only one time)
A1c >6.5
Random or glucose tolerance >200
Fasting >126

Asymptomatic patients with positive tests need to repeat the same test

If there are discrepancies after second test, do a different one

Question 22

Methemoglobinemia

Etiology
Presentation
Treatment

Answer 22

Anestetics: benzocaine,
Dapsone
Nitrates (in infants)

Elevated O2 sat. gap: Pulse oxy is usually around 85%, meanwhile ABG sat is a lot higher (measures O2 but no effective O2)
Cyanosis (10% of hemoglobin)
Hypoxia (20% of hemoglobin)
AMS, seizures, deaths (>50%)

Treat with methylene blue

Methemoglobinemia is the treatment for cyanide poisoning

Question 23

Medical futility

Answer 23

Continue treatment that can have no beneficial effect (eg. give dialysis to an uncouncious patient who will die from cancer in the next few days)

It is different from poor prognosis

Question 24

Anticoagulation therapy for patients with aortic mechanical valve replacement

Answer 24

Aspirin AND Warfarin

No risk factors
INR 2-3

Risk factor: a fib., history of thromboembolism or hypercoagulable state, severe LV dysfunction EF<30, mechanical mitral valve
INR 2.5-3.5

Question 25

Age for Tdap vaccine

Answer 25

2,4,6 m
4 years

every 10 years

When the patient has a wound:
If the last dose >10 years ago and the wound is clean
If the last dose was >5 years ago and the wound is dirty
If <3 doses or unknown immunization + IVIG (if dirty)

Question 26

Extraarticular manifestations of Ankylosing spondylitis

Answer 26

Anterior uveitis

Aortic regurge

Pulmonary fibrosis, restrictive lung disease

IgA nephropathy, nephrotic syndrome

Atlantoaxial subluxation: cord compression

Cauda equina

Question 27

Xrays use as control for Ankylosing spondylitis

Answer 27

Lateral cervical

AP spinal

Pelvic: Sacroiliac joint, hip joints

ESR can also be use