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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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Old 07-08-2016
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Hello guys, I hope everyone is doing fine. People like me, without a SP, is having quite a tough time. Still this forum helps a lot. I took NBME 4 today but to my utter surprise I scored lower than I expected. Although I was quite sure of a few q, a few turned out to be wrong. I need ur help. Please contribute your own doubts too.

1 block/ q 42. 82 yr female with 9 mo h/o progressive incontinence. Atleast 1 episode of strong urge to micturate,can't make it to the bathroom, voids a large amount of urine. Past h/o cerebral infarction. current Meds- lovustatin, aspirin. PE- no abnormalities. What can be the cause?
Detrusor instability?


2block/2. 18 mo child not using her right arm since falling while running. right arm is by her side , forearm pronated,unable to supinate or flex her forearm, No swelling or tenderness noted.
mx?
a. rest,ice,elevation of elbow
b. supination of elbow
c. use of sling and swathe
d. application of figure of 8 strap
e. application of a posterior splint.
my ans- e.

2block/13. Previously healthy 22 yr female brought by friends to Er after she passed out at a party following inatke of a few pills.She was acting normal before passing out, doesn't drink alcohol. nor was she depressed. unresponsive to stimuli. pulse-60, bp 110/60, respiratory rate-8/min, pupils-1-2 mm b/l, no nystagmus .cause?
a. anticholinergics
b. BZD
c. Cocaine
d. Opioid
e. PCP
I marked b.

Last edited by praru; 07-08-2016 at 10:54 AM.
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  #2  
Old 07-08-2016
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Steps History: 1+CK+CS
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Quote:
Originally Posted by praru View Post
Hello guys, I hope everyone is doing fine. People like me, without a SP, is having quite a tough time. Still this forum helps a lot. I took NBME 4 today but to my utter surprise I scored lower than I expected. Although I was quite sure of a few q, a few turned out to be wrong. I need ur help. Please contribute your own doubts too.

1 block/ q 42. 82 yr female with 9 mo h/o progressive incontinence. Atleast 1 episode of strong urge to micturate,can't make it to the bathroom, voids a large amount of urine. Past h/o cerebral infarction. current Meds- lovustatin, aspirin. PE- no abnormalities. What can be the cause?
Detrusor instability?


2block/2. 18 mo child not using her right arm since falling while running. right arm is by her side , forearm pronated,unable to supinate or flex her forearm, No swelling or tenderness noted.
mx?
a. rest,ice,elevation of elbow
b. supination of elbow
c. use of sling and swathe
d. application of figure of 8 strap
e. application of a posterior splint.
my ans- e.

2block/13. Previously healthy 22 yr female brought by friends to Er after she passed out at a party following inatke of a few pills.She was acting normal before passing out, doesn't drink alcohol. nor was she depressed. unresponsive to stimuli. pulse-60, bp 110/60, respiratory rate-8/min, pupils-1-2 mm b/l, no nystagmus .cause?
a. anticholinergics
b. BZD
c. Cocaine
d. Opioid
e. PCP
I marked b.
Yes, detrusor instability.

Looks like nursemaid's elbow (dislocation of radial head). So the answer would be B. Either hyperpronation or supination with elbow flexion to reduce the radial head back into its place. Once this is done, the child will be able to move the forearm immediately so other measures are not done first and closed reduction is preferred.

Its D. Pinpoint pupils + respiratory depression = opiate overdose
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praru (07-08-2016)



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