All about Usmle
Friday, 8 February 2013
Wednesday, 6 February 2013
USMLE Requirements Chart – iii
Monday, 4 February 2013
USMLE Requirements Chart – ii
Friday, 1 February 2013
USMLE Requirements Chart – i
Wednesday, 30 January 2013
Usmle Step 1 MCQ’s # 50
Title: Usmle Step 1 MCQ’s # 50
Subject: Behavioral Science
Q NO 50: A 55-year-old man with a history of alcoholism and hepatitis C undergoes an orthotopic liver transplant. His surgery goes well, and he is taken to the intensive care unit. On postoperative day 4, the patient’s sedation is discontinued, and he is extubated. On postoperative day 5, the patient begins to experience tremor, tachycardia, hypertension, nausea, and malaise. He begins to have visual hallucinations. On examination, his wound is clean, dry, and intact. No unexpected abdominal tenderness is elicited. Which of the following pairs best explains the patient’s symptoms and gives the appropriate treatment?
A. Alcohol withdrawal/administer benzodiazepines
B. Mallory-Weiss syndrome /administer benzodiazepines
C. Mallory-Weiss syndrome/ administer thiamine
D. Wernicke-Korsakoff syndrome/administer benzodiazepines
E. Wernicke-Korsakoff syndrome/administer thiamine
Explanation:
The correct answer is A. Patients with a history of alcoholism should always be watched for symptoms of alcohol withdrawal because the sequelae can be life-threatening. In this case, the patient exhibits many of the classic findings of alcohol withdrawal: tremor, tachycardia, hypertension, malaise, nausea, hallucinations, and delirium tremens. Delirium tremens is a constellation of signs and symptoms including autonomic instability, tachycardia, hypertension, delirium, and death. Treatment for withdrawal can include replacing the alcohol or giving benzodiazepines.
Choice B does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. In Mallow-Weiss syndrome, patients develop longitudinal lacerations at the gastroesophageal junction. Itis caused by excessive vomiting with failure of the LBS to relax, and can lead to fatal hematemesis. Treatment may include preventing the emesis and/or managing hemorrhage. Choice C does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. See above (choice B) for explanation. Choice D does not correctly identify this patient’s condition, nor does it properly address the treatment for Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is caused by a thiamine deficiency, and results in psychosis, ophthalmoplegia, and ataxia. Untreated it may progress to memory loss, confabulation, and confusion. Treatment is thiamine replacement.
Choice E correctly matches the disease with the treatment, but it tails to correctly identify the symptoms seen in this patient.
Source: http://www.usmleworldwide.com/blog/?p=1312
Subject: Behavioral Science
Q NO 50: A 55-year-old man with a history of alcoholism and hepatitis C undergoes an orthotopic liver transplant. His surgery goes well, and he is taken to the intensive care unit. On postoperative day 4, the patient’s sedation is discontinued, and he is extubated. On postoperative day 5, the patient begins to experience tremor, tachycardia, hypertension, nausea, and malaise. He begins to have visual hallucinations. On examination, his wound is clean, dry, and intact. No unexpected abdominal tenderness is elicited. Which of the following pairs best explains the patient’s symptoms and gives the appropriate treatment?
A. Alcohol withdrawal/administer benzodiazepines
B. Mallory-Weiss syndrome /administer benzodiazepines
C. Mallory-Weiss syndrome/ administer thiamine
D. Wernicke-Korsakoff syndrome/administer benzodiazepines
E. Wernicke-Korsakoff syndrome/administer thiamine
Explanation:
The correct answer is A. Patients with a history of alcoholism should always be watched for symptoms of alcohol withdrawal because the sequelae can be life-threatening. In this case, the patient exhibits many of the classic findings of alcohol withdrawal: tremor, tachycardia, hypertension, malaise, nausea, hallucinations, and delirium tremens. Delirium tremens is a constellation of signs and symptoms including autonomic instability, tachycardia, hypertension, delirium, and death. Treatment for withdrawal can include replacing the alcohol or giving benzodiazepines.
Choice B does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. In Mallow-Weiss syndrome, patients develop longitudinal lacerations at the gastroesophageal junction. Itis caused by excessive vomiting with failure of the LBS to relax, and can lead to fatal hematemesis. Treatment may include preventing the emesis and/or managing hemorrhage. Choice C does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. See above (choice B) for explanation. Choice D does not correctly identify this patient’s condition, nor does it properly address the treatment for Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is caused by a thiamine deficiency, and results in psychosis, ophthalmoplegia, and ataxia. Untreated it may progress to memory loss, confabulation, and confusion. Treatment is thiamine replacement.
Choice E correctly matches the disease with the treatment, but it tails to correctly identify the symptoms seen in this patient.
Source: http://www.usmleworldwide.com/blog/?p=1312
Monday, 28 January 2013
Usmle Step 1 MCQ’s # 49
Title: Usmle Step 1 MCQ’s # 49
Subject: Behavioral Science
Q NO 49: A 50-year-old woman presents for a follow-up visit alter being diagnosed with diabetes one month ago. At that visit, her physician verbally requested that she have some labs drawn before today’s appointment. The patient did not remember to have the labs drawn. Which of the following would be most likely to improve the patient’s compliance?
A. Ask the patient to make a behavioral change in addition to the laboratory work
B. Provide the patient with a written laboratory request with clear instructions
C. Peter the patient to a physician with expertise in “difficult patients”
D. Repeat the lab requests lowly and more loudly
E. Show photographs of patients who had an amputation due to uncontrolled diabetes
Explanation:
The correct answer is B. Providing written diagnostic and treatment recommendations, including requests for labs has been shown to increase compliance. Many patients become anxious and ire less likely to remember and follow verbal recommendations, particularly when receiving difficult news.
Compliance is increased with simple clear instructions, and instituting a behavioral change (choice A) will overwhelm the patient. It is best to institute one behavioral change t a time.
Referral to another physician (choice C) is not the plan of choice except under extreme circumstances (not in a case such as this), and is likely to distress the patient.
Repeating i verbal instruction (choice D) does not facilitate compliance and may increase noncompliance and frustration on the part of both patient and physician.
Scaring or intimidating patients (choice E) is not recommended to increase compliance and could also have i negative impact on the physician-patient relationship.
Source: http://www.usmleworldwide.com/blog/?p=1234
Subject: Behavioral Science
Q NO 49: A 50-year-old woman presents for a follow-up visit alter being diagnosed with diabetes one month ago. At that visit, her physician verbally requested that she have some labs drawn before today’s appointment. The patient did not remember to have the labs drawn. Which of the following would be most likely to improve the patient’s compliance?
A. Ask the patient to make a behavioral change in addition to the laboratory work
B. Provide the patient with a written laboratory request with clear instructions
C. Peter the patient to a physician with expertise in “difficult patients”
D. Repeat the lab requests lowly and more loudly
E. Show photographs of patients who had an amputation due to uncontrolled diabetes
Explanation:
The correct answer is B. Providing written diagnostic and treatment recommendations, including requests for labs has been shown to increase compliance. Many patients become anxious and ire less likely to remember and follow verbal recommendations, particularly when receiving difficult news.
Compliance is increased with simple clear instructions, and instituting a behavioral change (choice A) will overwhelm the patient. It is best to institute one behavioral change t a time.
Referral to another physician (choice C) is not the plan of choice except under extreme circumstances (not in a case such as this), and is likely to distress the patient.
Repeating i verbal instruction (choice D) does not facilitate compliance and may increase noncompliance and frustration on the part of both patient and physician.
Scaring or intimidating patients (choice E) is not recommended to increase compliance and could also have i negative impact on the physician-patient relationship.
Source: http://www.usmleworldwide.com/blog/?p=1234
Saturday, 26 January 2013
Usmle Step 1 MCQ’s # 48
Title: Usmle Step 1 MCQ’s # 48
Subject: Behavioral Science
Q NO 48: A 56-year-old man visits his primary care physician complaining of difficulty while having sexual relations with his wife. In the past two months, he has often been unable to achieve an erection. When he does achieve an erection, he is unable to maintain it for a sufficient duration to permit intercourse. The patient appears distressed. He has been married for over 30 years and says that he has never encountered this problem before. To further assess this man’s problem, the physician’s next question should be which of the following?
A. Are you afraid that this will not go away by itself?
B. Have you ever heard of something called a ‘snap gauge’?
C. Have you heard about a drug called sildenafil?
D. How much alcohol do you usually consume in the course of the week?
E. Is this the reason that you feel distressed, or is there something else you would like to tell me?
F. What do you know about how sexual functioning changes as you age?
G. What is your wife’s reaction to all of this?
H. Would you like me to make an appointment for you with a specialist with whom you can talk about this?
Explanation:
The correct answer is D. More information is required before a course of action to address this man’s erectile dysfunction can be decided upon. Before more invasive interventions are considered, the physician should first explore the effect that life circumstances may be having on the man’s sexual functioning. In particular the physician should ask about: 1) alcohol use, 2) smoking 3) diabetes 4) marital conflict and 5) work-related stress. It is critical to gain a sense of the etiology of the condition before moving on to a discussion of treatment options.
Drawing attention to the patient’s anxiety (choice A) distracts from gathering information that will help diagnose the patient’s condition. While noticing and even commenting on the patient’s emotional state is good practice, itis unlikely to reassure the patient that the physician is ting to solve the problem that is presented. Discussing the patient’s distress will most likely be more effective once the patient’s condition is better understood.
Discussing diagnostic options before fully exploring the patient’s lifestyle and life circumstances (choice B) is inappropriate. A “snap gauge” is a device used to help determine whether the erectile disorder is primarily physiological or psychological. The device is fitted around the penis before the man goes to sleep at night and responds to any erections the man achieves during REM sleep. If the man does achieve an erection during sleep physiological problems can be ruled out.
Discussing therapeutic options before making a diagnosis is inappropriate. Sildenafil (Viagra; choice C.) is one of the most commonly prescribed mediations for male secondary impotence. However the prescription is inappropriate before the etiology is fully explored.
Choice E suggests that the physician believes that the patient may be hiding something. Such a direct confrontation, at this early point in the interaction, risks offending the patient, and does little to foster sense of support and rapport.
Although the incidence of erectile dysfunction does increase with age (choice F), this degree of sexual dysfunction is not a natural part of the aging process. To ask this question suggests to the patient that that is the case. The physician should seek specific proximate causes, and not hide behind misconceptions of aging. Many individuals will be able to have sexual relations for the lull duration of their life.
The locus should be on the patient, his symptoms, his life and his reactions. Turning the focus onto his wife’s reactions (choice G) is at best premature.
The physician can in all likelihood treat this patient on his/her own. Even if a referral to a specialist (choice H) is ultimately needed a preliminary inquiry’ needs to be completed before this step is considered.
Source: http://www.usmleworldwide.com/blog/?p=1230
Subject: Behavioral Science
Q NO 48: A 56-year-old man visits his primary care physician complaining of difficulty while having sexual relations with his wife. In the past two months, he has often been unable to achieve an erection. When he does achieve an erection, he is unable to maintain it for a sufficient duration to permit intercourse. The patient appears distressed. He has been married for over 30 years and says that he has never encountered this problem before. To further assess this man’s problem, the physician’s next question should be which of the following?
A. Are you afraid that this will not go away by itself?
B. Have you ever heard of something called a ‘snap gauge’?
C. Have you heard about a drug called sildenafil?
D. How much alcohol do you usually consume in the course of the week?
E. Is this the reason that you feel distressed, or is there something else you would like to tell me?
F. What do you know about how sexual functioning changes as you age?
G. What is your wife’s reaction to all of this?
H. Would you like me to make an appointment for you with a specialist with whom you can talk about this?
Explanation:
The correct answer is D. More information is required before a course of action to address this man’s erectile dysfunction can be decided upon. Before more invasive interventions are considered, the physician should first explore the effect that life circumstances may be having on the man’s sexual functioning. In particular the physician should ask about: 1) alcohol use, 2) smoking 3) diabetes 4) marital conflict and 5) work-related stress. It is critical to gain a sense of the etiology of the condition before moving on to a discussion of treatment options.
Drawing attention to the patient’s anxiety (choice A) distracts from gathering information that will help diagnose the patient’s condition. While noticing and even commenting on the patient’s emotional state is good practice, itis unlikely to reassure the patient that the physician is ting to solve the problem that is presented. Discussing the patient’s distress will most likely be more effective once the patient’s condition is better understood.
Discussing diagnostic options before fully exploring the patient’s lifestyle and life circumstances (choice B) is inappropriate. A “snap gauge” is a device used to help determine whether the erectile disorder is primarily physiological or psychological. The device is fitted around the penis before the man goes to sleep at night and responds to any erections the man achieves during REM sleep. If the man does achieve an erection during sleep physiological problems can be ruled out.
Discussing therapeutic options before making a diagnosis is inappropriate. Sildenafil (Viagra; choice C.) is one of the most commonly prescribed mediations for male secondary impotence. However the prescription is inappropriate before the etiology is fully explored.
Choice E suggests that the physician believes that the patient may be hiding something. Such a direct confrontation, at this early point in the interaction, risks offending the patient, and does little to foster sense of support and rapport.
Although the incidence of erectile dysfunction does increase with age (choice F), this degree of sexual dysfunction is not a natural part of the aging process. To ask this question suggests to the patient that that is the case. The physician should seek specific proximate causes, and not hide behind misconceptions of aging. Many individuals will be able to have sexual relations for the lull duration of their life.
The locus should be on the patient, his symptoms, his life and his reactions. Turning the focus onto his wife’s reactions (choice G) is at best premature.
The physician can in all likelihood treat this patient on his/her own. Even if a referral to a specialist (choice H) is ultimately needed a preliminary inquiry’ needs to be completed before this step is considered.
Source: http://www.usmleworldwide.com/blog/?p=1230
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