Posted on February 8, 2014 by Archer USMLE Reviews
Q448 ) A 78 year old man presents to emergency room with severe pain in his right lower extremity. Pain began after he stumbled and fell on a sidewalk. He does not report pain anywhere else and did not lose consciousness. No tingling or numbness in either extremity. He reports inability to bear weight because it is extremely painful. His past medical history is significant for coronary artery disease and hypertension. He does report about 8lbs weight-loss in the past 1 month. On examination, he is afebrile. There is tenderness in the right thigh area. Laboratory investigations reveal Hemoglobin 10.5gm%, Platelet count 110k/ul, Calcium at 10.4 mg/dl ( N = 9.0 to 10.5 mg/dl) , Serum creatinine 2.0 mg/dl, Total protein 4.5 gm/dl, Albumin 2.0gm/dl and Ferritin 200 ng/ml. Liver function tests including Alkaline phosphatase are within normal limits. Whole body bone scan is negative for any lesions. Serum protein electrophoresis is normal with out any monoclonal spike.
An x-ray of the femur is shown below :
448) Which of the following is most helpful in diagnosing this condition?
B) DEXA scan
C) 24 hour urine electrophoresis
D) Vitamin D level
E) Parathyroid hormone level
449) Which of the following is likely to explain the patient’s findings?
A) Metastatic colon cancer
B) Multiple Myeloma
D) Secondary Hyperparathyroidism
E) Metastatic Prostate cancer
Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer endocrinology, archer general internal medicine, Archer oncology, USMLE STEP 3 ONCOLOGY | 25 Comments »
Posted on October 26, 2013 by Archer USMLE Reviews
447) A 54 year old caucasian man is seen in your office for initial visit examination. He recently moved from Texas to your town and would like to establish care with you. He has no significant past medical problems except for Gastro-Esophageal Reflux Disease for twenty years. He previously suffered hearburn symptoms that were controlled with over the counter ranitidine . Later, his symptoms became refractory and he was started on omeprazole by his previous physician. He currently takes 20 mg of Omeprazole and is very happy that he has been asymptomatic for the past 1 year. He has had colonoscopy 2 years ago and this was normal. His father died of Colon cancer at the age of 70. He does not smoke.
Which of the following is the most appropriate action at this time ?
A) Instruct him to continue Omeprazole and follow up in 1 year.
B) Refer to gastroenterology for Upper Endoscopy
C) 24 hour Esophageal pH monitoring
D) Stool Guaic test and Flexible Sigmoidoscopy
E) Stool test for H.Pylori antigen
Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, archer preventive medicine, USMLE STEP 3 GASTROENEROLOGY, usmle step 3 preventive medicine | 21 Comments »
Posted on October 19, 2013 by Archer USMLE Reviews
446) A 64 year old woman presents to your office with productive cough and fever for the past three days. About two months ago, she was admitted for pneumonia. Past medical history is significant for Rheumatoid arthritis. Her medications include hydroxychloroquine and prednisone. Previously, she was treated with Azathiprine for about 6 years.
On examination, temperature is 101F, blood pressure 120/80 and heart rate of 106/min. Chest examination reveals decreased breath sounds at left lower lobe. No hepatomegaly, spleen tip is palpable. Chest X-Ray reveals left lower lobe consolidation Labs reveal WBC 1000/µl with differential count showing neutrophils of 30% and Hemoglobin 9.9 gm%
Which of the following is the most likely explanation for the patient’s presentation?
A) Hypogammaglobulinemia from Rheumatoid arthritis
B) Marrow suppression by Hydroxychloroquine
C) Marrow toxicity by Azathiprine
D) Myeloproliferative disorder
E) Felty Syndrome
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer general internal medicine, Archer hematology, Archer Rheumatology, Hematology, usmle hematalogy, USMLE step 3 Hematology, USMLE step 3 Rheumatology | 13 Comments »
Posted on June 9, 2013 by Archer USMLE Reviews
445) A 45 year old african-american man presents to the emergency room with altered mental status. His past medical history is significant for skin nodules. One of the nodule was recently biopsied and it revealed non-caseating granuloma. On examination, his oral mucosae are dry. Blood pressure is 90/60 . Skin examination reveals multiple scattered skin nodules about 1 to 2cm in diameter. Chest X-ray reveals bilateral hilar adenopathy. Laboratory Studies reveal
HGB: 11.8 gm%,
Platelets : 300k/µl
He is started on agressive intravenous hydration. In addition to the above measures, you should also proceed with intervention directed to towards which of the following at this time ?
A) Reducing serum phosphorous
B) Reducing serum parathyroid hormone
C) Reducing Blood Calcitrol level
D) Promoting loop diuresis
E) Direct removal of calcium by Hemodialysis
Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER FLUID AND ELECTROLYTES, ARCHER GENERAL MEDICINE, ARCHER NEPHROLOGY, dr.red nephrology lecture, internal medicine board review, usmle step 3 nephrology | 17 Comments »
Posted on May 28, 2013 by Archer USMLE Reviews
444) A 25 year old woman is seen by you today due to an abnormal blood count. Three weeks ago, she volunteered for blood donation and a complete blood count that was drawn at that time showed abnormal values. She has regular menstrual periods with normal flow. Her last menstrual period was one week ago. Her previous blood count was done several years ago and she is unaware of being told they were abnormal. A complete blood count is as follows :
HGB: 12.1 gm%
MCV 84 fl
Platelets : 800k/µl ( Normal 140k to 340k/ul)
Differential count : Neutrophils : 64% Lymphocytes 30% Monocytes 4%
Which of the following is the most important next step?
A) Obtain Bone Marrow Biopsy
B) Order Transferrin Saturation
C) Obtain Jak-2 Mutation Analysis
D) Obtain Arterial Blood Gases
E) Start her on Aspirin
Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer hematology, Hematology, usmle hematalogy, USMLE step 3 Hematology | 41 Comments »
Posted on May 28, 2013 by Archer USMLE Reviews
443 ) A 38 year old man is evaluated in your office for a chronic rash on his elbows. He reports this has been worsening over the last 6 months and is intensely itchy. He lost about 8lbs weight in the past 6 months. Review of systems is normal except for 4 to 5 episodes of loose stools every day. Laboratory investigations reveal moderate microcytic anemia. On examination, he is afebrile. There is a vesicular rash on the extensor aspects of his bilateral elbows as shown below:
Which of the following is most helpful in diagnosing this condition?
A) Fecal occult blood testing and Sigmoidoscopy
B) Anti-nuclear antibodies
C) Anti-Endomysial antibodies
D) Small bowel follow through
E) Anti-Sacharomyces Cerviseae antibodies ( ASCA)
Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, Archer hematology, Hematology, USMLE STEP 3 DERMATOLOGY, usmle step 3 dermatology images, USMLE STEP 3 GASTROENEROLOGY, USMLE step 3 Hematology | 12 Comments »
Posted on May 23, 2013 by Archer USMLE Reviews
442 ) A 14 month old toddler is brought to your out-patient clinic by her concerned mother regarding a rash that appeared recently in her ano-genital region. The rash has appeared 3 weeks ago and is persistent. Mother says she tried to use local Zinc Oxide cream but it did not help. There is no history of fever. No vaginal discharge. She is otherwise healthy and reaching all her milestones appropriately. On examination, she is afebrile. There are several papules seen in the ano-genital area as shown below.
Which of the following is the most appropriate next step?
A) Screen for Child Sexual Abuse
B) Local steroid application
C) Reassure that the rash will resolve in few months
D) Refrain the child from Day-care to prevent transmission
E) Local antibiotic application
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer pediatrics, USMLE STEP 3 DERMATOLOGY, usmle step 3 dermatology images, usmle step 3 pediatrics | 25 Comments »