Question of the Week # 396

April 23, 2012 6:01 am12 Comments
Archer USMLE Step 3

396)  A 45 year old woman presents to your office for annual physical examination. She reports that she has had a fasting lipid panel done 6 months ago and her HDL – C was low at 25 mg%. She started healthy diet rich in fruits and vegetables. She used to smoke about 4 cigarettes/ day earlier but quit smoking after she came to know about her lipid results. She occasionally uses red wine in moderate amounts. She has also started aerobic exercises at least 3 days per week. Physical examination is unremarkable. A repeat lipid panel reveals Total cholesterol 128 mg%, LDL-C 80mg%, Triglycerides 100mg%, HDL-C 28mg%. Which of the following is the most appropriate next step?

A) Fenofibrate

B) Niacin

C) Ezetemibe

D) Atorvastatin

E) Omega-3-Fatty Acids

Posted in Uncategorized, USMLE Test PrepTagged approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, usmle step 3 preventive medicine

Question of the Week # 395

April 23, 2012 5:46 am5 Comments
Archer USMLE Step 3

395)  A 65 year old man with history of Hypertension, Peripheral Artery disease and Dyslipidemia is seen during a follow-up office visit. His medications include Atorvastatin 80mg, Enalapril 20mg and Clopidogrel 75 mg/ day.  He does not have any new complaints and tolerating his medications well. He still smokes about 1 pack per day despite repeated counselling however, he has been strictly compliant with low-fat diet. On examination, his vitals are stable. Lower extremity dorsalis pedis are slightly diminished bilaterally. Reminder of the examination is unremarkable. A fasting lipid profile obtained a week ago showed :  Total Cholesterol : 205 mg% LDL cholesterol (calculated) 90mg%, HDL – cholesterol 45 mg%, Triglycerides 350mg%.  Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limits. Which of the following is the most appropriate next step?

A) Add Fenofibrate

B) Add Niacin

C) Add Cholestyramine

D) Change Atorvastatin to Rosuvastatin

E) Increase the dose of Atorvastatin

Posted in Uncategorized, USMLE Test PrepTagged approach to hyperlipidemia, Archer cardiology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, USMLE STEP 3 CARDIOLOGY, usmle step 3 preventive medicine

Question of the Week # 394

April 22, 2012 10:55 pm4 Comments
Archer USMLE Step 3

394)  A 36 year old woman with Type I diabetes mellitus presents to your office because she just learned that she is pregnant. She is excited and seeks your advise. Her home blood sugars are well controlled on a basal-bolus regimen of Glargine and Lispro insulin. Her other medications include Atorvastatin and aspirin. Her most recent HgbA1C was 6.0%. Her records also reveal that her most recent fasting lipid profile met the therapeutic goals at LDL of 80mg% and Non-HDL cholesterol of 100mg%. On examination, she is comfortable. Vitals are stable and reminder of the examination is unremarkable. An office based serum pregnancy test is positive. A repeat fasting lipid profile reveals Total Cholesterol : 250 mg% LDL cholesterol (calculated) 140mg%, HDL – cholesterol 40 mg%, Triglycerides 350mg%.  Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limitsWhich of the following is the most appropriate next step?

A) Therapeutic Abortion

B) Add Niacin to her Lipid Regimen

C) Discontinue Statin and Start Niacin

D) Discontinue Statin and advise Diet modification alone

E) Increase Atorvastatin

Posted in Uncategorized, USMLE Test PrepTagged approach to hyperlipidemia, Archer cardiology, archer ostetrics and gynecology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, hyperlipidemia in pregnancy, USMLE STEP 3 CARDIOLOGY, usmle step 3 gynecology and obstetrics, usmle step 3 preventive medicine

Question of the Week # 393

April 22, 2012 7:53 am9 Comments
Archer USMLE Step 3

393)  A 36 year old homeless man is evaluated in the Emergency Room for intermittent fever, cough, night sweats and weight-losss. He also reports having chronic cough with progressively increasing bloody expectoration for the past 1 month. He has lost about 10lbs weight over the past 3 months. He smokes 1 pack per day and has a history of intravenos drug abuse. On examination, he is cachectic.  He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 120/80 mm Hg, Oxygen saturation 98%.  Reminder of the physical examination is unremarkable. Which of the following is the most appropriate initial step in managing this patient?

A) Sputum samples for Acid Fast Bacilli

B) Start Multi-drug therapy for Tuberculosis

C) Obtain a Chest X-ray

D) Tuberculin Skin test

E) Air-Borne Isolation

F) Test for HIV

Posted in Uncategorized, USMLE Test PrepTagged APPROACH TO SUSPECTED TUBERCULOSIS, Archer Infectious Diseases, USMLE STEP 3 INFECTIOUS DISEASES

Question of the Week # 392

April 22, 2012 7:12 am8 Comments
Archer USMLE Step 3

392)  A 28 year old woman presents with a history of amenorrhea of about 6 month duration. She does not have any breast discharge, visual deficits or headaches. Her home pregnancy test was negative a week ago. Her past medical history is significant for three missed abortions for which she underwent dilatation and curettage. On examination, her vitals are stable. Body mass index is about 22 . Breast examination is normal with out any discharge.  Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit.  A trial of medroxyprogesterone and a later trial of estrogen-progesterone combination fails to induce bleeding. Which of the following is the most appropriate next step?

A) Anti-phospholipid Antibodies

B) Hysteroscopy

C) Dehydro-epiandrosterone level

D) Pituitary MRI

E) Ultrasound of Ovaries

Posted in Uncategorized, USMLE Test PrepTagged archer obstetrics, obgyn, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics

Question of the Week # 391

April 22, 2012 6:21 am3 Comments
Archer USMLE Step 3

391)  A 26 year old woman is seen in the outpatient clinic for amenorrhea of about 6 months. The patient ah d been on oral contraceptives but discontinued 6 months ago. She reports having regular menstrual cycles prior to  starting oral contraceptives. She denies any excessive stress or physical activity. She does not have any breast discharge, visual deficits or headaches. presents to your office with complaints of change in her menstrual cycles. On examination, her vitals are stable. Body mass index is about 28 . Breast examination is normal with out any discharge. Pelvic exam is normal. Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit.  The patient is started on  medroxyprogesterone acetate at 10 mg/ day for 10 days and experiences menstrual bleeding a week after stopping progesterone. This patient is at increased risk for which of the following conditions?

A) Visual Deficits

B) Endometrial Cancer

C) Osteoporosis

D) Pituitary Necrosis

E) Vertebral Compression Fractures

Posted in Uncategorized, USMLE Test PrepTagged archer obstetrics, obgyn, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics

Question of the Week # 390

April 22, 2012 6:11 am24 Comments
Archer USMLE Step 3

390)  A 28 year old woman has had amenorrhea for the past 4 months. She reports having regular menstrual cycles prior to these episodes. She is sexually active and a home pregnancy test was negative on two occasions over the last one week. She denies any excessive stress or physical activity. She has had headaches almost daily over the past three months. She denies any visual deficits. Her past medical history is significant for schizophrenia for which she is using risperdal for several years with good control of her disease. On examination, her vitals are stable. Body mass index is about 28 . There is milky discharge on breast examination. Pelvic exam is normal. Serum pregnancy test is negative. A serum prolactin level is 30mcg/ml (5 to 20 mcg/L). A serum Thyroid Stimulating Hormone and Follicle Stimulating Hormone level are within normal limit. An MRI of the brain reveals 10 cm lobulated mass in the anterior skull base. Which of the following is the initial step in evaluating this patient?

A) Repeat Prolactin after Serum Dilution

B) Discontinue Risperdal

C) Trans-Sphenoidal Resection of the Tumor

D) Pituitary Irradiation

E) Bromocriptine

Posted in Uncategorized, USMLE Test PrepTagged Archer endocrinology, archer obstetrics, endocrinology mcqs, endocrinology questions, obgyn, usmle step 3 endocrinology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics

Question of the Week # 389

April 22, 2012 5:43 am4 Comments
Archer USMLE Step 3

389)  A 26 year old woman is seen in the outpatient clinic for amenorrhea of about 6 months. The patient ah d been on oral contraceptives but discontinued 6 months ago. She reports having regular menstrual cycles prior to  starting oral contraceptives. She denies any excessive stress or physical activity. She does not have any breast discharge, visual deficits or headaches. presents to your office with complaints of change in her menstrual cycles. On examination, her vitals are stable. Body mass index is about 28 . Breast examination is normal with out any discharge. Pelvic exam is normal. Serum pregnancy test is negative. A serum Thyroid Stimulating Hormone, Prolactin level and Follicle Stimulating Hormone level are within normal limit.  The patient is started on  medroxyprogesterone acetate at 10 mg/ day for 10 days and experiences menstrual bleeding a week after stopping progesterone. Which of the following explains her amenorrhea?

A) Past use of Oral Contraceptive Pills

B) Uterine Adhesions

C) Hypothalamic amenorrhea

D) Polycystic Ovarian Syndrome

E) Premature Ovarian Failire

Posted in Uncategorized, USMLE Test PrepTagged Archer endocrinology, archer obstetrics, endocrinology mcqs, endocrinology questions, obgyn, usmle step 3 endocrinology, usmle step 3 gynecology and obstetrics, usmle step 3 obstetrics

Question of the Week # 388

April 21, 2012 9:18 pm6 Comments
Archer USMLE Step 3

388)  A 58 year old man with history of  severe depression is brought to the emergency room with altered mental status. He has been on treatment with amitryptyline for depression for many months. He is accompanied by his wife who reports that they had re-filled one month supply of amitryptyline a week ago but today she discovered an empty bottle at his bedside.  He There is no history of fever, nausea, vomiting or diarrhea. There is no evidence of  any witnessed seizure.  On examination, he is disoriented and lethargic. He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 120/80 mm Hg, Oxygen saturation 98%. He does not respond to verbal commands. Gag reflex is present. Respiratory examination is normal with out any wheezing, rhonchi or crepitations. Cardiac examination and abdominal exam is benign. Intravenous Naloxone and Thiamine were administered in the field without any response. An electrocardiogram is normal. Serum electrolytes and complete blood count, finger stick glucose and arterial blood gases are within normal limits. The patient is intubated and is placed on ventilator. Which of the following is the most appropriate next step?

A) Activated Charcoal

B) Procainamide

C) Sodium Biacrbonate

D) Lidocaine

E) Amiodarone

Posted in Uncategorized, USMLE Test PrepTagged archer poisoning questions, drug overdose questions, poisoning, usmle step 3 poisoning questions

Question of the Week # 387

April 21, 2012 9:07 pm13 Comments
Archer USMLE Step 3

387)  A 56 year old man with history of depression and hypertension is brought to the Emergency Room by his sister for altered mental status. There is no history of fever, nausea, vomiting or diarrhea. There is no evidence of  any witnessed seizure. She is not aware of what medications he takes. On examination, he is disoriented and lethargic. He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 80/40 mm Hg, Oxygen saturation 98%. He does not respond to verbal commands. Gag reflex is present. Respiratory examination si normal with out any wheezing, rhonchi or crepitations. Cardiac examination and abdominal exam is benign. Intravenous Naloxone and Thiamine were administered in the field without any response. An electrocardiogram is normal. Serum electrolytes and complete blood count, finger stick glucose are within normal limits. Arterial blood gases does not show any acidemia. A urine drug screen reveals:

Cocaine  - Negative

Amphetamines – Negatives

Benzodiazepenes – Positive

Opiates – Negative

Cannabis – Negative

Tricyclic Anti-Depressants - positive

A suction of his airway and central line are placed and he is started on intravenous fluids. His systolic blood pressure remains in 70 to 80 mm Hg range

Which of the following is the most appropriate next step?

A) Activated Charcoal

B) Intravenous Flumazenil

C) Serum Alkalinization

D) Start Norepinephrine

E) Intravenous Lidocaine

Posted in Uncategorized, USMLE Test PrepTagged Archer cardiology, archer poisoning questions, drug overdose questions, poisoning, USMLE STEP 3 CARDIOLOGY, usmle step 3 poisoning questions
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