Posted on January 7, 2017 by Archer USMLE Reviews
485. A 10-year-old female presents with a 3 week history of cough. Initially she had a runny nose and was tired with a slight cough but as the runny nose resolved the cough seemed to get worse. She states that the cough is dry sounding and occurs during the day and night. She describes having coughing spasms that occasionally end in vomiting but between episodes of coughing she is fine. Her mom reports that during a coughing spasm she will gasp for air and sometimes make a “whooping” noise. A nasopharyngeal swab confirms a diagnosis of Bordatella pertussis. Which of the following is true?
A. Her 3-month-old brother should be treated with azithromycin as prophylaxis
B. She should be started on azithromycin for more rapid resolution of cough.
C. Her classmates should be treated with clarithromycin as prophylaxis
D. She will have lifelong natural immunity against Bordatella pertussis.
E. Her classmates should receive a Tdap booster regardless of their vaccination status
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Infectious Diseases, archer pediatrics, ARCHER STEP3 LIVE REVIEWS, usmle step 3, USMLE Step3 | 10 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 50-year-old African american woman presents to your clinic with increased thirst and increased urination. You review her old records and it appears like she had a Chest X-ray in the ER last year that showed bilateral hilar lymphadenopathy. She was advised follow-up but she did not comply at that time. Upon examination, you discover some subcutaneous skin nodules and biopsy of one of these comes back positive for non-caseating granulomas.
Laboratory studies from a week ago show:
Calcium : 11.6mg%
Creatinine : 1.0mg%
Which of the following investigations may explain the underlying mechanism of her Hypercalcemia?
A. Biopsy of Hilar Lymph Node
B. 25 Hydroxy Vitamin D Level
C. PTH related peptides
D. 1,25 di-hydroxy Vitamin D level
E. Serum Protein Electrophoresis
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER FLUID AND ELECTROLYTES, ARCHER NEPHROLOGY, ARCHER STEP3 LIVE REVIEWS, ARCHER STEP3 RAPID REVIEW, Foundations of Independent Practice (FIP), lab interpretation, Pathophysiology correlation, usmle step 3 nephrology | 7 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 50-year-old previously healthy man comes to his physician for a scheduled follow-up examination. He works as an electrician, which involves a significant amount of physical activity when working. He says he also runs 5 miles twice a week and is on a low-fat, low-cholesterol diet. His father died of a ‘heart attack’ at the age of 54, and he has smoked one pack of cigarettes daily for the past 25 years. He denies alcohol or illicit drug use. He says he leads a low-stress lifestyle and has no complaints. His current medication include lisinopril. On presentation, his blood pressure is 135/85 mm Hg. Laboratory studies from a week ago show:
Total cholesterol 287 mg/dL
HDL 65 mg/dL
LDL 180 mg/dL
Which of the following is the best next step in patient care?
||Initiate drug therapy for control of his hyperlipidemia
||Educate the patient about diet and exercise and repeat the tests within 4 weeks
||Educate the patient about diet and exercise and repeat the tests within a year
||Initiate a mandatory low-fat diet for the patient
||No intervention is indicated
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: approach to hyperlipidemia, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, usmle step 3 preventive medicine | 4 Comments »
Posted on January 1, 2017 by Archer USMLE Reviews
A 63-year-old woman comes to the emergency department complaining of severe midabdominal pain. She reports that the pain has increased in intensity over the past few days. There has been no associated nausea or vomiting, no change in bowel habits, and no relief afforded by position changes. She is postmenopausal and does not take hormone replacement therapy. She has a 30-year history of hypertension, and has been noncompliant with her therapy of calcium channel blocker and thiazide diuretic. On examination her abdomen is obese but there is a suggestion of a nontender, pulsatile mass in the epigastric region. The remainder of the physical examination is normal. Which of the following is the best next step in management?
|A. Abdominal ultrasound
|B. Abdominal CT scan without contrast
|C. Abdominal CT scan with contrast
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, archer surgery, usmle step 3 surgery | 8 Comments »
Posted on November 24, 2016 by Archer USMLE Reviews
Beta-blockers reduce mortality in patients who have chronic heart failure, systolic dysfunction, and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome.
In a multicenter, double blind, and randomized parallel group trial, we assigned 1511 patients with chronic heart failure to treatment with carvedilol (target dose 25 mg twice daily) and 1518 to metoprolol (metoprolol tartrate, target dose 50 mg twice daily). Patients were required to have chronic heart failure (NYHA II-IV), previous admission for a cardiovascular reason, an ejection fraction of less than 0.35, and to have been treated optimally with diuretics and angiotensin-converting enzyme inhibitors unless not tolerated. The primary endpoints were all-cause mortality and the composite endpoint of all-cause mortality or all-cause admission. Analysis was done by intention to treat.
The mean study duration was 58 months (SD 6). The mean ejection fraction was 0.26 (0.07) and the mean age 62 years (11). The all-cause mortality was 34% (512 of 1511) for carvedilol and 40% (600 of 1518) for metoprolol (hazard ratio 0.83 [95% CI 0.74-0.93], p=0.0017). The reduction of all-cause mortality was consistent across predefined subgroups. Incidence of side effects and drug withdrawals did not differ by much between the two study groups.
- To which of the following patients are the results of this clinical trial applicable?
- A 62-year-old male with primarily diastolic congestive heart failure.
- A 75-year-old female with systolic dysfunction and an EF of 45%.
- A 56-year-old male with NYHA class I systolic heart failure.
- A newly diagnosed 66-year-old male who has yet to begin treatment for his NYHA class II systolic heart failure.
- A 68-year-old male with NYHA class II systolic heart failure and EF 30%.
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer USMLE RESEARCH ABSTRACT QUESTIONS, Research Abstract Questions, Research Abstract Questions Step 3, usmle step 3 | 4 Comments »
Posted on October 29, 2016 by Archer USMLE Reviews
RESEARCH ABSTRACT QUESTION #1
Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.
Patients were randomly assigned to eplerenone (25 mg per day initially, titrated to a maximum of 50 mg per day; 3319 patients) or placebo (3313 patients) in addition to optimal medical therapy. The study continued until 1012 deaths occurred. The primary end points were death from any cause and death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia.
During a mean follow-up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (relative risk, 0.85; 95 percent confidence interval, 0.75 to 0.96; P=0.008). Of these deaths, 407 in the eplerenone group and 483 in the placebo group were attributed to cardiovascular causes (relative risk, 0.83; 95 percent confidence interval, 0.72 to 0.94; P=0.005). The rate of the other primary end point, death from cardiovascular causes or hospitalization for cardiovascular events, was reduced by eplerenone (relative risk, 0.87; 95 percent confidence interval, 0.79 to 0.95; P=0.002), as was the secondary end point of death from any cause or any hospitalization (relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.98; P=0.02). There was also a reduction in the rate of sudden death from cardiac causes (relative risk, 0.79; 95 percent confidence interval, 0.64 to 0.97; P=0.03). The rate of serious hyperkalemia was 5.5 percent in the eplerenone group and 3.9 percent in the placebo group (P=0.002), whereas the rate of hypokalemia was 8.4 percent in the eplerenone group and 13.1 percent in the placebo group (P<0.001).
- Which of the following statements represents the most accurate interpretation of the results from the aforementioned clinical trial?
- There was no significant difference in the incidence of hyperkalemia between trial arms.
- There was no significant difference in the rate of sudden cardiac death between trial arms.
- Epleranone, when added to optimal medical therapy, decreases all cause mortality in patients with left ventricular dysfunction following myocardial infarction.
- The rate of hypokalemia was not significantly different between trial arms.
- The most common causes of death seen in enrolled patients over the course of this trial were non-cardiac in nature.
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Bio-statistics, Archer USMLE RESEARCH ABSTRACT QUESTIONS, Research Abstract Questions, Research Abstract Questions Step 3, USMLE Step 3 Bio-statistics | 1 Comment »
Posted on September 18, 2016 by Archer USMLE Reviews
A 90 year old man with history of advanced dementia is brought to hospital with aspiration pneumonia. This is his 5th episode of Aspiration pneumonia in the past 1 year. He is accompanied by his daughter who also happens to be his healthcare proxy. She wants to focus on her father’s comfort as the goal of care and requests no further diagnostic interventions and she would like to avoid further hospitalizations. She wants to know what would make him eligible to receive hospice care. Based on which of the following factors, can he be qualified for hospice?
A. His advanced age
B. Diagnosis of advanced dementia
D. His wishes to die at home
Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER ETHICS, Hospice, Hospice Care, Hospice Eligibility, Hospice qualify, usmle step 3 ethics | 15 Comments »