USMLE Step 3 Flashcards Set #4

Questions and Answers

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)

What are the brain death criteria?

Presence of confounding factors like intoxication

Neuro exam showing absent cerebral and brainstem reflexes (correct)

Evidence of a devastating cause via brain imaging (correct)

Is it possible to see spontaneous limb movements in people with brain death?

True

Saw palmetto is an alternative medicine most commonly used to treat?

BPH Signup and view all the answers

Ginseng, garlic, ginkgo biloba, and saw palmetto all have the risk of the side effect of ___________.

bleeding Signup and view all the answers

What is a buzzword for the 'non-ejection click'?

Mitral valve prolapse Signup and view all the answers

What is the typical sound of mitral valve prolapse?

Non-ejection click followed by systolic murmur Signup and view all the answers

In botulism, are sensations intact?

Yes Signup and view all the answers

In botulism, are reflexes often diminished or absent?

True Signup and view all the answers

What is the best advice for a mother whose child has night terrors after a move?

His condition will most likely resolve spontaneously over 1-2 years. Signup and view all the answers

Do sleep terrors occur during REM sleep?

False Signup and view all the answers

Describe the epidemiology and symptoms of sleep terrors.

They occur between ages 4-12, are self-limiting, arise during the first third of sleep, and the child awakens abruptly with a scream. Signup and view all the answers

Are you allowed to accept travel compensation from pharmaceuticals?

Yes, to travel compensation Signup and view all the answers

What is the next best step for a patient with potential hepatitis C?

Further investigation is required. Signup and view all the answers

Are patients with proven Hep C via RNA in the blood candidates for antiviral treatment?

True Signup and view all the answers

Which has vaginal pH > 4.5: trichomonas or gardnerella?

Both Signup and view all the answers

Describe the appearance of trichomonas versus gardenerella.

Trichomonas = Pear-shaped motile organisms on wet mount Gardnerella = Clue cells Signup and view all the answers

What is the best way to prophylax against fat embolism in the setting of a fracture?

Early immobilization and operative correction Signup and view all the answers

What is the classic triad of fat embolism?

Respiratory insufficiency, neurologic impairment, petechial rash Signup and view all the answers

Rx for + tuberculin skin test with - CXR

Isoniazid mono therapy for 9 months, rifampin for 4 months, or isoniazid and rifapentine weekly for 3 months Signup and view all the answers

Study Notes

Brain Death Criteria

Compatible with brain death: irreversible absence of cerebral and brain stem reflexes.
Absence of respiratory drive must last for 8 minutes to confirm brain death.
Neuro exam must show absence of reflexes: pupillary, corneal, oculocephalic, oculovestibular, sucking, swallowing, and extensor posturing.
Confounding factors like drug intoxication or electrolyte disturbances must be ruled out.
Brain imaging should reveal a devastating cause.

Brain Death Sensations and Reflexes

Patients with brain death may still exhibit spontaneous limb movements.
Sensations remain intact as botulism inhibits acetylcholine release, preserving sensory pathways.
Reflexes may be diminished or absent in cases of botulism.

Sleep Terrors and Nightmares

Night terrors generally affect children aged 4-12 and are self-limiting.
Symptoms include abrupt awakening, screaming, frightened expression, and inability to recall the event.
Most children will resolve their night terrors over 1-2 years, particularly as they adjust to new environments.

Alternative Medicines

Saw palmetto is primarily used for benign prostatic hyperplasia (BPH), though evidence of its effectiveness is lacking.
Ginseng, garlic, ginkgo biloba, and saw palmetto are associated with an increased risk of bleeding.

Cardiac Murmurs

A "non-ejection click" is characteristic of mitral valve prolapse.
The sound typically includes a non-ejection click followed by a systolic murmur indicating mitral regurgitation.
Click timing is influenced by left ventricular end-diastolic volume, potentially disappearing if volume increases.

Hepatitis and Liver Health

For a case of hepatitis with positive antibodies but unclear active infection, further investigation is required.
Additional scenarios can include a previous hepatitis C infection that cleared spontaneously or a false positive result.
Definitive diagnosis of active hepatitis C requires HCV RNA testing.

Tuberculosis Prophylaxis

Treatment options for a positive tuberculin skin test with negative chest X-ray include:
- Isoniazid monotherapy for 9 months.
- Rifampin for 4 months.
- Isoniazid and rifapentine weekly for 3 months.

Fat Embolism

The best prophylaxis against fat embolism after a fracture involves early immobilization and operative correction.
The classic triad of fat embolism symptoms includes respiratory insufficiency, neurologic impairment, and petechial rash.

Ethical and Legal Considerations

Acceptable to receive travel compensation and honorarium from pharmaceuticals.
Receiving pre-made slides for presentations is not acceptable.

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Description

Test your knowledge with this set of flashcards specifically designed for USMLE Step 3. Covering key concepts related to brain death criteria, this quiz will help reinforce your understanding of essential medical knowledge for the exam. Perfect for medical students preparing for their licensure assessments.