Question of the Week # 237

July 12, 2011 4:37 am3 Comments
Archer USMLE Step 3

237 )  A 25-year old primi-para is evaluated for soreness in her breasts. She just started breast feeding her three day old male infant. She also reports low grade fever over the past few hours. On examination, her temperature is 99.2F. Her breasts are hard and swollen. They are warm to touch. She has pain on movement of the breast. Which of the following is the most appropriate recommendation?

A) Hand expression of milk between feedings

B) Use of  ”Breast Pump”

C) Correction of improper “Latch on”

D) Re-assurance

E) Breast massage

Posted in USMLE Test PrepTagged archer obstetrics, archer pediatrics, breast feeding problems, obstetrics, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics, USMLE STEP3 PEDIATRICS

Question of the Week # 236

July 12, 2011 4:34 am2 Comments
Archer USMLE Step 3

236)  A 25-year woman presents to your office with complaints of soreness in her right nipple. She had a uneventful delivery 10 days ago. She has been breast feeding for the past ten days. She had some nipple soreness initially however, it resolved after five days. The soreness returned on the eighth day and is persistent since then . The pain is present through out the nursing episode. On examination, she is afebrile. Her right breast is full. There is no erythema or tenderness. Which of the following is the most appropriate recommendation to the patient?

A) Hand expression of milk between feedings

B) Use of  ”Breast Pump”

C) Correction of improper “Latch on”

D) Re-assurance

E) Breast massage

Posted in USMLE Test PrepTagged archer obstetrics, archer pediatrics, breast feeding problems, obstetrics, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics, USMLE STEP3 PEDIATRICS

Question of the Week # 235

July 12, 2011 4:07 am3 Comments
Archer USMLE Step 3

235)  A 25-year woman presents to your office with complaints of soreness in her right nipple. She had a uneventful delivery 10 days ago. She has been breast feeding for the past ten days. She had some nipple soreness initially however, it resolved after five days. The soreness returned on the eighth day and is persistent since then . The pain is present through out the nursing episode. On examination, she is afebrile. Her right breast is full. There is no erythema or tenderness. Which of the following is the most likely cause of her clinical presentation?

A) Poor positioning of infant while feeding

B) Prolonged suckling

C) Inadequate feeding

D) Infection

E)  ”Normal” Nipple Sensitivity

 

Posted in USMLE Test PrepTagged archer obstetrics, archer pediatrics, breast feeding problems, obstetrics, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics, USMLE STEP3 PEDIATRICS

Question of the Week # 234

July 12, 2011 4:02 am4 Comments
Archer USMLE Step 3

234 )  A 25-year old primi-para is evaluated for soreness in her breasts. She just started breast feeding her three day old male infant. She also reports low grade fever over the past few hours. On examination, her temperature is 99.2F. Her breasts are hard and swollen. They are warm to touch. She has pain on movement of the breast. Which of the following is the most likely cause of her clinical presentation?

A) Poor positioning of infant while feeding

B) Prolonged suckling

C) Inadequate feeding

D) Infection

E) Plugged ducts

Posted in USMLE Test PrepTagged archer obstetrics, archer pediatrics, breast feeding problems, obstetrics, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics, USMLE STEP3 PEDIATRICS

Question of the Week # 233

July 11, 2011 1:37 am5 Comments
Archer USMLE Step 3

233 )  A 36 year old man is evaluated in the emergency room for nausea, vomiting and diarrhea. He also reports fever of one day duration. He denies any rash. He has had 4 to 5 watery bowel movements in the last 24 hours. The diarrhea started 3 days ago and is progressively worse. He feels extremely weak.  His last sexual activity was 6 months ago and he always uses condoms. He denies any fever or  using any recent medications. He works in tourism industry and returned from a business trip to Mexico one week ago.  On examination, temperature is 101F, blood pressure 90/50 mm hg, his oral mucosa are dry. Abdominal examination is benign. The patient has been adequately hydrated and feels better now though, he continues to have diarrhea. Which of the following is the most appropriate next step in management?

A) Observation

B) Rifaximin

C) Amoxicillin

D) Trimethoprim-Sulfamethoxazole

E) Metronidazole

Posted in USMLE Test PrepTagged ARCHER GASTROENTEROLOGY, Archer Infectious Diseases, archer travel medicine, travel medicine, USMLE STEP 3 GASTROENEROLOGY, USMLE STEP 3 INFECTIOUS DISEASES, usmle step 3 travel medicine

Question of the Week # 232

July 11, 2011 1:13 am4 Comments
Archer USMLE Step 3

232 )  A 32 year old man is evaluated in the clinic for an intensely itchy rash on his feet.  He denies any fever or  using any recent medications. He just returned yesterday from a pleasure trip to Philippines. While on vacation , he spent his time visiting historical sites, rivers and beaches. He does not swim but enjoys walking in the water near shore. On examination, there  are multiple papules on the plantar and dorsal aspect of the feet bilaterally. There are no vesicles or pustules. The skin above the level of calves is not involved. Which of the following is the most likely diagnosis?

A) Hot tub folliculitis

B) Vibrio Vulnificus

C) Cutaneous Larva Migrans

D) Swimmer’s itch

E) Strongyloidiasis

Posted in USMLE Test PrepTagged Archer Infectious Diseases, archer travel medicine, itchy traveler, travel medicine, USMLE STEP 3 DERMATOLOGY, usmle step 3 travel medicine

Question of the Week # 231

July 11, 2011 12:36 am3 Comments
Archer USMLE Step 3

231) A 62 year old woman was admitted to the hospital two days ago for complicated acute pyelonephritis. She was initially started on piperacillin-tazobactam. On day 2 of hospital stay, urinary cultures are positive for ampicillin resistant enterococci. The patient is started on Vancomycin . While receiving her first dose of vancomycin, she develops flushing, redness and itching over her upper body. On physical examination, her temperature is 101F, HR 120/min and blood pressure is 120/70 mm hg.  There is  erythema on her chest. An intravenous cannula is in place on her left arm. There is no erythema or tenderness at the cannula site. Which of the following is the most appropriate next step in management?

A)     Diphenhydramine

B)     Stop Vancomycin and switch to Linezolid

C)     Change the IV cannula

D)     Methylprednisolone

E)     Stop Vancomycin and restart at slower rate

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

Question of the Week # 230

July 10, 2011 5:42 am4 Comments
Archer USMLE Step 3

230) A 72-year-old white man with history of type 2 diabetes mellitus and hypertension is evaluated in your office during a follow up visit. He was discharged 3 days ago from the hospital after undergoing diagnostic cardiac catheterization for an abnormal exercise stress test. Femoral sheath was removed three days ago. He denies any chest pain or shortness of breath.  On physical examination, he is afebrile, HR 120/min and blood pressure is 120/70 mm hg.  There is a new palpable mass in the right groin and systolic bruit is heard at the catheter insertion site. Dorsalis pedis and posterior tibial pulses are intact. Which of the following is the most likely diagnosis?

A)     Arterio-venos fistula

B)     Local Hematoma

C)      Femoral artery true aneurysm

D)     Hematoma in continuity with arterial lumen

E)     Femoral artery thrombosis

Posted in USMLE Test PrepTagged Archer cardiology, Archer Critical Care, archer surgery, USMLE STEP 3 CARDIOLOGY, usmle step 3 critical care, usmle step 3 surgery

Question of the Week # 229

July 10, 2011 5:39 am4 Comments
Archer USMLE Step 3

229 )  A 70-year-old white man with history of poorly controlled type 2 diabetes mellitus and hypertension is evaluated in the emergency room for severe pain in the right thigh. The patient has a coronary artery disease for which he underwent cardiac catheterization with percutaneous coronary intervention 2 days ago. He denies any chest pain or shortness of breath.  On physical examination, temperature is 99.2F, HR 120/min and blood pressure is 80/40 mm Hg.  There is erythema at the site of  cardiac catheterization in the femoral area. Laboratory studies reveal a creatinine of 4.2mg% as opposed to his baseline creatinine of 1.8mg% one week ago. Which of the following is the most likely diagnosis?

A)  Toxic shock syndrome

B)  Atheroembolism

C)  Contrast Nephropathy

D) Ruptured femoral artery pseudo-aneurysm

E)  Retroperitoneal bleeding

Posted in USMLE Test PrepTagged Archer cardiology, Archer Critical Care, ARCHER NEPHROLOGY, dr.red nephrology lecture, USMLE STEP 3 CARDIOLOGY, usmle step 3 critical care, usmle step 3 nephrology

Question of the Week # 228

July 10, 2011 3:43 am4 Comments
Archer USMLE Step 3

228 )  A 70-year-old white man  with type 2 diabetes mellitus and hypertension is evaluated in the emergency room for lacy purplish discoloration of the lower extremities that developed few hours ago. He reports diffuse bodyaches and low grade fever. He denies chest pain or shortness of breath. His past medical history is significant for coronary artery disease for which he underwent cardiac catheterization with percutaneous coronary intervention one week ago.  He has a history of chronic atrial fibrillation for which he is on 5mg coumadin daily. His most recent INR has been therapeutic at 2.5. Physical examination reveals lacy purplish pattern on bilateral lower extremities shown in the image below.

Archer USMLE Step 3

The site of cardiac catheterization in the femoral area is clean and healing with out any tenderness or erythema. Neurological examination is normal. Laboratory studies reveal a creatinine of 4.2mg% as opposed to his baseline creatinine of 1.8mg% one week ago. Hemoglobin and platelet count are within normal limits. WBC count is 12.6k/µl with neutrophils 70%, bands of 2% , eosinophils 18% and lymphocytes 10%. Which of the following is the most likely diagnosis?

A)  Toxic shock syndrome

B)  Atheroembolism

C)  Contrast Nephropathy

D)  Anti-Phospholipid antibody syndrome

E)  Cryoglobulinemia

Posted in USMLE Test PrepTagged Archer cardiology, Archer Critical Care, ARCHER NEPHROLOGY, dr.red nephrology lecture, USMLE STEP 3 CARDIOLOGY, usmle step 3 critical care, usmle step 3 nephrology
WordPress SEO fine-tune by Meta SEO Pack from Poradnik Webmastera
Freelance PHP Developer