WALTER P STEP 3

Question 1

Treatment Neuorpathic (charcot) Arthropathy

Answer 1

Acute: Foot cast to reduce edema & offload weight bearing

Chronic: Orthotic footwear, infection management, surgical realignment

Question 2

Abnormal AFP (ALFA FETO PROTEIN)

Answer 2

1. REPEAT TEST

HIGH AFP –> OBSTETRIC USG
LOW AFP –> KARYOTYPE

Question 3

Cystic lesions of pancreas –> NEXT STEPS

Answer 3

Differentiate between MALIGNANT vs BENIGN –> ENDO USG with ASPIRATION
ENODSCOPIC ULTRASOUND –> BEST for biopsy of lymph nodes and lesions in PANCREAS, LIVER, ADRENAL GLAND, BILE DUCT, PERITONEAL FLUID, and PLEURAL FLUID

BENIGN LESIONS - MONITOR with CT every 3-6 months

Malignant lesions of pancreas SURGERY
- Distal pancreatomy –> tail and body of pancreas
- Pancreaticoduodenotomy –> head of pancreas

Question 4

DNR

Answer 4

Irreversible chronic conditions –> respect wishes
Reversible (acute infection) –> discuss with proxy about his/her knowledge about DNR and reversible conditions

Question 5

Alpha-feto protein levels

Answer 5

Measured at 15-20 weeks of gestation
HIGH –> Neural tube defects
LOW –> Aneuploides (trisomy 18/21)

Question 6

Pediatric pneumonia

Answer 6

Preschool age / focal findings –> S. Pneumoniae –> amoxicillin

Well appearing child / bilateral lung findings –> mycoplasma –> Azithromycin