Arlete Usmle Step 3 Notes
Arlete Usmle Step 3 Notes
Arlete Usmle Step 3 Notes
skin ca)
73. Moh's micrographic surgery = for squamous cell ca (lower 1/3 of the face), makes 1-2 mm
margins
74. MCC of encephalitis in adults = HSV; meningeal signs + focal neurological signs, temporal
lobe changes on CT; Rx = IV Acyclovir 14-21 days
75. Listeria monocytogenes meningitis Rx = ampicillin; NB, elderly
76. Chronic sinusitis = longer than 3 months; clinical Dx, but if something is going to be ordered
= CT sinus; Rx = amoxicillin +/- clavulanate +/clindamycin for 21 days, nasal steroid sprays, endoscopic surgery if necessary
77. Otitis media, ac. sinusitis Rx = TMP/SMX or amoxicillin +/- clavulanate
78. Otitis externa Rx = topical ofloxacin with steroids; remember to clean the ear before applying
the Rx; Pseudomonas, swimmers
79. Chr carriers of group A strep Rx = clindamycin
80. Smoker with pneumonia, diarrhea, increased LDH = think Legionella; Dx = urine Ag; Rx =
doxycycline
81. Cystic fibrosis pneumonia Rx = IV ceftazidime + IV levofloxacine = IV aminoglycoside;
MCC = Pseudomonas
82. Aspiration pneumonia Rx = IV ceftriaxone + IV azythromycin + IV clindamycin; chronic, not
presentiated, RF positive
83. Aspiration pneumonitis = acute event, presentiated by somebody, no need for atbtcs
84. PCP pneumonia Dx = silver stain of sputum, bronchial lavage; Rx = IV TMP/SMX or inhaled
pentamidine, add prednisone if: PaO2 less than 70 or
A-a gradient more than 35
85. TB Rx = RIPE for 8 w., then INH + rifampin for 16 w. more
86. Add vit. B6 for INH
87. Keep an eye on uric acid for Pyrazinamide
88. Order ophtalmologic avaliation for Ethambutol
89. Latent TB Rx = nine months of INH (+ B6)
90. TB + HIV = use Rifabutin instead of Rifampin because of possible drug interaction
91. Ac. prostatitis Rx = TMP/SMX or fluoroquinolone for 14 d
92. Chr prostatitis Rx = fluoroquinolone 1 m. or TMP/SMX 3 m.
93. Primary/secondary syphilis Rx = Penicillin G 2.4 million U IM; if disease present for more
than 1 year = three doses with 1 w. intervals; notify health
department
94. Neurosyphilis Rx = Penicillin G IV for 14 days
95. DM Dx = random glucose test >200 + symptoms OR twice fasting glucose > 126 OR 75 GTT
> 200 at 2 h. OR 50 g GTT > 146 at 2 h
96. Annual influenza vaccine = patients older than
50 yo, healthcare workers
97. OCPs = decrease risk for gonococcal PID
98. Osteoporosis Rx with drugs, not only calcium is indicated when = T-score < 1.5 OR < 2.5 +
RF
99. Dual X-ray absorptiometry (DEXA) T-score = compared to young adults
100. DEXA z-score = compared to age and race matched population
101. Elderly + fall = do a home safety evaluation, avoid narcotics
102. Woman sexually active, younger than 25 yo or with RF = screen for Chlamydia
103. HTN Dx = 3 separate readings with increased BP
104. Post exposure TB prophylaxis = 2 drugs chosen according to bug susceptibility
105. Smallpox Rx = Cidofovir
106. Anthrax Rx and prophylaxis = ciprofloxacin (adults), penicillin (children)
107. Household with children = water heater < 120-130 F
264. Erythema multiforme minor = bull's-eye on palms, herpes simplex; Rx = long-term use
acyclovir
265. Pustular psoriasis = sterile, post steroids, fever, malaise, arthralgia, diarrhea; Rx =
cyclosporine
266. Seborrheic keratitis = "stuck=on", waxy grease scale
267. Dermatomyositis = often is paraneoplasic
268. Hypercalciuria (renal stones) Rx = hctz orally
269. Dye S.E. = ac. tubular necrosis = muddy granular casts
270. ATN = BUN/Cr < 20:1; cisplatin is one of the causes
271. Ac. interstitial nephritis (drugs) = rash, fever, hematuria, white cell casts, eosinophiluria
272. Increase in eosinophils = tumors, parasitic infectious, autoimmune diseases
273. Renal calculi = Abd XR, if - = CT scan of abdomen (shows all types of stones) actually this information is conflicting between some sources, so one should do some
research about it
274. Indinavir (HIV drug) S.E. = renal stone
275. Struvite stones = Mg ammonium phosphate, pH>7.2, presence of urea splitting bugs
(Proteus, Pseudommonas, Klebsiella; Rx = removal
276. Uric acid stones = radiotranslucent
277. Asymptomatic bacteriuria in non-pregnant, healthy patient = no Rx is indicated
278. Doxorubicin (Adriamycin) S.E. = cardiac toxicity, myelosuppression
279. Vincristine S.E. = motor, sensory and autonomic neuropathy
280. Bleomycin S.E. = pulmonary fibrosis
281. Myelosuppressant drugs = methotrexate, vinblastine, doxorubicin
282. Polycystic kidney dis = colonic diverticular dis (with increased risk for perfuration), it may
evolute to end stage renal dis, 10-15% of the patients have intracranial aneurysm
283. Chrug-Strauss dis = nephritic syndr + eosinophilia + asthma, p-anca +; Rx = steroids,
cyclophosphamide, azathioprine
284. Goodpasture syndr = nephritic syndr + pulmonary hemorrhage; Abs to glomerular basement
membrane
285. Wegener granulomatosis = nephritis + nasal/sinus problems, c-anca +; Rx = same as ChrugStrauss
286. Berger's syndr = IgA nephropathy, no latent period post infection, nephrotic syndr
287. DMSA renal scan = radionucleotide study for renal function
288. IV pyelogram = C.I. in renal insufficiency
289. Kegel exercises = benefits within 6 weeks
290. Dribbling + dyspareunia + dysuria in woman = urethral diverticulum; Dx = urethroscopy or
voiding cystourethrography
291. Nephrotic syndr = increased susceptibility to bact. infections, hyperlipidemia, mildly
hypercoagulable state, hypovolemia
292. Renal cell ca suspicion = radical nephrectomy; Bx only for metastatic cases (when Sx is not
indicated)
292. Rapidly progressive GN Rx = high dose IV methylprednisolone
293. Alport syndr = hematuria +/- blindness +/- deafness; type IV collagen of GMB in abnormal
294. Membranous glomerulonephropathy = MCC of nephrotic syndr in adults; Rx = ACEi
295. Membranoprolipherative GN = nephrotic sundr; renal dis + decreased complement, realted
to hepatitis C virus
296. Painless hematuria = CT urogram or IVP (check ureteres)
297. Pyelonephritis suspicion = blood + urine cultures, urinalysis
298. Immunotherapy = for asthmatics patients with a single allergen
299. Interstitial fibrosis = decerased FVC, FEV1,
RV, TLC, diffusion; increased FEV1/FVC; no response to bronchodilator
cefepime
419. Ecthyma gangrenosum Rx = IV atbtc (not debridement)
420. Cryptococcal meningitis Dx = + india ink preparation; Rx = amphotericin B + flucytosine
10-14 d, then fluconasole prophylaxis forever (for HIV);
may require repeated lumbar punctures to decrease the pressure
421. Phenytoin toxicity = nystagmus on far lateral gaze, neurotoxicity; remember that it decreases
the OCP levels in the blood
422. Catheter-related syst. infection = removal + vancomycin + gentamycin
423. Vertebral osteomyelitis Dx = MRI is the most accurate, bone Bx is the gold standard
424. Meningococcal meningitis prophylaxis = oral rifampin OR S.D. oral ciprofloxacin OR S.D.
IM ceftriaxone
425. IV pentamidine S.E. = metabolic disturbances, such as hypoglycemia (always check in case
of seizure)
426. Herpes zoster Rx = acyclovir within 48 h of onset of rash
427. Candida ophtalmitis with vitreal involvement Rx = vitrectomy + systemic antifungal
428. Hypothermia or shock post blood transfusion = think hypocalcemia!
429. HIV prophylaxis post exposure = zidovudine + lamivudine for 4 w 430. Lungs + sinuses
infections post bone marrow transplant = invasive aspergillosis
431. Rhinocerebral mucormicosis Rx = surgical debridement + IV amphotericin B
432. MCC of FUO = infection (30-40%)
433. Progressive multifocal leucoencephalopathy (JC) = multiple focal neuro symptoms in HIV
patient
434. Shoulder dystocia Rx = stop pushing, suprapubic pressure, McRobert's maneuver
435. McRobert's maneuver = two assistants flexing thighs back against abd.
436. Zavanelli maneuver = replace fetal head back into the pelvis, but then you have only 7
minutes to perform the c-section
437. ARDS = clear lungs + diffuse bilat. infiltrates on CXR; Rx = PEEP around 9, high O2
concentration, low tidal volume (<6 ml/kg)
438. Neonatal polycythemia Rx = hydration + partial exchange transfusion
439. Mendelson's syndrome = aspiration pneumonitis
440. Ac. tubular necrosis = after prerenal azotemia; muddy brown casts in urinalysis; increased
BUN and creatinine, anion gap acidosis
441. Hemosiderin laden macrophages = Wegener's, Goodpasture's
442. Heparin induced thrombocytopenia Rx = suspend it, lepirudin or argatroban; prevention =
use low molecular heparin instead, or limit the use to a
maximum of 5 days
443. Ascities fluid analysis = serum-ascitic fluid albumin gradient (SAAG) - if <1.1 g/dl =
cirrhosis, CHF; if >1.1 = ca, pancreatitis
444. Ac. compartment syndr. complication = rhabdomyolisis that may lead to ARF; Dx =
pressure > 30 mmHg; Rx = emergent fasciotomy
445. Mental status change in the elderly = meds, infection, metabolic, thyroid dis.
446. Metastasis prostate ca Rx = leuprolide (LHRH agonist) + flutamide (antiandrogen)
447. Octreotide = somatostin analog, for bleeding esophageal varices
448. Active lower GI bledding = STAT colonoscopy or radionuclide scan
449. Ac. hemolytic transfusion reaction Rx = stop it and hydrate!
450. Metronidazole = contraindicated for breastfeeding women
451. Postpartum endometritis Rx = clindamycin + gentamicin
452. Infant botulism Rx = supportive care, human derived botulin antitoxin; expect 1-3 m of
hospitalization and full recovery
453. Febrile transfusion reaction avoidance = washed cells
454. Pre-angiography = discontinue metformin to avoid renal complications and acidosis
499. Cystic fibrosis infertility = 95% for men, 20% for women
500. Hyperthyroidism + pregnancy Dx = free T4, total T4, TSH
501. Pap smear screening = 3 y after first intercourse or 18 yo
502. Hypothyroidism in pregnincy = dose of Lthyroxine needs to be increased (increased
thyroglobulin)
503. Pessaries (+ vaginal estrogen) = structures to support the vagina walls
504. ASCUS Dx next step = HPV DNA testing, then colposcopy if necessary
505. RA with poor response to methotrexate = infliximab OR etanercept; do a PPD first!
506. PCP intoxication Rx (if patient not extremely agitated) = low-sensory enviroment;
haloperidol, diazepam if necessary
507. Metoclopramide S.E. = extrapyramidal symptoms
508. Influenza Rx = zanamivir, rimantadine or amantadine within first 30-48 h of symptoms
509. Sup. vena cava syndr = CT of neck + chest w/ contrast
510. MCC of Guillain-Barre syndr = C. jejunii infection; Rx = IV Ig or plasmapheresis,
respiratory support if necessary, keep an eye on the patient, with
bedside pulmonary function tests!
511. Ac. stress disorder = < 4 w post event
512. Post-traumatic stress disorder = > 4w post event, even years
513. Hyperviscosity syndr = Waldenstrom's macroglobulinemia (increased Ig M), multiple
myeloma
514. PE suspicion = V/Q scan, then venous USG, then CT angiogram of the chest (in this order, if
necessary)
515. Chlamydia infection + HLA-B27+ = Reiter's syndr; Rx = atbtc, exercise, sulfasalazine,
methotrexate
516. Ethylene glycol = severe anion gap acidosis, Kussmaul's respiration
517. Ethylene glycol, methanol intox. Rx = fomepizole infusion (ADH competitive inhibitor)
518. Klinefelter's syndr = risk factor for male breast cancer
519. Doxycycline S.E. = photosensitivity
520. Isotretinoin S.E. = hypertriglyceridemia, may lead to pancreatitis
521. Pulm. contusion Rx = admission for 24-48 h, pulm. toilet, O2, pain control, fluid
management
522. Renal cell ca = renal mass + polycythemia + flank pain + smoking
523. Amiodarone S.E. = thyroid dysfunction, corneal deposits, skin discoloration, pulm. fibrosis,
liver toxicity
524. Metformin S.E. = metabolic acidosis, weight loss
525. Glyburide = metabolized by kydneys; glitazones = metabolized by liver
526. indirect inguinal hernia Rx = elective repair ASAP
527. TSS Rx = clindamycin +/- naficillin + IV fluids (up to 20 L!)
528. Metformin C.I. = CHF, alcoholism, renal failure
529. Glitazones C.I. = CHF NYHA classes III, IV
530. C. difficile infection is caused by = clindamycin, ampicillin, amoxacillin, cephalosporins
531. After 2 cystitis in 6 months = prophylaxis for 6-12 m
532. Decreased TSH, but normal T3, T4 = repeat TSH after 6-8 w
533. Anorexia nervosa with <75% of ideal weight = hospitalization
534. Early childhood respiratory disease with apnea = RSV bronchiolitis
535. Heat stroke Rx = augmentation of evaporative cooling
536. Isolated increase in alkaline phosphatase = liver tb, liver lymphoma (prolipherative
processes)
537. Epididimitis association = hydrocele
538. Rabies prophylaxis in pat. prevoiusly vaccinated = only vaccine, no Ig
539. Hemochromatosis = liver dysfunction, arthropathy, central hypogonadism, skin
718. Mass in the hepatic duct Rx = ERCP + stent placement; if it fails = percutaneous
transhepatic cholangiography + stent
719. Borderline personality = splitting, e.g. primitive idealization; Rx = dialectical behavour
therapy
720. Falling on an outstretched hand = scaphoid fracture; Dx = CT scan of the hand, bone scan;
complication = nonunion
721. Epidural spinal cord compression (metastasis) = thoracic radicular pain, neuro symptoms;
Rx = high dose corticosteroids, MRI, radiation
722. Hemochromatosis Rx = phlebotomy
723. Penicillamine = promotes copper excretion (Wilson's dis)
724. Extremely ominous sign of preeclampsia/eclampsia = retinal hemorrhages
725. Ac. adrenal insuf. Rx = dexamethasone + cosyntropin stimulation test
726. Symptomatic rectocele Rx = surgery or pessary + estrogen cream
727. HIV and RPR + = CSF examination; if nl = benzathine penicillin weekly x 3, warn about
possible Jarisch-Herxheimer reaction
728. Painless low GI bleeding = colonoscopy or radionuclide scan with technitium-99
729. IgM HIV Ab assay = low sensitivity, do NOT use!
730. Indeterminate HIV ELISA = order HIV RNA PCR assay or p24 Ag
731. HIV with or without Rx = monitor CD4 count and HIV load q 3-4 m
732. Survival analysis = accounts for number of events AND timing of events
733. Blepharospasm = focal dystonia; Rx = botulin toxin injection
724. Prerenal azotemia = decrease fractional excretion of sodium
725. Drug-induced allergic interstitial nephritis = happens after 3-5 d of causal agent; eosinophils
in urine
726. Most benefitial step to decrease osteoporosis risk = quit smoking
727. Ankylosing spodilitis suspition = X-ray sacroiliac joint, repeat q 3 m + ESR
728. Chr. Foley catheter + candida on urine culture = no Rx if asymptomatic
729. Viral meningitis in chidren = enterovirus, arbovirus; in adults = HSV
730. Drugs with thrombocytopenia as S.E. = clopidogrel, heparin
731. Ideal blood culture = 1 h before fever
732. Chr. non-remiting cluster headache Rx = verapimil, lithium; ac. crisis = 100% oxygen
inhalation
733. Condyloma acuminata in pregnancy = do NOT use podophilin, use trichloroacetic acid
instead
734. Chr. hepatitis C Rx = interferon alpha-2b (+/-ribavirin)
735. Hormone replacement therapy cessation = do not do it abruptly, taper it down instead!
736. Confidence interval includes 1.0 = not sattistically significant
737. Latent TB infection = PPD + and CXR WNL; Rx = isoniazid + B6 for 6-12 m
738. ARDS causes = sepsis, pneumonia, severe trauma, burns, drowning, pancreatitis; clear lungs
on PE + diffuse, bilat infiltrates on CXR; Rx = PEEP
around 9 cmH2O, high O2 concentration, low tidal volume (6 ml/kg)
739. Emergency contraception after 120 h = copper IUD
740. DM + C-section prep = normal insulin the night before; insulin drip + D5 1/2 NS + KCl
during the day, keep glucose <160
741. Single most important predictor for CV risk = DM
742. Diet for diarrhea = normal, age appropriate with low fat and low sugar
743. Sedative and hypnotic drugs for the elderly = increased risk for falls, so risk x benefits have
to be carefully evaluated
744. BZD withdrawal = tremolousness, seizure, psychosis, increased HR, BP, body temperature,
anxiety, restlessness, confusion, disorientation; Rx =
IV lorazepam, diazepam
745. Anemia of chr. dis. = RA, SLE, vasculitis; if severe, with normal erythropoietin levels = red
cell transfusion
746. Sjogren's syndr Dx = anti-Ro, anti-L2 in salivary gland; gold standard = labial minor
salivary gland Bx = focal collections of lymphocytes; associated with non-Hodgkin's lymphoma
(B-cell lymphoma)
747. MEN 1 = hyperparathyroidism, pancreatic tu, pituitary tu
748. MEN 2A = medullary thyroid ca, pheochromocytoma, hyperparathyroidism
749. MEN 2B = medullary thyroid ca, pheochromocytoma, mucosal neuromas, marfanoid habitus
750. Vertebrae osteomyelitis and diabetic foot = most accurate test = MRI; gold standadrd = bone
Bx; culture = deep curetage tissue
751. Addison's dis = decreased Na, increased K, hyperchloremic metabolic acidosis; Dx = ACTH
stimulation test, early mornong cortisol
752. IV pentamidine S.E. = increased or decreased K, decreased Ca, hyper or hypoglycemia
753. Obesity surgery indications = BMI > 40, coexisting diseases, decreased quality of life
754. Erb's palsy prognosis = 80% chance near full recovery in 1 y
755. NF 1 = cafe-au-lait spots, cutaneous neurofibromas, axillary freckling, unilat. acoustic
neuroma
756. NF 2 = hypopigmented spots, family history of bilat. deafness (bilat. acoustic neuromas)
757. Tuberous sclerosis = congenital ash-leaf spots, glial prolipheration, organ hamartomas/cysts
758. Sturge-Weber syndr = facial port-wine stain, leptomeningeal angiomatosis
759. Osler-Rendu-Weber syndr = vascular lesions of the CNS, multiple telangiectasias
760. Diaper rash Rx = topical zinc oxyde paste, petrolatun, keep area dry; if it fails = low-potency
corticosteroids ointment, but keep an eye open for
fungal infections!
761. Situations with increased amylase = pancreatitis, ac. parotiditis, intestinal dis., renal failure,
cholecystitis, fallopian tube dis.
762. Mild ac. pancreatitis Rx = IV fluids + pain control + NPO + NG tube aspiration; atbtcs if
severe necrotizing pancreatitis, fever, evidence of infection
(imipenem, third gen. cephalosporin, piperacillin, fluoroquinolone, metronidazole); if it fails =
CTguided aspiration of tissue, culture and sensitivity
763. Infant, children with TB meningitis Rx = 12 m of anti-TB drugs + corticosteroids; if
resistant = 18-24 m
764. LDL goal is < 100 in = coronary dis. peripheral and cerebral vascular dis., DM
765. Hypophosphatemia = respiratory weakness, hemolysis, decreased release of O2 from Hb
766. Postpartum endometritis + breastfeeding Rx = clindamycin + gentamycin; main risk factor =
Csection
767. Sarcoidosis = hypercalciuria, hypercalcemia, thrombocytopenia, increased serum ACE,
hypergammaglobulinemia
768. Herpes gestationis = paules, plaques, vesicles around umbilicus; Rx = topical steroids, oral
antihistamins (it has nothing to do with the virus)
769. Inflammatory myositis Rx = high-dose glucocorticoids (prednisone 1 mg/kg),
immunosuppressants
770. Depot medroxyprogesterone indicated as contraceptive = menorrhagia, PID, fibrosis, heavy
smoking; decrease the incidence of endometrial ca
771. Shuffling gait = decreased speed and amplitude of leg movements; Parkinson's
772. Spastic paraparesis = patient drags legs forward, no bending of the knees
773. Cerebellar ataxia = "drunken sailor", zigzag, jergy gait
774. Senile gait = "walking on ice"
775. Neonatal polycythemia = Htc > 65%, apnea, hypoglycemia, increased bilirubin, cardiac and
respiratory compromise; Rx = adequate hydration +
partial exchange transfusion