USMLE Step3 Question of the Week #493

#493. A 77-year-old male is brought into the Emergency Department after the staff at his nursing home witnessed a syncopal event. Once a week a barber comes to the nursing home to provide haircuts and shaving services. After the barber raised the head of the patient’s bed and started to shave his neck, the patient suddenly lost consciousness. The barber called for help, and the patient was regaining consciousness by the time staff arrived. Within a few minutes the patient was at his baseline mental status and did not lose control of his bladder or bowels or bite his tongue during the episode. The barber didn’t notice any abnormal movements by the patient but reports he was trying a new “natural” shaving foam this morning. The patient has a history of Parkinson’s disease and hypertension. He does not smoke or drink alcohol. Blood pressure is 124/84 mm Hg and heart rate is 92 beats/minute sitting and 128/82 mm Hg and 88 beats/minute after standing two minutes. What would be the next best step in management?

A. Immediate referral for permanent pacemaker

B. Carbamazepine

C. Referral to an Electrophysiologist

D. Carotid endarterectomy

E. Reassurance, education and clinical follow-up

cardio@jamesv

USMLE Step3 Question of the Week #492

#492.  A 37-year-old woman with a history of bulimia nervosa presents with chest pain. Patient describes it as a sharp pain, localized to the middle of the chest, and occurred acutely last night after vomiting.  Current medications are fluoxetine 60 mg orally daily and a daily multivitamin.

On physical exam, patient appears ill and diaphoretic.  Vital signs show temperature of 37 °C (98.6 °F), blood pressure of 135/85 mm Hg, pulse of 90 /min, respiratory rate of 30 / min, and oxygen saturation of 98% on room air.  Oropharynx is erythematous, dentition is poor and back molars show significant erosion.  There is dullness to percussion and diminished breath sounds over the lower lobe of the left lung.  Remainder of the physical exam is normal.   EKG and laboratory tests are normal.  Chest x-ray shows a small left pleural effusion and evidence of pneumomediastinum.

Which of the following is the definitive diagnostic step in this patient?

A. Esophagogastroduodenoscopy

B. Barium swallow study

C. Helical CT of the chest without contrast

D. Gastrografin swallow study

E. Thoracentesis

 

@card-hageman

Archer USMLE Step 3 CCS Live Webinar – January 2018

Live Workshop/ Webinar date: JANUARY 27TH 2018

Regsiter at https://register.gotowebinar.com/register/6510772772300949763

Interactive practice of USMLE Step3 CCS Cases.

The most time efficient strategy to pass USMLE Step 3! A component of Archer Live USMLE Reviews. Schedule ( Starts at 10 AM CDT i.e; 11 AM EST)

10 AM to 10:15 AM – Intro on the Webinar functions

10:15 AM to 12:15 PM – Recognizing Unstable vitals. – General approach to ER cases– Real time vs. Simulated time – Strategies to keep Simulated time low (ER) – Demonstration of high scoring strategies

12:15 pm to 12:30 pm – Q and A session

12:30 PM to 1:30 PM – Office case manAgement principles – General approach to office cases – Indications for admisiion – Scheduling follow up tests – Navigating the clock with ease to score more. – Demonstration of office cases

1:30 PM to 2:30 PM – Q and A session

2:30 PM to 4:00 PM – Lunch break

4:00 PM to 5:30 PM – Practice of very High Yield cases with one on one Q and A sessions

5:30 PM to 5:45 PM – Break

5:45 PM to 7:45 PM – Practice of Very Highyield CCS cases

7:45 PM to 8:00 PM – Break

8:00 PM to 9:00 PM – Case Practice, discussion and wrap-up!

Can’t make it to the Webinar ? Have exam before next live session? :   PPV recordings of most high-yield CCS workshops are readily available at https://archerreview.com/products?subexamid=4  Price: $88 and you may access those 24/7.

Question of the Week #490

490. An 18-year-old male presents to the Emergency Department for evaluation of chest pressure for an hour. The pain is radiating to his jaw. On examination, he is diaphoretic, and he complains of nausea. Past medical history is unremarkable. Urine reveals positive benzolegonine. Below is his ECG. What is the most likely cause of the patient’s symptoms?

ekg

A. Early repolarization

B. Ischemia

C. Cocaine induced myocardial infarction

D. Atrial fibrillation

E. Wolf-Parkinson-White Syndrome

Question of the Week #489

A 35 Year old woman presents for evaluation of recurrent headaches for the past few months.  Lately, she has been waking up with a headache almost daily though it tends to improve in the latter half of the day. She is frustrated as she can not even get some sleep during the attack since lying down makes her feel worse . She has associated nausea. She has transient attacks of light flashes  that resolve spontaneously. Her menstrual history is unremarkable. On physical examination, she has no neurological deficits. Funduscopic examination shown below: QBANK INSTA AD

Which of the following information, if elicited in the patient history, would increase the clinical suspicion of the diagnosis?

A)     Constipation

B)     Family history

C)      Recent weight gain

D)      Galactorrhea

E)   Urinary Incontinence

Question of the week # 488

A 31 Year old woman diagnosed with suspected diagnosis of Idiopathic intracranial hypertension underwent a lumbar puncture for diagnostic purposes. An MRI of the brain that was obtained prior to lumbar puncture did not reveal any structural abnormalities or mass effect. Laboratory investigations including coagulation parameters were normal. About 12 hours after the procedure, the patient complains of moderate to severe headache. Headache is mainly in the occipital region which increases while sitting up and improves on lying flat. She has two episodes of vomiting in the last one hour. She also complains of dizziness and ringing sensation in her ears.  Physical examination does not reveal any papilledema or focal neurological deficits.

Most appropriate next step in managing this patient?

A) Blood cultures

B) MRI of the Lumbar Spine

C) Non-Contrast CT scan of brain

D) Observation

E) Acetazolamide

USMLE Step 3 Question #487

487) 57-year-old male with a history of mild COPD has been using albuterol as needed to manage his COPD without any other maintenance medications. Recently he has been experiencing a greater degree of shortness of breath, wheezing and a productive cough. Pulmonary function tests demonstrate a FEV1 that is 60% of predicted. What is the next best step for management of his COPD?

A. Add budesonide to treatment regimen

B. Add rofilumast to treatment regimen

C. Add tiotropium to treatment regimen

D. Add tiotropium plus fluticasone to treatment regimen

E. Add carbocystine to treatment regimen

 

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