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

Question of the Week #74, 75

74) A 75 year-old man with history of hypertension presents to the emergency room with complaints of shortness of breath and palpitations. His vital reveal a heart rate 142/min, blood pressure 130/86, temperature 98.6 and oxygen saturation of 89% on room air. On auscultation, there are no rhonchii or crepitations, the heart rate was irregular and rapid with out any murmurs. The patient is placed on oxygen by nasal cannula. An urgent EKG is obtained which reveals rapid atrial fibrillation with no evidence of significant ST-T changes. The patient is started on diltiazem. Chest x-ray is normal and a brain natriuretic peptide is 80ng/L. Electrolytes, TSH and complete blood count are with in normal limits. Cardiac enzymes are drawn. Arterial blood gases reveal a pH of 7.48, po2 of 58, pco2 of 20 on room air ( Fio2 of 21%). The next step in establishing the etiology of his atrial fibrillation :

A) Cardiac catheterization
B) Spiral CT scan of the chest
C) Venos doppler of lower extremities
D) 2D Echocardiogram
E) D-Dimer

75) What is the most likely etiology of atrial fibrillation in Case 1?

A) Acute ST elevation MI
B) Acute pulmonary embolism
C) Pneumothorax
D) COPD exacerbation
E) Congestive heart failure

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

Archer USMLE Step 3 Live Rapid Review – A Webinar! Access it from Home!

Archer Online Step III review is the most unique way to listen & participate in the live reviews with out leaving your home. This innovative lectures have reached about 800 people in the last 6 months and have achieved a very high success rate. It is our practice to mail a survey to the attendees after each Rapid Review and CCS Workshop – about 100% of our attendees rated us “Very helpful”, “Extremely patient”, ” Very affordable” and “Very focused and highyield”. Almost 95% felt that they did not need any other review material for step 3 preperation apart from our powerpoint slides and live lectures.

The review is very affordable at $295 ( $50 off for early registrants until May 12th 009) and includes 26 hours of rapid live lectures and all the high-yield study material for all the topics mentioned below. The idea of the rapid review is to focus on most frequently tested Step3 clinical topics which are usually not clearly explained in many review books that are available on the market. This review intends to make step3 live lectures extremely affordable and easily accessible for everyone.

The rapid review online virtual classroom will be in the same way as CCS Workshop. You can raise your hand when you have a question and your question will be answered at the end of each sub section. We recommend you to write down all the questions as the topic lecture runs. At the end of each sub-section, our teaching physician will be available for you to answer your questions. This course is three-day cumulative session of about 26 hours long, stresses on high-yield topics and step3 questions. No extensive details – you will be provided with explainations on the concepts that are exactly needed to pass and score high on this exam. You will be quizzed during the session with sample questions after the topic Review. Extremely interactive with personal attention placed on each and every attendee. After you sign up, you will be provided with high-yield study material in a power-point format.
Our first two Rapid reviews were 2-day long (20 hours) in duration. But with a desire to cover more topics, we extended it now to 3-day (26 hour) long review in April 2009 ( 4/17 to 4/19). This review worked out very well and received a huge applause from the attendees. At this time the plan is to do this review on June 12th, 13th and 14th in the following format spread over 26 hours in three days.

Each day starts at 10 AM EST ( except Day I)

Day I – Friday ( 3 Hours) – June 12th 2009

7:00 PM to 9:00 PM EST – Preventive Medicine ( Topics – Smoking cessation, vaccinations, Lipid screening, Antibiotic prophylaxis prior to surgery, prevention of osteoporosis, steroid induced osteoporosis, Cancer screening discussed under oncology, AAA screening)

9:00 PM to 10:00 PM EST – Psychiatry/ ethics

DAY II Saturday(11.5 hours ) – June 13th 2009

10 to 12:30 pm – Cardiology
12:30 to 1:00 PM – Lunch BREAK
1:30 to 3:00 pm – Endocrinology
3:00 to 5:00 pm – Gastroenterology
5:00 to 5:15 – Break
5:15 to 7:15 – Pulmonary/ventilators/ critical care
7:15 to 8:45 – Infectious Diseases
8:45 to 9:00 – Break
9:00 to 9:30 – Dermatology

DAY III Sunday ( 11.5 hours) – June 14th 2009

10:00 to 12:00 – Nephrology/ Acid Base
12:00 to 1:30 – OBGYN ( Very Highyield only)
1:30 to 2:00 – Lunch Break
2:00 to 3:30 – Rheumatology/ Orthopedics/ Sports Medicine
3:30 to 5:30 – Hematology/ Oncology (cancer screening)
5:30 to 5:45– Break
5:45 to 8:00 – Pediatrics, Highyield only
8:00 to 8:15 – Break
8:15 to 9:30 – Neurology

This is a very extensive course and the price that has been set is too low to make it affordable to everyone including an IMG as well as to a medical student.. In view of price being set too low, we will not be able to do the session if a minimum number of 20 is not reached. Our last two Rapid Reviews have reached a maximum capacity of 70. Please send us an e-mail if you are interested. You will receive an invoice for $295 for this two day course and also for all the teaching slides that will be e-mailed to you in a PPT format. As soon as you sign up, you will me mailed our updated Archer rapid review notes in a powerpoint format. However, we may be adding several more highyield concepts to this notes by June 2009. In that case, we will send you the updated version of the notes again by e-mail a week before rapid review. You can also sign up for this course via. our online store at

The minimum number of enrollees is 20 and the maximum is 70.
If you have any questions, please feel free to contact us at

Thank you very much
Sincerely yours,
Support Team
Your Key to Success!

Excerpts from Archer Rapid Review – Nephrology by Dr.Red

this is a 30 minute clip from recent Archer USMLE Step 3 Rapid review quickly summarizing electrolyte imbalance and acid-base

The above embedded video is not displaying the video. For access to full video+ audio, click here : Nephrology

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