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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 09-23-2012
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Arrow NBME 1 Discussion

I'm currently doing NBME 1 offline, and if anyone's interested in discussing answers and explanations, your input will be highly appreciated

unlike the step 1 forum, there are no nbme CK discussion threads, so I hope this thread fulfills that gap

i'm using the key here: http://nbmeanswerkeys.blogspot.com/2...ne-answer.html
its pretty authentic, but with limited explanations

queries and suggestions are welcome
Please do not post questions directly from nbme, just refer to the block & q. no.
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  #2  
Old 09-24-2012
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These are the questions i got wrong in
Block 1

3 [B]
Myocardial contusion vs traumatic rupture of aorta
are there specific findings to differentiate between these two? both can be suspected & need to be ruled out in a road accident

4 [B]
TMP-SMX causes hemolysis in G6PD deficiency, not sickle cell disease

9[I]
h/o decreased appetite, difficulty sleeping, episodes of similar symptoms in past -> major depressive disorder, pseudodementia

16 I think [E] is correct
from Uptodate: Management of PSGN is supportive and is focused upon treating the volume overload that causes the clinical complications of PSGN. These general measures include sodium and water restriction, and diuretic therapy.
In patients with acute renal failure, dialysis may be required.
Renal replacement modality (40, 49, and 81 percent survival with hemofiltration, peritoneal dialysis, and hemodialysis, respectively).
no where is protein restriction advised for PSGN or AKI

22
Mother has a wart on her hand, is that not the obvious source of infection?
on the other hand, Always rule out child abuse in childhood condylomata acuminata

25
MS presents most frequently in pregnancy, typical murmur description(just listening to murmurs is not enough it seems, need to remember the description too)

30
from uptodate: current protocol is to treat a first episode of acute, predominantly cellular rejection with a steroid pulse. A biopsy should almost always precede the administration of any therapy, unless absolutely contraindicated.


38
BV vs. Trichomonas
- Color?
- Trichomonas has dyspareunia & vulvovaginal erythema
- BV classic color: gray, pH>4.5
- Trichomonas classic color: greenish yellow, pH = 5-6

can anyone help me with 16,22 & 38?
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  #3  
Old 10-06-2012
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BV vs. Trichomonas
- Color?
- Trichomonas has dyspareunia & vulvovaginal erythema
- BV classic color: gray, pH>4.5
- Trichomonas classic color: greenish yellow, pH = 5-6

Both have pH > 4.5
The best way to differentiate is by Pruritus (when pH is given)-
BV : No pruritus
Trichomonas:Pruritus

Similarly if they give Pruritus as the presentation, you differentiate with pH:

Candida: pH<4.5
Trichomonas pH> 4.5
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  #4  
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Myocardial contusion vs traumatic rupture of aorta

Depends on the the scenario presented.

However,

Myocardial contusion: raised enzymes starting with CK

Traumatic rupture of aorta: Mediastinal widening
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  #5  
Old 10-06-2012
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I got the "Child's warts" wrong...
So what should be the right answer there?

It is probably an abuse, so the most appropriate answer could have been to culture gonorrhea and chlamydia...

Weird q.
Cuz bf do not live with them and never stayed w child and her brother stays w them only when they are asleep - makes suspicion of an abuse...
=================

so how many q's did you get wrong?
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  #6  
Old 10-06-2012
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Generally I'd say, most of the questions were not very hard...
Compared to nbmes for step 1, I felt relaxed while doing this one.
2-3 questions are in the UW
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Old 10-06-2012
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i got 147 right, out of 184(didnt have images for 2 questions)
or, 37 mistakes

the answer to the wart question is indeed D; culture for STDs
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Old 10-07-2012
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Block 2

1 [D]
?? Only 2 instances of memory impairment; does that warrant further investigation?
Also, shouldnt we further investigate the cause of tremor of outstretched hands?

5 [D]
Give both HBV vaccine & Ig to neonates of HBV+ mothers

10 [C]
Osteoblastic lesions in lumbar vertebrae of a 70y/o man – metastatic prostatic CA

15 [C]
Contraindications to B blockers include COPD as well as peripheral arterial disease
ACE inhibitors only cause cough

18[A]
Paracentesis ≠ pericardiocentesis
Echo for confirming pericardial effusion

26 [C]
Why c?
The most common symptoms [of Bupropion overdose] include sinus tachycardia, hypertension, drowsiness, lethargy, agitation, nausea and vomiting, and in particular delirium and seizures.
In rare circumstances, valproic acid can cause blood dyscrasia, impaired liver function, jaundice, thrombocytopenia, and prolonged coagulation (clotting) times due to a lack of blood cells.

[wikipedia]


36 [E]
Age of pt.
Negative straight leg raising test

40 [E]
Topical retinoid for mild acne
from uptodate:



41 [D]
Pap smear The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer
Serum cholesterol The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease.
Serum glucose The USPSTF recommends screening for type-2 diabetes in adults with hypertension or hyperlipidemia.
Mammography The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
Flexible sigmoidoscopy every 5 years, colonoscopy every 10 years

44
Somehow, ACEI’s have mortality benefit that ARB’s don’t have


need help on 1 & 26
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  #9  
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26:
I think anorexics have screwed up electrolytes, so if you give them bupropon - they seize.

1: no clue.
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Quote:
Originally Posted by DocSikorski View Post
26:
I think anorexics have screwed up electrolytes, so if you give them bupropon - they seize.
i think u got the wrong question
26 is about a young guy getting frequent nosebleeds. bupropion & valproic acid are the wrong answers, checking platelet count is the right answer; but the patient also complains of restlessness & stuff like that
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Quote:
Originally Posted by theundead View Post
i think u got the wrong question
26 is about a young guy getting frequent nosebleeds. bupropion & valproic acid are the wrong answers, checking platelet count is the right answer; but the patient also complains of restlessness & stuff like that
this one I do not remember
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Old 10-07-2012
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I got 20 wrong in this NBME , i was cool and relaxed.

in the child with warts question, whenever a child has an STD one must always rule out other STD's, it doesnt matter if her momma wart was in the little finger pulp, suspect child abuse and act accordingly.
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Quote:
Originally Posted by XpaezX View Post
I got 20 wrong in this NBME , i was cool and relaxed.

in the child with warts question, whenever a child has an STD one must always rule out other STD's, it doesnt matter if her momma wart was in the little finger pulp, suspect child abuse and act accordingly.
Does nbme 1 come with extended feedback ??
I thought only nbme 4 had feedback
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Old 10-07-2012
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Quote:
Originally Posted by step_enhancer View Post
Does nbme 1 come with extended feedback ??
I thought only nbme 4 had feedback

I did it offline, the others will do online, so i think you are right, thats why i dont know what my score is.. i just did it to see how I was and how the questions are written.
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The way I was doing this NBME 1 was:
I bought the self-pace mode, did all 4 blocks at once.

I timed myself not to exceed "a-minute-per-question" rule, but after each question I would pause and google it to see weather I was right or wrong, based on what others thought. Never changed the wrong to right, was honest with myself and got 41 question wrong, several of them due to unattentivenes...
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Quote:
Originally Posted by XpaezX View Post
I got 20 wrong in this NBME , i was cool and relaxed.
take the exam already!
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Originally Posted by theundead View Post
take the exam already!
No sir, I still have 3 more NBME to do and still have to polish some silly mistakes i do when asnwering questions, besides I want a pretty good score and lets fight for it, will take NBME 2 ONLINE next sunday
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How did you guys calculate your scores for this NBME? Since I'm doing it offline I don't know how to find out my score in the end. Thanks!
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Quote:
Originally Posted by stepdoc1 View Post
How did you guys calculate your scores for this NBME? Since I'm doing it offline I don't know how to find out my score in the end. Thanks!
I did it offline too, & did not calculate the predicted score, just the number of mistakes.
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Originally Posted by XpaezX View Post
No sir, I still have 3 more NBME to do and still have to polish some silly mistakes i do when asnwering questions, besides I want a pretty good score and lets fight for it, will take NBME 2 ONLINE next sunday
Doesnt everyone want a jaw-dropping killer score!
May the Force be with You!
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Old 10-14-2012
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Block 3
4 B
CT scan to look for abscess/any other complication.
8 C
What vaccinations r indicated in young HIV+ patient with normal CD4 count?

All adults should get annual influenza virus vaccine.
13 A
Normal estrogen means pituitary is functioning; +ive Progestin challenge test  anovulation
21 C
Anticoagulation therapy with heparin reduces mortality rates from 30% to less than 10%. Thrombolytic therapy should be used in patients with evidence of hemodynamic compromise. Thrombolytic therapy is not recommended for most patients
http://emedicine.medscape.com/article/300901-treatment

23 A
Both salt water and fresh water wash out surfactant, often producing non cardiogenic pulmonary edema and the acute respiratory distress syndrome (ARDS)
27 A
Flexing the woman's knees toward her shoulders is simpler than delivering the posterior shoulder & successful in >42% of cases of shoulder dystocia, therefore should be attempted before other maneuvers.
30 B
Most probable diagnosis is intussusception; treatment is enema
33 E
Lithium causes both thyroid & kidney dysfunction, so why measure TSH & why not creatinine?
For asymptomatic patients, regular thyroid function testing every 6-12 months is recommended in Li users, but no such indication for renal function?
39 A
In general, resistance rates >20 percent were reported in all regions for ampicillin, and in many regions for trimethoprim (with or without sulfamethoxazole) Also, TMP-SMX is not contraindicated in the 3rd trimester; so why not E?
42 C
LDL is calculated indirectly using the formula C = H+ L + kT
where H is HDL cholesterol, L is LDL cholesterol, C is total cholesterol, T are triglycerides, and k is 0.20 if the quantities are measured in mg/dl and 0.45 if in mmol/L. Because LDL is normal, correct answer is to repeat about five years.

Block 4
12 A
(estrogen can increase sex hormone binding protein, cause testosterone unavailable, cause decreased libido)
Moreover, ovary is the source of postmenopausal androgen production, which has been removed in this pt.
18 E
(too late for any prophylaxis now) prophylactic oseltamivir only good within first 24-48 hours of symptom onset
27 B
Up-to-date says: Given the high specificity and limited sensitivity of the available tests, a positive RSAT is useful in establishing the diagnosis of GAS pharyngitis, but a negative RSAT does not rule out GAS. Because some RSAT may miss as many as 35 percent of cases of GAS pharyngitis, we recommend that throat culture be performed in children and adolescents with negative RSAT
34 D
Low Na = SIADH = small cell CA
35 A
(Yogurt and cottage cheese are low in lactose. Probably a case of irritable bowel syndrome)
37 F
What’s a to-and-fro murmur?
Bounding pulses = AR or PDA
PDA is a continuous infraclavicular murmur loudest at 2nd left intercostal space.
42 C
(HIV seems more likely compared to other options) chronic watery diarrhea; white plaques on oral mucosa
43 B
Somatosensory symptoms point toward partial seizures, motor automations can occur in both absence & partial seizures
But for complex partial seizures there should be history of loss of consciousness?
46 C
(Haloperidol decanoate for non-compliant patients in depot form. Fluphenazine can also be given as a depot form but as fluphenazine decanoate but not fluphenazine hydrochloride.)
Chemistry question!


stuff in bold needs your kind attention fellows; really appreciate any help
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Old 10-17-2012
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done with 1st block . .this nbme is extremely easy,,but still i made 9 mistakes,in 46 questions . .

Q1=seriously i don't know difference between physical findings of perforation and ascities . .stupid
9= difficult for my standard,sometime i correct it,sometimes i miss the clues. .
12= due to bad instincts
16= it should be E . .but well don't know it clearly
19= thought it's ARDS,but my 2nd choice was pulmonary contusion
28=AR murmur radiates to apex?what is apex?doesn't it radiate to neck?
29= we are already giving steroids y shouldn't we go for other options,,by the way i clicked renal dialysis
41= y not D?confused
42= haven't done derma yet,so no clue

Overall i think it was quite easy,just done with 1st read,,read few topics way way back . .
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Old 10-17-2012
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Quote:
Originally Posted by zohaib View Post
done with 1st block . .this nbme is extremely easy,,but still i made 9 mistakes,in 46 questions . .
charlie u kidding right. "extremely easy"
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done with 2nd block . .

Q=13 i thought alochol raises Aspartate aminotransferase,and it's estrogen .apparently i am wrong
Q 19,well i diagnosed it as Chediak Higashi syndrome,,but i don't know y i missed phagocytic oxidative mechanism impairment,,i thought this option is for GCD . .so i clicked Bruton,
Q25=ok i forgot vaccination schedul,i click pneumococcal . .
Q26= y not discontinue Lithium?
Q28= ok seriously y not CT scan,y we should go directly to laparotomy
Q33=haven't read psychiatry yet
Q34= it was very difficult according to my standards . .
Q40= i clicked hydrocrtisone,i thought she is in reproductive age,we should avoid retinoic acid,,haven't even seen it's topical retinoic acid
Q41= y not flexible sigmoidoscopy,,should we do mammography annually
Q46= clearly i don't know hyperkalemia treatment,clicked insulin and glucose . .
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Old 10-17-2012
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Q1=seriously i don't know difference between physical findings of perforation and ascities . .stupid
high leukocyte count, fever = infection

9= difficult for my standard,sometime i correct it,sometimes i miss the clues. .

12= due to bad instincts
no comments

16= it should be E . .but well don't know it clearly
if uptodate is a reliable reference, its E

19= thought it's ARDS,but my 2nd choice was pulmonary contusion
ARDS is supposed to be bilateral, no? plus, this guy has bruises on his chest after an accident, so pulm contusion is more probable

28=AR murmur radiates to apex?what is apex?doesn't it radiate to neck?
AS radiates to neck; AR radiates to the apex. Yes; the apex of the heart, aka cardiac apex

29= we are already giving steroids y shouldn't we go for other options,,by the way i clicked renal dialysis
acute rejection = steroids

41= y not D?confused
until we dont know what caused the first IU death, we cant comment on future prospects; & i think its inappropriate to tell a mother grieving on the death of her 1st pregnancy to get pregnantagain

42= haven't done derma yet,so no clue
D, i dont know why either, but i got it right


Q=13 i thought alochol raises Aspartate aminotransferase,and it's estrogen .apparently i am wrong
ALT & AST are normal; AP & GGT are raised; & the correct answer is alcohol, not estrogen

Q 19,well i diagnosed it as Chediak Higashi syndrome,,but i don't know y i missed phagocytic oxidative mechanism impairment,,i thought this option is for GCD . .so i clicked Bruton,
diagnosis is indeed CGD; & universal law #1: s**t happens

Q25=ok i forgot vaccination schedul,i click pneumococcal . .
u dont need to remember a schedule; only that influenza virus vaccine is given to all adults before flu season, pneumococcal after 65 except in presence of comorbidities, Td booster every 10 years with a TdaP once in adult life.

Q26= y not discontinue Lithium?
pt is bleeding, check platelet count. lithium is barely above normal

Q28= ok seriously y not CT scan,y we should go directly to laparotomy
rigid abdomen, raised leukocyte count, free air under R diaphragm = something seriously wrong; emergency laparotomy. CT will waste toomuch time

Q33=haven't read psychiatry yet
start studying this is probably the simplest of the psychiatric questions, in that the pt is normal; she's just panicking & needs a sedative

Q34= it was very difficult according to my standards . .
exam standards need to be lowered

Q40= i clicked hydrocrtisone,i thought she is in reproductive age,we should avoid retinoic acid,,haven't even seen it's topical retinoic acid
yp

Q41= y not flexible sigmoidoscopy,,should we do mammography annually
not annually, every 2 years

Q46= clearly i don't know hyperkalemia treatment,clicked insulin and glucose .
if hyperkalemia causes ECG changes, immediate Ca gluconate is the answer
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Old 10-29-2012
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Q1 of Block 2

The old man with dementia...findings in this patient warrants further evaluation
I suspect answer to be

B) Decreased sensation to vibration over the toes

Which suggest B12 deficiency Which is a reversible cause of dementia...

In which serum B12 level is estimated and treated with parenteral B12 injections
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Old 10-31-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
Q1 of Block 2

The old man with dementia...findings in this patient warrants further evaluation
I suspect answer to be

B) Decreased sensation to vibration over the toes

Which suggest B12 deficiency Which is a reversible cause of dementia...

In which serum B12 level is estimated and treated with parenteral B12 injections
Sorry for the late reply;
loss of vibration sense is part of normal aging
Quote:
In non‐diabetic elderly subjects loss of vibration sense is particularly pronounced but perception of light touch and pain are comparatively preserved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563781/
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  #28  
Old 04-22-2014
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Warning! NBME 6 (modified NBME 1)

hello people

I have one question from NBME 6 about HYpertensive emergency-Treatment. 250/135 BP With end-organ damage ..
Which one of antihypertensives to use (so diagnosis was clearly emergency not urgency I'm sure about that),the options are:

(A) clonidine
(B) Hydralazine
(C) Nifedipine
(D) Nitroglycerin
(E) Nitroprusside

I thought Hydralazine, but got it wrong
My second choice is (E) Nitroprusside

Does anybody know the answer, explanation appreciated
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