CCS Workshop for Step 3

Dear Friends,

I have programmed a CCS online workshop for USMLE 3 Exam Takers.
You will be required to register for CCS USMLE World or USMLE Consult.
I will be discussing selected high yield cases online, and shall provide you with Tips to Excel in the examination.

We shall be using Skype to discuss the cases. Charges would be $ 10 per hour, and the entire course would be about 20 hours.

Soon We are working on Podcasting the cases too.

If interested please, leave your mail IDs in the Chatroll at the bottom of the Blog or mail me at drsajjadp@gmail.com

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Question 33

65 year old african american patient is brought to the ER with fever and shortness of breath for last 2 days. He is a chronic smoker for last 25 years and has been occassionally consuming alcohol. He gives history of heroin abuse. On chest auscultation he has diffuse rhonchis and decreased breath sounds at the right base. His BP is 88/30 mm Hg, P 120/min, Oxygen saturation of 86 %, and has a Temperature of 102.5 F. Chest X Ray is suggestive of bilateral lower lobe patches. His saturation continues to drop in the ER. He is appropriately managed with IV antibiotics and mechanical ventilation. On third day of hospitalization in the ICU, he appears to be confused. His ABG is given as PaO2 = 92, PCO2 = 50, HCO3 = 12, and SaO2 94 %. His other investigations are as follows:
Hb 13.8, Hct = 45, TLC 14500, Neutophils 70, Lymphocytes 26, Bands 2, Eosinophils 1, Basophils 1, Glucose = 240 mg%, Na = 121, K = 3.9, Cl = 100, Ca = 9.0, Mg = 2.1. What is the most likely cause of his confusion?

a) Diabetes Mellitus

b) Diabetes Insipidus

c) SIADH

d) Alcohol withdrawal

e) Ventilator associated pneumonia

f) Drug abuse

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Question 32

54 year male patient comes to the ER with pain in abdomen. The pain is present since a week, but it is become so severe now that he had to rush to the ER. He also gives history of having pain in his calves for the last week. On examination, he has a palpable liver and spleen. There is shifting dullness present. He also gives history of severe itching after taking showers, and had been on allopurinol for Gout since a few months. His Liver enzymes are raised and PT is 24 with an INR of 2.0, Hb is 17 gm%, and Hct is 60. He has a remote history of alcohol dependence, and smokes 2 - 3 cigerettes per day for last 10 years. He lives with his only sexual partner for the last 30 years and occassionally uses condoms. He has never been treated with any STDs. What is pathological cause of his condition at present?

a) Peliosis hepatis

b) Myeloproliferative diseases

c) Alcoholism

d) CBD obstruction

e) Hematobilia

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Question 32

What is the definitive treatment for this patient discussed under question 31?

a) Methylene Blue

b) Vitamin C

c) 100 % Oxygen

d) Blood Transfusion

e) Bronchodilators

f) Surgery

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Question 31

37 year old white male is brought to the ER with acute onset breathlessness. He is a known case of HIV on Triple therapy. Last month his CD4 count was 180 when he visited his physician. He appears to be thin and weak. His BP is 90/40 mm Hg, pulse is 92/min, and he has no fever. He lives with his same sex partner for last 3 years. The partner is also HIV positive and on treatment. He is a chronic smoker and occasionally consumes alcohol and marijuana. No other significant history is obtained. On chest auscultation, there are few scattered rhonchi and rest of the examination is unremarkable. He appears to be cyanotic and the arterial blood gas shows decreased Saturation with a normal PaO2. What is the most likely cause of his decreased saturation?

a) Drug induced

b) Tuberculosis

c) Pneumocystic Carini

d) CO Poisoning

e) Anemia

f) Smoking induced

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