Question of the Week #48

A 55 year old man was recently found to have a 2.0 cm thyroid nodule on palpation during his annual physical. An ultrasound revealed no suspicious features of malignancy. TSH  and free T4 levels were normal. Patient denies any history of neck irradiation, pain, dysphagia or hemoptysis. There is no history of cancer in his family.  The next best step in evaluation of the nodule :

A. Suppressive therapy with levothyroxine


C. Lobectomy with isthmectomy

D. Observation

E. Radio iodine therapy

Question of the week #46 and #47

1. A 55-year-old man presented for a regular follow-up to your office 2 weeks ago at which time a palpable nodule of 1.7 cm was noted in the left thyroid lobe. He denies a history of head and neck irradiation, hoarseness, pain, dysphagia, or hemoptysis. His physical exam is otherwise normal, with no lab abnormalities. Most appropriate next step in management?

A. Ultrasound of thyroid

B. TSH level

C. Fine Needle Aspiration ( FNAC)

D. Observation

E. Suppressive therapy with levothyroxine

2. The patient in Q1. subsequently, underwent an FNAC which revealed Papillary Carcinoma of thyroid. Staging work-up revealed no evidence of distant metastases and a neck CT scan does not reveal any lymphadenopathy. The most appropriate management of his thyroid cancer involves:

A. Radio iodine therapy ( RAI)

B. Partial thyroidectomy

C. Total thyroidectomy

D. Life long levothyroxine + Total Thyroidectomy + RAI therapy

E. Total Thyroidectomy + Life long levothyroxine

F. Partial thyroidectomy + life long levothyroxine


Most of the highyield CCS cases will be demonstrated with individual one on one practice in our monthly interactive CCS Workshops. Slots are limited and you  may register at

Archer USMLE Step 3 CCS Workshop – August 22, 2010

Archer USMLE Step 3 CCS Workshop – August 22, 2010

Archer online live step 3 reviews aims to bring USMLE step 3 courses on your desktop, at your doorstep! These highly successful live USMLE Step3 online reviews are an extension of our very popular and successful ” Dr.Red’s online ccs workshop, which has reached more than two thousand step3 takers in less than 12 months and has resulted in 98% pass rate. Archer Reviews have achieved a high success rate even with examinees with multiple attempts by our unique approach. These online reviews are done live and in a webinar format. You can stay at home and listen to lectures live and like in a virtual classroom, you can raise your hand and your question will be immediately answered by the instructor. This is a live online classroom which reduces the pain of flying several miles to attend live reviews. These are the only one in the market that offer successful step 3 lectures in this unique, live format. Archer’s most successful endeavor has been Dr.Red’s CCS Workshop which has helped hundreds of examinees to pass easily by excelling on CCS component.

Archer’s next CCS online workshop for the month of January will be on Sunday 8/22/2010 at 10 AM EST.

If you are interested in registering for this course, you can pay for the course on the website at Upon payment of the registration fee, your registration request will be automatically approved and an approval e-mail will be sent to you. This approval notice will have a button “Join Webinar” in it. Clicking this button on the day of the workshop will open up the live workshop on your desktop

To participate in the workshop, you will need a computer with internet access. For the audio, you can use either your computer’s microphone or a telephone. You will use the phone for the voice and log in to the conference call while you watch the power-point slides and the CCS demonstration on your desktop via. our unique net meeting software. You can also just opt to use your computer’s microphone in which case you do not need a telephone. Then you will get to practice a case while we watch and analyze your approach and correct it.

CCS Workshop Includes :

1. Lecture on CCS Strategies
2. Live demonstration of CCS cases
3. Common mistakes committed by the examinees and preventing them
4. Tips to score extremely high on CCS
5. Follow-ups of office and ER cases
6. Efficient use of time, doing more stuff without advancing the clock
7. Avoiding invasive tests
8. Basic set of orders for emergency cases
9. The 5-minute screen – adding/ disconinuing the orders that can matter
10. Obtaing consults and their appropriateness
11. Differential diagnosis for common ER and office presentations and easy tips to get the most out of few orders.
12. Working on efficiency
13. Live practice of 15 to 20 CCS cases by the attendees in the workshop
14. A these in addition to –> 20 minutes of supervised practice of one CCS case by each attendee who volunteers to practice. About 15 to 20 Highyield CCS cases will be practiced. During this time, you will be thoroughly analyzed, corrected and given instantaneous feedback by our experienced faculty

The total course fee is $97 .Slots are limited at 35.
If you are interested in the course, you visit Archer’s online store directly to pay :

If you have further questions, please directly contact

Archer’s other courses include very informative topic reviews and the high-yield rapid review – please check our website.. Archer theory reviews are now available as streaming videos so that you can start accessing them from the beginning of your step 3 preperation and fine tune your conceptual understanding to score maximum on the Multiple Choice Questions on USMLE Step 3

Question of the Week # 44

A 24 y/o athlete presents to your office with complaints of reddish discoloration of urine. He claims that he has been exercising and running vigorously for the past two days. He is very determined to lose the extra weight that he has put up in the recent months and has been fasting in the nights for the past one week. His past medical history is significant for two abdominal surgeries which included laparotomy and appendicectomy in the past for intermittent severe abdominal pain. The patient does not smoke but does occassional consumes alcohol in binges. He did involve in one such alcohol binge last night. Physical examination is benign except for decreased power and reflexes in bilateral lower extremities. There is no rash. His urine specimen was grossly red in color. Urine dipstick was negative for protein, blood, leucoesterase and nitrite. Urine microscopy did not reveal any RBCs, WBCs or Casts. Serum creatinine and complete blood count are with in normal limits. A Creatinine Phosphokinase ( CPK) level has been ordered but is not yet available. The most likely cause of this patient’s grossly red urine is :

A) Rhabdomyolysis
B) Paroxysmal Nocturnal Hemoglobinuria
C) Acute Intermittent Porphyria
D) Await CPK level for correct diagnosis
E) Glomerulonephritis

Question of the Week # 43

A 55 y/o woman with history of well controlled DM Type II presents for her regular follow-up visit. She has no new complaints. She has been well controlled on Metformin alone with a hemoglobin A1c of 6.5. The patient is afebrile with a B.P 96/72, HR 88, RR 16. Physical examination is benign except for decreased sensation in her bilateral lower extremities consistent with diabetic neuropathy and bilater lower extremity edema. Her last urinary microalbumin about one year ago was negative. A repeat dipstick test now is positive for protein and blood but negative for leucoesterase and nitrite. Subsequent urine microscopy reveals 4 dysmorphic RBCs/HPF and red cell casts. Labs reveal elevated serum creatinine at 1.4 as opposed to her baseline creatinine of 0.8 6 months ago. The next important step in approaching this patient’s Renal Insufficiency is:

A) Obtain CPK level
B) 24 hour urine for microalbumin
C) Start ACE inhibitor
D) Repeat urinalysis in 3 months
E) Referral to Nephrologist and Renal biopsy
F) Start emperic antibiotic therapy for UTI

Question of the Week # 42

A 65 y/o man with history of chronic smoking and COPD presents for follow up visit in your office after being discharged from the hospital about three weeks ago. The patient was admitted and treated in the hospital for community acquired pneumonia and COPD exacerbation. During his hospital stay he was noted to have microscopic hematuria on routine urinalysis. The patient denies any symptoms now. His COPD is well controlled on tiotropium inhaler. His allergies include Isoniazid and Penicillin. Past medical history is significant for a positive PPD test ( latent tuberculosis) for which he has been on treatment with Rifampin for past three months. Physical examination is benign. Labarotory investigations reveal a normal CBC and serum creatinine. Dipstick is positive for blood. A repeat urinalysis during this visit reveals persistent microscopic hematuria with 3 RBCs/HPF. A urine cytology has been sent. The next appropriate step in evaluating this patient’s hematuria is:

A) Repeat urinalysis in 3 months
B) Urine cultures
C) Intravenos pyelogram
D) CT urogram and Cystoscopy
E) Stop Rifampin

Archer USMLE Step 3 HighYield Lecture Series

Watch your favorite streaming video lectures at your own convenience!

ARCHER USMLE Step 3 Reviews
Pay-Per-View System

Missed out on recent Archer live online review?
You can now access them any time during the year!

You may have wanted to attend the recent live Archer Review. But your busy schedule probably did not permit it. Archer Review receives several e-mails each month to do additional CCS Workshop sessions as well as Rapid Reviews because of these scheduling concerns. But since we have limited number of teaching physicians, at this time, we are able to do only one live CCS Workshop per month and one live three-day rapid  review in 2 months. Archer Live Rapid Review is also a very exhausting three-day ( 30 hour ) session that some attendees feel very tired at the end of each day. Archer Review realizes your concerns and hence, Archer Review is now introducing the Pay-Per-View option in which you can access the streaming videos of our live session on your desktop at your own convenience. These recordings are exactly similar to the live webinar review in that you can see the Powerpoint presentation running on your desktop screen while you also listen to the instructor’s audio. 

Pay-Per-View FAQ

What is Pay-Per-View?
Pay-Per-View system allows you to access the streaming video lectures online at your convenience and watch them at your home on your own desktop. You may purchase the full length course or topic-wise access.

Can I watch a Demo?
Yes, please contact us if you wish to watch two one hour samples.

What lectures for USMLE Step 3 do you currently offer via. Pay-Per-View?
The lectures that are currently available via. Pay-Per-View are :

  • Archer Full length ( 36 hours) USMLE Step 3 Review Course.
  • Archer USMLE 3 Topic-Wise Lectures ( Hematology, Cardiology, Gastroenterology, Nephrology/Acid-base/Electrolytes, Pulmonology/Ventilators, Infectious diseases, Endocrinology, Neurology, Ethics, Rheumatology/ orthopedics/ sports medicine, Oncology, Preventive medicine, Psychiatry, Gynecology, Pediatrics and Dermatology )
  • A collection of two recent CCS Workshops + CCS Strategies – Covering about 20 CCS cases + discussions + demonstration of key high-scoring CCS strategies
  • A compilation of Ten Archer CCS Workshops – Covering 60 Highveld CCS Case demonstrations and Approach total 120 hours in length – at 
  •  Lectures for USMLE Step2 CK will be available very soon.

I really want to attend your CCS Workshop but the date you have on your website does not suit my schedule. Can you provide it as Pay-Per-View?
Archer CCS Workshop is an interactive workshop for USMLE Step 3 CCS and involves live practice. PPV options are available as listed above and give you the convenience of accessing and learning at your own pace.

What are these Video Lectures? Are they similar to your live reviews?
 These streaming video lectures are the recordings of our live webinar sessions. These are exactly similar to our live review in that you can see both the Powerpoint presentation ( a capture of the instructor’s desktop screen) as well as listen to the audio in conjunction with the Powerpoint presentation. This eliminates the need for looking at a hand out or notes while listening to the lecture as you can directly see the Powerpoint running on your screen.

Are we provided with any hand-outs or lecture notes?
Yes, you will be provided with relevant Archer USMLE Step 3 notes by e-mail once you purchase the streaming video for a particular topic or for the entire review.

Is Pay-Per-View more expensive than live review?
At this time,  Pay-Per-View is cheaper than the live reviews.

What are the benefits of Pay-Per-View over the Live review?
Live review needs to be attended at a designated time. Pay-per-view can be watched at your own convenience giving you time to learn according to your own pace.
In Pay-Per-View, you can pause and listen to a particular portion again. You can also listen to the same lecture almost two times with the “watch time” that we currently provide.

What are the limitations of Pay-Per-View when compared to Live Review?
During the live review, you can directly ask questions and talk with the instructor. There is no such possibility via. Pay-Per-View. However, you may send us questions by e-mail and our instructor will try and answer them in about 3 days.

What is “Watch Time”?
Watch time is the amount time you are provided to watch the lecture. You are approximately provided with a watch time that is much greater than the length of the review. This allows to rewind and replay certain portions of the lecture if you wish. Watch time will not expire when you exit the lecture. Any unused watch time will be stored in your account and you can use it on an other day. When you resume the lecture, make sure to forward the player to the point where you left off. You can also replay the previous session as long as you have sufficient watch time in your account
For each lecture, you will be provided with the duration of the lecture and the “Watch time” when you begin.

Will the “Watch time” ever expire?
The “Watch time” will expire if unused in “one week” after subscribing to a “Topic Review”. The Watch time for the full course will expire if unused in “Two month” of purchasing a full length course. However, if you have special requirements, you can request us to extend the expiry date.

Do I need any special system requirements to play these?
These are WMV files and will play with any Windows Media Player.

How about the Internet connection requirements?
Dial-Up connections are ok but broad band connection is preferred for uninterrupted access.

Do you have Question and Answer Sessions in the review?

Yes. CCS Workshop – PPV contains interaction with several attendees and discussion of very important questions and challenges that many attendees face on USMLE Step 3. These sessions accompany every case demonstration during the CCS Workshop. Archer Full Length USMLE Theory lectures contain Q and A sessions accompanying many high yield topics. Some of these questions are freely accessible through our free blogs or

What is the impact of your courses?
Archer review focuses on key strategies that are necessary to excel on Step 3. This include excelling on the CCS component and assuring above average performance on the USMLE Step 3 MCQs. Our lectures are based on the most updated guidelines. These lectures dissect the concept and present you the most simplified approach to answer the multiple choice questions. The dissection of the concepts is similar to the way concepts are separated and well-presented in our sample question bank posted in our blogs. By listening to the lectures, you understand why certain step is the most appropriate clinical strategy and also, will learn clinical scoring systems and evidence related to the best strategy. The clinical scoring systems and the evidence-based guidelines presented in the lectures will make complex Step 3 MCQs an easier task to deal with. That is the reason, Archer has achieved > 98% success rates on the board exams among its attendees. Archer reviews’ achievements are reflected in its huge customer base of more than 10,000 physicians with in just 2 years of inception, an increasing “word-of-mouth” recommendations from highly satisfied customers and its huge presence on very highly active social media groups on Facebook , LinkedIn and Twitter

You may  visit Pay-Per-View to sign up!

Thank you
Sincerely yours,
Support team,
Archer Online Reviews

Question of the Week # 39

•A 46-year-old fisherman and Vietnam veteran presented with a recurrent rash on his arms and legs and a painful, swollen area on his left leg of several days’ duration. The rash had been a problem for about two years and was treated with several courses of antibiotics for cellulitis. The patient reported that for the past two years his skin had been prone to blister and tear with minor trauma and that at times his urine appeared to be dark reddish in color. On examination, he had a slight fever and an area of cellulitis on his left leg. His face was erythematous. On his hands, arms, and legs were vesicles and small bullae, some crusted lesions, and hypopigmented and hyperpigmented macules. What is the most important next step in diagnosis?


B. Rheumatoid factor

C. Skin biopsy

D. Hepatitis C serology

E. Hepatitis B serology

Question of the Week # 38

A 45-year-old woman is very concerned about an eruption on her face. She has developed lesions on the cheeks and forehead over the last few months. They are not associated with itching.  The eruptions are worsened with by prologed exposure to sun, excessive stress and hot drinks. She denies any history of alcoholism. Physical examination reveals a papular eruptions with assocaited erythema, telangiectasia and  pustules. There are no lesions in any other areas except on her face.

What are my options?

The Most Likely Diagnosis :

A.Nodulo cystic acne

B. Rosacea

C.Porphyria Cutanea Tarda

D. Seborrheic Dermatitis

E. Cutaneous Lupus

The most apprpriate next step in management :

A) Topical Corticosteroid

B) Topical Benzoyl Peroxide

C) Oral Isotretinoin

D) Topical Metronidazole

E) Oral Doxycycline

Copy Rights: USMLEGalaxy

Question of the Week # 37

A 34 year old man with no significant past medical history is seen in your office for a painful blister that appeared on his lower lip yesterday. He compians of burning and itching in the area. He never had similar lesions in the past. He denies any fever or chills. Vital signs reveal a temperature of 98.4, HR 88, RR18 and BP of 120/76. On physical examination a lesion is seen on his lower lip as shown in the picture. rest of the physical examination is benign.

What is this?

The most appropriate next step in management is:

A) Oral Acyclovir

B) Re-assurance

C) Topical Penciclovir

D) Cold compresses

E) Oral Cephalosporin


Question of the Week # 36

A 25 year old woman presents to your office with history of genital lesions. The patient says that she has has read about genital warts on the internet and is now very concerned that she might be suffering from the same. She is sexually active with her boyfriend and does not want him to get infected with her condition. Physical examination reveals lesions that are are flesh-colored, soft pearly papules found on the inner aspects of  labia minora which are  symmetrically distributed on  either side of the vulva and are easily seperable from each other.

A concerned woman in a doctor's office. What is the Next Step?

Next Step in the Management:

A) Topical Imiquimod

B) Trichloroacetic Acid

C) Treat both patient and her partner with Podophyllin

D) Re-assurance

E) Oral Acyclovir

Copy Rights: USMLEGalaxy

Question of the Week # 34

•A 10 y/o boy is brought by his mother for extensive rash on his lower extremities that started one day ago and has been worsening. There is no history of fever . The family just returned four days ago from a camping trip and the mother does not recall any exposure to ticks except that the boy stepped in to a bush while walking downhill. On examination, there is extensive erythema along with vesicles and bullae on the front and the back of bilateral lower extremities up until the level of the knees. The upper portion of the lower extremities is unaffected. The rest of the physical examination is normal. The best treatment for the management of this child’s condition is : •

A. Topical triamcinolone •

B. Prednisone orally •

C. Ceftriaxone intra-muscular •

D. Diphenhydramine •

E. Observation

Copy Rights: USMLEGalaxy

Question of the Week # 29

A 10 year old girl who is a Jehovah’s witness is brought to the ER after a car accident. She needs IV fluids and transfusions. The mother refuses consent for fluids and transfusions, saying its against her religious beliefs. Your next step: 

A.  Order the fluids and transfusions, overruling the mother.
B.  Get an emergency court order 
C.  Get an emergency ethics consult
D.  Agree with the mother and not give the treatment

Copy Rights: USMLEGalaxy

Question of the Week # 31

Q31) Lisa was one of your patients 2 years ago. While Lisa was in NJ she has been your regular patient for her depression. She trusts and respects you a lot. She even told you earlier that she would be very lucky if she could date a person like you at least once in her lifetime. She is a beautiful 25 year old whom any man would like at a first sight. You have lost contact with Lisa and she has not been your patient for past 2 years because she moved to Florida. She happens to meet you incidentally at a mall and requests that you go for a date with her the following weekend. Your response should be:

A) Tell her that since she no longer your patient you can get involved with her.
B) Refuse her proposal because its not ethical for you to do it
C) Tell her you could go for a dinner this weekend but you will not get sexually involved as that part is unethical
D) Tell her its not appropriate for her to make such advances towards her past physician
E) Tell her you would definitely get involved with her provided she signs a paper releasing you from any liability

Copy Rights: USMLEGalaxy ( excerpted from Archer Ethics Lectures)

Question of the Week # 14

A 46 y/o woman who is a school bus driver by occupation presents to your office for regular follow up. She has a history of  ADPKD. Her blood pressure is well controlled at 120/70 on enalapril. She has no other problems. She denies any headache. There is no family history of intracranial or subarachnoid hemorrhage. However, she is concerned that her head might explode because her sister who also has ADPKD was recently diagnosed of having a berry aneurysm. She wants to be screened for berry aneurysm as soon as possible. Her physical examination is benign and does not reveal any focal neurological deficits. Which of the following suggests the necessity for screening in her case?

A. Family history of berry aneurysm
B. Polycystic kidneys
C. School bus driving
D. Cysts in the liver
E. No screening necessary in her case

Copy Rights: Archer USMLE Reviews

Questions of the Week # 12, 13

Q12) A 12 y/o boy is brought to you by his mother for skin rash and complaints of intermittent abdominal pain, joint pains for past 2 days. He did have an upper respiratory infection about 2 days ago. On physical exam, his vitals are normal. Abdomen is benign with out any tenderness or rigidity. However, you notice patchy purple discolorations on his extremities and the back. Lab studies are obtained that revealed

WBC: 6.6 , HGB: 15.3 , MCV: 88 , Platelets: 290,000 ( normal 180k to 400k)
BUN: 11 , Creatinine : 0.6 ( normal) , Anti streptolysin O titer : negative
Streptozyme : negative ,Urine dipstick : normal without any blood
Urinalysis : normal/ no rbcs/ no protein
The mother is very anxious and asks about the long term prognosis of her son. Your response :

A) Reassure the mother that boys disorder is self limiting and does not require any follow up
B) Tell her the boy needs to be admitted and treated vigorously to prevent renal failure
C) Tell her that renal failure develops 100% of such cases and hence needs very cautious follow up
D) Tell her that 50% of such cases progress to end stage renal disease.
E) Tell her that the boy requires follow up monthly urinalysis for at least 3 months in order to make sure there is no heamaturia/ renal dysfunction.

Q13) If the boy presented with Renal failure in the above case, the most likely underlying pathology would be :
A) IgA mediated vasculitis
B) Post streptococcal glomerulonephritis
C) Anti GBM disease
D) Acute tubular necrosis
E) Interstitial Nephritis.

Copy Rights : Archer USMLE Reviews

Question of the Week #11 – Archer USMLE Step 3

A 7-year-old boy is brought to the emergency department by his mother because of “tea-colored urine” for the last several days. He has also had some nausea and vomiting, and his eyes appear swollen when he wakes up in the morning. The eye swelling tends to resolve over the course of the day. He is generally very healthy and there is no family history of any chronic diseases. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination is unremarkable. A urinalysis shows red cell casts. At this time the most appropriate study to confirm your diagnosis is

A. antinuclear antibody
B. antistreptolysin O antibody
C. renal biopsy
D. renal ultrasound
E. urine culture

Question of the Week # 10

•A 55 y/o man presents with shortness of breath on exertion. Laboratory studies reveal iron deficiency anemia. Patient was started on Iron pills orally. The patient consumes a lot of red meat and was surprised to know that he was iron deficient. Fecal occult blood testing revealed a positive stool guaic. A colonoscopy and EGD were subsequently performed which were absolutely normal. A repeat Guaic was performed and was found to be negative. A further investigation for the cause of iron deficiency in this patient revealed celiac disease leading to iron malabsorption. What is the most likely cause of positive Guaic in this patient? •

A. Obscure GI Bleeding

B. Celiac disease

C. False positive from red meat

D. False positive from Iron pills

E. Colon cancer

Copy rights: Archer USMLE Reviews

Question of the Week # 9

A 65 y/o man with history of chronic smoking and COPD presents for follow up visit in your office after being discharged from the hospital about three weeks ago. The patient was admitted and treated in the hospital for community acquired pneumonia and COPD exacerbation. During his hospital stay he was noted to have microscopic hematuria on routine urinalysis. The patient denies any symptoms now. His COPD is well controlled on tiotropium inhaler. His allergies include Isoniazid and Penicillin. Past medical history is significant for a positive PPD test ( latent tuberculosis) for which he has been on treatment with Rifampin for past three months. Physical examination is benign. Labarotory investigations reveal a normal CBC and serum creatinine. Dipstick is positive for blood. A repeat urinalysis during this visit reveals persistent microscopic hematuria with 3 RBCs/HPF. A urine cytology has been ordered. The next appropriate step in evaluating this patient’s hematuria is:

A) Repeat urinalysis in 3 months
B) Non-Contrast CT scan
C) Intravenos pyelogram
D) CT urogram + Cystoscopy
E) Stop Rifampin

Question of the Week # 8 – Archer USMLE Step 3

A 72 y/o man with hx of chronic alcoholism and smoking presents to your office with extreme fatigue. Denies any fever or weightloss or nightsweats. Vital signs were normal and physical examination reveals generalized small lymphadenopathy and mild splenomegaly. Laboratory studies reveal CBC with hgb 9.5, wbc 10k with 25% neutrophils, 65% mature lymphocytes and 9% monocytes, platelets 90k. LDH is increased at 600 and reticulocyte count of 8.0% . Haptoglobin level is 22mg% ( N 27 to 160) and urinary hemosiderin level is with in normal limits. Basic metabolic panel, Vitmain B12 and Folic acid levels are within normal limits. Peripheral smear is shown below and reveals many Smudge cells.

Archer USMLE Step 3 QBANK

Most likely etiology of this patient’s Anemia is :

A. Microangiopathic Hemolysis

B. Bone marrow infiltration with Chronic Lymphocytic Leukemia

C. Acute Lymphoblastic Leukemia

D. Autoimmune Hemolysis

E. Hypersplenism

Copy Rights: USMLEGalaxy

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