question

high-grade reflux in females that persists into adulthood with no clear secondary cause

answer

surgical repair

question

multiple 2nd trimester spontaneous abortions

answer

cervical cerclage

question

erythematous knee with effusion and fever

answer

arthrocentesis [ need to tell apart gout from septic arthritis]

question

spontaneous pneumothorax in a tall young man

answer

supplemental oxygen

question

clue cells seen in vaginal swab in a fertile woman

answer

oral metronidazole

question

acute open-angle glaucoma

answer

1)beta-2-antagonist eye drops i.e. timolol, betaxolol 2) carbonic anhydrase inhibitors 3) if medication fails, then a trabeculoplasty or trabeculectomy can improve aqueous drainage

question

chronic sinusitis refractory to medical Tx or neurological deficits

answer

CT scan of the face (coronal section)

question

someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo

answer

dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)

question

someone that comes in with headaches and shows papilledema in the opthalmic exam

answer

CT scan of the head non-contrast - r/o mass

question

treament for scabies

answer

permethrin

question

Scaphoid fracture that is negative on X-ray

answer

spica cast and re-evaluate in 2~3 weeks

question

3-hour old infant with poor feeding who vomits green material and has a double-bubble on KUB

answer

decompression of the GI tract...requires nasogastric tube

question

mini-mental status exam of <24

answer

neuropsychologic testing to rule-out alzheimer's (other causes of dementia)

question

cord compression confirmed with CT-spine

answer

dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)

question

Pulmonary edema in acute CHF exacerbation

answer

100% O2 therapy

question

Pulmonary edema in acute CHF exacerbation after 100% O2 therapy

answer

IV furosemide

question

supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm

answer

Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine

question

Asymptomatic aortic stenosis

answer

Hydrocholorothiazide to reduce preload

question

Hypertension with underlying diabetes type 2

answer

ACE-inhibitor or ARB

question

Syncope with normal vitals and no previous episodes

answer

Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia

question

PR interval=o.3 sinus rhythm normal

answer

Nothing, no management needed; PR>0.2 is first degree heartblock

question

A-fib secondary to hypertension for >48 hours

answer

Diltiazem; rate control + anticoagulant

question

A patient presents with hypertension and chest pain on exertion

answer

IV nitroglycerin for lowering the blood pressure

question

Palpitations with underlying lung disease i.e. COPD

answer

72 hr Holter monitor

question

Angina symptoms

answer

Beta-blockers - they increase the threshold of angina

question

Posterior anterolateral MI and Percutaneous coronary intervention

answer

Clopidogrel

question

teenage patient grunting and blinking many times a day for at least 1 year

answer

haloperidol

question

prinzmetal angina

answer

calcium channel blockers or nitrates (also for esophageal spasm)

question

Lambert Eaton Syndrome

answer

radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.

question

stroke outside the 3 hour period but within 6 hours

answer

intra-arterial tPA administration

question

osteopenia in an elderly patient

answer

calcium, vitamin D, and weight-baring exercise

question

tracheobronchial rupture

answer

bronchoscopy (flexible or rigid)

question

abdominal pain out of proportion to clinical findings

answer

laparatomy

question

Guillane Barre Syndrome

answer

plasmapheresis or IVIG with admission to ICU

question

shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)

answer

McRoberts maneuver - flexion of mother's thighs against her abdomen

question

central retinal artery occlusion

answer

ocular massage with high flow oxygen

question

nephrogenic diabetes insipidus

answer

free water and hydrochlorothiazide

question

carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%

answer

hyperbaric oxygen (oxygen >100%)

question

flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin <25%

answer

100% oxygen

question

a digoxin user with a potassium of 5.5 mg/dL

answer

Digibind (Fab fragment

question

Wernicke's Encephalopathy

answer

thiamine, then glucose ( in that order)

question

Alcohol withdrawal

answer

fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)

question

septic arthritis

answer

ceftriaxone + vancomycin

question

prophylaxis against acute limb ischemia in a person with a-fib

answer

dabigatran

question

acute febrile non-hemolytic transfusion reaction

answer

discontinue transfusion, give IV acetaminophen

question

acute cholecystitis

answer

IV fluids, pain medication, and cholecystectomy within 72 hours

question

abscess size >3cm

answer

CT-guided percutaneous drainage

question

single 2cm nodule on Chest X-ray in a 25 yo male

answer

check old Chest-X-ray to compare size or presence of the nodule.

question

ulcer that is not infected and does not involve the bone

answer

debridement

question

how to diagnose hepatorenal syndrome

answer

IV colloid challenge , if no improvement then positive for hepatorenal syndrome

question

Primary light chain amyloidosis

answer

mephalan and prednisone

question

local baldness

answer

minoxidil

question

severe acute pancreatitis >30% necrosis on MRI

answer

imipenem followed by percutaneous needle biopsy

question

pseudocyst on CT-abdomen

answer

if expanding or pain symptoms, then drain it. otherwise leave it alone.

question

elderly patient with intermediate to high risk factors for coronary artery disease

answer

stress test

question

needle-stick and unvaccinated for HepB

answer

give HepB IV-IgG and HepB vaccine

question

MRI contraindicated in suspicious looking equivocal X-ray

answer

Technetium bone scan

question

man comes in with a painless chancre on the penis

answer

swab the exudate and perform dark-field microscopy

question

vesicles on skin and mucous membranes which erode into ulcers with inguinal lymphadenopathy Tzanck positive

answer

acyclovir famciclovir valacyclovir

question

methods of treating genital warts

answer

cryotherapy , lasers, trichloroacetic acid or podophyllin imiquimod(originally for basal cell , acktinic akeratosis) , no side effects

question

acute viral pericarditis recurrence prevention

answer

colchicine

question

pericardial effusion

answer

pericardial window placement or pericardiocentesis

question

pneumonia, dyspnea, dry cough fever chest pain in HIV patient

answer

Bronchoscopy with alveolar lavage

question

dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI

answer

CT-scan of the abdomen and pelvis

question

the first test to determine beta-thalassemia anemia in genetic counseling

answer

complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner)

question

no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus

answer

measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)

question

dog bite with suspicion of rabies

answer

quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)

question

pinpoint calcifications in a newborn whose mother owns a cat

answer

pyramethamine and sulfadiazine (Treats toxoplasmosis)

question

peripartum cardiomyopathy - biventricular cardiac failure

answer

supportive care

question

eisenmenger's syndrome in a pregnant woman

answer

avoid hypotension give pressors

question

Rheumatic mitral stenosis in a pregnant woman

answer

decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume

question

pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL

answer

do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus.

question

Estimated fetal weight is >4.5kg by sonogram

answer

C-section

question

perinatal management of gestational diabetes

answer

IV D5w with insulin drip maintain glucose within 80-100mg/dL

question

non-reactive stress test

answer

vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping

question

non-reactive stress test with positive contraction stress test

answer

delivery the baby immediately

question

fibromuscular dysplasia

answer

percutaneous angioplasty with stent placement

question

4 month old boy with leg-length discrepancy and positive Ortolani test

answer

U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction

question

45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea

answer

aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation moderate intoxication =>IV sodium bicarbonate to alkalinize the urine and promote excretion severe intoxication => hemodialysis

question

suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior.

answer

perform a skin biopsy -> top ddx is Lepromatous leprosy.

question

A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion

answer

Trams esophageal echo

question

5 day old newborn has lost 7% of their body weight

answer

follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)

question

skin lesions in a patient with celiac disease

answer

dapsone (Tx for dermatitis herpetiformis)

question

clinical suspicion for abnormal uterine bleeding

answer

endometrial biopsy

question

reproductive-age woman with widespread pain ,fatigue, poor-sleep, frequent headaches and tenderness to palpation of her neck, shoulders and back. Vitals and labs are normal.

answer

exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.

question

1 month old boy with a harsh holosystolic murmur over the left lower sternal border

answer

echocardiography - he has a VSD

question

infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen

answer

botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)

question

Lichen sclerosus

answer

corticosteroids

question

admission to inpatient ward with febrile neutropenia

answer

piperacillin-tazobactam

question

cafe au lait spots with sensorineural hearing loss

answer

MRI with gadolinium (suspect acoustic neuroma)

question

MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib.

answer

drainage, surgical debridement and antibiotics ( acute mediastinitis)

question

DVT identified on ultrasound

answer

CT scan of abdomen, chest, and pelvis - search for any embolism

question

Rhabdomyolysis

answer

IV fluids, mannitol and bicarbonate

question

Baseline EKG changes on patient with SSx of stable angina

answer

Stress echocardiography instead of exercise treadmill stress test -- (echo you need to have a normal EKG reading at rest)

question

presence of bilateral popliteal artery aneurysms

answer

CT Abdomen -> 25% chance of abdominal aortic aneurysm present.

question

Asystole

answer

CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole

question

hepatorenal syndrome

answer

midodrine and octreotide

question

Needlestick from an HIV infected person

answer

Triple HAART therapy for 28 days

question

pancreatic cancer with elevated direct bilirubin

answer

endoscopic stent to relieve jaundice from extrahepatic cholestasis

question

positive whiff test

answer

amine production with KOH prep = bacterial vaginosis -- Tx --> clindamycin or metronidazole

question

symptoms of malabsorption returning from a foreign country

answer

Tx empirically with metronidazole. i.e. giardiasis, amoebiasis.

question

skin rash in a person with gluten-intolerance

answer

dapsone for dermatitis herpetiformis

question

patient with hypothermia at 32-35C, 28-32C, and 27C degrees

answer

general - IV hot crystalloid for hypotension with endotracheal intubation in comatose patients. 32-35 degrees - dry and cover with blankets 28-32 degrees - warm bath, heating pad, blankets <28 degrees - pleural, peritonealwarm irrigation -internal rewarming

question

recurrent coughs with mucopurulent sputum

answer

CT scan - bronchiectasis - dialated bronchiolar airways

question

microcytic, hypochromic anemia in an otherwise healthy adult

answer

test for stool occult blood - because the most common cause of iron-deficiency anemia is GI blood loss. Otherwise, colonoscopy is indicated because it has a higher sensitivity and specificity

question

meningitis in people age 2-50

answer

vancoymcin + 3rd generation cephalosporin

question

meningitis in people older than 50

answer

vancomycin + ampicillin + 3rd generation cephalosporin

question

infection post-neurosurgery shunt

answer

vancomycin + 4th generation cephalosporin (cefepime)

question

meningitis in an immunocompromised state

answer

vancomycin + ampicillin + 4th generation cephalosporin(cefepime)

question

infection after penetrating trauma to the skull

answer

vancomycin + 4th generation cephalosporin (cefepime)

question

Tx of carcinoid syndrome

answer

octreotide for symptomatic patients before surgery

question

patient has blood cultures that grow Streptococcus bovis and has vegetations on mitral valve

answer

perform colonoscopy NOT FOBT- colonoscopy is more sensitive and specific

question

patient had a Hx of flu ten days earlier but now has increased tactile fremitus in LLL of the lung and a fever

answer

Tx: anti-staph penicillin i.e. methicillin, oxacillin, dicloxacillin, naficillin - most common organism is Staph aurues post-influenza pneumonia.

question

patient with a PMH of drug addiction and addiction comes in with severe pain from a motor vehicle accident. What analgesic do you give him?

answer

Give him IV morphine. It doesn't matter what his drug abuse history is. Physicians never undertreat pain even with a risk of abuse.

question

lupus nephritis

answer

1. mycophenolate mofetil 2. cyclophosphamide + corticosteroids OR 3. azathioprine + corticosteroids

question

MALT lymphoma restricted to the mucosa with no lymph node involvement

answer

PPI + clarithromycin + amoxicillin ( most common cause is H-pylori) then use

question

multiple consecutive PVCs without symptoms what if you DO have symptoms with multiple consecutive PVCs?

answer

observation; if multiple consecutive PVCs with symptoms then you give beta-blockers first, then amiodarone as a second-line therapy.

question

cancer-related anorexia and/or cachexia symptoms

answer

megestrol acetate ( progesterone analogs) they are superior to cannabinoids

question

positive PPD test in HIV patients

answer

isoniazid + vitamin B6 for 9 months.

question

unstable patient with narrow-complex tachycardia

answer

DC cardioversion stat supraventricular tachycardia = narrow complex tachycardia

question

patient with flank pain gets abdominal imaging showing 6mm calculus in distal right ureter. No hydronephrosis seen. IV hydration and analgesics started. What is the next step?

answer

alpha-1 receptor blocker i.e. tamsulosin - acts at the distal ureter lowering muscle tone and reduces ureteral spasm from stone impaction.

question

elderly patient with abnormal gait, incontinence and dementia showing enlarged lateral ventricles on CT scan

answer

1. serial large volume lumbar punctures 2. ventriculoperitoneal shunting if symptoms relieved by sequential CSF removal by the lumbar punctures

question

painless hematuria with elevated hemoglobin, 50 pk-yr smoking history

answer

CT Scan of the Abdomen

question

symmetrical pain and stiffness in the neck, shoulders, and hip with elevated ESR

answer

low dose prednisone ( Polymyalgia Rheumatica)

question

widened pulse pressure, irregular breathing, and elevated ICP

answer

intubation with possible ventilation, elevated head of the bed , mannitol

question

symmetric descending flaccid paralysis that started with dry mouth and diplopia

answer

administer antitoxin with high clinical suspicion simultaneously with collecting specimens identify in stool, serum or gastric lavage -> botulinum toxin.

question

hypertonic extremities with lockjaw

answer

(1)admit to ICU immediately, (2) diazepam, and give (3)1x dose of IM tetanus immunoglobulin (4) active immunization with Td(tetanus/diptheria toxoid)

question

empiric osteomyelitis Tx

answer

cephalosoprins, fluoroquinolones, vancomycin, linezolid, daptomycin, and clindamycin rifampin for biofilm penetration If gram negative suspected add aminoglycoside +/- beta lactam

question

septic arthritis in an immunocompetent adult

answer

IV beta lactamase resistant penicillin --> oxacillin OR 1st generation cephalosporin ; MRSA coverage -> vancomycin

question

septic arthritis in a immunocompromised adult

answer

broad spectrum antibiotic - 3rd generation cephalosporin OR aminoglycoside ; consider pseudomonal coverage with aminoglycoside + extended spectrum pencillin

question

warts

answer

(1) freezing lesions with liquid nitrogen (2) salicylic acid daily topically applied for several weeks (3) 5-FU cream - retinoic acid cream for flat warts (4) surgical excision OR laser therapy (5) podophyllin for genital warts

question

molluscum contagiosum

answer

(1) curettage (2) podophyllin drops (3) cantharidin (4) cryosurgery

question

silvery scales on knees and elbows

answer

corticosteroids are first line calcipotriene and calcitriol - 1st/ 2nd line tars tazarotene ( vit A derivative) anthralin (anthracene derivative - smoke carcinogen)

question

young woman with tender breast mass on the upper outer quadrant. LMP was three weeks ago. She has no family history of breast cancer.

answer

Ask her to come back after the menstrual period and ask her to take note if the size of the mass has decreased after the menstrual period. Otherwise ultrasound, FNA, and excision biopsy would be the option.

question

acute exacerbation of COPD

answer

IV methylprednisolone 1-2x doses followed by oral therapy for 5 days.

question

allergic conjunctivitis

answer

olopatadine, azelastine

question

non-herpes viral conjunctivitis

answer

supportive therapy, warm compresses

question

collapsed gestational sac with no fetal heart tone on transvaginal ultrasound in a hemodynamically stable female at 8 wks gestation

answer

follow-up outpatient ; no suction and curretage.

question

meningitis in a 55 year-old man

answer

3rd gen. cephalosporin + vancomycin + ampicillin + dexamethasone

question

bruit left periumbilical region on auscultation in middle-aged man with hypertension

answer

captopril renal scan

question

eye pain with Hx of occupational trauma

answer

tetracaine for pre-op anesthesia prior to Fluorescein slit lamp examination

question

elderly male comes in with 1 episode of syncope with no smoking history BP equal on both arms and widened mediastinum and pericardial effusion on chest X-ray

answer

transesophageal echocardiogram --> it could be a type A retrograde aortic dissection , so the BP could be normal.

question

frostbite injuries

answer

rapid rewarming with warm water

question

high blood pressure in an otherwise healthy woman of child-bearing age

answer

1st step: discontinue oral contraceptive pills 2nd step: diet and exercise 3rd step: introduce thiazide diuretic

question

5mm radiolucent stone in the ureter

answer

potassium citrate --> uric acid is soluble at high pH

question

elderly male with history of recurrent aspiration presents with neck mass and RLL consolidation

answer

barium esophagram to rule out Zenker's diverticulum, CT scan of neck is indicated for airway obstruction by foreign object; bronchoscopy is 2nd line.

question

postpartum fever with leukocytosis and non-foul smelling bloody vaginal discharge

answer

reassurance. You don't even need empirical antibiotics. Endometritis requires the presence of foul smelling lochia

question

acute exacerbation of COPD

answer

non-invasive positive end expiratory pressure for 2hours

question

acute exacerbation of COPD with failed NPPV trial

answer

mechanical intubation

question

malignant hypertension

answer

lower BP 10-20% in the first hour , then 5-15% across the next 23 hours.

question

hypertension diagnosed in a young individual

answer

suspicion for co-arctation of the aorta --> check for radio-femoral delay..associated with Turner's, bicuspid aorta, and VSD.

question

adnexal mass in a postmenopausal woman.

answer

transvaginal ultrasound AND CA-125 serum marker

question

progressive back pain in prostate cancer patient with previous orchiectomy

answer

radiation therapy (the answer is NOT flutamide or any medical management)

question

white cloudy dialysate with tender abdomen in a patient getting peritoneal dialysis.

answer

trial of antibiotics cefazolin and ceftazidime; if refractory, then remove the catheter.

question

positive Tinel's sign and flick test

answer

First line: wrist splint 2nd line: injected glucocorticoids 3rd line: surgery

question

fever, hypertension and tachycardia along with altered mental status

answer

give Librium ( chlordiazepoxide) the patient is going through EtOH withdrawal

question

post-ictal metabolic acidosis on admission

answer

wait 60-90 min. for the metabolic acidosis to resolve, then redraw labs. No need for immediate medical intervention.

question

Failure of MALToma to regress after eradication of H-pylori with triple therapy

answer

CHOP therapy - cyclophosphamide, adriamycin, vincristine, and prednisone +/-bleomycin

question

woman in her thirties whom results for for AchR antibodies test came back positive

answer

CT scan of the anterior mediastinum -- a thymoma is more specific than a Tensilon(Edrophonium) test

question

opening snap with diastolic rumble in a patient who had a respiratory illness with joint pain an swelling recently

answer

IM benzathine penicillin G once a month for 5 years or until 21 years old (whichever is longer) for rheumatic fever + carditis rheumatic fever + carditis but no proven heart or valve disease (echocardiogram/clinical) - 10 years or until 21 yrs old - whichever one is longer rheumatic fever + carditis, heart or valve disease = 10 yrs or until 40 years old

question

precocious puberty showing elevated LH at baseline

answer

MRI of the brain - need to rule out central vs. peripheral gonadotropin dependent precocious puberty

question

cat bite with puncture wound showing no debris or active bleeding in a patient with recent Td vaccination <5 yrs

answer

amoxcillin-clavulanate for Pasteurella multocida

question

dyspnea and tachycardia in a pregnant woman with low pretest probability of P.E. chest X-ray

answer

d-dimer in a pregnant patient has high false negative rate; need to perform V/Q scan to rule out P.E. If V/Q is equivocal then perform CT angiogram.

question

urge incontinence

answer

bladder training ; 2nd line is oxybutynin(anticholinergic) and mirabegron(beta-3 adrenergic agonist @ the detrusor)

question

gas gangrene infection

answer

IV penicillin - 24 million units per day

question

1 or 2 coronary vessel stenosis

answer

angioplasty and stent followed by Gp2b3a inhibitor i.e. tirofiban or abiciximab

question

postmenopausal woman with pruritis of the vulvar region that is refractory to medical management

answer

vulvar biopsy.

question

history of cancer with suspicion of bony metastasis i.e. back pain

answer

radionuclide bone scan ( X-ray of the back is to rule out other causes of bone pain because radionuclide bone scan has high sensitivity BUT low specificity)

question

suspicion for SLE; which lab test first

answer

anti-nuclear antibody first because of high sensitivity; use anti-dsDNA antibody as a confirmation test because of high specificity

question

amytrophic lateral sclerosis

answer

riluzole - glutamate receptor antagonist

question

moderate-to-severe restless leg syndrome

answer

1st line - pramipexole, ropinirole 2nd line - alpha-2-delta calcium channel agonists i.e. gabapentin enacarbil

question

mild restless leg syndrome

answer

1) iron supplementation if serum ferritin <75 2) supportive measures - heating pad exercise 3) avoid triggers - sleep deprivation, medications

question

sore throat two weeks after starting PTU for treatment of Graves disease

answer

stop PTU. It is causing the agranulocytosis

question

person with a core body temperature of 88 degrees F, bradycardia and hypotension

answer

active rewarming with blankets - hypothermia will slow the heart and the blood vessel vascular resistance.

question

patient brought to E.R. after smoke inhalation from a burning building

answer

100% oxygen by facemask - first suspicion is carbon monoxide poisoning.

question

recent gastrectomy with nausea, diarrhea, abdominal pain and palpitations

answer

manage diet -- dumping syndrome - small frequent meals, avoiding simple sugars, increase fiber and protein, drink fluids during rather than after meals.

question

patient with Hx of tonic-clonic seizures comes in post-seizure 15 min. ago and has a pH of 7.2. confused and appears confused. anion gap is elevated.

answer

This patient has post-ictal lactic acidosis. No management for the first two hours and draw second labs. a pH >7.1 does not require intervention. If value <7.1 then IV sodium bicarbonate is indicated.

question

unilateral renal artery stenosis 80%

answer

treat initially with ACE-I or ARBs. stenting and surgical revascularization is reserved for patients with resistant HTN or flash pulmonary edema or refractory heart failure due to severe HTN

question

patient shows morning glucose of 300mg/dL consistently; they deny any late night snacks

answer

make them record their blood sugar at 3am - to determine Somogyi (rebound hyperglycemia 2/2 hypoglycemia) or Dawn effect (cortisol and growth hormone effects)

question

PCP intoxication

answer

benzodiazepines - midazolam, diazepam, or lorazepam ; 2nd line is haloperidol

question

R supraclavicular lymph node biopsy shows squamous cell carcinoma cells

answer

do a panendoscopy because the cancer is coming from larynx, bronchus or esophagus most likely.

question

nausea and vomiting caused by chemotherapy

answer

ondansetron + Fosaprepitant + dexamethasone ( 5HT3 antagonist and NK-1 antagonist) dexamethasone mechanism unclear.

question

condyloma acuminata - patient wants self-treatment

answer

imiquimod (induction of IFN-alpha leading to reduction in HPV viral DNA synthesis). Canthardin and Podophyllin require in-office administering of the drug.

question

vomiting, lethargy, dehydration, with posturing in a 10 month old infant

answer

IV dexamethasone; increased ICP can counteract vasogenic edema - corticosteroids have an anti-inflammatory and membrane stabilizing effect

question

pediatric patient 4 years old has PPD <5mm but lives in the same house as someone who has

answer

isoniazid _ vit B6 along with follow up PPD test in 8-12 week- the kid is still exposed to T.B.

question

agitation and chest pain in someone with acute-onset chest pain who recently used cocaine

answer

benzodiazepine --> use diazepam

question

patient comes in with tearing chest pain radiating to the back, has a moderate pericardial effusion and happens to be hemodynamically stable

answer

CT angiogram - definitive test for aortic dissection

question

an unchanged consolidation in the right lower lobe of the lung after multiple bouts of pneumonia

answer

CT scan of the chest -- concern for malignancy. Bronchoscopy is most commonly for biopsy of hilar centrally located masses.

question

adnexal mass palpated in a post-menopausal woman

answer

need to obtain a serum CA-125 ( pelvic U/S would have been the first intervention in a pre-menopausal woman)

question

temporal lesions on MRI in a male with seizure. He also has a fever and altered mental status

answer

empirical treatment with IV acyclovir. If IV acyclovir fails , then lumbar puncture is warranted.

question

male in his 20s diagnosed with HOCM, refractory to beta blockers and calcium channel blockers

answer

myomectomy

question

vomiting in a young child with olive-shaped mass in the epigastric region

answer

correct the metabolic alkalosis first, then consult for surgery for pyloromyomectomy

USMLE Step 2 CK: Next Step in Management – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards