Master the board step 3

Master the Boards: USMLE Step 3
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24-hour urine collection for protein excretion and creatinine clearance
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Plasma renin activity (PRA): Best screen for renovascular and renal
disorders
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Endocrine causes:
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Urine and serum catecholamines, if pheochromocytoma is suspected
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Thyroid and adrenal hormone levels
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Drug screening (in adolescents), if drug abuse is suspected
Treatment
If the patient is obese, order lifestyle changes:
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Weight control
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Aerobic exercise
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No-added-salt diet
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Monitoring of blood pressure
If there is no response to lifestyle changes, give antihypertensives:
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The best initial antihypertensive is a diuretic or beta blocker.
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Then add calcium channel blocker and ACE inhibitor (good in high-renin
hypertension secondary to renovascular or renal disease or high-renin
essential hypertension)
Gastrointestinal Disease
Diarrhea
Acute Diarrhea
The most common cause of acute diarrhea in infancy is a rotavirus. The most
common causes of bloody diarrhea are Campylobacter, amoeba (E. histolytica),
Shigella, E. coli, and Salmonella.
Following are characteristics of selected microbes causing acute diarrhea:
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Rotavirus: double-stranded DNA virus
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Shigella: gram-negative, non-spore-forming rod
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Campylobacter: gram-negative spiral that is motile with flagella
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Salmonella: gram-negative rod that is motile
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Clostridium difficile: gram-positive, spore-forming bacteria
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Giardia: anaerobic protozoan with flagella
· · Cryptosporidium: protozoan that mostly affects immunocompromised
patients
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