USMLE World Step 3: Set #4 Questions And Answers With Latest Solution

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USMLE World Step 3: Set #4 Questions And Answers With Latest Solution Which is compatible with brain death: -absence of respiratory drive for 3 mins off the ventilator - irreversible absence of ... cerebral and brain stem reflexes Correct Answer: irreversible absence of cerebral and brain stem reflexes; the absence of respiratory drive must be for 8 minutes brain death criteria Correct Answer: - neuro exam showing absent cerebral and brainstem reflexes - pupillary, corneal, oculocephalic, oculovestibular (caloric), sucking, swallowing, and extensor posturing - absence of confounding factors aka intoxication with drugs or major endocrine/ electrolyte disturbances - evidence of a devastating cause via brain imaging is it possible to see spontaneous limb movements in people with brain death? Correct Answer: YES Saw palmetto is an alternative medicine most commonly used to treat Correct Answer: BPH; there's no evidence it works, however Ginseng, garlic, ginkgo biloba, and saw palmetto all have the risk of the side effect of ___________ Correct Answer: bleeding "non-ejection click" is a buzzword for which valvular murmur Correct Answer: mitral valve prolapse typical sound of mitral valve prolapse Correct Answer: non ejection click followed by systolic murmur (which is mitral regurgitation) The click and murmur occur later in systole if the L ventricular end diastolic volume increases, and it may disappear entirely if the LVEDV is large enough (i.e., squatting, supine leg raise) in botulism, are sensations intact? what about reflexes? Correct Answer: sensations are intact (botulism inhibits release of acetylcholine, so it spares sensory tracts) reflexes are diminished or absent a child is diagnosed with night terrors. they recently moved to a new city. best advice for mother is: - he will likely experience these nightmares until he adjusts to his new home - his condition will most likely resolve spontaneously over 1-2 years - these episodes should resolve as soon as he gets adequate sleep Correct Answer: his condition will most likely resolve spontaneously over 1-2 years do sleep terrors have REM sleep? Correct Answer: No; it is a non-rapid eye movement arousal disorder describe sleep terrors epidemiology and symptoms Correct Answer: they occur between ages 4-12. it is self-limiting, resolving over 1-2 years. it arises during the first third of sleep. the child awakens abruptly with a scream, a frightened expression, and signs of autonomic arousal. the child is unable to recall the episode in the morning are you allowed to accept travel compensation from pharmaceuticals? what about an honorarium (a payment)? what about pre-made slides at a presentation? Correct Answer: Yes to travel compensation and an honorarium No to pre-made slides 44 yo M comes in for concern for hepatitis infection. he donated blood at an office event and received a letter a few days later saying that hepatitis performed on his sample was positive. he used injection drugs in his 20s but not since then. Lab results are: AST 15 ALT 16 Hep A IgG + Hep C AB + Hep B sAg neg Hep B s AB neg HIV ab neg next best step: - initiate antiviral therapy because the patient has chronic hep C - it is unclear if the patient has hep c; further investigation is required Correct Answer: it is unclear if the patient has hep c; further investigation is required 2 other scenarios besides his having hep c are possible: 1) he USED to have hep C but CLEARED IT spontaneously (that happens) 2) it's a false positive result You need HCV RNA to DEFINITIVELY DIAGNOSE ACTIVE HEP C Are patients with proven Hep C via RNA in the blood candidates for antiviral treatment? Correct Answer: Yes Which one has vaginal pH > 4.5; trichomonas or gardnerella ? Correct Answer: BOTH describe the appearance of trichomonas, versus gardenerella Correct Answer: TRICH: pear-shaped motile organisms on wet mount GARDNERELLA: CLUE CELLS the best way to prophylax vs fat embolism in setting of fracture - early immobilization and operative correction - LWMH - breathing exercises Correct Answer: early immobilization and operative correction the classic triad of fat embolism Correct Answer: respiratory insufficiency neurologic impairment petechial rash Rx for + tuberculin skin test with - CXR Correct Answer: Any of the following is acceptable: 1) isoniazid mono therapy for 9 months 2) rifampin for 4 months 3) isoniazid and rifapentine weekly for 3 months a 32 yo F with SLE comes to office for follow up. Symptoms of SLE well controlled on hydroxychloroquine Labs: BUN 36 creatinine 2 U/A: 2+ protein, 20-30 RBC, RBC casts. 2 months ago chemistry and u/a were WNL Best next step: - cyclophosphamide and methylprednisolone - high dose prednisone - methylprednisolone - pulsed cyclophosphamide - renal biopsy Correct Answer: renal biopsy [Show More]

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