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Joshua 2023 PDFelement
Step 3
Day 2 vikash mandhan
@usmledoctor
1 picture of red leg cellulitis antibiotics no option for clindamycin
in order to cover MRSA - = choosed vancomycin
2- lung xray , fever . hypotension . child of ALL takes immunosuppressant . what
antibiotics alongwith fluid ?
since on sepsis vancomycin (MRSA) and gentamicin (for gram negative , pseudomonas)
3- 4 YO boy pharyngitis , ear pain , cponjunctivitis = amoxicillin given yet fever was
there . bilateral LN and macculopapular rash it was Kawasaki- ANSWER : stop
amoxicillin and gv aspirin. Other option give IM epinephrine, continue
amoxicillin add clavulanate
4- 52 YO pap smear normal. What shud be physician recommendation
- every 3 year till age 65
5- 67 YO chest mass on XRAY refused screening PE: had hepatomegaly FOBT
positive which screening was important to prevent this
answer colonoscopy at age 50, other options mammography at 50 , low dose CT at 55
6- IE confirmatory test . in addition to blood culture what test is diagnostic answer TEE
not TTE
7- 40 yo F has MVP diagnosed recommendation donot take any antibiotic with any
gingveal procedure
8- pregnt women on US had periventricular Ca child will have senorineaural heaing
loss . other option macroccephaly, liver failure, cataract
9- HZ rash thi 1 side of thorax ab 4 month se sef pain hai jo jaa nhi rahi now NSAID
donot relieve pain T of PHN gabapentin ..not TCA
10- ectopic preganancy RLQ pain . size 2.8cm , BHCG 2800 BP normal
T for this pt --- MTX
Laparascopy indication when >3.5cm , 3500 BHCG , rescent folic acid supplement
Laparatomy on rupture ie when BP hypotensive
11- PID SS discharge , pain , adnexal mass T inpatient hospitalization and IV antibiotics
answer
12 stone 5 mm pain management + fluids + which drug TAMSULOSIN
13- prostate mass Unilateral . 74 YO white American , back pain . worst prognosis
indication? Age , ethnicity , back pain , unilateral mass
14- 35 yo F had breast Ca her ftiend ask wht can I take to prevent breat CA
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IUD, OCPS, medoxyprogrosterone, tamixfen
15- BPH pt wake frequently to pee also HTN T: DEXAZOCIN
16- 16 yo girl , her one friend had depression , but she also getting bad grades physicians
councilling to this girl to this one? Same risk of despression as general population or
more risk than general population or less risk .. vikash did same risk as general
population
17- RA pt multiple flares take steroids for acute flares synovial fluid analysis
shows cloudy secretion T: add vancomycin --------- other option , inc
prednisolone
18- alcohol craving to decrease has tried naltrexone but no use due to SE and wants
to be preganant soon now give? Acamprostate , natrexone , disulfiram .
VIKASH DID ACAMPROSTE..check which is safe in preganancy
19- 7 m baby had 5 d diarrhea . had diaper dermiaitiis inguinal fold u couldnt see on
picture that were they involved or not no satellite lesion
what was it contact dermaititis T topical hydrocortisone ----------it wasnt candidiasis
20- 44 yo male DM , DTP 6 y ago, influenza 6m ago , no rescent travel hisroty
neither intention to travel. What vaccine now- pneumococcal PPSV23
21 child NM headache fever neckrigidity LP gram negatice cocci physician immediate
response rifampin to family and contacts -------------not vaccine to all classmates
21- tinea capitis treatment started when can go school
- school can go now.vikash did
- school when rash go away
- when treatment is completed
22- IgA def risk of transfusion reaction
23- Stoke pt next step CT without contrast
24- Hydrocodeine taking pt having severe constipation take other drugs also . which
else drug worsens his constipation . ans DILTIAZEM . other options bblocks
digoxin amlodipine
25- Adult fecal incontinence DRE recgtal tone dec , empty rectum , severe diarrhea
7 times a day ------ what to do ? vikash did. Diphenoxylate and atropine (to inc
rectal sphinter tone)
26- LSD agitated pt ---------lorazepam or haloperidol ----------ans LORAZEPAM
27- father was swinging daughter arm inward XRAY of subluxation T supine and
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hyperextension-----------other option manage pain and put cast
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28- COPD case . old pt complication?
Corpulomnale due to pulm HTN
Passive congrstion of liver due to inc indirect bilirubin
29 ACLS pulseless CPR done, epinephrine given . now amiodarone
30- CHF pt BMI 35, age 54, otrhopnea 2 pillow, BNP 60, BP 90/60
what is worst prognostic sign ? Age , BMI, systolic hypotension , orthopnea, elevated
BNP
31- torsade ecg answer Mg sulfate
32 66 yo smoker , 2 Pack year 40 year smiking what to do?
US abdomen to AAA or CT chestwe dont CT chest we do low dose CT.
Writing low dose CT is important
33- ulcer lateral malleolus + PAD S/S . what stops healing
options age
pain on leg elevation---answer
34 60 YO afircan American . glaucoma SS dilated fixed pupil best prognosis time to
reach treatment ------other options age, ethnicity
35- depression pt fluoxetine takes and is responsive but when dec or stop drug recurrent
depression reemerge now have sexual problem . what to do?
Stop fluoxetine is wrong .
Start sildenafil is right
Inc fluoxetine.
Dec fluoxetine
36- limb sever eacute pain cool pale limb next step IV heparin
37 82 YO functionally poor, BMI 17, no cardiac RF. What to do before starting statin?
Functional status
Or cardiac RF
38- AS pt has syncope on exertion , SOB, physician recomned will?
Surgery will dec symptoms but no prolong life------------vikash did
Surgery will dec symptoms and prolong life------------------- I would have done
Surgery will make no difference to symptoms but prolong life
39- vasovagal syncope by injection N, V, syncope ====== t REASSURANCE
other option head tilt test,
40- xerodermatosis pigmentosa when go out skin becums red , and has freckling. What
next in life SCC of skin .other option shagreen patches .
41- BMI 35 , tried diet and exercise . no effect next step ORLISTAT
other option bariatic surgery , lisomerin
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42- HTN emeregency SBP230 and had CNS symptoms and Cr 3.2
cannot give nitroprusside coz of RF
what to gv. Labetaolol vikash did , nicardipine , nitroglycerine , nitroprusside
43 ADPKD what else to screen for IC berry aneurysm
44 turner syndrome 45XO 46 XX mosaicism risk of GONADOBLASTOMA
45 pregnant women 8th week TSH 0.002 thyroxine 21ug . which drugs? PTU.
Methimazole and RAI are CI in pregnancy
46- girl takes leuprolide (continuous GnRH agonist) has SE osteoporosis as dec FSH
LH and dec estrogen
47- pt has type 1 DM.inc risk of celiac disease + Addison -------- vikash said as T cell mediated
celiac disease + graves
pernicious anemia + myasthenia gravis
pernicious anemia +hashimoto -----------I think
48 thyroid Ca 1.2 cm mass age 50 years . childhood H/O radiation which is sign of
concerning sign ------ radiation histry
49- MEN 1 syndrome in father no S/S till age 20 in children now what to do?
Reassure.. or genetic test.. here vikash did reassure.. as endocrine diseases donot cause
any life threatening CA in MEN1 ------- while if it were MEN II --- which has MTC
medullary thyroid CA always do genetic test
50- hyperglycemia HONK 797 mg/dl ------- t 1st IV fluids
51 fibroadenoma breast prognosis if not treated will go in next menses.
Will go away after menopause . inc risk of CA
52. scaphoid fracuture normal xry what would u do thumb spica, wrist splint
53. pregnant women 3rd week gestation had vaginal itching . strectch mark abdomen
what to do for strectch mark answer REASSURE
53 liver cyst . lived with dog. E.granlosus multiple hydatid cyst . T:
partial hepatectomy , radiation , incision and drainage of cyst
54. trichinella spiralis in muscle of pt used to sheep muscle histology was shown
what drug? Praziquental or mebendazole
55 and 56 ARDS pO2 96 , PaCO2 64 . when TV 8ml/kg, fiO2 1.0 , PEEP 5 mm, R/R 16
to dec PaCO2 ===== inc RR and also dec fiO2 as O2 already in target
next question R/R was 22 , fiO2 1.0 --- PaO2 94 , PaCO2 34 after 4 days .. now what to?
Dec fiO2 and dec R/R
57- pt has cough for 5 days all collegues have taken sick leave due to common flu on PE
no nasal drip . no discharge . only cough what to do? Desmethorphan , loratadine ,
pesudoephdrine, antibiotic , desmethorphan is for cough
pseudoephdrin is for nasal congestion
loratadine is for allergy , nasal congestion, nasal drip
58 spnal muscular atrphy on genetic testing S/S weakness in all muscles physician will
tell mother what complication ? cardiac , neurological, food related
donot confuse with cardiac it is seen in Duchenne and myotonic .. not spinal dystrophy
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59 asthma 7d/wk dyspnea , takes SABA and inhaled steroid , add LABA
60 asthma pt took SABA . but not controlled SOB 2d/wk SOB add inhaled steroid
61 COPD pt smoking cessation , long term O2 therapy what inc life? Pneumectomy i.e
lung reduction surgery
62 Lung Ca pt had pnemectomy now remains fatigue what shud physician shud
recommend to dec fatigue progressive aerobic exercise , resp muscle exercise
63 6 yo girl . genital trauma after falling from bike . red and tender labia, not allowing
PE what to do?
I&D , anaethesia and do PE , reassure ,
64 - Fire bullet touched leg bone now pain on mvemnt sciatica , femoral nerve damage ,
compartment syndrome
65 back pain 6 wks . bladder incontinence . weakness legs . metastatic breast CA . now?
7 day trial of prednisolone . epidural steroids . MRI spine vikash did , .
Not radiotherapy as breast CA is not radiosensitive tumor .. its for prostate CA
66- osteoporosis DEXA score -1.4 , FRAX scale 10% , hip jo 1.6%
indication of alendronate when Tscore -2.5 , or osteopenia with FRAX 20% or hip3%
since this women do not qualify for alendronate give Ca and vit D and repeat DEXA
after 1 year .. but donot measure VIt d stores . they are normal .
67- 2 weeks baby old what to screen DDH
68 DDH ortani and Barlow Positive at 1 hr old next step Pelvic harness .
normally we donot do these tests at day 1 due to hip laxity
68- 4 yo child URTI - now hip pain cannot hip invert WBC in blood 10,000 , fever
mild 99 ------------ so it T: ibuprofen as transient synovitis not septic arthritis
69- vegan women loved animal physician tell her what RF? Vit b12 def
70- cirrhosis andesophageal varices fluid octreotide , pantoprazole . now?
Ceftriaxone, factor 7
71- 57 yo with abd fullness , next best step stool H.pylori or endoscopy
72- women 2nd time preganant 1st time did not blood froup now she knws she is Rh-
ve , husband Rh+ve . what next step ? indirect Coombs or give RhoGam or say
abortion karwao
73- pill induced esophagitis for 3wk food stuck, dysphagia hota hai. Took
doxycycline due to acne since 1 month stop doxycycline., hpylori testing, give
PPI, Triple thearapy
74- dyspepsia bloating, H.pylori +ve . risk of ===MALTOMA , other options
ovarian Ca, HCCA
75- post cardiac surgery pt has ischemic colitis diarrhea and blood in stool which
test will help in diagnsosis- CT angiography , colonoscopy . other test we can do
CT scan . But never CT angiography its for chronic mesenteric ischemia
76- valproate taking pt how to followup LFT , other option TFT, peripheral smear
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77- if mastitis not treated complication BREAST ABSCESS . other option
mastalgia
78- asymptomatic gallstones found on US - reassurance
79- brain tumor with ICP raised symptoms 1st give DEXAMETHASONE to dec
brain edema and ICP symptoms
80- acute flare of MS whch will preven further episodes . ie tell about drug to
maintain remission ans. Beta interferonnot steroid
81- 60 yo Parkinson pt 1st line ropinerole preffered dopamine agonist in <65y
and >65y levodopa-carbidopa
82- 6 weeks ago 92 YO F , son died . now alone . she had NORMAL GRIEF
so reassurance . not SSRI
83 62 YO M hearing problem more on left than right . business in noisy places
examination 75% EAC is stenosed by cerumen after clearing .still same problem
audiography or MRI Brain
84- EKG hyperK hyperacute T waves shown ans hyperK
85 Renal Cell Ca what to do percuteneous biopsy- vikash says CI , surgical resection .86
condylomata accuminata by HPV picture- women gave birth to child child will develop
benign laryngeal papilloma
87 murmur plus picture of AS , S/S of AS syncope , worsening sign? Physical
examination soft S2 , single S2 , delayed peakingejection fraction acha tha pt ka
88 bipolar used to take antipsychotic now has mania i.e treatment failure what to do?
Ans lithium
89 - sperm count was less in male. Female 42BMI and amenorrhea. Both are CARRIER
for cystic fibrosis . women says I wish I had biological child? Physician will send them to
- genetic consult
- bariatic consult
- fertility centre================= I think
- surrogate
- adaption centre ----------------- according to VIKASH as he had many problem
90 14 yo boy with lower abd pain and gets correct itself risk of testicular ischemia or
infertility , bowel infection ,
91- pt takes cytp450 inducer , what will he do now ? switch from OCP to other
contraceptive
92- F with H/O low lying C-sec physician will recommend? Yes there is minor RFbut
trial of vaginal delivery is possible in your case..or there is no RF in your case so no
problem to do vaginal delivery .
93- BMI 14 , anemic pregnancy counciling for child? LBW baby
94 eclmpasia women . given MgSO4 , breech presentation .ans. C-sec
95 ulcerated SCC on dorsum of hand surgical removal according to vikash .. not shave
biopsy which is done for dome shaped mass
96 melanoma biopsy stage 1a now what to do. PET , CT , abd US. No test needed
97 EN painful bumps on shin most likely prognosis if not treated ulcerate, infection ,
sponeateneous resolution
98 whch of following to dec risk of Cardiac RF smoking cessation
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99 women likes to put plates in line, hand wash, wash food multiple times has OCD
100 - ^^ above pt was started on SSRI ---- now exposure and response prevention
therapy
101- one women doesnt like her nose physician says it has no problem . but she wanted
plastic surgeon
physician shud
- refer to plastic surgeon
- refer to psychiatry
- again reassure
102- rupture AAA pt next step . No option of laparatomy refer to vascular surgeon
103 9 YO if I go to school, my mother will die.. physician will
- send school and followup in 2 week-----------------vikash send
- consult psychology
- start BDZ
- start SSRI
104 room fire pt burn on hand 5% - BP was okay , next step?
Not IV fluids , do larygenoscopy which is not invasive just to see laryngeal edema
105 US marine worker, PPD 14 , CXR old scar lesion in upper lungs next step sputum
test, all 4 drugs . just rifampin as latent
106 decubitus ulcer stage 1 red skin + old age women had some urine minor so answer
ASSISTED URINE EVERY 2 hrs - take her to bathroom every 2 hours so ulcer se bhi
pressure kum ho , ambulate bhi ho . options surgical biopsy of ulcer, pass FOLEY,
107 toe 1st MTP has red, toe pain 3 month ----------t colchince, shoe pad, footwear
change, physical therapy----------------vikash think bunion so use shoe pad
108 panic attack women started alprazolam doctor said took 2/dshe used it 3-4 times
her anxity attack frequency increased now? Start SSRI and taper BDZ
109- stoke pt BP 220. Donot dec BP by how much % ? 25%
110 intermittient foley vs indwelling cather ja faida and faraq ?
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