darkhorse
Forum Elite
Topics: 56
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Guys...I have recently started preparing for step 3...this what i have learned till now
1.step 3 is tough if u take it lightly
2.you need to have ecfmg certificate before you apply
3.connecticut is the best for IMG
3.there is no advantage in sitting with any other state compared to connecticut
4.once u complete the online form...u should take a print out of certificate of identity and also save the page for future use
5.there are 2 questions which bother everybody in the form...one is expiry of notary...there is no expiry of many notaries...u ask them to write my notary doesnt expire by effluxion of time...other thing it asks which state and which county...its for the notary to fill up...for example delhi, India..its not which state u r applying
6.the processing time is 10 days for connecticut...and ur 90 days starts as soon as ur application is accepted
I dont know how helpful its for others guys...i need to motivate myself for this monster exam....i will update every day here what i have learned..i will be reviewing step 2 kaplan...i m also doing uw...i have bought fa medicine and fa step 3...i have bought swanson...planning to get cmdt and shaher cd...this is what is my prep material...what ever i learn every day i will update here....I wish all of u GL!
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| egomez2001
Forum Guru
Topics: 51
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Good job Darkhorse , good luck on your prep
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| motorola
Forum Extremist
Topics: 66
Posts: 412
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goodluck dh
can u throw more light on the notary thing. i m an illiterate as far as step 3 app goes.
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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thank you egomez2001 for ur support
motorola.....this certificate of identity u get after u fill up ur online application.....the only thing u have to do is paste a recent photo and sign the form in front of a notary.....and i explained the rest above.....if u need any specific help....plz do not hesitate
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| darkhorse
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Topics: 56
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GASTROENTEROLOGY
GERD
1. Diagnosis of GERD is clinical and confirmed by response to therapy
2.24h ph test is gold standard and indicated in patients with refractory symptoms
3. Bernstein test is done to confirm the origin of source of pain
4. Life style modification is main stay.H2 blocker helps in 50% and proton pump in 80% cases
5. Nissen fundoplication in refractory cases.It requires normal peristalsis so a motility test has to be done before it.
ACHALASIA
1. Motility disorder due to reduction of intramural inhibitory neurons
2. Most common cause is idiopathic
3. Dysphagia to both solid and liquid
4. Manometry will be diagnostic
5. EGD will be needed to r/o malignancy
6. Treatment options-dilatation, botulinum toxin, calcium channel blocker, surgical myotomy
SCLERODERMA
1. Incompetent LES
2. GERD symptoms
3. Barium swallow+ motility study antireflux therapy
DES
1. Motility disorder with NONPERISTALTIC spontaneous contractions
2. Manometry is confirmatory
3. Treatment with Calcium channel blocker and nitrates
NUTCRACKER ESOPHAGUS
1.PERISTALTIC contractions due to increased excitatory activity
2. Manometry
ANATOMIC ESOPHAGEAL OBSTRUCTION
1. Schatzki ring is a mucosal ring
2. Episodic dysphagia to solids
3. PVS is at hypopharynx and there is increased risk of malignancy
4. Barium swallow is diagnostic
5. Dilatation for LES rings and surgery for PVS
ESOPHAGITIS
Infectious agent is the most common Candida is most common with HIV
BARRETT ESOPHAGUS
1. Metaplasia 10-20% of GERD patients
2. 30 fold greater incidence of Adenocarcinoma Risk of malignancy is more if Barrett’s is more than 8cm
3. Mainstay of treatment is antireflux therapy and survelliance .No dysplasia-EGD in 2-5 yrs, low grade dysplasia-EGD 3-6mo,high grade-resection
ESOPHAGEAL CARCINOMA
1. SCC in 50%,proximal 2/3
2. Adenocarcinoma in 50%, lower 1/3
3. Hypercalcemia can be a feature
4. Barium swallow is the first test, EGD with biopsy is confirmatory
5. 5% 5 yr survival chemoradio for metastatic disease
ZENKER DIVERTICULUM
1. Outpouching of upper esophagus
2. MC presentation is halitosis and transfer dysphagia (difficulty in initiation)
3. Barium swallow first.
4. EGD and NG tube are CI
5. Tt is myotomy or diverticulectomy
MALLORY WEISS SYNDROME
1. Mucosal tear EGD
2. Self limited
3. Angigraphic embolization or vasopressin in refractory cases
Edited by darkhorse on 11/04/07 - 04:58 PM
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| darkhorse
Forum Elite
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Some qs to supplement learning
A 36-year-old female presents with the chief complaint of burning epigastric pain. She notes
that the pain is worse after she eats spicy or fatty food and occurs approximately 90 min after
eating. Occasionally the patient awakens at night with the pain. Physical examination is
unremarkable except for mild midepigastric tenderness with deep palpation. You suspect a
duodenal ulcer. An EGD confirms this diagnosis, and biopsy specimens reveal Helicobacter
pylori. Which of the following statements regarding the role of H. pylori in this disease is not
correct?
A. H. pylori can be isolated in 95% or more of duodenal ulcers.
B. Among people infected with H. pylori, 15% will develop symptomatic ulcer disease.
C. Urease production by H. pylori helps protect it from destruction by gastric acid and promotes
colonization by H. pylori.
D. Detection of H. pylori antibody in the serum is sufficient for a diagnosis of peptic ulcer
disease.
E. The 1-year relapse rate for peptic ulcer disease is less than 15% after eradication of H.
pylori.
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| darkhorse
Forum Elite
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An immigrant from Brazil presents with difficulty swallowing, and is referred to a gastroenterologist
for evaluation of his dysphagia. Special studies demonstrate massive dilatation of the
esophagus. Which of the following other organs may also be seriously affected by the patient's
disease?
A. Bladder
B. Brain
C. Heart
D. Lungs
E. Small intestine
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| darkhorse
Forum Elite
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A 23-year-old college student comes to the clinic because of odynophagia with solids and liquids and dysphagia that is most severe when eating solid foods. The patient had a past medical history of Shigella colitis last year while she was a Peace Corps volunteer in Peru. She takes oral contraceptives and smokes 1 pack of cigarettes daily. She does not drink alcohol. Vital signs are: temperature 37.8 C (100 F), blood pressure 100/70 mm Hg, pulse 79/min, and respirations 8/min. Physical examination is normal. Electrocardiogram reveals normal sinus rhythms with a rate of 85/min and a markedly enlarged QRS complex in leads V3-V5. Chest x-ray reveals an enlarged cardiac silhouette. A barium esophagram demonstrates a tapering of the distal esophagus that eventually releases as the esophagus is distended. There is no evidence for extrinsic or intrinsic compression of the distal esophagus or an esophageal mass. There is no reflux. The test most likely to lead to a unifying diagnosis in this case is
A. an agglutination test for trypanosomes
B. a chest CT
C. an esophageal manometry
D. a liver biopsy
E. a myocardial biopsy
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| motorola
Forum Extremist
Topics: 66
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thank u dh
regarding the questuion it seems like chagas disease at first glance but i why a rr of 8 and wide qrs. i thought it caused a heart block. also why cardiolmegaly. and yea why odynophagia !?
i am so confused about this one. but i will go with A.
answer and explanation please !!!!!
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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I wasted my day yesterday....no study...had to stay in theatre long...was in forum for some time....didnt feel like study.....hopefully...i will compensate today...and also post the answers of above q....Jai Bhawani!
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| darkhorse
Forum Elite
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Posts: 275
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GASTRITIS
1. Antral biopsy is gold standard for diagnosis.
2. Serologic test is most widely used to confirm or r/o H pylori infection.
3. Breath test is best to follow the effectiveness of treatment.
PEPTIC ULCER DISEASE
1. H. Pylori is the most common cause for both duodenal and gastric ulcers
2. At least 2 weeks of combination therapy is given.
3. H.Pylori is also associated with MALT and gastric caricinoma.
ZOLLINGER ELLISON SYNDROME
1. Gastrinoma mostly in head of pancreas.
2. Fasting gastrin level more than 200
3. IV Secretin test is diagnostic
4. Curative resection in only 20% cases.
CROHN’S DISEASE
1. Transmural, skip lesions and noncaseating granuloma
2. Rectal sparing is common
3. Nonbloody diarrhea is most common presentation.
4. Oxalate stone formation is a complication
5. Sulphasalazine and corticosteroid are main stay
6. Sulphasalazine is ineffective in small bowel disease as it splits to active mesalamine in large bowel
7. Immunosuppressive therapy includes 6-Mercaptopurine, azathioprine, infliximab
8. Metronidazole is used for fistula’s
9. Surgery is only for complications a s recuurance rate is very high.
ULCERATIVE COLITIS
1. Continuous and rectal involvement common
2. Risk of cancer 10% at 10 years
3. Ca colon and primary sclerosing cholangitis are long term complications.
4. Sulfasalazine and corticosteroids are main stay of treatment.
5. Colectomy is curative.
DIARRHOEA
A 54-year-old male presents with 1 month of diarrhea. He states that he has 8 to 10 loose
bowel movements a day. He has lost 8 lb during this time. Vital signs and physical examination
are normal. Serum laboratory studies are normal. A 24-h stool collection reveals 500 g of stool
with a measured stool osmolality of 200 mosmol/L and a calculated stool osmolarity of 210
mosmol/L. Based on these findings, what is the most likely cause of this patient's diarrhea?
A. Celiac sprue
B. Chronic pancreatitis
C. Lactase deficiency
D. Vasoactive intestinal peptide tumor
E. Whipple's disease
The answer is D.
This patient has a stool osmolality gap (measured stool osmolality – calculated stool osmolality)
of <50 mosmol/L, suggesting a secretory rather than an osmotic cause for diarrhea. Secretory
causes of diarrhea include toxin-mediated diarrhea (cholera, enterotoxigenic Escherichia coli)
and intestinal peptide–mediated diarrhea in which the major pathophysiology is a luminal or
circulating secretagogue. The distinction between secretory diarrhea and osmotic diarrhea aids
in forming a differential diagnosis. Secretory diarrhea will not decrease substantially during a
fast and has a low osmolality gap. Osmotic diarrhea will generally decrease during a fast and
has a high (>50 mosmol/L) osmolality gap. Celiac sprue, chronic pancreatitis, lactase
deficiency, and Whipple's disease all cause an osmotic diarrhea
This q explains a lot about diarrhoea
PSEUDOMEMBRANOUS COLITIS
1. C dif overgrowth
2. Can be seen between 1-6 weeks post antibiotic use
3. Classically there is no blood or mucus
4. Diagnosis by isolating C Dif toxin in stool
5. At least 3 specimens are tested and sensitivity is 80%.
6. Metronidazole for 2 weeks is the treatment.
IRRITABLE BOWEL SYNDROME
1. Symptoms for at least 3 months and absent in night.
2. Pain relieved by defecation.
3. Rome Criteria for diagnosis.
4. Treatment is reassurance and dietary modification.
Edited by darkhorse on 11/09/07 - 02:34 AM
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,910
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Good job, man, keep on posting here...
One Qn regarding your initial post: why Connecticut is better for IMGs than the other states that do not require 1-year PG training?
Thanks...
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| miniaspirin
Forum Newbie
Topics: 2
Posts: 14
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darkhorse,
Good job! I found my anwers for application stuff here. I just about to start.
How long are you planning for study? I will apply in the next few days once I collect more materials to study.
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| linaorvos
Forum Elite
Topics: 47
Posts: 258
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great post, may i ask what the answer for #6.7.8? thank you.
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| dncosta
Licensed, finally
Topics: 19
Posts: 604
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Answer for 7 is definitively Heart. Chagas's Disease
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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hi justice
connecticut doesnt require pg training to sit the exam...that one yr training it says is required to get the license
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| darkhorse
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hi miniaspirin
tx...I am planning to study 3-4months...I really want a good score...and I know this exam is not easy...GL!
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| darkhorse
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linaorvos and dncosta...I will post the answers tonight
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