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USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


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  #1  
Old 05-05-2012
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Idea! Step 3 questions

HI guys i am starting new thread for step 3 questions, so we can put question here and discuss their answers.
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  #2  
Old 06-02-2012
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A 45-year-old homeless man shows up at an emergency
department because of an unhealing ulcer above his
right medial malleolus. The ulcer measures 3 cm in
diameter, has a bed of clean granulation tissue, and is
surrounded by edematous, hyperpigmented skin.
Higher up, in his inner anterior thigh, there is a 6-cm
soft tissue mass that feels deep and soft, with a prominent
palpable thrill and audible bruit. His pulse is
104/min, and he is chronically short of breath. He gives
a history of having suffered a gunshot wound to his
upper thigh at the age of 22 years. The scar of the
entrance wound can be seen at the anteromedial aspect
of the thigh, but there is no scar of an exit wound. Xrays
show a bullet embedded in the posterolateral thigh
muscles. At the time of that old injury, the patient was
a fugitive from justice, and he did not seek any medical
care. His friends “took care of him” and he “healed on
his own.” The most likely diagnosis is
(A) angiosarcoma
(B) arteriovenous fistula with secondary venous stasis
(C) chronic ischemic ulcer from arteriosclerotic occlusive
disease
(D) compartment syndrome
(E) venous insufficiency from congenital varicose veins
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  #3  
Old 06-02-2012
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Default 2

A 22-year-old man is accidentally pinned between the
high rear bumper of a truck and the loading dock the
truck was backing into.His pelvis is crushed in an anteroposterior
axis, as his pubic area is driven back into the
deeper tissues of his lower torso. He is transported
promptly to a nearby trauma center,where he arrives with
a blood pressure of 95/65 mm Hg and a pulse of 105/min.
He is resuscitated promptly and taken to a dedicated CT
scanner that is located in the emergency department. The
study shows the pubic symphysis to be separated approximately
4 cm, and the left sacroiliac joint and ligaments to
be completely disrupted. There is blood in the tissues surrounding
the fractures, but there is no large single pelvic
hematoma and there is no evidence of intra-abdominal
bleeding or intra-abdominal injuries. The urinary bladder
and rectum look normal in the CT scan, but the man
has not been able to provide a sample of urine for the laboratory.
The appropriate management for that problem is
(A) a bolus of intravenous fluid to increase diuresis
(B) insertion of a Foley catheter
(C) obtaining the sample by nephrostomy tube
(D) obtaining the sample by suprapubic cystostomy
(E) retrograde urethrogram
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  #4  
Old 06-02-2012
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Default 3

A 33-year-old woman is involved in a severe automobile
crash. She arrives in the emergency department in
shock, with physical evidence of pelvic fracture and
sonographic evidence of profuse intra-abdominal
bleeding. She is taken promptly to surgery for a “damage
control laparotomy.” At the surgical procedure she
is found to have extensive lacerations of the right lobe
of the liver, a smashed spleen, contused pancreas,
retroperitoneal hematoma, and several segments of
devitalized small bowel that were torn away from their
mesentery. Major bleeding sources are controlled and
extensive packing used to arrest blood loss from other
areas. During the procedure she received 8 U of packed
red cells and 15 L of Ringer’s lactate. No effort was
made at the time to complete all the necessary surgical
reconstructions, which were deliberately delayed until
proper resuscitation could be accomplished. The procedure
was terminated before coagulation defects or
hypothermia ensued, but closure of the abdominal wall
was difficult to do because of massive edema of the
abdominal viscera and the abdominal wall itself.
Should the closure be done forcefully, one could expect
the subsequent development of
(A) bowel necrosis
(B) coagulopathy
(C) hypothermia
(D) necrotizing fasciitis
(E) respiratory and renal failure
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  #5  
Old 06-02-2012
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For the first one I think it's the av fistula.
2nd is retrograde urethrogram
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  #6  
Old 06-02-2012
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both are right
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  #7  
Old 06-02-2012
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What about the 3rd one???
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  #8  
Old 06-02-2012
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Quote:
Originally Posted by Parag View Post
A 33-year-old woman is involved in a severe automobile
crash.

respiratory and renal failure ?? Abdominal Compartment Syndrome
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  #9  
Old 06-03-2012
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1.(B) arteriovenous fistula with secondary venous stasis
2.(E) retrograde urethrogram
3.(A) bowel necrosis
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  #10  
Old 06-03-2012
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Quote:
Originally Posted by pass7 View Post
1.(B) arteriovenous fistula with secondary venous stasis
2.(E) retrograde urethrogram
3.(A) bowel necrosis
Correcting the 3rd one to (E) respiratory and renal failure, ABD. compartment syndrome causing renal and res[iratory failure.
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