Step3 49

Question 1

Types of prevention

Answer 1

eg. Prevention of MI

Primordial: even before risks factors appear (diet and exercise habits during childhood)

Primary: before condition occurs. Give medication to a patient with a high risk for CAD

Secondary: prevent irreversible damage where the condition already started to appear. Give mediations to a patient with angina (before MI)

Tertiary: prevent further complications. Cardiac rehabilitation, revascularization

Quaternary: at a systemic level to avoid unnecessary procedures. Eg. electronic medical record to avoid repeating a medical test

Question 2

Common factors associated with the request for euthanasia

Answer 2

Fear of losing independence

Fear of suffering in the future

Question 3

Main clinical findings in an esophageal perforation that make Mallory-Weiss less likely

Diagnosis and treatment of each

Answer 3

Severe chest pain is present in perforation secondary to gastric secretions dump into the mediastinum
Pleural effusion usually left
Fever

Perforation
Esofagography or CT with water-soluble contrast
PPIs and antibiotics

Mallory-Weiss
Endoscopy
PPIs

Question 4

Long term risk for patients with IVC filters

Answer 4

Recurrent DVT

Filters stop clots from getting to the pulmonary vascular system but do not prevent clot formation

Question 5

Congenital adrenal hyperplasia

Answer 5

Deficiency
Labs
Physical presentation
Substrate elevated?

Question 6

Medical treatment for 21 hydroxylase deficiency in Congenital adrenal hyperplasia

Answer 6

Hydrocortisone (glucocorticoid)

Fludrocortisone (mineralocorticoid)

Question 7

Approach to renal stones

Answer 7

Pain control
Fluids (regular, not need to do it aggressively)

<5mm usually pass alone

<10:
Add tamsulosin for 4 weeks. If symptoms are controlled, discharge home
Repeat imaging to confirm

> 10:
consult urology

ATB if infection

Question 8

Workup for reversible causes of cognitive impairment

Answer 8

CBC, CMP, TSH, B12

For patients with risk factors
Alcoholic: folate
Risk sexual activity: syphilis
Nephrotic syndrome: vitamin D
Lyme

Question 9

Main differences between aspiration pneumonia and pneumonitis

Answer 9

Pneumonitis symptoms occur 2-5 hrs after aspiration. Patients usually present with AMS and different range of pulmonary symptoms

Treatment is supportive, no antibiotics are needed

Question 10

Most common cause of acute renal failure in hospitalized patients

Answer 10

Acute tubular necrosis

Dxx from prerenal if there is no improvement in renal function after fluids administration

Question 11

Treatment of Trichomonal infection in a lactating patient

Answer 11

Single-dose of ORAL metronidazole, the vaginal presentation does not clear urethra and anal colonization

Discard breast milk for 24 hrs

(Doxycycline for Chlamydia is contraindicated in lactating patients because it causes teeth discoloration on kids)

Question 12

Presentation of physiologic GERD in children, treatment, and prognosis

Answer 12

Happy spitter, everything is normal

Upright position after feeds
Small frequent meals
Burping during meals

Self-resolve by 12-18 months

Question 13

Rabies vaccine schedule

Answer 13

Pre-exposure: days 0, 7, 21 or 28

Post-exposure:

unvaccinated: day 0 + immunoglobulin, 3, 7, 14
vaccinated: day 0 and 3

Question 14

Laboratory differences between aplastic crisis and splenic sequestration in SCD

Answer 14

Reticulocyte count