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Step 3 > USMLE Step 3 > Flashcards

USMLE Step 3 Flashcards

1
Q

Patient presents with acute onset le5ft foot pain, diminished pulses, pale cooler foot. Young patient (25) with murmur (apical diastolic murmur). Cause?

A

left atrial myxoma

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2
Q

inheritance of hemophilia A?

A

x linked recessive

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3
Q

Patient has decreased hearing and subq nodules. Fam hx: dad has bilateral deafness tx with surgery. Patient has hypopigmented spots on his back. MRI shows bilateral cerebellopontine angle masses. Cell type causes sx?

A

schwann cells - acoustic neuromas develop from proliferation of schwann cells

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4
Q

Rash with stuck on appearance, how do you diagnose? dx?

A

seborrheic keratosis

benign lesions, clinical exam only

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5
Q

tx of cryptococcal meningitis?

A

ampotericin B and flucytosine, if worsening mental status consider repeat LPs

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6
Q

HIV patient with lesions. Described as multiple small papules with central umbilication all over body and some have central necrosis. Dx?

A

cutaneous cryptococcosis

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7
Q

Side effect of TURP for resection of BPH?

A

dry ejaculate

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8
Q

what factors do you use to monitor lupus nephritis?

A

serum complement or anti ds DNA levels

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9
Q

trigger for hemodialysis based on lithium level?

A

greater than 4.0, 2.5-4 with severe neuro sx or AKI, fluids are not working

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10
Q

dx confirmation of urethral diverticulum?

A

MRI of pelvis or TVUS

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11
Q

length of time for tx of TB meningitis?

A

12 months

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12
Q

When are corticosteroids used in patient with HIV and PCP?

A

a-a oxygen gradient > 35, or arterial oxygen tension < 70

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13
Q

HTN agent that causes photosensitivity reactioN?

A

HCTZ

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14
Q

tx of ringworm of thescalp or tinea capitis?

A

oral griseofulvin

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15
Q

dx of patient with polyarticular arthropathy associated with hepatomegaly and diabetes?

A

hereditary hemochromatosis

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16
Q

patient’s with hereditary hemochromatosis are at increased risk for?

A

hepatocellular carcinoma

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17
Q

tx of seborrheic dermatitis?

A

selenium sulfide, ketoconazole

steroids

topical calcineurin inhibitors

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18
Q

best diagnostic test for lumbar spinal stenosis?

A

MRI of the spine

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19
Q

best next step for patient with unilateral painless scrotal mass?

A

US of the scrotum

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20
Q

most common complication to occur from bacterial conjunctivitis?

A

keratitis

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21
Q

tx of bacterial conjunctivitis in contact wearers? in non contact wearers?

A

cipro drops, erythromycin drops

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22
Q

dx of patient with elevated alk phosph and unexplained pruritus? after LFTs and hepatitis panel and US of RUQ what is the next best test?

A

PBC

antimitochondrial antibody levels

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23
Q

what tx can slow progression of PBC

A

ursodeoxycholic acid

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24
Q

6 contraindications to tPA?

A
  1. presence of active internal bleeding
  2. bleeding diathesis (pltl below 100,000)
  3. hypodensity in > 33% of arterial territory on CT scan
  4. ICH
  5. intracranial surgery in last 3 months
  6. BP > 185/110
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25
Q

tx of one lesion of actinic keratitis? tx of multiple lesions?

A

cryosurgery or surgical excision

5-fluorouracil cream

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26
Q

2 ways to increase oxygenation of patient on vent?

A

increase PEEP

increase FiO2

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27
Q

tx of gout in patient with renal failure and history of GI bleed? first line tx of gout in normal patient?

A

intra-art corticosteroids

indomethacin

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28
Q

concern about thyroid nodule after ultrasound. Next step?

A

get TSH

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29
Q

concern about thyroid nodule if TSH is low. next step?

A

radionucleotide scan

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30
Q

concern about thyroid nodule if TSH is high. next step?

A

FNA

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31
Q

concerned about neuroendocrine tumor based on labs. Next step?

A

MRI of abdomen or CT scan

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32
Q

risk of colon cancer in patient by age of 45 if + colon polyps (FAP)

A

> 95%

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33
Q

3 year old with lump in armpit, fever, dogs and cats at home and attends daycare. next step in management? dx?

A

azithromycin

cat scratch disease

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34
Q

how do you follow disease activity in SLE patients?

A

anti double stranded DNA abd

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35
Q

tx of anti-dsDNA abd in patient with arthralgias, serositis, and cutaneous sx?

A

prednisone and hydroxychloroquine

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36
Q

tx for mixed cryoglobulinemia associated with hep C infection in normal patient. In patient with impaired renal function?

A

alpha-interferon and ribaviron

alpha interferon

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37
Q

risk of scaphoid fx in patient not treated?

A

nonunion and avascular necrosis

38
Q

sx of infant botulism?

A

constipation, lethargy, poor sucking, weak crying, impaired gag reflex

39
Q

difference in lab values of hypoPTH vs pseudohypoPTH?

A

hypoPTH - low ca, high phosph, low PTH

pseudohypoPTH - low ca, high phosph, high PTH

40
Q

young patient with DM, osteoporosis, HTN and hypokalemia…dx?

A

cushing syndrome

41
Q

tx of tinea versicolor?

A

topical azole

42
Q

best diagnostic test for concern for prostate bone mets? for MM bone mets? for mixed?

A

radioisotope bone scan

plain xrays

bone scans/PET

43
Q

tx of pyloric stenosis?

A

correct electrolytes and then pyloromyotomy

44
Q

abx associated with pyloric stenosis?

A

erythromycin

45
Q

best tx for raynaud’s?

A

nifedipine DHP

46
Q

original tx for toxic megacolon? next tx?

A

iv steroids, surgery

47
Q

extraarticular manifestations of ankylosing spondylitits?

A

eyes - acute anterior uveitis

heart - aortic regurg

lungs - restrictive lung disase, pulm fibrosis

kidney - iga nephropathy

48
Q

first screening test of patient with scrotal pain?

A

cremasteric reflex test, then scrotal elevation

49
Q

patient with jerking movements an hour of waking up and generalized tonic-clonic seizures in a 16 year old dx and tx?

A

juvenile myoclonic epilepsy, valproic acid

50
Q

patient with mild c diff tx? patient with moderate c diff? patient with severe c diff?

A

oral metro

oral vanc

iv metro and oral vanc

51
Q

infant of mother with poorly controlled diabetes have what heart disease?

A

hypertrophic septum from glycogen deposits

52
Q

tx of PML from JC virus in HIV positive patients?

A

highly active antiretroviral therapy

53
Q

patient with asthma or CF who develops recurrent fever, malaise, cough with mucoid sputum, wheezing or bronchial obstruction dx? tx?

A

aspergillus

steroids and itraconazol or voriconazole

54
Q

tx of shingles?

A

valacyclovir

55
Q

tx of post herpetic neuralgia?

A

TCAs, gabapentin, pregabalin

56
Q

first line therapy of onychomycosis?

A

terbinafine

57
Q

greatest sensitivity and negative predictive value for diagnosis or exclusion of osteo of the foot? how do you figure out best tx?

A

MRI with contrast

bone biopsy to guide abx

58
Q

single most important factor to determine prognosis of patient with COPD?

59
Q

patient who is immunocompromised who has painless red macules that progress rapidly to bullae and gangrenous ulcers dx? tx?

A

ecthyma gangrenosum from pseudomonoas, IV abx

60
Q

tx of child with ITP?

61
Q

findings of gastric endoscopy in patient with pernicious anemia?

A

absent rugae in fundus and body

62
Q

tx of patients with rosacea and pustules? complications associated with rosacea?

A

topical metronidazole or azelaic acid

ocular manifestations - test 14

63
Q

old people diagnosed with depression are more likely to develop which type of depression?

A

alz or vascular dementia

64
Q

patient’s with celiac disease see what on GI endo?

A

villus atrophy with increased intraepi lymph

65
Q

Patient on carvedilol, hydralazine, isosorbide dinitrate furosemide and spironolactone develops fatigue, night sweats, arthralgia, and pleuritis. Dx?

A

drug induced lupus from hydralazine

66
Q

pt treated for syphilis develops HA and muscle pain with temp. dx? tx?

A

jarisch herxheimer reaction, no prevention/tx

67
Q

most accurate test to confirm complete achilles tendon rupture

A

no plantar flexion on calf squeeze

68
Q

side effects from sodium glucose cotransporter 2 medications which promote glucose reabsorption at the level of the proximal renal tubule

A

vulvovaginal candidiasis, UTIs from glucosuria

69
Q

side effect of TURP in addition to retrograde ejaculation?

A

hyponatremia

70
Q

patient with neutropenia presents with fever, eye pain, decreased visual acuity, white mound like lesion in vitreous. Dx? tx?

A

candida enophthalmitis

vitrectomy and systemic amphotericin B

71
Q

Tx of 8 mm small densely pigmented lesion with irregular borders in peripheral right choroid? Tx of >10 mm lesions?

A

repeat exam in 3 months

radiation

72
Q

what contraindications exist for DTaP vaccine?

A

anaphylaxis within 7 days of admin of vaccine

encephalopathy within 7 days of admin

73
Q

Most common extrarenal manifestation of ADPKD?

A

hepatic cysts

74
Q

most common side effect of saw palmetto? what is it used to treat?

A

increased bleeding risk, BPH

75
Q

most common complication associated with compartment syndrome?

A

acute renal failure

76
Q

Preventive treatment for cluster headache?

77
Q

steps if patient positive for strep agalactiae at 14 weeks?

A

amox now, PCN prophylaxis during labor

78
Q

best test to differentiate pancreatic malignancy from nonmalignant causes?

A

endoscopic ultrasound with aspiration

79
Q

tx of patient with breast CA who has multiple brain mets?

A

whole brain radiation

80
Q

patient’s with tourette’s are most at risk of developing what disease?

A

OCD - beginning of set #10

81
Q

next step in patient who has resistant HTN?

A

renal duplex doppler US or CT/MR angio

82
Q

SLE patients are at increased for what CV effect?

A

premature coronary atherosclerosis

83
Q

how do you calculate odds ratio? meaning?

A

ad/bc

<1 means exposure is associated with lower odds

> 1 exposure is higher odds of outcome

84
Q

tx if patient has erosive joint disease in RA?

A

DMARDS (methotrexate)

85
Q

Patient presents with fatigue, night sweats, arthralgia/arthritis, and pleuritis/pleural effusion who takes carvedilol, hydral, isosorbide, furosemide and spironolactone for heart failure?

A

drug induced lupus by hydralazine

check anti-histone abd

86
Q

specific abd in dermatomyositis?

A

anti-ro, anti-la, anti-sm, anti-RNP, anti-jo1

87
Q

patient with RA does not respond to methotrexate and hydroxychlorine, next step in management?

A

add on another agent, infliximab

88
Q

strongest known risk factor for male breast cancer?

A

klinefelters syndrome

89
Q

calcium elevation, renal insuff, anemia, bone pain should make you think?

A

multiple myeloma

CRAB

90
Q

first line therapy for cluster headaches that last > 2 months?

91
Q

tx of thick plaques of plaque psoriasis?

A

topical fluocinonide

Step 3 (30 decks)

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