Step 3 Practice Test #1 Question and Answer

Skin rash and itching worse at night, mostly between fingers. Treatment? - topical permethrin for scabies 41yo M with fever, dysuria, pyuria and bacteruria. Next step in management? - perform DRE - must distinguish between UTI and prostatitis - prostatic warmth, tenderness, edema, boggyness suggests prostatitis 3yo girl, mother is not sure when she ingested coin. Next step? - flexible endoscopy - if ingestion time <24hrs and asx, observation and repeat xrays in 12-24hrs to ensure coin has passed pylorus - if ingestion time >24hrs or unknown or symptomatic, endoscopic coin removal 76yo M with abd cramps, vomiting, high pitched bowel sounds. Small tender mass palpable in R groin. Next step? - admit for surgical management - incarcerated inguinal hernia Primary hyperparathyroidism, asymptomatic. Next step? - regular follow up with DEXA and serum calcium/creatinine 9mth old boy with leg pain, mom says 18mth old sister jumped off couch and landed on it. Cafe au lait spots. Dx? - child abuse - femur fx in nonambulatory child, esp spiral fx is strange Recent MI s/p successful revascularization. Med changes? - switch to high dose atorvastatin - *regardless of baseline LDL level*, all pts <75yo w/CVD should be treated with high intensity statin 17yo boy w/rash on upper extremities. *Target like* erythematous plaques with central clearing. subjective fever, malaise prior to rash onset. Illness? - HSV - *erythema multiforme*, usually triggered by infection 43yo F with lump in L breast. Smooth, mobile. No nipple changes or discharge, no LAD. Mammography confirms mass but no other abnormalities. Next step? - ultrasound 45yo M with severe back pain for 2 weeks. Worse with movement and bending. Ankle reflexes are decreased bilaterally. Xray L spine w/narrowing of L4-L5 and L5-S1 jt spaces. Next step? - NSAIDs and observation - no red flag signs, xray findings c/w DJD Lifestyle modifcations for BP lowering? - weight loss, DASH diet, exercise, dietary sodium, EtOH intake How does PE appear on CT scan? - pulm infarct that is peripherally located, hemispheric consolidation abutting the pleura What is the role of the treating physician when discussing organ donation with a patient's family? - treating physician may initiate organ donation request with family if he is adequately trained - organ procurement organization staff member or dr who underwent special training 2mth old boy with small nontender reducable mass palpable in R inguinal region? - schedule surgery within 1-2 weeks - if incarceration occurs, can lead to irreversible bowel ischemia 66yo M with increasing episodes of involuntary urine leakage. DM2, diabetic nephropathy, orthostatic hypotension. Cause of incontinence? - incomplete bladder emptying - overflow incontinence due to autonomic dysfunction 2/2 to diabetic neuropathy 62yo M with leg pain, swelling. Similar sx 2 months ago. Scaly and fissuring between the toes, thickened toenails. What can prevent recurrences? - antifungal therapy - likely has cellulitis from tinea pedis