Posted on January 7, 2017 by Archer USMLE Reviews
A 48-year-old homeless man presenting with severe abdominal pain. He has been hospitalized 6 times in the past year for similar complaints. Hospital records indicate multiple admissions with alcohol intoxication. The pain radiates to his back, and is accompanied by nausea and vomiting. The patient has a temperature of 103F, but does not permit an abdominal exam. Laboratory analysis indicates elevated gamma glutamyl transpeptidase and an AST/ALT ratio > 2. What is the most likely diagnosis?
A – Cholecystitis
B – Pancreatitis
C – Choledocholithiasis
D – Duodenal peptic ulcer
E – Gallbladder cancer
Filed under: USMLE Step 2CK Qbank, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, usmle step 2 ck, USMLE STEP2 GASTROENTEROLOGY, USMLE STEP2CK QBANK | 7 Comments »
Posted on January 7, 2017 by Archer USMLE Reviews
485. A 10-year-old female presents with a 3 week history of cough. Initially she had a runny nose and was tired with a slight cough but as the runny nose resolved the cough seemed to get worse. She states that the cough is dry sounding and occurs during the day and night. She describes having coughing spasms that occasionally end in vomiting but between episodes of coughing she is fine. Her mom reports that during a coughing spasm she will gasp for air and sometimes make a “whooping” noise. A nasopharyngeal swab confirms a diagnosis of Bordatella pertussis. Which of the following is true?
A. Her 3-month-old brother should be treated with azithromycin as prophylaxis
B. She should be started on azithromycin for more rapid resolution of cough.
C. Her classmates should be treated with clarithromycin as prophylaxis
D. She will have lifelong natural immunity against Bordatella pertussis.
E. Her classmates should receive a Tdap booster regardless of their vaccination status
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Infectious Diseases, archer pediatrics, ARCHER STEP3 LIVE REVIEWS, usmle step 3, USMLE Step3 | 11 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 50-year-old African american woman presents to your clinic with increased thirst and increased urination. You review her old records and it appears like she had a Chest X-ray in the ER last year that showed bilateral hilar lymphadenopathy. She was advised follow-up but she did not comply at that time. Upon examination, you discover some subcutaneous skin nodules and biopsy of one of these comes back positive for non-caseating granulomas.
Laboratory studies from a week ago show:
Hemoglobin 15.2gm%
Calcium : 11.6mg%
Creatinine : 1.0mg%
Which of the following investigations may explain the underlying mechanism of her Hypercalcemia?
A. Biopsy of Hilar Lymph Node
B. 25 Hydroxy Vitamin D Level
C. PTH related peptides
D. 1,25 di-hydroxy Vitamin D level
E. Serum Protein Electrophoresis
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER FLUID AND ELECTROLYTES, ARCHER NEPHROLOGY, ARCHER STEP3 LIVE REVIEWS, ARCHER STEP3 RAPID REVIEW, Foundations of Independent Practice (FIP), lab interpretation, Pathophysiology correlation, usmle step 3 nephrology | 8 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 50-year-old previously healthy man comes to his physician for a scheduled follow-up examination. He works as an electrician, which involves a significant amount of physical activity when working. He says he also runs 5 miles twice a week and is on a low-fat, low-cholesterol diet. His father died of a ‘heart attack’ at the age of 54, and he has smoked one pack of cigarettes daily for the past 25 years. He denies alcohol or illicit drug use. He says he leads a low-stress lifestyle and has no complaints. His current medication include lisinopril. On presentation, his blood pressure is 135/85 mm Hg. Laboratory studies from a week ago show:
Total cholesterol 287 mg/dL
HDL 65 mg/dL
LDL 180 mg/dL
Which of the following is the best next step in patient care?
| A |
Initiate drug therapy for control of his hyperlipidemia |
| B |
Educate the patient about diet and exercise and repeat the tests within 4 weeks |
| C |
Educate the patient about diet and exercise and repeat the tests within a year |
| D |
Initiate a mandatory low-fat diet for the patient |
| E |
No intervention is indicated |
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, usmle step 3 preventive medicine | 6 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 63-year-old woman comes to the emergency department complaining of severe midabdominal pain. She reports that the pain has increased in intensity over the past few days. There has been no associated nausea or vomiting, no change in bowel habits, and no relief afforded by position changes. She is postmenopausal and does not take hormone replacement therapy. She has a 30-year history of hypertension, and has been noncompliant with her therapy of calcium channel blocker and thiazide diuretic. On examination her abdomen is obese but there is a suggestion of a nontender, pulsatile mass in the epigastric region. The remainder of the physical examination is normal. Which of the following is the best next step in management?
| A. Abdominal ultrasound |
| B. Abdominal CT scan without contrast |
| C. Abdominal CT scan with contrast |
| D. Angiography |
| E. Observation |
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, archer surgery, usmle step 3 surgery | 11 Comments »
Archer USMLE Step 3 Blog 