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First Aid USMLE Step 3 Questions and Answers A+ Graded
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First Aid USMLE Step 3 Questions and Answers A+ Graded
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First Aid USMLE Step 3 Questions andAnswers A+ Graded
A 42 year old woman presents with HA, nausea, vomiting, and a red eye that
has progressively worsened since this morning. She also notes vision changes. Exam reveals conjunctival injection: a mid-range fixed, dilated pupil: and no focal weakness in the extremities. What should you do next? - -Use tonometry to check IOP. A pressure of over 30 mmHg confirms the diagnosis of acute closed angle glaucome. Emergent referral to ophthamology and possible hospitalization to reduce IOP. Treatment includes
topical BB (timolol), IV acetazolamide, and topical steroids. -A 71 year old man with a history of well controlled asthma presents in November for his annual checkup. He has no complaints, and his PE findings are unremarkable. He received the pneumococcal vaccine 3 years ago. What
should be given before the completion of his visit? - -Annual influenza vaccination is recommended for all patients over 6 months of age who lack contraindications (severe allergy/ anaphylaxis to egg protein). The live attenuated vaccine should not be used in populations who are pregnant, immunosuppressed, or have taken influenza antiviral medication within 48 hours. -A 68 year old woman is brought to your office because her son is concerned
that she is losing her memory. He describes several instances in which she forgot what he has just told her, adding that she was recently unaware that he was calling to her at a crowded park. She spends most of her time at home watching television. What is the diagnosis? - -Presbycusis, or age related hearing loss. Hearing loss in elderly persons must be evaluated. Patients may have difficulty distinguishing voices in a crowd, which is often misinterpreted as memory loss. Patients may become socially isolated. -A 24 year old medical student develops a rash when he puts on a pair of latex examination gloves. What is the mechanism leading to this rash? - -
Allergic contact dermatitis is a result of delayed contact (type IV) hypersensitivity caused by allergen-primed memory T lymphocytes (vs irritant contact dermatitis, which results from cytokines released following irritant contact). -A 26 year old man presents with targetoid papules that appeared on his palms 2 days ago. He states that he was recently prescribed a new antiseizure medication for his epilepsy. He denies any other symptoms, and exam reveals no other lesions. What is the diagnosis? - -Erythema multiforme secondary to the new antiseizure medication. EM differs from Steven-Johnson syndrome/ toxic epidermal necrolysis in that lesions are genrally localized to the extremities (vs spreading from the face and trunk), and the disease course is usually less severe. -A 71 year old man complains of a lesion on his right flank that was preceeded by tingling in the same area 1 day ago. Exam reveals a 4 inch band of painful vesicles with secondary crusting and a clear midline border. What test do you send to confirm your clinical diagnosis? - -Although a clinical exam is typically sufficient for the diagnosis of herpes zoster, a PCR of fluid from the lesion can be confirmatory. NSAIDs may be useful for pain control, and antiviral therapy may speed resolution and decrease the likelihood of postherpetic neuralgia. -A patient presents for evaluation of a pigmented skin lesions. Biopsy reveals melanocytes with marked atypia characteristic of melanoma. What feature is the most important prognostic factor? - -Depth of invasion of the melanoma -A 74 year old man presents with inability to maintain an erection. Although the problem started several years ago, he states that he ignored it because he thought it was a normal part of aging. How should the patient be counseled? - -Although erectile dysfunction is associated with age, it is still considered abnormal, and patients with erection difficulties should be adequately evaluated for all potential causes. -A 70 year old man is prescribed terazosin for his benign prostatic hyperplasia. How does the drug treat his condition, and what other medical condition does its mechanism of action address? - -Alpha blockers such as terazosin act on smooth muscle in the prostate, bladder neck, and urethra. They also act on vascular smooth muscle, causing vasodilation; therefore, they can work to lower HTN as well. -A 41 year old woman with woman with no significant medical history comes
to your clinic for her first checkup. Her mother has type 2 DM. Her PE findings, including BMI, are normal. Which screening tests might you recommend? - -A Pap smear and HTN screening. A diabetes workup (fasting glucose test, HbA1c) is not needed as the patient is under 45 years of age with a normal BMI. Given the patient's age, a screening mammogram is controversial. It is important to discuss the risks, benefits, and alternatives of
screening before proceeding. -A 58 year old woman with long standing HTN is admitted to the hospital with dyspnea on exertion and bibasilar crackles, and you suspect heart failure. Which imaging modality would confirm your diagnosis? - -
Transthoracis echocardiography (TTE). TTE provides specific information, such as left ventricular ejection factor (LVEF) and diastolic compliance and relaxation, which can confirm the diagnosis of systolic and diastolic heart failure. It also yields information about specific etiologies or precipitants such
as valvular or wall motion abnormalities. -A 54 year old business executive develops chest pain while at work. His vital signs remain stable. The chest pain is partially relieved by nitroglycerin but worsens with cough and deep inspiration. He is brought to the ED, where his ECG reveals diffuse ST-T elevations. His cardiac biomarkers are normal. What is the appropriate treatment? - -NSAIDs. The patient most likely has pericarditis, which is a clinical diagnosis. -A 64 year old woman suddenly develops hypotension and SOB 1 day after CABG surgery. Exam reveals JVD and muffled heart sounds, and bedside pulsus paradoxus is present. Besides ordering an urgent echocardiogram, what are your next therapeutic steps? - -Administer IV fluids pursue emergent therapeutic pericardiocentesis or pericardial window. -A 65 year old Caucasian man who has a history of diabetes and is currently on meformin has BP readings of 150/90 and 140/95 on multiple office visits. You start him on an ACEI, but he returns for follow-up complaining of a dry cough with a measured BP of 145/92. What is your BP goal for this patient, and what are additional options for treating his hypertension? - -Thiazide diuretics, CCBs, ACEIs, and ARBs are all therapeutic options. The BP goal for this patient would be under 130/80. In light of his cough (a potential adverse effect of ACEIs), you could switch the patient to an ARB and add a second medication to achieve goal BP. -A 69 year old hospital administrator presents to the ED with severe, tearing
chest pain that radiates to his back. CXR is unrevealing. Given your concern for potential aortic dissection, what is the next diagnostic step? - -Chest CT with IV contrast. TEE is appropriate for patients with a history of allergic reaction to IV contrast. -A 73 year old man with a history of diabetes mellitus, but with no history of clinical CAD, comes to your office for the result of his recent bloodwork. His fasting lipid panel is significant for an LDL of 130 mg/dL, and his 10 year risk of atherosclerotic cardiovascular disease is 7%. In addition to educating him on diet and lifestyle changes, what action should you take? - -Start moderate intensity statin therapy with a goal LDL reduction of 30-50%. -A 26 year old IV drug user is admitted to the hospital with fevers and chills. Despite broad antibiotic therapy, blood cultures remain persistently (+), but TTE is normal. Given your suspicion of infective endocarditis, what is your next step? - -Order a TEE, which is more sensitive than TTE for visualizing vegetations and diagnosing endocarditis. When endocarditis is suspected clinically but TTE is normal, a TEE is indicated to better confirm or rule our infection.
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