CompTIA
Checkpoint
ISC
HP
Dell
EC-Council
EXIN
Fortinet
ITIL®
Juniper
PMI
Microsoft
VMware
Avaya
Google
Salesforce
Amazon
Palo Alto Networks
Certiport
ISC2
All Vendors
  2. Home
  3. Exams
  4. USMLE
  5. STEP3

Free STEP3 Exam Braindumps (page: 75)

Page 74 of 202
PDF with 804 Questions

Apatient undergoes a gastrectomy following a gunshot injury. How would you counsel him about postgastrectomy syndromes?

  1. Most patients tolerate gastrectomy without a change in their digestive habits.
  2. Dumping syndromes can be treated with high carbohydrate liquid diets.
  3. Cholestyramine is a treatment for postvagotomy diarrhea.
  4. Most patients with these syndromes require surgical intervention.
  5. Proton pump inhibitors are effective against alkaline reflux syndrome.

Answer(s): C

Explanation:

Most patients have a change in their digestive habits after gastrectomy. These symptoms are actually related to the vagotomy done with the operation. The majority of patients learn to manage their symptoms with only a small amount requiring surgical intervention. Dumping syndrome is associated with abdominal pain, nausea, vomiting, dizziness, and palpitations related to the quick hyperosmolar emptying into the small intestine. These symptoms can be managed by eating small, low carbohydrate meals throughout the day. Postvagotomy diarrhea is related to the rapid transit of unconjugated bile salts and is effectively treated with cholestyramine. Proton pump inhibitors are not a useful therapy for alkaline reflux.



A 19-year-old female presents to the ED complaining of swelling in her left lower extremity. She reports that she had arthroscopy of the right knee about a week ago for a torn meniscus. The swelling started last night and is uncomfortable.

Which of the following statements most accurately describes the situation?

  1. This condition is less likely to occur in women than men.
  2. The patient should be put on strict bed rest with leg elevation until her swelling resolves.
  3. Her surgically treated knee should be aspirated immediately to rule out a septic joint.
  4. Prophylaxis to prevent this complication includes subcutaneous heparin or daily coumadin.
  5. Directed lytic therapy is indicated for this patient if her lower extremity becomes bluish and has evidence of vascular compromise.

Answer(s): E

Explanation:

This patient has developed a DVT of her left leg. This is a complication following surgery that can be prevented in part by the use of subcutaneous heparin and sequential compression devices. Coumadin is not used as a prophylaxis, but rather as a treatment modality. Risk factors for developing DVTs include female gender, obesity, orthopedic surgery, use of oral contraceptives, smoking, and long periods of being sedentary. Her knee should be aspirated if she has a red, hot, or swollen joint; as these symptoms are not mentioned and the DVT is in the leg opposite to the surgically treated joint, aspiration is not necessary at this time.



A 72-year-old woman undergoes a sigmoid colectomy for diverticulitis. Postoperatively, she develops a wound infection for which she is transferred to the ICU for 2 days because of hypotension. Which of the following would have had the most effect on reducing her risk of developing complications?

  1. preoperative treatment of her concomitant urinary tract infection
  2. nurses changing gloves in between their patient assessments so they don't have to wash their hands as often
  3. using a preoperative antibiotic specific for E-coli, the most common intestinal flora
  4. giving preoperative antibiotics immediatel after the skin incision
  5. treatment of the infected wound with an antibiotic only

Answer(s): A

Explanation:

Wound infection is a complication of surgery that can lead to a great deal of morbidity and longer hospital stay. Prevention of wound infection includes perioperative antibiotics, which should be at their peak tissue concentration at the time of skin incision. This means they should be given at least 30 minutes prior to incision. Patients who have other infections, such as urinary tract infections, are at increased risk for wound infection. Bowel surgery exposes the wound to the normal intestinal flora, the most common being Bacteroides. Washing hands is an essential part of preventing spread of infectious pathogens between patients. Using gloves is not a substitute for good hand hygiene. Once a wound is infected, it must be opened and drained. Antibiotic therapy alone is not adequate.



A40-year-old man presents with chronic diarrhea and peptic ulcer disease refractory to medical management with proton pump inhibitors. An octreotide scan is shown in Figure



which corresponds to an area near the head of the pancreas. Which of the following factors directly results in the release of the hormone produced by this tumor?

  1. secretin
  2. glucagon
  3. antral pH <2.0
  4. vagus nerve
  5. somatostatin

Answer(s): D

Explanation:

This patient has a gastrinoma, seen in Zollinger-Ellison syndrome, and should also be evaluated for possible MEN I. Gastrin is a GI hormone that is released from the antral G cells of the stomach to regulate acid secretion by the gastric parietal cells. It is released when the stomach gets the signal that is needed to initiate the digestion process, and also acts to stimulate chief cells to secrete pepsinogen and to increase gastric mucosal blood flow. Known stimulants for the release of gastrin include: vagal stimulation, calcium, alcohols in the stomach, proteins/amino acids in the stomach, antral distention, and gastric pH greater than
3. Antral pH less than 2 inhibits gastrin release, as does somatostatin. Secretin has no effect or decreases gastrin levels in healthy patients, but it increases gastrin release in patients with Zollinger-Ellison syndrome.
Glucagon has little or no effect on gastrin release.






Post your Comments and Discuss USMLE STEP3 exam with other Community members:

STEP3 Exam Discussions & Posts