Master the board step 3

Master the Boards: USMLE Step 3
Incontinence
The following table summarizes the presentation, diagnosis, and treatment of
incontinence.
Urge Incontinence
Presentation Pain followed by urge to urinate No pain
No relationship to coughing, laughing, or
straining
Stress Incontinence
Brought on by coughing and laughing
Testing Urodynamic pressure monitoring Observe leakage with coughing
Treatment
• Behavior modification
• Anticholinergic medications
- Tolterodine
- Trospium
- Darifenacin
- Solifenacin
- Oxybutynin
• Kegel exercises
• Estrogen cream
Hypertension
A man comes to the office for a routine visit. He is found to have a blood pressure
of 145/95. What is the next best step in management?
Answer: Repeat the blood pressure measurement in 1–2 weeks.
Diagnostic Testing
The first step when a case of hypertension presents is to repeat the blood pressure
measurement. It may take 3–6 measurements to get an accurate assessment
of blood pressure.
CCS Tip: Routine tests for hypertension cases on CCS are:
··
Urinalysis
··
EKG
··
Eye exam for retinopathy
··
Cardiac exam for murmur and S4 gallop
Treatment
If the blood pressure is repeatedly abnormal, initiate lifestyle modifications
such as these:
··
Sodium restriction
··
Weight loss
··
Dietary modification
··
Exercise
··
Relaxation techniques
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