Master the board step 3

Master the Boards: USMLE Step 3
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Immune thrombocytopenic purpura (ITP): Most patients recover platelet
counts within 6 months. Transfusion is contraindicated, unless there is
life-threatening bleeding. Do not treat platelet count; treatment is based on
clinical bleeding.
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1st choice: Prednisone
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2nd choice: IVIG
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10–20 percent of patients develop chronic ITP, and immune therapy with
rituximab or splenectomy can be considered
Except for petechiae and ecchymosis, the physical exam should be normal
in ITP. If there is hepatosplenomegaly or lymphadenopathy, consider doing a
workup for other disorders (e.g., acute leukemia).
Neurology
Seizures
You are asked to see a previously well 13-month-old boy who is brought in after
a generalized tonic-clonic seizure 1 hour ago. The seizure lasted several minutes.
The mother remembers that a similar episode occurred when she was a child. On
examination vitals are BP 100/52, HR 110, Temp 101.4°F, RR 32. She wishes to know
if her child has epilepsy. What is the most appropriate response to the parents?
a. Reassure mother that there is no risk of epilepsy.
b. There is a slightly increased risk of epilepsy.
c. There is a high risk of epilepsy developing in the next year.
d. The patient has epilepsy but medications will be withheld until
second episode of seizure.
e. The patient has epilepsy and will require anti-seizure medications
Answer: A. This patient presents with simple febrile seizure—generalized tonic-clonic
seizure < 10 min duration occurring with rapid onset high fever (when > 39°C [102°F]) in
child 9 months to 5 years of age. There is usually positive family history. There is no risk of
epilepsy. Management includes evaluation for meningitis and controlling fever. DO NOT
order EEG or neuroimaging.
The risk of epilepsy is increased in a case presenting as febrile seizure under
any of the following conditions:
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Atypical seizure: > 15 minutes, more than 1 in a day, and focal findings
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Family history of epilepsy and initial seizure before 9 months of age
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Abnormal development
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Preexisting neurologic disorder
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