Master the board step 3

Master the Boards: USMLE Step 3
Diagnostic Testing
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EEG: May be normal
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CBC, electrolytes, calcium, magnesium, glucose (hypo gly cemia is a common
cause of seizures in infants of diabetic mothers)
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Amino acid assay and urine organic acids to detect inborn errors of metabolism
and pyridoxine deficiency
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To look for infectious causes, perform the following:
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TORCH infection studies: Total cord blood IgM for screening
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Blood and urine cultures
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Lumbar puncture if meningitis is suspected
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Ultrasound of head in preterms to look for intraventricular hemorrhage
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Intracranial hemorrhage causes seizures typically 2–7 days after birth
Treatment
Correct the underlying cause, including electrolyte abnormalities. For acute
seizure, use lorazepam or diazepam (rectally). Treatment for chronic seizures
depends on type; with absence seizures, use ethosuximide.
Basic Science Correlate
Benzodiazepines bind the alpha-1 receptor site of the GABA receptor.
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f2
GABA
site
`1
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pore
BZD
site
`1
a2
GABA
site
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