Question of the Week # 257

September 17, 2011 6:11 pm3 Comments
Archer USMLE Step 3

257)  A 72 year old man with history of Diabetes Mellitus is rushed to the emergency room by the EMS 30 minutes after he collapsed at his home with severe left sided chest pain. Upon arrival, the patient was found to have very low blood pressure at 70/40 mm Hg.  Chest examination revealed diffuse coarse crepitations. An electrocardiogram showed ST elevations in the anterior leads with reciprocal depressions. The patient was immediately started on Aspirin, GP IIb/IIIA inhibitors, Clopidogrel and Heparin. He is placed on 50% 02 by Venturi mask and his oxygen saturation on this supplemental oxygen is 92%. A diagnosis of cardiogenic shock and pulmonary edema is made and the patient is admitted to intensive care unit. The patient is placed on Intra-Aortic Balloon Counterpulsation Pump (IABP) and is rushed to cardiac catheterization lab. In which of the following situations, IABP confers more harm than benefit?

A) Acute Mycocardial Infarction (MI) with Cardiogenic Shock

B) Aortic dissection with aortic regurgitation

C) Severe left ventricular failure with pulmonary edema

D)  Post-MI Ventricular Septal Perforation

E) Post-MI Acute Mitral Regurgitation

Posted in Uncategorized, USMLE Test PrepTagged Archer cardiology, Archer Critical Care, cardiogenic shock, USMLE STEP 3 CARDIOLOGY, usmle step 3 critical care

Question of the Week # 256

September 7, 2011 3:58 am11 Comments
Archer USMLE Step 3

256)  A 72 year old man with history of Diabetes Mellitus is rushed to the emergency room by the EMS 30 minutes after he collapsed at his home with severe left sided chest pain. Upon arrival, the patient was found to have very low blood pressure at 70/40 mm Hg.  Chest examination revealed diffuse coarse crepitations. An electrocardiogram showed ST elevations in the anterior leads with reciprocal depressions. The patient was immediately started on Aspirin, GP IIb/IIIA inhibitors, Clopidogrel and Heparin. He is placed on 50% 02 by Venturi mask and his oxygen saturation on this supplemental oxygen is 92%. A diagnosis of cardiogenic shock and pulmonary edema is made and the patient is admitted to intensive care unit. If performed immediately, which of the following interventions would most likely reduce his risk of death?

A)     Thrombolytic therapy

B)     Dopamine infusion

C)      Intra-Aortic Balloon Pump (IABP)

D)     Percutaneous Coronary Intervention

E)     Left Ventricular Assist Device (LVAD)

Note : SHOCK TRIAL

Posted in Uncategorized, USMLE Test PrepTagged Archer cardiology, Archer Critical Care, cardiogenic shock, USMLE STEP 3 CARDIOLOGY, usmle step 3 critical care

Question of the Week # 255

September 7, 2011 3:27 am9 Comments
Archer USMLE Step 3

A 16 year old woman is brought to your office by her mother for medical evaluation. Her mother has been out of country on a long business trip for 8 months and upon her return, she was shocked to notice that her daughter looked much skinnier than she was 8 months ago. The patient has lost about 30 lbs weight in the past 8 months and reports irregular menstruation. She is fearful of gaining weight and has been exercising excessively.  Physical examination reveals a very thin woman with a Body Mass Index (BMI) of 16. She has fine, downy dark hair all over her body. Which of the following findings are frequently seen in association with this condition?

A)     Diarrhea

B)     Tachycardia

C)      Hyperkalemia

D)     Decreased Bone mineral density

E)     Metabolic Acidosis

Posted in USMLE Test PrepTagged ARCHER GENERAL MEDICINE, Archer Gynecology, archer pediatrics, Archer Psychiatry, usmle step 3 gynecology, usmle step 3 pediatrics, USMLE Step 3 psychiatry

Question of the Week # 254

September 4, 2011 5:32 pm5 Comments
Archer USMLE Step 3

254 )  A 72 year old man with history of metastatic prostate cancer is admitted with severe weakness and lethargy. He has been having vomiting and abdominal pain for the past two weeks.  He also reports intermittent diarrhea alternating with constipation over the past 2 months. Three months ago, he was noted to have progressive prostate cancer despite therapy with bicalutamide and leuprolide. His PSA at that time was 300ng/ml. He was started on Ketoconozole at that time and he is compliant with it. His most recent visit to the outpatient clinic was 4 weeks ago at which time his PSA was 60ng/ml. On examination, his temperature is 98F, Heart rate is 130/min, Respiratory rate 20/min and Blood pressure 70/40 mm Hg. Chest is clear to auscultation and abdominal examination is benign. A CT scan of the adbomen reveals enlarged prostate and osteoblastic bone metastases in pelvis but no evidence of bowel obstruction. Urinalysis and Chest x-ray are benign. The patient is started on intravenous isotonic saline. Which of the following is the most appropriate next step in managing this patient?

A) Start Chemotherapy

B) Refer to Hospice

C) Intravenous Hydrocortisone

D) Start Norepinephrine drip

E) Intravenous Biphosphonates

 

Posted in USMLE Test PrepTagged Archer Critical Care, Archer endocrinology, Archer oncology, endocrinology questions, STEP 3 ONCOLOGY, usmle step 3 critical care, usmle step 3 endocrinology, USMLE STEP 3 ONCOLOGY

Question of the Week # 253

August 29, 2011 5:03 am6 Comments
Archer USMLE Step 3

253 )  A 75 year old african-american woman with history of Alzheimer’s dementia and recent cerebro-vascular accident is transferred from the Nursing home for deterioration in mental status and fever. As per the nursing home staff, she has stopped feeding and has been having fever for the past three days. On examination, her temperature is 102F, Heart rate is 130/min, Respiratory rate 28/min and Blood pressure 80/45 mm Hg. Chest is clear to auscultation and abdominal examination is benign. A foley catheter is in place draining very cloudy urine. Dipstick urinalysis revealed 2+ protein, positive leucoesterase and nitrite. Blood cultures are obtained and the intravenous normal saline is started via. two large bore needles. In managing her Septic Shock, which of the following is the most appropriate goal that must be met in the first 6 hours of adequate resuscitation?

A) Mean Arterial Blood pressure > 50mm Hg

B) Serum Creatinine < 1.5 mg%

C) Urine output > 0.25ml/kg/hr

D) Mixed Venous Saturation > 65%

E) Hematocrit > 30%

Note: Surviving Sepsis guidelines

Posted in USMLE Test PrepTagged Archer Critical Care, Archer Infectious Diseases, usmle step 3 critical care, USMLE STEP 3 INFECTIOUS DISEASES

Question of the Week # 252

August 29, 2011 4:57 am4 Comments
Archer USMLE Step 3

252 )  A 75 year old african-american woman with history of Alzheimer’s dementia and recent cerebro-vascular accident is transferred from the Nursing home for deterioration in mental status and fever. As per the nursing home staff, she has stopped feeding and has been having fever for the past three days. On examination, her temperature is 102F, Heart rate is 130/min, Respiratory rate 28/min and Blood pressure 80/45 mm Hg. Chest is clear to auscultation and abdominal examination is benign. A foley catheter is in place draining very cloudy urine. Dipstick urinalysis revealed 2+ protein, positive leucoesterase and nitrite. Blood cultures are obtained and the intravenous normal saline is started via. two large bore needles. Which of the following is the most important next step in managing this patient?

A) Put in reverse trendelenberg position

B) Place a central venos catheter

C) Start Dopamie infusion via. peripheral access

D) Intravenous Hydrocortisone

E) Obtain Arterial Blood Gas analysis

note: Surviving Sepsis guidelines

Posted in USMLE Test PrepTagged Archer Critical Care, Archer Infectious Diseases, usmle step 3 critical care, USMLE STEP 3 INFECTIOUS DISEASES

Question of the Week # 251

August 21, 2011 4:48 am9 Comments
Archer USMLE Step 3

251 )  A 65 year old woman is evaluated in your office for pain in bilateral feet for the past four weeks. The pain is burning in quality and is associated with intense itching. Her past medical history is significant for difficult to control Type II Diabetes Mellitus. Her recent HgbA1C was 7.9% and Creatinine was 1.8mg%.  On physical examination, she is obese, afebrile and in no apparent distress. She has diminished pinprick and vibration sensation in glove and stocking pattern in bilateral upper and lower extremities. Dorsalis pedis and posterior tibial pulses are mildly diminished. There are multiple erythematous tiny vesicles between the toes and on the plantar aspect of the both feet.  Which of the following is the most appropriate treatment option for this patient’s pain?

A)      Oral Pregabilin

B)      Topical Corticosteroids

C)      Oral Cefazolin

D)     Topical Terbinafine

E)     Topical Acyclovir

Posted in USMLE Test PrepTagged archer dermatology, Archer endocrinology, Archer Infectious Diseases, archer neurology, USMLE STEP 3 DERMATOLOGY, usmle step 3 endocrinology, USMLE STEP 3 INFECTIOUS DISEASES

Question of the Week # 250

August 21, 2011 1:00 am5 Comments
Archer USMLE Step 3

250 )  A 30 year old woman presents to your office with complaints of fatigue and headache.  She reports that the headaches occur almost daily and are mild to moderate. They are not associated with nausea or vomiting and are unrelated to menstrual cycles. She also reports chronic diffuse abdominal pain and pelvic pain for the past several months for which she did not seek any medical attention. Her chart reveals that she was seen by your colleague few months ago for similar complaints. She was asked to return after few laboratory investigations but she had been non-compliant with her follow-ups. Physical examination reveals an anxious appearing woman who otherwise appears healthy. She does not make an eye contact. Abdominal and pelvic examination is benign. There are no tender points. There are no neurological deficits. The most appropriate next step in managing this patient:

A)     Support and Counseling

B)     Refer to Psychiatry

C)      Start Selective Serotonin Reuptake Inhibitors

D)     Trial of Tricyclic anti-depressants

E)     Screen for Domestic Violence

Posted in USMLE Test PrepTagged Archer Gynecology, archer neurology, Archer Psychiatry, neurology mcqs, Psychiatry, usmle step 3 gynecology and obstetrics, usmle step 3 neurology, USMLE Step 3 psychiatry

Question of the Week # 249

August 9, 2011 5:06 pm5 Comments
Archer USMLE Step 3

249 )  A 64 year old  man is evaluated in your office for a left sided headache that started 24 hours ago. He describes the headache as a burning sensation over his left temple and the forehead. He also reports fatigue and malaise for the past one day. He has no significant past medical history.   On examination, he has a low grade fever at 100.4F, Blood pressure is 120/70 mm Hg. Physical examination reveals hyperesthesia on his left forehead and skin findings as shown in the picture below:

Archer USMLE Step 3

Which of the following is the most appropriate immediate next step in management ?

A) Mupirocin cream

B) Start Oral Cephalexin

C) Refer to Ophthalmology

D) Refer to Dermatology

E) Topical Acyclovir

Posted in USMLE Test PrepTagged archer dermatology, Archer Infectious Diseases, dermatology usmle, dermatology usmle step 3 questions, USMLE STEP 3 DERMATOLOGY, usmle step 3 dermatology images, USMLE STEP 3 INFECTIOUS DISEASES

Question of the Week # 248

August 5, 2011 11:31 pm6 Comments
Archer USMLE Step 3

248 )  A 34 year old  african-american man with past medical history of HIV infection is evaluated in the Emergency Room for severe shortness of breath on exertion for the past few hours. He also reports dry cough for the past 3 days. He has been non-compliant with Anti-retroviral therapy and his most recent CD4 count was 160 cells/µl. On examination, he is febrile with a temperature of 101F, respiratory rate is 22, Blood pressure is 120/70 mm Hg. Oxygen saturation is 86% by pulse-oximetry. Chest examination reveals scattered rhonchii bilaterally. He is immediately placed on 4 liters oxygen by nasal cannula and his repeat oxygen saturation is 94%.  Arterial blood gases on 4 liters nasal oxygen show Ph 7.45, Po2 75, Pco2 32, Hco3- 24. A chest x-ray shows bilateral interstitial infiltrates. A Lactic Dehydrogenase level is elevated at 700U/L.   Which of the following is most appropriate management ?

A) Intubation

B) Start Trimethoprim/ Suflamethoxazole

C) Start Trimethoprim/ Sulfamethoxazole, Levofloxacin and Corticosteroids

D) Start Trimethoprim/ Sulfamethoxazole and Corticosteroids

E) Start Levofloxacin

 

Posted in USMLE Test PrepTagged Archer Infectious Diseases, Archer pulmonology, USMLE STEP 3 INFECTIOUS DISEASES, USMLE STEP 3 PULMONOLOGY
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