Question of the Week # 72

A 55 y/o african american man with newly diagnosed Stage B prostate cancer undergoes radical prostatectomy and is referred to you from surgical clinic for routine follow up. The patient requests how often he should follow up with you and what tests he would need. Your best response is:

A) You do not need any follow up because you had a local cancer that was completely resected
B) PSA need to be tested every six months for 5 years and thereafter, every year
C) Bone scan to evaluate metastasis is needed every year
D) Digital Rectal Exam every year to look for local recurrence
E) You need endocrine therapy before we proceed further

Question of the Week # 71

Q71) A 65 y/o African American man is brought by his daughter to you and requests a PSA test because there is a hx of prostate ca in their family. You perform PSA and DRE. DRE does not reveal any palpable mass. The lab test reveal : PSA : 8ng/ml, Free PSA: 1.5ng/ml. You reveal the results to patient and his daughter. The daughter asks you if her father has a cancer. Your best response is :

A) The PSA level increases with age and your father’s PSA  is in the  age-appropriate range
B) PSA level is very nonspecific and your father does not have a cancer
C) The fact that the free PSA is only 1.5ng/ml as opposed to a bound of 6.5 indicates that your father most likely has a cancer etiology rather than benign cause
D) PSA will not help in diagnosing carcinoma prostate
E) I did this test only because you requested for it, I do not think this results mean anything.

Question of the Week # 70

Q70) A 40-year-old man presents to your office for regular follow up. He has history of  hypertension  for which he has been on Hydrochlorthiazide and Lisinopril. Lately, his blood pressure has not been well controlled and this has been documented both in the office and outside during several visits. The patient says he has had increasing fatigue and irritability over the last few months and has difficulty concentrating at work. He  thinks his boss has never been supportive and he attributes his irritability to this. He has smoked 2 packs of cigarettes per day for the past 15 years. On physical examination he is a obese male with a neck circumference of 18cm. He has a ruddy complexion. His vitals reveal a HR of 90 and a BP of 152/92.  Reminder of the physical exam is normal. EKG reveal changes consistent with long standing hypertension. A CBC, electrolyes and creatinine are normal. Which of the following is the most important investigation that can identify the cause of  his uncontrolled hypertension?

( A ) Ambulatory blood pressure monitoring

( B ) Pulmonary function studies

( C ) Polysomnography

( D ) Arterial blood gases

(E)  Urine drug screen

Question of the week # 69

Q69) You are treating an 18-year-old white male college freshman for allergic rhinitis. It is September and he tells you that he has severe symptoms every autumn, which impair his academic performance. He has a strongly positive family history of atopic dermatitis. Which one of the following is the most appropriate management?

a) Intranasal decongestants

b) Intranasal glucocorticoids

c) Intranasal cromolym sodium

d) Intranasal antihistamine

e) RAST testing

Question of the Week # 67, 68

Q67) A 44 year old woman presents to your office with pain and swelling of the small joints in his hands and wrists. The symptoms have been progressing over the past 4 months. She denies any fever or weightloss. She reports stiffness in his both hands that occurs every morning and lasts for 2 hours. On examination, she has symmetrical involvement of both the wrists and two of her left proximal interphalangeal joints. The involved joints are swollen and tender. Laboratory tests shows normal ESR, negative rheumatoid factor, and a negative anti-CCP antibody. X-ray of the wrist and hands reveal mild joint space narrowing with only very small peripheral erosions. The most appropriate next step in management :

A. Prednisone
B. Start NSAID and follow-up in one month.
C. Start NSAID and Methotrexate
D. Start Infliximab
E. Start NSAID and Hydroxychloroquine

Q68) The patient in the above question is started on appropriate therapy. He returns to your clinic in 1 month for regular follow up and his disease is well controlled with near complete remission. The most important next step in follow up of this patient :

A. DEXA scan in 1 year
B. PPD placement
C. Check hepatitis B serology
D. Ophthalmology referral at 3 months
E. Liver function tests

Question of the Week # 61

A 24 year old woman presents to the Emergency Room with complaints of  left sided weakness and slurred speech. The patient has history of Systemic Lupus Erythematosus. Her SLE was diagnosed 2 years ago when she had malar rash and abnormal blood counts. She reports that she has not received any treatment for it since her physician felt this was not needed at that time. She denies any history of kidney involvement. She denies any joint pains or rash. Physical examination revealed left hemiparesis consistent with cerebrovascular accident. A CT of the head reveals right parietal infarct with out any bleed. An EKG is obtained and is normal.  Anti-cardiolipin antibody is +ve which was also positive 1 year ago as per her old records . The patient is started on adequate therapy and follows up in your office 1 month later. Which of the following interventions is most appropriate to prevent recurrent stroke in her case?

a)        Aspirin  for life

b)       Warfarin for 1 year

c)        Warfarin for 6 months

d)       Warfarin for life

e)        Hydroxychloroquine

Question of the Week # 60

A middle aged man presents with a history of foot pain on walking for a few weeks. The patient has a history of long standing diabetes mellitus for more than 15 years. He has been on Metformin and Glyburide combination. His HGBA1C that was obtained 3 months ago revealed inadequate control  at 9%. He reports pain and swelling in his right foot for about one month.  On examination the foot is swollen & tender to touch. Neurlogical examination reveals loss of vibratory sensation and position sensation in bilateral feet. There is also impaired light touch until the level of knees bilaterally. Joint motion at the level of ankle is within normal limits. Complete blood count , creatinine and ESR are with in normal limits. Most likely working diagnosis for his right foot pain  is :

a)      Chronic  Gout

b)       Septic arthritis

c)        Peripheral Neuropathy

d)       Charcot arthropathy

e)       Reflex Sympathetic Dystrophy

Question of the Week # 58, 59

Q58) A 30 year old man comes to your office with complaints of pain in both the wrists and in the hands for the past two months. The pain is particularly worse in the nights and awakens him from sleep. It radiates to the forearms from the wrists.  Occassionally, the pain is associated with abnormal sensations in both hands.  He denies any pain or paresthesiae at this time. Upon further questioning, he also reports some mild stiffness & very mild pain in the neck in the past two weeks. Physical Examination is normal. The most appropriate initial investigation is:

A. Nerve conduction studies

B. Plain X-ray of the wrist

C. Plain X-ray of the cervical spine

D. Rheumatoid factor

E. MRI cervical spine

Q59) The most likely underlying etiology of this patient’s clinical features is :

A. Spinal cord compression

B. Brachial plexopathy

C. Rheumatoid arthritis

D. Hypothyroidism

E. Cervical Spondylosis

Question of the week # 56, 57

Q56) A 42 year old presents with a  pain & swelling in the left knee. The symptoms started 3days ago and have been progressively worsening. Upon further questioning, the patient tells you that he has experienced intermittent pain and swelling in the toes, wrists and ankles for more than 10 years. On examination the left knee is swollen and warm to touch. There is also soft tissue swelling of the wrists, ankles and right foot.  He has  a 10  year history of intermittent  pain & swelling in the toes, wrists & ankles. On examination the right knee is warm to touch with an effusion, & there is soft tissue swelling of the wrists, right ankle & right foot. X-ray of the wrist is shown below. Laboratory studies reveal increased ESR at 90mm/hr WBC are elevated at 12k.
The most likely diagnosis :

A. Early erosive osteoarthritis

B. Reactive Arthritis

C. Psoriatic Arthritis

D. Pseudo-Gout

E. Rheumatoid Arthritis

Q57) The most important next step in management :

A) Obtain Rheumatoid Factor level

B) Obtain Anti citrullin peptide level

C) Start prednisone

D) Start ibuprofen and Methotrexate

E) Arthrocentesis of the Right knee

Question of the Week # 53

A 4-month-old girl is brought by her concerned mother  because the child has been inconsolably crying for 6 hours. The child is breast fed and has been doing well. There is no vomiting, diarrhea, constipation, or increased gas. The mother has not changed her diet and the infant is on no medications. There has been no fever. On physical examination the child is active and screaming. There is no fever.  The physical examination is normal except that there is redness and swelling affecting the left  third toe with indentation proximal to the redness. It is tender to touch. There was no history of similar problems.  The picture is shown below:

 

The most likely working diagnosis:

A. Trauma

B. Herpetic whitlow

C. Hairy tourniquet syndrome

D. Acute paronychia

E. Ingrown toe nail

F. Acute Gout

The most appropriate next step in management :

A. Joint aspiration

B. X-ray of the foot

C. Inspect the toe for hair strangulation

D. Incision and drainage

E. Topical acyclovir

Question of the week # 51

A 75 year old woman was diagnosed with Stage II breast cancer one year ago. The patient received chemotherapy, underwent modified radical mastectomy and radiation. . The cancer was ER+, PR+ and Her2-neu negative. The patient has been receiving Tamoxifen for the past few months. She reports that she has been experiencing vaginal spotting and intermittent mild vaginal bleeding over the past few months. She has also been experiencing intermittent hot flashes after starting Tamoxifen therapy. On physical examination, her vitals are with in normal limits. Pelvic examination does not reveal any gross pathology. Next step in managing this patient:
A. Stop Tamoxifen
B. Start oral progesterone
C. Obtain endometrial biopsy
D. Do a hysterosalpingogram
E. Recommend Hysterectomy with bilateral oophorectomy

Question of the Week # 50

A 50 year old woman with history of coronary artery disease and hypertension presents to your office for regular health check up. The patient is compliant with her medications which include aspirin, atorvastatin and enalapril. Her blood pressure is 110/70. Laboratory investigations including CBC and comprehensive metabolic panel are with in normal limits. A fasting lipid panel that was performed one week ago reveal an LDL cholesterol of 65, HDL of 50 and Triglycerides of 150. You discuss the results with her and you inform her that the goals of therapy are being adequately met. She seemed happy to know about the results but tells you that lately, her mood has been slightly low. There are good days but she tends to have frequent bad days as well. She enjoys surfing as she used to before. She has no weightloss and her appetite is good. She denies any suicidal ideations. She asks you if there is any medication that would benefit her heart and also, help her mood. The next best step in managing this patient is :

A. Start escitalopram
B. Start clozapine
C. Refer to psychiatrist
D. Start Omega 3 Fatty Acids
E. Start St.John’s Wort

Question of the Week # 49

A 45 year old woman presents to your clinic with history of intermittent epistaxis. Of late, this has become more frequent. The patient has a history of atrial fibrillation for which she has been taking aspirin as recommended by her cardiologist. She has no other past medical history. The patient also takes over the counter medications such as Vitamin b-complex which she thinks keeps her from getting tired. She says she also takes about 4 grams of Omega 3 fatty acids to keep “her heart healthy” and Ginkgo biloba to slow the “ageing of her brain”. Her laboratory tests reveal normal complete blood count. Prothrombin time and partial thromboplastin time are with in normal limits. Which of the following is your next step in managing this patient’s recurrent epistaxis?

A. Advise her to discontinue omega 3 fatty acids.
B. Discontinue Aspirin
C. Advise her to stop both Omega 3 fatty acids and Ginkgo biloba
D. Advise her to stop Ginkgo biloba
E. Advise her to stop Vitamin B-complex

Archer Step 3 CCS Workshop – Live Webinar – September 2011

Archer live Online CCS Workshop – September 2011


Archer Live Online USMLE Step3 CCS Workshops from http://www.CcsWorkshop.com

Archer is the only live CCS Workshop in which experienced Internal Medicine board certified physicians will teach you live how to apply unique high-yield CCS strategies to score the most in the CCS Component.

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 Twelve thousand step3 takers in less than 2 years 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 September 2011 will be on Sunday 09/11/2011 at 10 AM EST.

If you are interested in registering for this course, you can pay for the course on the website at http://www.shop.ccsworkshop.com. 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 : http://www.shop.ccsworkshop.com

If you have further questions, please directly contact support@ccsworkshop.com

Archer’s other courses include very informative topic reviews and the high-yield rapid review – please check our website. Next 3-Day Step 3 Rapid Review is in November -2011. 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.

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