USMLE WORLD STEP 3 NOTES

By GEBBILS
Risk of Limb Anomalies in Chorionic Villi Sampling – is greatest at Less Than 9 weeks of
Gestation
Children diagnosed with Infant Botulism – will be hospitalized for 1-3 months and will have a full
recovery
Vasovagal Syncope – is a NeuroCardiogenic Event of Passing Out
Spontaneous Bacterial Peritonitis – is treated with Antibiotics and if there is presence of
Encephalopathy, then Lactulose is to be added
End Stage Liver Disease – survival is calculated using INR, Bilirubin and Creatinine Values
Acute Variceal Bleeding – should be managed with Endoscopy where Sclerotherapy or Banding
Can be used
Variceal Prevention – can be Managed with Non Selective Beta Blockers
Patients with Horner Syndrome – (Miosis, Anhydrosis, Ptosis) must have MRA to detect Carotid
Dissection
Hepatic Adenomas – are usually managed by Discontinuation of OCPs, if patients are on it.
Non Secretory Pituitary Tumors – are Managed Surgically by Transphenoidal Removal (Tumors
that are Gonadotropin (LH/FSH) Secreting)
Carpal Tunnel Syndrome – is Associated with Hypothyroidism, DM, Direct Trauma and ESRD.
(Not Osteoporosis)
Acute Fecal Impaction – is managed by Disimpaction First and then Stool Softeners.
Patients with Sarcoidosis – must have a Biopsy of Parotid Gland, Lacrimal Gland and Palpable
Superficial Lymph Nodes
Screening for Cushing’s Disease – must be done with Dexamethasone Suppression Test
Chlamydia Pneumonia – presents between 2-19 weeks after birth, with Staccato Cough,
Conjunctivitis and Otitis.
Hypertensive Patients with Hyperuricemia – will Benefit from ARBs
Clopidogrel – is a Better Agent for Patients who had a Stroke while being on Aspirin.
PSA Elevation – might be Transient (due to Rectal Exam) and the Levels might need to be
rechecked.
Infant with Down Syndrome – must be Evaluated with Echocardiography if there are Cardiac
Symptoms
Diabetic Mothers – might have Fetal Hypertrophic Cardiomyopathy, due to Glycogen Deposition,
and will have Hypertrophic Interventricular Septum
Painless Testicular Mass – must be evaluated with Scrotal Ultrasound and only then if suspicious
to have a CT Scan.

Fibrinolytic Therapy for Strokes – must be initiated within 3-4.5 hours

All patient with CVA – must have Echocardiogram to evaluate for Thrombus Formation
Anaphylaxis – is treated with Epinephrine 0.5 mg IntraMuscularly
Dashboard Injury – affects Posterior Cruciate Ligament
Hyperkalemia with EKG Changes – must be managed with Calcium Gluconate or Calcium
Chloride
Patients with Ankylosing Spondylitis – are managed with Repeat X-Ray in 3 months to evaluate
for Progression of the Disease
Patients with Sickle Cell Splenomegaly – must have CBC and IV Hydration
Psoriatic Lesions are Worsened – with Beta Blockers, NSAIDs, Anti-Malarial Drugs, ACE
Inhibitors and Lithium. Thus Medication must be Stopped
Heparin Induced Thrombocytopenia – is managed with D/C of Heparin and Argatroban (Thrombin
Inhibitor) must be initiated.
21 Alpha Hydroxylase Deficiency – will have Elevated Levels of 17-Alpha Hydroxyprogesterone
Patellar Tendon Rupture – will present with Swelling of Anterior Part of the Knee and Inability to
maintain Passive Extension of the Knee against gravity
Most Common Complication of Tick Bites – is a Local Infection, if the Tick is not Engorged with
Blood, there is no Risk of Lyme Disease
Swallowing Evaluation – must be done in All Stroke Patients
Patients with Stroke – must be started on Lovenox, to reduce the Risks of PE and DVTs
Acute Hepatitis – is treated with Supportive Measures
Adults with Acute Hepatitis – only 1-10% will go on to Develop Chronic Hepatitis
Elevated Troponin – is indicative of a Worse Prognosis, as it shows the embolus is large enough
to place more strain on the Heart
Warfarin – must be started after Heparin, in the patients with PE
Patients with Hip Fractures – who have a lot of Comorbidities, need to be adequately controlled
for pain and Surgery is not indicated.
Lumbar Spinal Stenosis – presents in patients in their 60s, where the pain disappears upon sitting
down, but increases with spine extension and decreases with flexion
Lumbar Spinal Stenosis – must be evaluated with MRI
Primary HIV Associated Thrombocytopenia – must be treated with Zidovudine, which reduces the
risk of Opportunistic Infections
Rash in patients with Infectious Mono – treated with Amoxicillin is due to Circulating Immune
Complexes
Isotretinoin – used for Sever Acne, has been associated with Hypertriglyceridemaa and causes
Pancreatitis, it’s also Teratogenic
Achilles’ Tendon Rupture – will present with Plantar Flexion, when the Calf is Squeezed
(Thompson Test)
Esophageal Rupture – is Best evaluated with Esophagogram with Water Soluble Contrast

Ecthyma Gangrenosum – is treated with IV Antibiotics and Not Surgical Debridement

Progestin Releasing IUD’s – such as Mirena are Widely Used in Patients with Sickle Cell
Disease, especially those who have had strokes in the past.
ARDS – is best managed with Low Tidal Volume
GSB + Mothers – babies, who did not received an adequate Prophylaxis (within 4 hours of
delivery) are to be Observed for 48 hours
Hypertension in Scleroderma Patients – is to be controlled with Captopril (ACE Inhibitor)
Acute Cholecystitis Patients – must get RUQ Sono and Abx to be Started
Hepatic Hydrothorax – in patients with Hepatic Failure where the Ascitic Fluid leaks and causes
Pleural Effusion. It must be Treated with Diuretics and Sodium Restriction
Refeeding in Anorexia Patients – must be treated with Potassium Replacement and can present
with Edema, Heart Failure and Delirium
Advanced Osteonecrosis – must be treated with Total Hip Replacement
Flexible Kyphosis – is easily correctable by Voluntary Extension, it is a Common Finding, it must
be treated with Bracing and Exercises
Levonorgestrel (Mirena) – is the best Emergency Contraception
Breast Milk Jaundice – presents after 7 days of Breastfeeding and the management is to Stop
Breastfeeding and Start Formula Feed, and then Resume Breast Feeding in 1 week.
Piglitazone – can cause Pulmonary Edema
Sudden Onset of Hyperglycemia – in patients receiving TPN is caused by Sepsis
High Dose Nicotine Patch – is helpful in patients in the early stages of Smoking Cessation
Asymptomatic Bradycardia – in patients with recent MI, should be treated with Atropine
Retinal Hemorrhage – is the most Ominous Sign of Preeclampsia
Rotator Cuff Tendonitis – presents with Lateral Shoulder Pain, and aggravated by Abduction and
External Rotation
Patients with Benign Essential Tremor – will have a normal life expectancy
Patients with Cocaine Induced Ischemia – must have Angiography to check for any Thrombus
Patients with Brain Death – will not have a Cough Reflex with Suctioning, but it’s possible to have
Babinski Reflex present
Patients with Infected Catheters – must have it removed and placed on Vancomycin and be
treated for Gram Negative Sepsis such as Cefepime
If patient with Staph Aureus – is suspected to have Osteomyelitis and must have MRI to confirm
that
Toxic Megacolon – in patients with Ulcerative Colitis and must have Abd X-Ray imaging done,
and Glucocorticoids are to be started in the Acute Attack
Patients with PCP – if have a A-a gradient more than 35, must be started on Steroids
Patients with SLE – will have MI due to Atherosclerosis

Patients with Hyperreflexia – will not have any unusual symptoms

Diabetic Patients with Neuropathy – must have a Tuning Fork Test to identify for Vibratory Sense
Loss. Patients may be treated with TCA such as Duloxetine, not SSRIs
Hepatic Cysts – are the most common manifestation of Adult Polycystic Kidney Disease
Patients with Initial Onset of Depression – must be treated for at least 6 months with SSRIs
Any patient with RA – if develop Fevers, must have Joint Aspiration to test for Infection
Scrotal Trauma – must be evaluated with Surgical Exploration
Lyme Arthritis – must be evaluated with Aspiration of Synovial Fluid and ELISA antibodies in it.
Patients with TB – who have a new Pleural Effusion must have Thoracocentesis
Rupture of Chorda Tendinae – must be suspected in healthy adults with new onset of Pulmonary
Edema
Toxic Shock Syndrome – will present with Exotoxin Wide Spread (X for Tox)
In Diabetic Ketoacidosis – the Blood Glucose will be more than 250. If patient presents with
Confusion, Ketonuria then it’s most likely Alcoholic Ketoacidosis
Secondary Hypertension – due to Renal Artery Stenosis is evaluated with MR Angiography of the
Renal Vessels
Sarcoidosis – must be Evaluated with Chest X-Ray for Hilar Nodes Enlargement, and confirmed
with Lung Biopsy
New Onset of CHF – must be evaluated with Echo and Stress Test
Right Blood Glucose Control – will prevent conditions such as Retinopathy
Medial Medullary Syndrome – is associated with Contralateral Spastic Hemiplegia, Contralateral
Vibratory and Proprioception Loss and Tongue Deviation to the Injured Side.
Bright Red Blood Per Rectum – must be evaluated with Colonoscopy, where Radionuclide and
Angiography are Reserved when it cannot be visualized.
APACHE Score – is now used to assess the serverity of Acute Pancreatitis
Myelomeningocele – will also present with Bladder Dysfunction
VQ Scan – does not completely rule out Acute PE in patients highly suspected to have one
Patients with Pheochromocytoma – if being prepared for surgery, then Alpha Blockers must be
started 10-14 days prior
Diagnostic Work up in Multiple Myeloma – includes Serum Protein Electrophoresis, Skeletal
Survey and Bone Marrow Biopsy
Hashimoto’s Thyroiditis – is confirmed with high titers of Antimicrosomal (anti-TPO) antibody is
diagnostic.
Majority of Patients with Hypothyroidism – will also present with Hypercholesterolemia
History of Egg Allergy – has to be known before administering Influenza Vaccine
Febrile Reaction during Transfusion – can be prevented by Washing the Cells, where Leukocytes
are removed from Blood

H.Pylori Treatment – is Proton Pump Inhibitor, Clarithromycin and Amoxicillin (or Metronidazole if
Penicillin Allergic) for 2 weeks
If H. Pylori – is resistant to Triple Therapy, then try Quadruple Therapy which is Proton Pump
Inhibitor and Bismuth, Tetracycline and Metronidazole
Retrograde Ejaculation (Dry Ejaculate) – occurs in up to 70% of patients after TURP.
Schistosomiasis – is diagnosed with Urine or Stool Microscopy and not Cystoscopy
Cluster Headaches – typically present with Lacrimation, Retroorbital Pain, Conjunctival Injection,
Rhinorrhea and usually last 30 or more minutes
Verapamil – is the Drug of Choice for Prevention of Cluster Headaches
Patients with Acne – Topical Retinoid, Benzoyl Peroxide and Erythromycin
Patients with Symptomatic Rectoceles – who are poor surgical candidates, are to be fitted with
Pessaries and Estrogen Cream.
Patients treated with Thrombolytics for Ischemic Strokes – are not to be placed on Anti-Platelet
Meds or Heparin, instead the Blood Pressure Control is Labetalol or Nitroprusside
Children with Sickle Cell Disease – will have Dactylitis and also Splenic Sequestration
Patients Post Cholecystectomy – who present with Diarrhea are to be Treated with
Cholestyramine
Non Gonococchal Urethritis – in men, may be due to Trichomonas and to be treated with
Metronidazole
Dermatomyositis – which presents as a scaly rash over the knuckles should suspect Malignancy
in these patients
Pyelephlebitis – is the most common complication of Ruptured Appendicitis
Condyloma Acuminata – is not a contraindication for Vaginal Delivery
Supraglottic Edema – should be suspected in the patients exposed to Smoke Inhalation
Women under 30 with a Breast Mass – must have an Ultrasound initially and only then a Biopsy
Treatment for TB – is usually at least 9 months with INH
Renal Parenchymal Disease – should be suspected in young patients with Secondary
Hypertension
Patients who are Kidney Donors – are at Slightly Increased Risk of Gestational Complications,
otherwise the risks for other conditions are the same as general population
Patients with Mallory-Weis – who are not actively bleeding, can be observed. Hiatal Hernia is the
known complication in these patients
Massive PEs – can cause Pulmonary Hypertension and can lead to Right Ventricular Dysfunction
and Acute Tricuspid Regurgitation
Limited Sigmoidoscopy – is the Study of Choice in Patients with C.Diff Colitis
Meniere’s Disease – presents with Triad of Periodic Vertigo, Unilateral Hearing Loss and Tinnitus

Septate Uterus – doesn’t interfere with inability to conceive, but must be Surgically Corrected to
Avoid the Risk of Miscarriages
Acute Gout – is Diagnosed with Arthrocentesis by Demonstrating Negatively Birefringent Crystals,
Serum Uric Acid can be Normal in the Acute Attack, Treatment is Indomethacin
Implantable Levonorgestrel and Depot – are the Most Effective and have the Lowest Rate of
Pregnancies among Non Permanent Types of Sterilization
Acute Pericarditis – can occur days after MI and must be treated with High Dose Aspirin
Infant Botulism – will present with Absent Gag Reflex and may result in Aspiration
Lichen Planus – is associated with Hepatitis C
Sildenafil and Alpha Blockers – such as Terazosin must be given 4 hours apart to reduce the Risk
of Hypotension
HIV Prophylaxis – consists of Two Nucleoside Reverse Transcriptase Inhibitors for 4 weeks (If
HIV Viral Load is High, then add Protease Inhibitor)
Patients with Sulfonylurea Overdose – must be given Octreotide which decreases Insulin
Secretion
Fat Embolism – can be prevented by Early Immobilization and Operative Fixation
Imipenem – is contraindicated in Patients with Seizure Disorders
IgA Nephropathy – presents with Gross Hematuria, following Acute URI, where in
Postrstreptococcal Glomerulonephrosis Gross Hematuria is Uncommon
Absent Cremasteric Reflex – is Highly Suspicious for Torsion
Group A Strep – GAS is the causative Agent for Necrotizing Fasciitis and Rapidly Spreading
Cellulitis
Necrotizing Fasciitis – is treated with IV Penicillin, Clindamycin and Surgical Debridement
Diverticular Bleeding – is most commonly caused by Erosion of the Artery
Asymptomatic Patients with BV – who are Pregnant are not to be treated, as it doesn’t show
improval in prevention of PTL
Patients with High Pretest Probability for C.Diff – are to be Repeated the Rapid C. Diff, even if the
Initial is Negative
Patients with Recurrent C.Diff – after 1 relapse must be still treated with Flagyl
TB in Pregnancy – is treated with Isoniazid, Rifampin and Ethambutol (Pyrazinimide is thought to
be not safe)
Hyperflexion of the Wrist – must be done in the Patient suspected to have Carpal Tunnel as it
Compresses the Median Nerve, and to be Confirmed with Nerve Conduction Studies
Epidural Hematoma or Transverse Myelopathy – the First Step is MRI!!!!
Sputum Study – is the Test to Confirm the Presence of TB, where PPD just shows the Exposure
to TB in the Past
St. John’s Wart – is used in the Treatment for Depression (SE is GI Distress)
Kava – is used for Anxiety and Insomnia. (Side Effect is Hepatotoxicity)
Garlic – is used for Hypercholesterolemia (SE is Bleeding and Platelet Dysfunction, which is also
seen in Gingko Biloba)

Saw Palmetto – is used in Benign Prostatic Hyperplasia (SE is Hypertension)

Congenital Toxoplasmosis – can present as Microcephaly and is usually due to Undercooked
Lamb Meat Conusmption during Pregnancy
Adults who cannot tolerate Rifampin – for Meningitis Prophylaxis must receive Ciprofloxacin
Chronic Alcoholics – who are treated with IV Fluids and Thiamine, if present with Muscle
Weakness the Next day that is due to Hypopshophatemia
CML – is to be treated with Tyrosine Kinase Inhibitor such as Infliximab
Multiple Sclerosis – is diagnosed with MRI, and then once confirmed to be started on
Methylprednisolone. Once stabilized then Start Interferon and Repeat MRI in 3 months
In ARDS – after Sepsis, Pulmonary Wedge Pressure is less than 18 mmHg and presents with
diffuse bilateral infiltrates on Chest X-Ray
Acute Otitis Media – usually presents with Mucosal Response of Mastoid Air Cells.
In End Stage Renal Disease – Anemia is usually due to deficiency of Erythropoietin
Mitral Stenosis – usually presents with Rumbling Diastolic Murmur, and can result in Hemoptysis,
can have Prominent Pulmonary Arteries
Amiodarone - causes a decrease in conversion of T4 to T3 and thus causing an increase in T4
and Decrease in T3 Levels.
Restless Leg Syndrome – can be an indicator of Iron Deficiency Anemia
Licorice – can aggravate Hypertension in Patients
In patients with AAA – the greatest effect of reducing the risk is Smoking Cessation
Diagnosis of Diabetes – can be made when HgbA1C is more than 6.5, Fasting Blood Glucose is
over 126 or a Random Glucose of more than 200 with Symptoms of Hyperglycemia
Women on OCPs – if want to get pregnant, must stop OCPs and start Folic Acid Supplementation
1 month prior to conception
Patients with Barret’s Esophagus – must have an annual surveillance with Endoscopy.
Peripheral Edema – is a Known Side Effect of Calcium Channel Blocker, where ACE Inhibitors
cause Angioedema
Benzodiazepines – are the first line of Management in Patients with Status Epilepticus, who were
stabilized initially
Femoral Nerve Injury – presents with the loss of Knee Jerk Reflex, Inability to Extend the Knee,
Sensory Loss of Anterior and Medial Aspects of the Thigh, Medial Aspect of the Shin and Arch of
the Foot
Obturator Nerve Injury – presents with Inability to Adduct the Thigh
Common Peroneal Nerve Injury – will present with Foot Drop and Weakness in Foot Dorsiflexion
and Eversion
Patients with DKA – who are getting better, must have Subcutaneous Insulin started and have IV
Insulin going for at least 2 hours before discontinuation of IV Insulin
X-Ray of the Spine – is the first step in patients with Spondyloarthropathy
Patients with Reiter’s Syndrome – must have Antibiotics, Exercise and Methotrexate for
Treatment
Fluphenazine – is the treatment of Choice for Facial Tics, in patients with Tourette’s Syndrome
Varenicicline – is a partial Agonist of Nicotinic Acetylcholine Receptor and is used in Smoking
Cessation Therapy. Side Effect is Major Depression
Bacterial Conjunctivitis – is treated with Erythromycin Drops, the patient can go to school after 24
hours of Antibiotic Therapy
Corticosteroids – must be initiated in the setting of Complicated Infectious Mononucleosis
G6PD – usually presents with Jaundice within the First 24 hours of Birth
Lithium – has a known Interaction with Thiazide Diuretics, which decrease its Excretion
Clonidine – is the Drug of Choice in Patients with Opioid Withdrawal Hypertension
Ineffective Erythropoiesis – is a known manifestation in patients with B12 Deficiency
TB Treatment – in Infants and Children with TB Meningitis, Miliary TB and TB Osteomyelitis
consists of 12 months!!!
Cimetidine – can cause a Decreased Tubular Secretion of Creatinine
Cutaneous Cryptococcus – is Diagnosed with Skin Lesion Biopsy
Hypertension Control – is the most Effective in prevention of Stroke
Schmidt’s Syndrome – is Addison’s disease that presents with Type I Diabetes
Alloantibodies – is the issue in patients with previous blood transfusions that will make it difficult
to match the blood.
IV Heparin – must be started once DVT is diagnosed clinically and by history, such as cold leg
with no pulse
Acute Pancreatitis – can be caused by Thiazide and Furosemide
Tretinoin – is an excellent choice for treating hyperpigmentation in smokers
Patients taking SSRIs – if present with Sexual Dysfunction, must have the medication either
decreased or switched to another (Mirtazapine or Bupropion)
Patients with PMS – if were started on Fluoxetine and see no Relief, then must be switched to
Alprazolam
PMS patients – have a high predisposition to Psychiatric Conditions and Depression
Patients with Snoring – must be advised to stop drinking Alcohol before bedtime
Hyperactive DTRs – are present in patients with Hypocalcemia, especially who underwent a
major surgery, with Blood Transfusion
Methimazole – is contraindicated for use in the First Trimester as it causes Scalp Defects, but
once in 2nd or 3rd Trimester may be switched back from PTU, as PTU carries a Risk of Liver
Failure
All Post-Menopausal – must be taking Calcium and Vitamin D Supplements
Neonatal Polycythemia – is defined as Hct more than 65%, and the sample from Heel Prick must
be rechecked with Peripheral Venous Sample

Peptil Ulcer Perforation – must be managed with Laparotomy with Surgical Repair of Perforation
Pituitary Enlargement – after Bilateral Adrenalectomy, is called Nelson’s Syndrome and is due to
the Loss of Negative Feedback Mechanism.
Obsession – in Obsessive Compulsive Syndrome, is the Recurrent Thought or Image that cause
Severe Distress. Such as Mother always getting ideas wanting to kill her children.
Patients with Papillary Thyroid Cancer – must have a Near Total Thyroidectomy
Risk of B-Cell Lymphona – is 5% for Sjogren’s Syndrome Patients
Familial Adenomatous Polyposis – once diagnosed on Colonoscopy, then the patient must have
an Endoscopy to rule out Gastric and Duodenal Involvement
Slipped Capital Femoral Epiphysis – must be managed with Internal Fixation and the Screw
Placement. There is a strong associated with Obesity in these Children
Patients with Hyperlipidemia – must be started on Statins, and if that doesn’t improve
Hypertrglyceridimea, then must be started on Gemfibrozil
Splenic Vein Thrombosis – must be suspected in patients with Recurrent Chronic Pancreatitis
and Isolated Gastric Varices
Co-Oximetry – is used to Diagnose Carbon Monoxide Poisoning
Stress – increases Insulin Resistance, and may be Responsible for Hyperglycemia in a Patient
with Recent Acute Attack of Gout, and not Steroids that were given to the patient to treat
Tinea Pedis – is treated with Topical Antifungal Cream
Lobular Carcinoma in Situ – is a Non Malignant Lesion and the Treatment is Excisional Biopsy
Patients with Undescended Testes – are to be referred for surgery at 6 Months of Age
Dandruff – is a Seborrheic Dermatitis and the Treatment is Selenium Shampoo
Peristalsic Waves – can be seen in the patients with Pyloric Stenosis
Left Ventricular Dysfunction – must be treated with ACE Inhibitor (Most Important) and Beta
Blockers
Autoimmune Hepatitis – must be tested for Presence for Anti-Smooth Muscle Antibodies and
Antinuclear Antibodies
Indinavir – has been found to cause Crystal-Induced Nephropathy
Prolactinomas – are to be treated with Oral Dopaminergic Receptor Agonists, Surgery is rarely
done for Prolactinomas
Elevated Ferritin Levels – are found in Acute Setting of Dermatomyositis and Inflammatory
Muscular Conditions, where CPK Levels will be Elevated
Radiation – is the treatment of choice for Patients with Metastatic Prostate Cancer with Bony
Lesions
Patients treated with Pernicious Anemia – treated with Vitamin B12, will have low levels of
Potassium, due to Rapid Uptake of Potassium by newly formed cells.
Acute Pharyngitis treated with Abx – is to prevent development of Rheumatic Fever

Patients that are High Risk for Colon Cancer – must be offered colonoscopy at the age of 40 or
10 years before the diagnosis in the relative, whichever comes first
Bacterial Rhinosinusitis – that is lasting more than 10 days, must be treated with Abx and no need
for testing
Benzodiazepines – must be discontinued in elderly patients with frequent falls
Cardiac Tamponade – will show as Diastolic Collapse of Both Right Atrium and Ventricle during
Filling
In Acute Asthma Exacerbation – add Oral Corticosteroids
In Carpal Tunnel Syndrome – Forced and Prolonged Flexion of the Wrist will reproduce the
symptoms
Patient desiring Herbal Medication – must sign the written agreement but still be told to follow up
Patients with TB – that is Resistant to INH, must be treated with Rifampin for 6 months
External Otitis – must be initially treated with Cerumen Wire Look or Cotton Swab to Clean out
the Ear Canal
Patients with Grave’s Disease – must be treated with Radioactive Iodine Ablation and
Corticosteroids
Patients with Clear Evidence of Pain – must be given the Rx but must sign the agreement that
they will seek further treatment with another specialist.
Patients with Pseudotumor Cerebri – must have an Opthalmic Examination to evaluate for
Papiledema
Prolonged Therapy with Amiodarone – can cause Pulmonary Fibrosis
A Newborn – must be fed every 2-3 hours
Dialectical Behavior Therapy – is a successfully way of treating a Borderline Personality Disorder
Foreign Objects – that have made their way to the stomach, will pass on its own in 90% of the
time
Constipation in Children – should be treated with Dietary Modifications and if that doesn’t work,
then Magnesium Hydroxide
FEV – remains the single most important factor in prognosis for COPD patients
Autoimmune Metaplastic Atrophic Gastritis – presents with Pernicious Anemia and Absent Rugae
in the Fundus
If Exposed to the Bats – administer Rabies Immunoglobuline and Rabies Vaccine
Urethral Diverticulum – must be suspected in women with Post Voidal Dribbling, Dysuria and
Dyspareunia and it’s Diagnosed by Transvaginal Ultrasound
Patients with Prostate Cancer – c/o Musculoskeletal Pain and Elevated PSA, must have a
Radioisotope Bone Scan
IV Drug Abusers – commonly have Right Sided Endocarditis, where Rheumatic Fever damages
the Left Side
Cystoscopy – is the Gold Standard in Diagnosing Bladder Malignancy, when the patients
presents with Painless Hematuria
Patients with Porcelain Gallbladder – must have an Elective Cholecystectomy, as it increases the
Risk of Malignancy
Staph Aureus – is the most common Isolated Organism from the Cornea

Infant born to Hep B+ mother – must have a Serology Repeat at 9 months of age
IV Pentamidine – is associated with multiple Electrolyte Abnormalities such as Hyperglycemia,
Hypo and Hyperkalemia, Hypoglycemia and Hypocalcemia
Superior Vena Cava Syndrome – must be evaluated in patients with CT of the Head and Neck,
who are complaining of Dyspnea, Neck Pain and Swelling and Venous Dilatation of Cervical and
Upper Extremities
RBC Cholinesterase – the Test to Confirm Organophosphate Poisoning
Displaced Clavicular Structures – must have Open Reduction and Internal Fixation, where Non
Displaced, are managed with Conservative Therapy
Rubella – presents with Rash that starts on the Face and Spreads Downward, patient will have
Fever, Posterior Cervical and Auricular Lymphadenopathy
Rocky Mountain Fever – starts in the Lower Extremities and spreads upward
Renal Stones – less than 5 mm will pass on its own, more than 5 but less than 10, will need
Extracorporeal Lithotripsy, and more than 10mm will need Stone Removal
Viral Arthritis – should be suspected in a patient with a recent URI and now symptoms with less
than 6 weeks in duration, the treatment is supportive
Dose of Levothyroxine – must be Increased as soon as you find out that the patient is pregnant
Patients with Back Pain – if less than 6 weeks, ESR must be drawn and if the symptoms persist
more than 12 weeks then MRI must be ordered
Patients with Lupus and Renal Involvement – must have a Renal Biopsy to evaluate the severity
of the Disease.
Serum Complement and Anti-dsDNA – must be monitored in Patients with SLE for Disease
Activity
Compartment Syndrome – must be suspected in patients with Pain on Passive Movement
Tenosynovitis – which is a pain along the tendons and ankle joints is characteristic of Gonococcal
Arthritis
Plasma 25-Hydroxyvitamin D – must be measured to Assess for Vitamin Deficiency in patients
who underwent Gastric Bypass
Lidocaine – is the Drug of Choice for TCA Induced Arrhythmia, and Sodium Bicarbonate is given
for Cardiac Effects of TCA Overdose
Atrial Fibrillation – with High Ventricular Rate must be managed with Diltiazem
Ischemic Stroke – in patients with DVTs, there needs to ben Echocardiogram done to evaluate
further
Dog Bite Injuries – are not to be closed and must be left open to drain, as to not get infected
Dumping Syndrome – is to be treated with High Protein, Low Carbohydrates and Smaller and
More Frequent Meals
Failure To Thrive – babies are to have a Diet Modification
Painless Testicular Mass – suspected for Malignancy, must be evaluated with Ultrasound
Levothyroxine – must be taken on an empty stomach, as medications such as Iron and Calcium
can impair its absorption
Anterior Uveitis – is the most common Eye Involvement in Sarcoidosis
In Pregnancy – Hyperthyroidism is treated with PTU in the 1st trimester and then to be switched
to Methimazole in 2nd and 3rd
Patients with Cerebral Palsy – must undergo evaluation with MRI for abnormalities
Patients requesting to use Chinese Herbs – must be told not to use it, because of the lack of
evidence
Hepatitis – is the most Common Side Effect of Isoniazid
Before considering Peritoneal Dialysis – a patient must have a Total Colonoscopy, to rule out
Diverticulosis
Any Sharp Object in the Esophagus – must be removed with Endoscopy
Thiazide Diuretics – have been known to cause Photosensitive Rash
In Subacute Thyroiditis – there is a Decreased Radioactive Iodine Uptake and Thyrotoxicosis, the
treatment is NSAIDs and Beta Blockers
Corticosteroids – given for less than 3 weeks, do not need to be tapered
Pancreatic Cyst – is best evaluated with Ultrasound and Cyst Aspiration
Lactating women with Trichomonas – are to be treated with 2g Metronidazole and must
discontinue Breastfeeding for 24 hours
Tension Headaches – are usually Non Throbbing and Bilateral
Cluster Headaches – are usually Unilateral and Localize in Periorbital Region
When switching from SSRI to MOAI – you must wait a Month, to avoid Serotonin Syndrome
Clavicular Fracture – the patients can return to activity in 4-6 weeks
Local Anesthetics – are not useful in managing cellulitis, due to the irregular borders and shape
Akathisia – which presents as inability to sit still, which is a common side effect of anti-psychotic
medications, can be treated with Beta Blockers
Lactose Breath Test – is the diagnostic test for Lactose Intolerance, the patient must fast for 8
hours before the test
HIV+ Women – who find out that they’re pregnant, must continue HAART Therapy, if they found
out in the early 1st trimester, then they can stop and continue in the 2nd trimester.
Batteries lodged in Esophagus – must be removed endoscopically, those that passed into the
stomach, you can watch for spontaneous passage
Upright Table Tilt Test – must be done to evaluate for Vasovagal Syncope
Genetic Testing Information – is prohibited by Law, when an Employer asks for it
Nephrolithiasis in Pregnancy – must first be evaluated with Abdominal Ultrasound
Urethral Catheterization – must be used in any case of retention, once Urethral Injury is excluded
Aortic Valve – is heard best at 2nd and 3rd Intercostal Space on the Right Sternal Border
Pulmonic Valve – is heard best at 2nd and 3rd Intercostal Space on the Left
Tricuspid Valve – is best heard in between 5th and 6th Space at the Left Sternal Border

Mitral Valve – is best heard between 5th and 6th Intercostal Space in the Left Mid Clavicular Line
PPD+ Patients who were treeated with INH – do not need to be treated again if they still test + for
PPD
When Diagnosed with Serious Hereditary Disease – the patient if refuses to tell the family, then
has to sign a Refusal Form and it must be placed in the chart
In Normocytic/Normochromic Anemia – Reticulocyte Count must be obtained to determine the
cause
Medical Board – must be notified of Physician Misconduct
Abdominal Ultrasound – is the Test of Choice for Abdominal or Subphrenic Abscess
Confirmation of H.Pylori Cure – is the Fecal Antigen Test 4 weeks after completion of the Therapy
DVT – that developed as a complication of a Hospital Stay must be treated with Coumadin for at
least 3 months, but no more than 6 months
Patello-Femoral Syndrome – most common cause of knee pain in patients younger than 45,
present with anterior knee pain upon climbing the stairs