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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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  #1  
Old 07-05-2016
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Star To beat the curve....... score high

Hey guys... I am an internal medicine resident. I wanted to help you guys to score high and give something back to the forum too. I am starting a thread where i will be discussing a small topic each day to help you make those questions right that is considered difficult.. the questions that will help you go above 250s and 260s. I also want u to remind u that u should be thorough with your basics before aiming for the 250s. Even if u have just started i am sure these will help you in the long run. Will be back soon. Enjoy medicine.

NB: those who like to participate in discussions can like this post and we will take it from here. will be waiting for responses
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  #2  
Old 07-05-2016
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Default rhematoid arthitis.1

a patient with symmetric arthritis in 3 small joints and morning stiffness more than 90 min negative ccp antibody and negative RF factor, X-ray showing erosion and periarticular osteopenia - would you diagnose this patient as RA?
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  #3  
Old 07-05-2016
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Default rhematoid arthitis.2

arthritis and heart
- If this same patient develops chest pain diffuse st segment elevations (of course you know the answer) its pericarditis sec to RA
- In fact 1/3 will have asymptomatic pericardial effusion and and 10 percent of pt with RA develop symptomatic pericarditis
- IMPORTANT: RA is an independent risk factor for CAD and Heart failure
- Can u guess another symmetric polyarthritis involving small joint of hand with increased risk for cad and HF- psoriatic arthritis.
- In ankylosing spondylitis - its conduction defect and aortic ring dilation /AR
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  #4  
Old 07-05-2016
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Default Osteoarthritis with cppd

first of all can u identify what this is. we generally study this as pseudo gout. BUT in reality cppd( calcium pyrophosphate deposition is divided into four clinical presentation.
1. cartilage calcification (also known as chondrocalcinosis),
2. acute CPP crystal arthritis (also known as pseudogout),
3. chronic CPP crystal inflammatory arthritis( mimicks RA especially interms of joint involvement)
4. osteoarthritis with CPPD.

We don't need to go deep into the subject but know that pseudo gout is just one variant.

beware that if a patient presents symptoms(worsening with activity and brief morning stiffness in non weight bearing(usually OA is in weight bearing joints) joints like shoulder or wrist- its no.4; MAKE SURE U KNOW TO IDENTIFY CHONDROCALCINOSIS.
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  #5  
Old 07-05-2016
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Default jaccouds arthropathy- another condition mimicking RA.

SLE patient with reducible subluxation, ulnar deviation of finger swan neck deformity and non erosive arthritis in X-ray--->jaccoud arthropathy
how to differentiate?--> RA is erosive and shows periarticular osteopenia; non reducible joint defects unlike jaccoud.
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  #6  
Old 07-05-2016
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Default Rheumatoid arthritis.4 - more close d/d

Similar to the first post; patient with negative ccp, negative rf, central erosions, joint space narrowing and osteophytes in X-ray in a women- affecting the DIP and PIP with signs of inflammation ad reduced function of joint. could this be RA?
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  #7  
Old 07-05-2016
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Default

Quote:
Originally Posted by DOCTOC View Post
Similar to the first post; patient with negative ccp, negative rf, central erosions, joint space narrowing and osteophytes in X-ray in a women- affecting the DIP and PIP with signs of inflammation ad reduced function of joint. could this be RA?
this would be OA. but is the first case RA?
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  #8  
Old 07-06-2016
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Yes this is OA; but is the regular OA- No; its the variant called Inflammatory OA ; regular OA is non erosive; Where as here its erosive; in rheumatoid arthritis is also erosive but there is marginal erosion where the erosions begin at places not covered by the cartilage.
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  #9  
Old 07-06-2016
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Default RA1

Quote:
Originally Posted by DOCTOC View Post
a patient with symmetric arthritis in 3 small joints and morning stiffness more than 90 min negative ccp antibody and negative RF factor, X-ray showing erosion and periarticular osteopenia - would you diagnose this patient as RA?
This is what is called seronegative RA; a negative serology doesn't rule out RA; Remember anti ccp is extremely SPECIFIC not sensitive; use the criteria for RA:2010 ACR/EULAR criteria DONT NEED TO REMEMBER BUT JUST MAKE YOUR SELF FAMILIAR
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  #10  
Old 07-07-2016
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Default let me know

Guys let me know if you have trouble with any specific topics... one of the stratergies I used was to study thoroughly about common topics so that it becomes useful to rule out that option.This very useful startergy to answer difficult qs, That's why I started with RA. We get a lot of qs in RA and its close differential. I will be posting multiple myeloma and its close differentials as the next topic. Let me know about other topics u need.
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  #11  
Old 07-07-2016
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Thank you Doctor so much ..I appreciate the time you are taking to help us.
My respect.
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  #12  
Old 07-08-2016
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Thanks for your post!!Would you consider discussing glomerulonephritis and leukaemia/lymphoma?
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  #13  
Old 07-08-2016
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Prevention Prevention Prevention Please
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  #14  
Old 07-08-2016
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Quote:
Originally Posted by Ina2990 View Post
Thanks for your post!!Would you consider discussing glomerulonephritis and leukaemia/lymphoma?
Sure we can discuss leukemia and lymphoma next.
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  #15  
Old 07-08-2016
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Quote:
Originally Posted by wa87el View Post
Prevention Prevention Prevention Please
I didnt get that.
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  #16  
Old 07-08-2016
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Quote:
Originally Posted by DOCTOC View Post
I didnt get that.
Awww I meant preventive medicine dear doctor ..
Any note will be valuable ..
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  #17  
Old 07-08-2016
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Default 2 more confusing topics

Thanks a lot Doctor. Would you please help us in 2 more confusing DDX:-
1. Backache- Lumbar stenosis, ank spond, pivd, vertebral collapse
2. Urinary Incontinence.
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  #18  
Old 07-10-2016
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Default step 2 ck orthopaedics

Thanks a lot doctor. The topics you discussed previously were a lot useful to me.
can you please discuss important ortho topics that are high yield for step 2
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  #19  
Old 07-11-2016
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Default

I will try to accommodate all your request. Sorry, I am a bit busy with personal things. Will be back soon in couple of days
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  #20  
Old 07-11-2016
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Quote:
Originally Posted by DOCTOC View Post
Guys let me know if you have trouble with any specific topics... one of the stratergies I used was to study thoroughly about common topics so that it becomes useful to rule out that option.This very useful startergy to answer difficult qs, That's why I started with RA. We get a lot of qs in RA and its close differential. I will be posting multiple myeloma and its close differentials as the next topic. Let me know about other topics u need.
Thanks a ton sir... we r in debt..
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Old 07-11-2016
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Default random trick qs

1.A 48 yr patient with no PMH, BP 165/98 - persistently which drug would you start the patient on?
lisinopril
thiazide
combination of both
2. Patient with ACS(stemi) h/o diabetis, ckd , treated with aspirin, clopidogrel, UFH, atenolol going for PCI-whihc of the following would you start the patient on-
Enoxaparin; eptifibatide; bivalirudin; abxciximab
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  #22  
Old 07-15-2016
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Quote:
Originally Posted by DOCTOC View Post
1.A 48 yr patient with no PMH, BP 165/98 - persistently which drug would you start the patient on?
lisinopril
thiazide
combination of both
2. Patient with ACS(stemi) h/o diabetis, ckd , treated with aspirin, clopidogrel, UFH, atenolol going for PCI-whihc of the following would you start the patient on-
Enoxaparin; eptifibatide; bivalirudin; abxciximab
1. both
2. enoxaparin
Right?
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