Posted on April 30, 2012 by Archer USMLE Reviews
412) An 78 year old man with history of dementia is evaluated in your office for three episodes of “syncope” over the past two months. He lives with his daughter at home. She reports that he fell to the floor and lost consciousness in the morning after getting up from his bed and the episodes would last for few minutes but he would return to his usual baseline mental status after the event. There is no history of chest pain or shortness of breath. She has seen him become increasingly “stiff” over the years and he has had worsening of tremors in his hands. When he writes, the letters are very small and difficult to decipher. He has been taking Donepezil and Memantine for Alzheimer’s for about 2 years. On examination, his pulse is 90/min, Blood Pressure 110/60 mm Hg. He has Bradykinesia and Pill rolling tremor in his hands. Cardiac examination is normal with out any murmurs. Laboratory investigations revealed a normal hemoglobin, blood glucose and electrolytes. An electrocardiogram is within normal limits. Which of the following is indicated next?
A) Orthostatic Vitals
B) 24 hour Holter-Monitoring
C) Discontinue Memantine and Donepezil
D) CT Scan of the Head
E) Tilt-Table Test
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Posted on April 30, 2012 by Archer USMLE Reviews
411) An 88 year old man with history of moderate dementia is evaluated in your office for recurrent episodes of “syncope” over the past few months. There is no history of any chest pain or shortness of breath for a similar complaint. Nursing home staff reports that lately, he has been noted to be more confused than usual on several occasions and becomes very drowsy. He was sent to the Emergency Room twice last month for the same issue. There is no history of complete loss of consciousness. As per his nursing home chart, his other medical issues include poorly-controlled Osteoarthritis pain, “Sun-Downing” and Insomnia. On examination, his vitals are stable. He is currently awake. There are no focal neurological deficits. Cardiac examination is normal with out any murmurs. Laboratory investigations revealed a normal hemoglobin, blood glucose and electrolytes. An electrocardiogram is within normal limits. Which of the following is indicated next?
A) Orthostatic Vitals
B) 24 hour Holter-Monitoring
C) Electroencephalogram
D) Review of his medications
E) Tilt-Table Test
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Posted on April 30, 2012 by Archer USMLE Reviews
410) A 30 year old man presents to the emergency room after having had a syncopal episode. His girl friend reports he suddenly collapsed to the floor and lost consciousness for few minutes. There was no evidence of tonic clonic movements. After regaining his consciousness, he was completely alert and awake. He reports he has had sweating and nausea prior to the episode. He has had about 2 to 3 such episodes per year for past several years. He was admitted for similar episodes in the past and telemetry monitoring was uneventful. He denied any chest pain, shortness of breath or palpitations prior to the episode. He has no other significant medical problems. On examination, his vitals are stable. He is completely awake and oriented. There are no focal neurological deficits. Cardiac examination is normal with out any murmurs. Laboratory investigations revealed a normal hemoglobin, blood glucose and electrolytes. An electrocardiogram is within normal limits. Which of the following is indicated next?
A) Holter Monitoring
B) CT scan of the Head
C) Tilt-Table testing
D) Carotid Doppler
E) Electrophysiology Study
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer cardiology, USMLE STEP 3 CARDIOLOGY | 10 Comments »
Posted on April 29, 2012 by Archer USMLE Reviews
409) A 64 year old post-menopausal woman with history of hypertension and coronary artery disease presents to the Emergency Room with severe left sided chest pain that started 1 hour ago at rest. The pain radiates to her left shoulder and her jaw. Her history is significant for per-cutaneous coronary intervention to the left anterior coronary artery and placement of drug-eluting stent 9 months ago. Her medications include aspirin, Clopidogrel, Metoprolol and Lisinopril. One week ago, she had a dental extraction procedure and had discontinued Aspirin and Clopidogel prior to the procedure. She was scared of bleeding and has not resumed these medications yet. A chest X-ray is normal. An electrocardiogram reveals 5mm ST segment elevations in the anterior leads and reciprocal depressions in the inferior leads. Which of the following is the most appropriate explanation of this patient’s presentation?
A) Pericarditis
B) Re-Stenosis within the stent
C) Stent Thrombosis
D) Rupture of a new plaque in anterior coronary artery
E) Stenosis from progressive atherosclerosis of anterior coronary artery
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Posted on April 29, 2012 by Archer USMLE Reviews
408) A 52 year old post-menopausal woman with history of hypertension, coronary artery disease and early stage breast cancer is evaluated in your office prior to breast reconstruction surgery. She was diagnosed with left breast invasive ductal carcinoma one year ago and has undergone left modified radical mastectomy followed by chemotherapy. Her history is significant for cardiac catheterization 3 months ago with coronary stent placement. Medications include Aspirin, Clopidogrel, metoprolol, lisinopril and anastrozole. She is physically active and walks about 3 blocks per day with out any chest pain or shortness of breath. Physical examination is unremarkable except fore evidence of left mastectomy. A resting electrocardiogram, chest x-ray , complete blood count and electrolytes are normal. Which of the following is the most appropriate recommendation at this time?
A) Schedule exercise stress test and if normal, clear for surgery
B) Discontinue Clopidogrel and clear for surgery
C) Obtain 2D echo and if normal, clear for surgery
D) Admit, discontinue clopidogrel, start heparin and then, proceed with surgery
E) Recommend delaying surgery at least another 8 months
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Posted on April 28, 2012 by Archer USMLE Reviews
407) A 62 year old woman with history of bilateral knee osteoarthritis presents with complaints of progressively increasing pain of her left knee for the past one week. Her knee hurts more on standing and walking down the stairs. She denies any fever or trauma. She has no other significant medical problems. She takes acetaminophen for her osteoarthritis pain. for urinary problems. On examination, she is afebrile. Left knee is normal with out any swelling, erythema or warmth. There is severe tenderness on the medial aspect of the left leg approximately two inches below her left knee joint. When passively stretched, she has full range of motion with out any pain. Which of the following is the most likely explanation of this patient’s presentation?
A) Anserine Bursitis
B) Pre-Patellar bursitis
C) Medial Meniscus injury
D) Medial Collateral ligament injury
E) Trochanteric bursitis
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Posted on April 27, 2012 by Archer USMLE Reviews
406) A 65 year old woman is evaluated in your office for urinary problems. She reports involuntary loss of urine upon coughing almost daily for few months. She presented with similar problems 6 months ago and has been advised pelvic floor exercises and lifestyle modifications . These measures have not improved her symptoms. She denies any nocturia, frequency, hesitancy or urgency symptoms. She has no other medical problems On examination, vitals are stable. Pelvic examination reveals changes consistent with vaginal atrophy. When she is asked to cough in lithotomy position, there is large urinary leakage about 30 seconds after coughing which was difficult for her to stop. Complete blood count, Plasma glucose, Serum electrolytes and Urinalysis are within normal limits. Which of the following is the most appropriate next step?
A) Start Vaginal Estrogen
B) Recommend Vaginal Pessary
C) Obtain Urodynamic Studies
D) Mid-Urethral Sling placement
E) Trial of Alpha-Adrenergic Agonists
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Posted on April 27, 2012 by Archer USMLE Reviews
405) A 80 year old woman with advanced dementia is sent to your office for evaluation of a vaginal ulcer. The patient has a history of Stage III uterine prolapse. She had been fitted with a pessary for control of her symptoms about 6 months ago. She has no history of fever or chills. On examination, she is afebrile, blood pressure is 130/80. Pelvic examination revealed complete procidentia with impacted pessary and a 2 x 2 cm ulcer without any exudate. An attempt to remove the pessary is unsuccessful. Biopsies of the ulcer have been obtained. Which of the following is the appropriate initial management?
A) Vaginal Estrogen
B) Oral Antibiotics
C) Surgical removal of Pessary
D) Hysterectomy
E) Admit for parenteral antibiotics
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Posted on April 27, 2012 by Archer USMLE Reviews
404) A 70 year old woman in excellent physical health presents to your office because she has noticed a mass falling out of her vagina for the past one year which is progressively worse. For the past six months, she has difficulty voiding. During voiding, she has to constantly change her position and sometimes, needs to push the mass inside in order to urinate. Lately, voiding has become even more difficult despite all these measures. She has problems with defecation which she describes as having to apply pressure on her vagina in order to completely evacuate her bowel. . She denies any fever or burning urination. She has normal bowel movements and has no problems with defecation. She is embarrassed to have sex anymore after having had urinary incontinence during sex. She blames herself for neglecting the mass without seeking medical attention for such a long time. Otherwise, she is in excellent physical health and has no other co-morbidity. She is willing to consider any option including surgery if feasible. On examination, vitals are stable. Pelvic examination revealed a total prolapse with total eversion of the vagina which was oedematous with marked ulceration in the dependent portion of the mass. Which of the following is the appropriate initial management?
A) Obtain Urodynamic studies
B) Biopsy
C) Admit for daily Vaginal packing with estrogen
D) Vaginal estrogen and Pessary
E) Vaginal Hysterectomy
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Posted on April 27, 2012 by Archer USMLE Reviews
403) A 68 year old woman with history of Diabetes mellitus is evaluated in your office during routine follow-up visit. She reports that lately she has been experiencing pressure and bulge in her vaginal area and has a sensation of something falling out of her vagina. She denies any fever, burning, frequency or urgency of urination. She has normal bowel movements and has no problems with defecation. She is sexually active with her husband and enjoys it. She denies any urinary incontinence even upon coughing or sneezing. On examination, vitals are stable. Pelvic examination reveals changes consistent with vaginal atrophy and a Grade 1 Cystocele. Which of the following is the most appropriate recommendation?
A) Screen for latent Stress incontinence
B) Observation
C) Pessary
D) Surgery
E) Raloxifene
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Filed under: Uncategorized, USMLE Test Prep | Tagged: aRCHER GERIATRICS, Archer Gynecology, usmle step 3 geriatrics, usmle step 3 gynecology | 8 Comments »
Posted on April 27, 2012 by Archer USMLE Reviews
402) A 68 year old woman with history of Diabetes mellitus is evaluated in your office during routine follow-up visit. She reports that lately she has been experiencing pressure and bulge in her vaginal area and has a sensation of something falling out of her vagina. She denies any fever, burning, frequency or urgency of urination. She has normal bowel movements and has no problems with defecation. On examination, vitals are stable. Pelvic examination reveals changes consistent with vaginal atrophy and presence of moderate cystocele. She has marked urinary leakage when she was asked to cough in lithotomy position. Complete blood count, Plasma glucose, Serum electrolytes and Urinalysis are within normal limits. She requests information regarding surgery for vaginal prolapse. Which of the following is the most appropriate statement regarding surgery for her cystocele?
A) Surgery may worsen her Incontinence
B) Surgery may increase urinary obstruction
C) If she were to undergo prolapse surgery, no additional incontinence treatment is needed
D) Surgery may cause defecation problems
E) Surgery is optimal option for her at this time.
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Posted on April 27, 2012 by Archer USMLE Reviews
401) A 78 year old woman presents for annual health-maintenance examination. Her medical problems include Hypertension, Diabetes, Coronary artery disease and Chronic obstructive pulmonary disease. During review of systems, she reports that she has been experiencing involuntary loss of urine upon coughing almost daily for few months. She has been too embarrassed to disclose it and so, has not mentioned it during previous visits. However, the problem has been limiting her social activities and she really would like to “do something about it”. She denies any nocturia, frequency, hesitancy or urgency symptoms. Her medications include albuterol, ipratropium, glyburide, clopidogrel and losartan. She had a myocardial infarction followed by coronary stent placement six months ago. On examination, vitals are stable. Pelvic examination reveals changes consistent with vaginal atrophy and presence of moderate cystocele. She has marked urinary leakage when she was asked to cough in lithotomy position. She has tried pelvic floor exercises and scheduled-voiding for past several weeks and has cut down on her coffee consumption however, these measures have not helped her much. Complete blood count, Plasma glucose, Serum electrolytes and Urinalysis are within normal limits. Which of the following is the most appropriate recommendation for this patient?
A) Check Post-Void Residual volume
B) Vaginal Estrogen
C) Pessary
D) Mid-Urethral Sling placement
E) Oxybutynin
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Filed under: Uncategorized, USMLE Test Prep | Tagged: aRCHER GERIATRICS, Archer Gynecology, usmle step 3 geriatrics, usmle step 3 gynecology | 16 Comments »
Posted on April 23, 2012 by Archer USMLE Reviews
400) A 28 year old woman with history of depression is brought to the emergency room by her friend after she purposefully took large number of acetaminophen tablets. Her friend can not estimate how many tablets she took but she says there were at least fifty extra strength tablets in the bottle and the bottle was found empty when she went to visit her. She last spoke with her 18 hours ago over the phone when she sounded very depressed. So, her friend reports she probably must have ingested these tablets at least 12 to 18 hrs ago. On examination, she is drowsy but arousable. Her liver function tests are within normal limits and an acetaminophen level is 15µg/ml . Serum electrolytes, creatinine , prothrombin time and INR are within normal limits. Which of the following is the initial step in management
A) Hemo-Dialysis
B) Supportive care with strict monitoring of Liver function, Creatinine and INR
C) Activated Charcoal
D) N-Acetyl Cysteine
E) Consult Liver Transplant expert
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Posted on April 23, 2012 by Archer USMLE Reviews
399) A 65 year old man with history of diabetes mellitus is evaluated in your office during a routine follow-up visit. He does not have any complaints. He uses Glyburide and Metformin for his diabetes and Atorvastatin 80mg/day and Omega-3 Fatty Acids for his dyslipidemia. He is compliant with diet and exercise. His weight has been stable. He does not smoke or consume alcohol. His most recent HgbA1C was 6.0% and a fasting lipid panel a month ago showed Total cholesterol of 125 mg%, LDL-C 70mg%, Triglycerides 100mg% and HDL-C 35mg%. You discuss with him that his lipid panel meets the recommendations with regard to LDL cholesterol and Non-HDL cholesterol goals. However, he insists that he be treated for his low HDL-cholesterol. You offer adding Niacin but after he heard about it’s side effects he refuses it and seeks alternatives. Which of the following is the most appropriate recommendation for him?
A) Change Atorvastatin to Rosuvastatin
B) Add Cholestyramine
C) No further therapy
D) Discontinue Omega-3 Fatty Acids
E) Increase Atorvastatin
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, usmle step 3 preventive medicine | 6 Comments »
Posted on April 23, 2012 by Archer USMLE Reviews
398) A 45 year old man with well-controlled diabetes presents to your office with complaints of troublesome flushing of his face and trunk for the past one week. Frequently, the flushing is severe and causes stinging sensations. His past medical history is significant for dyslipidemia with an isolated low HDL cholesterol for which he was started on Niacin one week ago. On examination, his blood pressure is 120/88 mm Hg. His face and trunk have flushed appearance. Reminder of physical examination is unremarkable. Which of the following is the most appropriate recommendation for him at this time?
A) Discontinue Niacin
B) Take Niacin with food
C) Diphenhydramine as needed
D) Take Aspirin before Niacin
E) Re-assure symptoms will bate in one week
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, usmle step 3 preventive medicine | 9 Comments »
Posted on April 23, 2012 by Archer USMLE Reviews
397) A 65 year old man with past medical history of Hypertension presents to your office to discuss his lipid profile results which were obtained two weeks ago. He takes Losartan for his high blood pressure and is compliant with 2gm sodium diet. He smoked about 1 pack per day for the past 35 years. On examination, his blood pressure is 140/88 mm Hg. Reminder of physical examination is unremarkable. His fasting lipid panel reveals Total cholesterol 220 mg%, LDL-C 150mg%, Triglycerides 150mg%, HDL-C 40mg%. Which of the following is the most appropriate initial step?
A) Diet and lifestyle modifications alone
B) Diet, Lifestyle modification and Statin therapy
C) No Intervention
D) Omega 3 Fatty Acids
E) Repeat Lipid Panel in 3 months
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, usmle step 3 preventive medicine | 7 Comments »
Posted on April 23, 2012 by Archer USMLE Reviews
396) A 45 year old woman presents to your office for annual physical examination. She reports that she has had a fasting lipid panel done 6 months ago and her HDL – C was low at 25 mg%. She requests to be treated for this. She started healthy diet rich in fruits and vegetables. She used to smoke about 4 cigarettes/ day earlier but quit smoking after she came to know about her lipid results. She occasionally uses red wine in moderate amounts. She has also started aerobic exercises at least 3 days per week. Physical examination is unremarkable. A repeat lipid panel reveals Total cholesterol 128 mg%, LDL-C 80mg%, Triglycerides 100mg%, HDL-C 28mg%. Which of the following is the most appropriate next step?
A) Fenofibrate
B) Niacin
C) Ezetemibe
D) Atorvastatin
E) Omega-3-Fatty Acids
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, usmle step 3 preventive medicine | 12 Comments »
Posted on April 23, 2012 by Archer USMLE Reviews
395) A 65 year old man with history of Hypertension, Peripheral Artery disease and Dyslipidemia is seen during a follow-up office visit. His medications include Atorvastatin 80mg, Enalapril 20mg and Clopidogrel 75 mg/ day. He does not have any new complaints and tolerating his medications well. He still smokes about 1 pack per day despite repeated counselling however, he has been strictly compliant with low-fat diet. On examination, his vitals are stable. Lower extremity dorsalis pedis are slightly diminished bilaterally. Reminder of the examination is unremarkable. A fasting lipid profile obtained a week ago showed : Total Cholesterol : 205 mg% LDL cholesterol (calculated) 90mg%, HDL – cholesterol 45 mg%, Triglycerides 350mg%. Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limits. Which of the following is the most appropriate next step?
A) Add Fenofibrate
B) Add Niacin
C) Add Cholestyramine
D) Change Atorvastatin to Rosuvastatin
E) Increase the dose of Atorvastatin
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, Archer cardiology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, USMLE STEP 3 CARDIOLOGY, usmle step 3 preventive medicine | 5 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
394) A 36 year old woman with Type I diabetes mellitus presents to your office because she just learned that she is pregnant. She is excited and seeks your advise. Her home blood sugars are well controlled on a basal-bolus regimen of Glargine and Lispro insulin. Her other medications include Atorvastatin and aspirin. Her most recent HgbA1C was 6.0%. Her records also reveal that her most recent fasting lipid profile met the therapeutic goals at LDL of 80mg% and Non-HDL cholesterol of 100mg%. On examination, she is comfortable. Vitals are stable and reminder of the examination is unremarkable. An office based serum pregnancy test is positive. A repeat fasting lipid profile reveals Total Cholesterol : 250 mg% LDL cholesterol (calculated) 140mg%, HDL – cholesterol 40 mg%, Triglycerides 350mg%. Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limitsWhich of the following is the most appropriate next step?
A) Therapeutic Abortion
B) Add Niacin to her Lipid Regimen
C) Discontinue Statin and Start Niacin
D) Discontinue Statin and advise Diet modification alone
E) Increase Atorvastatin
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Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, Archer cardiology, archer ostetrics and gynecology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, hyperlipidemia in pregnancy, USMLE STEP 3 CARDIOLOGY, usmle step 3 gynecology and obstetrics, usmle step 3 preventive medicine | 5 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
393) A 36 year old homeless man is evaluated in the Emergency Room for intermittent fever, cough, night sweats and weight-losss. He also reports having chronic cough with progressively increasing bloody expectoration for the past 1 month. He has lost about 10lbs weight over the past 3 months. He smokes 1 pack per day and has a history of intravenos drug abuse. On examination, he is cachectic. He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 120/80 mm Hg, Oxygen saturation 98%. Reminder of the physical examination is unremarkable. Which of the following is the most appropriate initial step in managing this patient?
A) Sputum samples for Acid Fast Bacilli
B) Start Multi-drug therapy for Tuberculosis
C) Obtain a Chest X-ray
D) Tuberculin Skin test
E) Air-Borne Isolation
F) Test for HIV
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Filed under: Uncategorized, USMLE Test Prep | Tagged: APPROACH TO SUSPECTED TUBERCULOSIS, Archer Infectious Diseases, USMLE STEP 3 INFECTIOUS DISEASES | 9 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
392) A 28 year old woman presents with a history of amenorrhea of about 6 month duration. She does not have any breast discharge, visual deficits or headaches. Her home pregnancy test was negative a week ago. Her past medical history is significant for three missed abortions for which she underwent dilatation and curettage. On examination, her vitals are stable. Body mass index is about 22 . Breast examination is normal with out any discharge. Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit. A trial of medroxyprogesterone and a later trial of estrogen-progesterone combination fails to induce bleeding. Which of the following is the most appropriate next step?
A) Anti-phospholipid Antibodies
B) Hysteroscopy
C) Dehydro-epiandrosterone level
D) Pituitary MRI
E) Ultrasound of Ovaries
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Filed under: Uncategorized, USMLE Test Prep | Tagged: archer obstetrics, obgyn, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 8 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
391) A 26 year old woman is seen in the outpatient clinic for amenorrhea of about 6 months. The patient ah d been on oral contraceptives but discontinued 6 months ago. She reports having regular menstrual cycles prior to starting oral contraceptives. She denies any excessive stress or physical activity. She does not have any breast discharge, visual deficits or headaches. presents to your office with complaints of change in her menstrual cycles. On examination, her vitals are stable. Body mass index is about 28 . Breast examination is normal with out any discharge. Pelvic exam is normal. Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit. The patient is started on medroxyprogesterone acetate at 10 mg/ day for 10 days and experiences menstrual bleeding a week after stopping progesterone. This patient is at increased risk for which of the following conditions?
A) Visual Deficits
B) Endometrial Cancer
C) Osteoporosis
D) Pituitary Necrosis
E) Vertebral Compression Fractures
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Filed under: Uncategorized, USMLE Test Prep | Tagged: archer obstetrics, obgyn, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 3 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
390) A 28 year old woman has had amenorrhea for the past 4 months. She reports having regular menstrual cycles prior to these episodes. She is sexually active and a home pregnancy test was negative on two occasions over the last one week. She denies any excessive stress or physical activity. She has had headaches almost daily over the past three months. She denies any visual deficits. Her past medical history is significant for schizophrenia for which she is using risperdal for several years with good control of her disease. On examination, her vitals are stable. Body mass index is about 28 . There is milky discharge on breast examination. Pelvic exam is normal. Serum pregnancy test is negative. A serum prolactin level is 30mcg/ml (5 to 20 mcg/L). A serum Thyroid Stimulating Hormone and Follicle Stimulating Hormone level are within normal limit. An MRI of the brain reveals 10 cm lobulated mass in the anterior skull base. Which of the following is the initial step in evaluating this patient?
A) Repeat Prolactin after Serum Dilution
B) Discontinue Risperdal
C) Trans-Sphenoidal Resection of the Tumor
D) Pituitary Irradiation
E) Bromocriptine
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer endocrinology, archer obstetrics, endocrinology mcqs, endocrinology questions, obgyn, usmle step 3 endocrinology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 24 Comments »
Posted on April 22, 2012 by Archer USMLE Reviews
389) A 26 year old woman is seen in the outpatient clinic for amenorrhea of about 6 months. The patient ah d been on oral contraceptives but discontinued 6 months ago. She reports having regular menstrual cycles prior to starting oral contraceptives. She denies any excessive stress or physical activity. She does not have any breast discharge, visual deficits or headaches. presents to your office with complaints of change in her menstrual cycles. On examination, her vitals are stable. Body mass index is about 28 . Breast examination is normal with out any discharge. Pelvic exam is normal. Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit. The patient is started on medroxyprogesterone acetate at 10 mg/ day for 10 days and experiences menstrual bleeding a week after stopping progesterone. Which of the following explains her amenorrhea?
A) Past use of Oral Contraceptive Pills
B) Uterine Adhesions
C) Hypothalamic amenorrhea
D) Polycystic Ovarian Syndrome
E) Premature Ovarian Failire
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer endocrinology, archer obstetrics, endocrinology mcqs, endocrinology questions, obgyn, usmle step 3 endocrinology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics | 7 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
388) A 58 year old man with history of severe depression is brought to the emergency room with altered mental status. He has been on treatment with amitryptyline for depression for many months. He is accompanied by his wife who reports that they had re-filled one month supply of amitryptyline a week ago but today she discovered an empty bottle at his bedside. He There is no history of fever, nausea, vomiting or diarrhea. There is no evidence of any witnessed seizure. On examination, he is disoriented and lethargic. He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 120/80 mm Hg, Oxygen saturation 98%. He does not respond to verbal commands. Gag reflex is present. Respiratory examination is normal with out any wheezing, rhonchi or crepitations. Cardiac examination and abdominal exam is benign. Intravenous Naloxone and Thiamine were administered in the field without any response. An electrocardiogram is normal. Serum electrolytes and complete blood count, finger stick glucose and arterial blood gases are within normal limits. The patient is intubated and is placed on ventilator. Which of the following is the most appropriate next step?
A) Activated Charcoal
B) Procainamide
C) Sodium Biacrbonate
D) Lidocaine
E) Amiodarone
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Filed under: Uncategorized, USMLE Test Prep | Tagged: archer poisoning questions, drug overdose questions, poisoning, usmle step 3 poisoning questions | 7 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
387) A 56 year old man with history of depression and hypertension is brought to the Emergency Room by his sister for altered mental status. There is no history of fever, nausea, vomiting or diarrhea. There is no evidence of any witnessed seizure. She is not aware of what medications he takes. On examination, he is disoriented and lethargic. He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 80/40 mm Hg, Oxygen saturation 98%. He does not respond to verbal commands. Gag reflex is present. Respiratory examination si normal with out any wheezing, rhonchi or crepitations. Cardiac examination and abdominal exam is benign. Intravenous Naloxone and Thiamine were administered in the field without any response. An electrocardiogram is normal. Serum electrolytes and complete blood count, finger stick glucose are within normal limits. Arterial blood gases does not show any acidemia. A urine drug screen reveals:
Cocaine - Negative
Amphetamines – Negatives
Benzodiazepenes – Positive
Opiates – Negative
Cannabis – Negative
Tricyclic Anti-Depressants - positive
A suction of his airway and central line are placed and he is started on intravenous fluids. His systolic blood pressure remains in 70 to 80 mm Hg range
Which of the following is the most appropriate next step?
A) Activated Charcoal
B) Intravenous Flumazenil
C) Serum Alkalinization
D) Start Norepinephrine
E) Intravenous Lidocaine
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer cardiology, archer poisoning questions, drug overdose questions, poisoning, USMLE STEP 3 CARDIOLOGY, usmle step 3 poisoning questions | 18 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
386) A 54 year old man presents to the emergency room with dizziness and intermittent palpitations for the past 12 hours. He denies any syncopal episodes or headache or seizures. He has no significant cardiac history. He was seen in the outpatient clinic one week ago for pneumonia and was started on Moxifloxacin. His other medical problems include hypertension for which he is on enalapril and Gastro-esophageal reflux disease for which he takes esomoprazole. Physical examination reveals regular heart sounds and no murmurs. Complete Blood Count and Serum electrolytes are within normal limits. An electrocardiogram is obtained and is shown below:
Which of the following is the most appropriate action at this time?
A) Intravenous Magnesium sulfate
B) Discontinue Moxifloxacin
C) Discontinue Esomoprazole
D) Transvenous Pacing
E) Intravenous Isoproterenol
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer cardiology, USMLE STEP 3 CARDIOLOGY | 10 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
385) A 74 year old man with advanced dementia is sent from nursing for evaluation of umbilical hernia. He is accompanied by his sister who thought that the bulge looked ” ugly” and demanded that he be evaluated for surgery. The patient has been nursing home bound for the past four years. There is no history of nausea or vomiting. When fed, he eats normally. The patient is not oriented and is unable to give further history. He does not have living will or a power of attorney. On examination, his vitals are stable. He appears comfortable. Abdominal examination showed a palpable bulge in the umbilical area which is reducible. There is no erythema and the patient winces when pressure is applied. There is no rigidity. When tried to explain him about possible surgery, the patient does not comprehend. He is not oriented to place, person or time. Which of the following is the most appropriate action at this time?
A) Do not consent for surgery
B) Obtain Psychiatry evaluation for Capacity assessment
C) Re-Evaluate his competence to make decisions
D) Consent him for surgery
E) Obtain Consent from his sister
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Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER ETHICS, usmle ethics, usmle step 3 ethics | 8 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
384) A 55 year old airline pilot presents for a follow-up visit for hypertension. He was diagnosed with hypertension a year ago and has been on treatment with hydrochlorthiazide and lisinopril. He denies any chest pain, palpitations or shortness of breath on exertion. He has no other significant health issues. His Hemoglobin a1C about 6 months ago was 5.0% . A lipid profile obtained 3 months ago showed a total chlesterol of 270mg% with HDL cholesterol of 34mg%. He smokes about 1 pack per day but denies any drug or alcohol abuse. There is no family history of Diabetes or coronary artery disease or abdominal aorta aneurysm. On examination, his blood pressure is 138/74. Cardiac examination shows regular heart sound with no S3 gallop or S4. There are no audible murmurs. Abdominal examination is benign and there are no audible bruits. A complete blood count, comprehensive metabolic panel and urinalysis are unremarkable. A resting electrocardiogram shows changes consistent with left ventricular hypertrophy. He had a colonoscopy five years ago which was normal. Which of the following is indicated at this time?
A) No additional Tests
B) Exercise Stress Test
C) Cardiac catheterization
D) Abdominal Ultrasound for Aortic aneurysm
E) Fecal Occult Blood Testing
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer cardiology, archer general internal medicine, archer preventive medicine, USMLE STEP 3 CARDIOLOGY, usmle step 3 preventive medicine | 8 Comments »
Posted on April 21, 2012 by Archer USMLE Reviews
383) A 38 year old african-american male nurse is evaluated in your office because his blood pressure was found to be elevated when the doctor Employee Health Center checked his blood pressure. He was checked in the Employee Health 3 months ago and at that time, his blood pressure was 146/94 mm Hg and a repeat reading by the same doctor was 148/92 mm Hg a month ago. He checked his blood pressure at home two times at his home and it was ranging between 120/76 to 124/82. He does not trust this doctor at his work place so, he decided to come and visit you. He denies any dizziness, chest pain, palpitations or shortness of breath. He does not smoke or does not drink alcohol. Several members in family have history of Hypertension. On examination, his blood pressure is 150/94. His Body Mass Index is 26kg/m2. Cardiac examination shows regular heart sounds. There are no audible murmurs. An electrocardiogram reveals positive voltage criteria for left ventricular hypertrophy. A subsequent 2D-Echo reveals left ventricular hypertrophy with good ejection fraction at 60% and no valvular problems. Serum creatinine is 1.0mg% and Urinalysis is normal. A lipid profile has been ordered. Which of the following is the most appropriate investigation to be ordered next?
A) Exercise Stress Test
B) Ambulatory Blood Pressure Monitoring
C) Hemoglobin A1C
D) Plasma Metanephrines
E) Captopril Renal Scan
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Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer cardiology, archer preventive medicine, USMLE STEP 3 CARDIOLOGY, usmle step 3 preventive medicine | 5 Comments »
