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Neurology Restless Legs Syndrome (RLS) RLS often comes to the health care provider’s attention when the bed partner comes in complaining of pain and bruises in the legs. The patient experiences an uncomfortable feeling in the legs, which is relieved by movement. RLS is associated with iron deficiency. Treat with pramipexole or ropinirole. A man comes to the emergency department with weakness in his legs that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes in the legs. He recalls an upper respiratory illness about 2–4 weeks prior that resolved. What is the most urgent step? a. Steroids b. Intravenous immunoglobulins c. Peak inspiratory pressure d. Intubation e. Lumbar puncture Answer: C. This case is Guillain-Barré. Ascending weakness with loss of deep tendon reflexes is characteristic. Peak inspiratory pressure is the correct answer. The peak inspiratory pressure diminishes as the diaphragm is weakened. Peak inspiratory pressure predicts who will have respiratory failure before it happens. This is the most important factor in determining the need for therapy with either intravenous immunoglobulins (IVIG) or plasmapheresis. Combinations of these medications are not effective. Steroids are not effective. Lumbar puncture will show an elevated protein level with no cells. Myasthenia Gravis Myasthenia gravis presents with weakness of the muscles of mastication, making it hard to finish meals. Blurry vision from diplopia results from the inability to focus the eyes on a single target. The case may classically report drooping of the eyelids as the day progresses. Diagnostic Testing ·· Best initial test: Anti-acetylcholine receptor antibodies (ACHR) ·· Most accurate test: Clinical presentation and ACHR are more sensitive and specific than an edrophonium or “Tensilon” stimulation test. Treatment ·· Best initial therapy: Pyridostigmine or neostigmine ·· Thymectomy: Use in patients < 60 if pyridostigmine or neostigmine do not work. ·· Prednisone: If thymectomy does not work, or if there simply is no response to pyridostigmine or neostigmine. ·· Azathioprine and cyclosporine are used to try to keep the patient off of longterm steroids. 249
Master the Boards: USMLE Step 3 Basic Science Correlate Mechanism of Azathioprine Cyclosporine and azathioprine inhibit the immune system. They decrease the function of T-cells, which control cellular immunity such as organ transplant rejection. The drugs do not decrease T-cell numbers, just function. 250
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THIRD EDITION Master the Boards USM
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THIRD EDITION Master the Boards USM
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Dedication To the Reader, This book
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Table of Contents Acknowledgments .
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About the Authors Conrad Fischer, M
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Infectious Diseases 1 Introduction
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Infectious Diseases Anaerobes ··
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Infectious Diseases -- Adverse effe
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Infectious Diseases Basic Science C
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Infectious Diseases Otitis Media Ke
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Infectious Diseases Diagnostic Test
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Infectious Diseases Cellulitis Look
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Infectious Diseases KOH Prep Basic
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Infectious Diseases Treatment Treat
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Infectious Diseases Lymphogranuloma
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Infectious Diseases Answer: D. Perf
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Infectious Diseases Pyelonephritis
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Infectious Diseases Duke’s Criter
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Infectious Diseases Endocarditis Pr
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Infectious Diseases Basic Science C
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Infectious Diseases Maintenance the
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Infectious Diseases A 43-year-old m
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Infectious Diseases Treatment ··
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Allergy and Immunology 2 Anaphylaxi
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Allergy and Immunology Answer: This
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Allergy and Immunology Treatment Li
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Pulmonology 5 Asthma Asthma present
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Pulmonology Nonacute Asthma 1. Best
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Pulmonology -- Chemistry: Increased
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Pulmonology Diagnostic Testing A ch
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Pulmonology Diagnostic Testing ··
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Pulmonology Pulmonary Embolism (PE)
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Pulmonology Basic Science Correlate
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Pulmonology ·· If pleurodesis fai
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Pulmonology Treatment ·· Ventilat
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Pulmonology Specific Associations P
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Pulmonology Interferon gamma releas
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Hematology 7 Anemia All forms of an
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Hematology Microcytic Anemia Diagno
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Hematology Answer: B. The anemia of
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Hematology answer antiparietal cell
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Hematology Treatment ·· Next best
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Hematology Treatment ·· Best init
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Hematology Pyruvate Kinase Deficien
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Hematology A pregnant woman comes w
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Hematology Myelodysplasia This cond
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Hematology Smudge cell (found in CL
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Hematology Diagnostic Testing Initi
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Hematology Aplastic Anemia This con
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Hematology Distinguishing Types of
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Hematology Clotting Factor Deficien
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Gastroenterology 8 Esophageal Disor
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Gastroenterology Diagnostic Testing
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Gastroenterology CCS Tip: How do I
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Gastroenterology Barrett Esophagus
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Gastroenterology If treatment for H
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Gastroenterology Inflammatory Bowel
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Page 228 and 229: Gastroenterology When is a “virtu
Page 230 and 231: Gastroenterology Treatment Antibiot
Page 232 and 233: Gastroenterology Why not use the NG
Page 234 and 235: Gastroenterology Diagnostic Testing
Page 236 and 237: Gastroenterology Other symptoms inc
Page 238 and 239: Gastroenterology Most accurate test
Page 240 and 241: Gastroenterology Vaccination Vaccin
Page 242 and 243: Gastroenterology Primary Biliary Ci
Page 244: Gastroenterology Diagnostic Testing
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Page 308 and 309: Section 2 Preventive Medicine Cance
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Page 312 and 313: Section 3 Dermatology Bullous and B
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Dermatology Paronychia This is an i
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Dermatology Syphilis Both primary a
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Dermatology Toxin-Mediated Diseases
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Dermatology They are removed with l
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Dermatology Treatment ·· Preventi
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Section 4 Surgery contributing auth
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Surgery Abdominal Trauma A 24-year-
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Surgery A man is hit over the head
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Surgery ·· Diagnosis: CT scan sho
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Surgery Pneumoperitoneum in a child
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Surgery Obstruction Suspect obstruc
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Surgery Acute Pancreatitis Suspect
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Surgery Ischemia Always consider th
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Surgery Obstructive Jaundice Caused
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Surgery Preoperative and Postoperat
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Surgery The following table shows t
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Surgery Nutritional support should
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Surgery Basic Science Correlate Ven
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Surgery Basic Science Correlate Edw
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Surgery Hypertrophic Pyloric Stenos
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Surgery ·· Closed reduction is th
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Surgery ·· Rupture of the Achille
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Surgery Ankylosing Spondylitis This
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Surgery Testicular Torsion Testicul
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Surgery Vascular Surgery A 48-year-
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Surgery A 65-year-old man presents
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Surgery Patient Safety Catheter-Ass
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Section 6 Obstetrics contributing a
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Obstetrics Screening Test Diagnosti
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Obstetrics Third Trimester A 38-yea
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Obstetrics • Perform further step
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Obstetrics Abruptio Placenta Placen
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Obstetrics Management ·· Test for
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Obstetrics Treatment ·· Antiviral
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Obstetrics Syphilis If the case des
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Obstetrics Prevention ·· Hepatiti
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Obstetrics Treatment ·· Blood pre
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Obstetrics Management of Specific C
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Obstetrics Routine Monitoring in Di
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Obstetrics ·· Medical abortion th
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Obstetrics Ectopic Pregnancy The mo
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Obstetrics Symmetric IUGR Asymmetri
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Obstetrics Ferning pattern of amnio
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Obstetrics Umbilical Cord Prolapse
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Obstetrics A 31-year-old primigravi
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Obstetrics -- Carboprost is a prost
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Section 7 Gynecology contributing a
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Gynecology ·· Mammography (> 50 y
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Gynecology A 68-year-old woman visi
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Gynecology Leiomyoma Three layers f
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Gynecology Postmenopausal Bleeding
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Gynecology Prepubertal or Postmenop
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Gynecology When is screening starte
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Gynecology Invasive Cervical Cancer
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Gynecology Cervicitis This is the d
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Gynecology Endometriosis This invol
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Gynecology A 17-year-old girl is br
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Gynecology Premenstrual Syndrome Pr
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Gynecology Idiopathic Hirsutism Thi
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Gynecology ·· Calcitonin, denosum
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Gynecology Infertility A 35-year-ol
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Gynecology Benign: H. Mole Complete
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