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: 83)

Page 82 of 202
PDF with 804 Questions

A42-year-old male with extensive Crohn's disease undergoes a near complete resection of the ileum. Adeficiency of which of the following vitamin is likely to result?

  1. niacin
  2. thiamine
  3. vitamin B12
  4. vitamin C
  5. vitamin B6

Answer(s): C

Explanation:

The distal small bowel (ileum) is the site of absorption of fat-soluble vitamins (vitamins A, D, E, and K) as well as vitamin B12. Vitamin B12 binds with intrinsic factor, a glycoprotein secreted from parietal cells of the gastric fundus and body. Specific receptors in the terminal ileum take up the B12 intrinsic factor complex. Vitamin B12 deficiency leads to megaloblastic anemia. The patient will require monthly vitamin B12 injections



A 34-year-old male undergoes an uneventful excision of a parathyroid adenoma. The following postoperative day, he complains of numbness around his lips. Which of the following is the most likely cause of this symptom?

  1. hypocalcemia secondary to hypomagnesemia
  2. hypocalcemia due to acute renal failure
  3. hypocalcemia due to hungry bone syndrome
  4. hypocalcemia due to inadvertent injury to the recurrent laryngeal nerve
  5. postoperative hematoma of the neck

Answer(s): C

Explanation:

Hungry bone syndrome refers to hypocalcemia following surgical correction of hyperparathyroidism in patients with severe, prolonged disease, as serum calcium is rapidly taken from the circulation and deposited into the bone. Symptoms usually occur within 2448 hours following parathyroidectomy, when calcium levels reach a nadir. Early symptoms include numbness and tingling in the perioral area, fingers, or toes. Advanced symptoms include nervousness, anxiety, and increased neuromuscular transmission evidenced by positive Chvostek's and Trousseau's signs, carpal pedal spasm, and hyperactive tendon reflexes. In severe cases, one may develop a prolonged QT interval on ECG. Patients who manifest any signs or symptoms of hypocalcemia always require intervention. In severely symptomatic patients, treatment should begin with intravenous calcium gluconate. Mildly symptomatic patients may be given oral calcium in the form of calcium lactate, calcium carbonate, or calcium gluconate. If hypocalcemia remains despite calcium supplementation, additional therapy with vitamin D may be needed. Supplemental calcium and vitamin D therapy should be continued until serum calcium levels return to normal



A 34-year-old male undergoes an uneventful excision of a parathyroid adenoma. The following postoperative day, he complains of numbness around his lips.

Which of the following is the most appropriate intervention?

  1. oral calcium gluconate
  2. intravenous rehydration with normal saline
  3. intravenous magnesium sulfate infusion
  4. blood transfusion
  5. reassurance and close observation

Answer(s): A

Explanation:

Hungry bone syndrome refers to hypocalcemia following surgical correction of hyperparathyroidism in patients with severe, prolonged disease, as serum calcium is rapidly taken from the circulation and deposited into the bone. Symptoms usually occur within 2448 hours following parathyroidectomy, when calcium levels reach a nadir. Early symptoms include numbness and tingling in the perioral area, fingers, or toes. Advanced symptoms include nervousness, anxiety, and increased neuromuscular transmission evidenced by positive Chvostek's and Trousseau's signs, carpal pedal spasm, and hyperactive tendon reflexes. In severe cases, one may develop a prolonged QT interval on ECG. Patients who manifest any signs or symptoms of hypocalcemia always require intervention. In severely symptomatic patients, treatment should begin with intravenous calcium gluconate. Mildly symptomatic patients may be given oral calcium in the form of calcium lactate, calcium carbonate, or calcium gluconate. If hypocalcemia remains despite calcium supplementation, additional therapy with vitamin D may be needed. Supplemental calcium and vitamin D therapy should be continued until serum calcium levels return to normal



A CT scan in a patient with a temperature of 102.1°F and a history of an abdominal aortic graft reveals fluid around the graft. Which of the following is the most appropriate treatment?

  1. IV antibiotics and repeat CT scan in 2448 hours
  2. CT-guided catheter drainage of fluid collection
  3. exploration with graft excision, irrigation, and replacement with fresh graft
  4. exploration with graft excision and construction of axillobifemoral graft
  5. open exploration with debridement and drainage of fluid collection

Answer(s): D

Explanation:

The triad of fever, abdominal fluid collection, and history of abdominal graft surgery indicates the development of a graft infection. The most common organism isolated is S. aureus. It is a rare, but morbid, complication, with mortality rates as high as 36%. The infection may rapidly result in sepsis, hemorrhagic shock, and septic embolization. The standard treatment is early detection and surgical removal of the infected graft, with primary closure of the aorta and creation of an extra-anatomical reconstruction--most commonly an axillofemoral bypass. Such a bypass carries its own morbidities, including risk of limb loss, aortic stump blowout, and pelvic ischemia.






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

STEP3 Exam Discussions & Posts