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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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  #201  
Old 07-17-2014
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6 hour after cabg 62 y o M decrease systoloc BP fro 120/80 tp 100/85.urinary output decrease from 60 to 10. CO decease fro 6 to 3.Pulmonary artery diastolic pressure has increased.CXR shows widened mediastinum..ost paropriate next step?
A.administration of 2 ampules of sodium bicarb
B,epinephrine
C.placememnt of intra-aortic balloon
D.revision of coronary gaft
E.surgical exploration of the mediastinum


d is wrong
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  #202  
Old 07-17-2014
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"widened mediastinum." BP is down plus low urine output....blood was probably leaking into the mediastium...I chose E and it was correct.

Quote:
Originally Posted by starcrossed View Post
6 hour after cabg 62 y o M decrease systoloc BP fro 120/80 tp 100/85.urinary output decrease from 60 to 10. CO decease fro 6 to 3.Pulmonary artery diastolic pressure has increased.CXR shows widened mediastinum..ost paropriate next step?
A.administration of 2 ampules of sodium bicarb
B,epinephrine
C.placememnt of intra-aortic balloon
D.revision of coronary gaft
E.surgical exploration of the mediastinum


d is wrong
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  #203  
Old 07-17-2014
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what does an increased pulm a diastolic pressure signify in this question?
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  #204  
Old 07-17-2014
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47 y/o m , constipation 9 mnths, hemorrhoids seen, next best step in mgmt?

anoscopy was wrong!
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  #205  
Old 07-20-2014
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1. A 4 year old girl is brought to the physician because of cough and a 2.3kg weight loss during the past 4 months. There is no history of serious illness and she takes no medications. Immunizations are up to date. She is at the 50th percentile for height and 25th percentile for weight. Occasional crackles are heard over the right middle lung field. Intradermal skin testing with PPD, tetanus toxoid, and antigens for Candida albicans and Tricophyton transurans are non reactive at 72 hours. Her WBC count is 5100/mm^3. Nucleic acid hybridization testing of gastric aspirates shows Mycobacterium tuberculosis. Which of the following is the most likely explanation for this patient's findings?
a) antibody deficiency
b) complement deficienty
c) impaired chemotaxis
d) impaired respiratory burst
e) neutropenia
f) splenic dysfunction
g) T-lymphocyte dysfunction.
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  #206  
Old 07-20-2014
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T cells problem

Quote:
Originally Posted by davisjunge View Post
1. A 4 year old girl is brought to the physician because of cough and a 2.3kg weight loss during the past 4 months. There is no history of serious illness and she takes no medications. Immunizations are up to date. She is at the 50th percentile for height and 25th percentile for weight. Occasional crackles are heard over the right middle lung field. Intradermal skin testing with PPD, tetanus toxoid, and antigens for Candida albicans and Tricophyton transurans are non reactive at 72 hours. Her WBC count is 5100/mm^3. Nucleic acid hybridization testing of gastric aspirates shows Mycobacterium tuberculosis. Which of the following is the most likely explanation for this patient's findings?
a) antibody deficiency
b) complement deficienty
c) impaired chemotaxis
d) impaired respiratory burst
e) neutropenia
f) splenic dysfunction
g) T-lymphocyte dysfunction.
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  #207  
Old 07-20-2014
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Quote:
Originally Posted by nacht hund View Post
T cells problem
Thanks! Is it AIDS?
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  #208  
Old 07-20-2014
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I really dont know. all I know was, the poor kids Type IV hypersensitivity is outta whack, and thats T cell problem.
Quote:
Originally Posted by davisjunge View Post
Thanks! Is it AIDS?
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  #209  
Old 07-26-2014
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Quote:
Originally Posted by Andante View Post
A 32 y/o women is brought to ER because of a 2-day history of vomiting, diarrhea, and right-sided pelvic pain. Her LMP was 3 weeks ago.. Her vitals are T 39' C, R 20/min, P 100/min, Bp 120/70 mm Hg, abdominal examination shows right lower quadrant tenderness with rehound. bowel sounds are decreased, Pelvic examination shows right adnexal tenderness. A serum pregnancy tes is negative.

Lab:

Hb 12 g/d,
Wbc 15,000/ mm3
segmented neutrophile 80%
Bands 10%
lymphocytes 5%
monocytes 5%

Ultrasound shows no adnexal masses. Which of the following is the most likely diagnosis?

A. adnexal torsion
B. Appendicitis
C. Bowel obstruction
D. Corpus luteum cyst
E. Degenerating leiomyoma uteri
F. ovarian cancer
G. Ovarian hyperstimulation syndrome
H. Tubo-ovarian abscess
I. Urinary tract infection

Hey you guys what was the answer to this one? do you guys have an explanation? I thought it was A, but i got it wrong!
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  #210  
Old 07-26-2014
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Quote:
Originally Posted by microshara88 View Post
Hey you guys what was the answer to this one? do you guys have an explanation? I thought it was A, but i got it wrong!
sounds like appendicitis. no history of ovarian mass, LMP3 weeks ago, Mcburneys point, leukocytosis etc.
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  #211  
Old 07-26-2014
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Quote:
Originally Posted by starcrossed View Post
47 y/o m , constipation 9 mnths, hemorrhoids seen, next best step in mgmt?

anoscopy was wrong!
if colonoscopy was an option i would do that.
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  #212  
Old 07-26-2014
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thanks!

also, for block 1: 72 yo woman with indigestion walking uphill....it would be echo since she did not have it related to eating?

14 yo boy with 150/90 BP, recheck in 4 weeks?


also, how do you approach the 42 yo woman with the meningioma who had the hypernatremia? im so bad with these types of q's!

thanks a bunch!
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  #213  
Old 07-26-2014
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Quote:
Originally Posted by microshara88 View Post
thanks!

also, for block 1: 72 yo woman with indigestion walking uphill....it would be echo since she did not have it related to eating?

14 yo boy with 150/90 BP, recheck in 4 weeks?


also, how do you approach the 42 yo woman with the meningioma who had the hypernatremia? im so bad with these types of q's!

thanks a bunch!
Don't remember questions that well would need full q and answer choices. Took this a few weeks ago
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  #214  
Old 07-26-2014
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Quote:
Originally Posted by 2cool4medschool View Post
Don't remember questions that well would need full q and answer choices. Took this a few weeks ago
K i'll try and get them for u, i took the actual exam, so can't copy& paste. so i'll try and type them up when i get to my comp

---
16 year old girl brougt to phsyciian for OCP by mom. mom knows what's going on with the girl (she likes to receive calls from boys, loves to wear make up. Father is furious and berates girl, but mom is her confidant. She protects duaghter by hiding activites. You talk individually with girl and she does not understand why she doing these things....but she wants to understand. Physical exam shows no abnormalities....so whats next best step?

tell mama her girl is going throguh phase
b. behavior therapy for pt
c. family therapy
d. marital therapy for parents
e. psychodynamic psychoterahpy for pt
f. triazolam therapy for pt.


i know its not E, cuz i got it wrong.

is it family therapy? dad seems a little overprotective to me. ...thanks a bunch!
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  #215  
Old 07-26-2014
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Quote:
Originally Posted by microshara88 View Post
K i'll try and get them for u, i took the actual exam, so can't copy& paste. so i'll try and type them up when i get to my comp

---
16 year old girl brougt to phsyciian for OCP by mom. mom knows what's going on with the girl (she likes to receive calls from boys, loves to wear make up. Father is furious and berates girl, but mom is her confidant. She protects duaghter by hiding activites. You talk individually with girl and she does not understand why she doing these things....but she wants to understand. Physical exam shows no abnormalities....so whats next best step?

tell mama her girl is going throguh phase
b. behavior therapy for pt
c. family therapy
d. marital therapy for parents
e. psychodynamic psychoterahpy for pt
f. triazolam therapy for pt.


i know its not E, cuz i got it wrong.

is it family therapy? dad seems a little overprotective to me. ...thanks a bunch!
yes family therapy, i took the online version too
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  #216  
Old 07-26-2014
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Quote:
Originally Posted by 2cool4medschool View Post
yes family therapy, i took the online version too
Cool thanks!

82 yo woman c breast CA who is cared for @ home has severe low back and left thigh pain for 5 days despite taking 5mg of morphine syrup every 4 hours. She says that morphine is moderately effective but loses its effectiveness 2-3 hrs after each dose....she is otherwise tolderating the morphine c/o side effects. Which of the following is most appropriate next step in pain mgmt?

a begin biofeedback
b refer pt for admission to hospital
c add acetaminophen to medication regiment
d continue the current dose of morphine and provide resssurance
e increase frequence of dose to q3hours
f swithc to subQ morphine 1 mg every 3 hours.


i know that C is wrong. what's biofeedback role in this? is that another word for Patient controlled analgesia?

don't know what right answer is.

thanks much in advance!
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  #217  
Old 07-26-2014
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Quote:
Originally Posted by microshara88 View Post
Cool thanks!

82 yo woman c breast CA who is cared for @ home has severe low back and left thigh pain for 5 days despite taking 5mg of morphine syrup every 4 hours. She says that morphine is moderately effective but loses its effectiveness 2-3 hrs after each dose....she is otherwise tolderating the morphine c/o side effects. Which of the following is most appropriate next step in pain mgmt?

a begin biofeedback
b refer pt for admission to hospital
c add acetaminophen to medication regiment
d continue the current dose of morphine and provide resssurance
e increase frequence of dose to q3hours
f swithc to subQ morphine 1 mg every 3 hours.


i know that C is wrong. what's biofeedback role in this? is that another word for Patient controlled analgesia?

don't know what right answer is.

thanks much in advance!
it's F, she has the pain every 3 hours so its appropriate to make the morphine more frequent.
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  #218  
Old 07-26-2014
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I did these timed and online, so I don't know what number or block they are in compared to the offline version...

The penis ulcers...why not chancroid? Its painful, grayish ulcers, with LAD, no fever/chills...seems classic chancroid. Yet I got it wrong...Why is it herpes?


What about the 27 y/o with molluscum question? What additional testing?
CBC w/diff
HIV
Syphilis
Viral Culture
No additional (WRONG)



10 y/o girl with rash on face and body?
Choices: acyclovir, doxy, amoxi, steroids, nothing



62 y/o lady with ovarian tumor admitted for resection...has BUN 82, Cr 5.7...what to do to evaluate renal failure?
I put Renal Biopsy - wrong
Renal U/S or Renal Arteriography?


Thanks in advance!
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  #219  
Old 07-26-2014
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Quote:
Originally Posted by nacht hund View Post
I really dont know. all I know was, the poor kids Type IV hypersensitivity is outta whack, and thats T cell problem.
they aren't testing Type IV hypersensitivity here; The gastric aspirates show TB, but why isn't the PPD picking it up? Its because her T-cells aren't being made properly, so she can't fight the TB. Remember, Th1 cells combat Mycobacteria.
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  #220  
Old 07-26-2014
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Quote:
Originally Posted by Pakmandibula View Post
I did these timed and online, so I don't know what number or block they are in compared to the offline version...

The penis ulcers...why not chancroid? Its painful, grayish ulcers, with LAD, no fever/chills...seems classic chancroid. Yet I got it wrong...Why is it herpes?


What about the 27 y/o with molluscum question? What additional testing?
CBC w/diff
HIV
Syphilis
Viral Culture
No additional (WRONG)



10 y/o girl with rash on face and body?
Choices: acyclovir, doxy, amoxi, steroids, nothing



62 y/o lady with ovarian tumor admitted for resection...has BUN 82, Cr 5.7...what to do to evaluate renal failure?
I put Renal Biopsy - wrong
Renal U/S or Renal Arteriography?


Thanks in advance!
Haven't taken the exam, so i don't know the first one...the second one, Molluscum Contagiousm; test for HIV...pt could be immunodefiecient.

The 10 yr old girl, i do know that Doxycycline has adverse effects in growing children, but they say it shouldn't be given to children below 8 yrs. If the rash is Measles, then you would just do supportive treatment. I'd need to see the whole question to get the context.

The 62 y/o lady, and i was racking my brain about it for a while, but it suddenly popped: You don't want to make the renal failure worse, by using contrast, which is what Renal Arteriography uses...so do a Renal U/S because its not harmful to the patient. I could be totally wrong, seeing as i haven't done the exam...but from the info that you gave me, i would pick U/S.

Last edited by CisternaChyli; 07-26-2014 at 05:23 PM.
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  #221  
Old 07-26-2014
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Quote:
Originally Posted by Pakmandibula View Post
I did these timed and online, so I don't know what number or block they are in compared to the offline version...

The penis ulcers...why not chancroid? Its painful, grayish ulcers, with LAD, no fever/chills...seems classic chancroid. Yet I got it wrong...Why is it herpes?


What about the 27 y/o with molluscum question? What additional testing?
CBC w/diff
HIV
Syphilis
Viral Culture
No additional (WRONG)



10 y/o girl with rash on face and body?
Choices: acyclovir, doxy, amoxi, steroids, nothing



62 y/o lady with ovarian tumor admitted for resection...has BUN 82, Cr 5.7...what to do to evaluate renal failure?
I put Renal Biopsy - wrong
Renal U/S or Renal Arteriography?


Thanks in advance!
Penis shows herpes, do renal ultrasound, observe girl with rash cuz it's prolly viral and do HIV test on the person with molluskom
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  #222  
Old 07-26-2014
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Quote:
Originally Posted by 2cool4medschool View Post
Penis shows herpes, do renal ultrasound, observe girl with rash cuz it's prolly viral and do HIV test on the person with molluskom
cool, i was right on my reasoning for Renal U/S. Yeah for kids, just observe since the rash is probably viral.
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  #223  
Old 07-26-2014
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Quote:
Originally Posted by CisternaChyli View Post
Haven't taken the exam, so i don't know the first one...the second one, Molluscum Contagiousm; test for HIV...pt could be immunodefiecient.

The 10 yr old girl, i do know that Doxycycline has adverse effects in growing children, but they say it shouldn't be given to children below 8 yrs. If the rash is Measles, then you would just do supportive treatment. I'd need to see the whole question to get the context.

The 62 y/o lady, and i was racking my brain about it for a while, but it suddenly popped: You don't want to make the renal failure worse, by using contrast, which is what Renal Arteriography uses...so do a Renal U/S because its not harmful to the patient. I could be totally wrong, seeing as i haven't done the exam...but from the info that you gave me, i would pick U/S.
A previously healthy 10 y/o girl is brough to the physician because of a 2 day history of mildly itchy rash that has spread from her face to her chest, arms, and legs. One week ago, she had a 2-day history of low grade fever, HA, and malaise. She has not had a sore throat. She appears well. Her temp is 37.3 (99.1). A photograph (showing red cheeks) is shown. The rash over the chest and upper and lower extremities is symmetric, maculopapular, reticular, erythematous and nonconfluent. The remainder of the exam shows no abnormalities. Which of the following is the most appropriate next step in pharmacotherapy?
Acyclovir
Amoxicillin
Doxy
Prednisone
None indicated

I didn't realize that it was Parvovirus and slap cheek fever...easy question in hindsight.
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  #224  
Old 07-26-2014
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Quote:
Originally Posted by Pakmandibula View Post
A previously healthy 10 y/o girl is brough to the physician because of a 2 day history of mildly itchy rash that has spread from her face to her chest, arms, and legs. One week ago, she had a 2-day history of low grade fever, HA, and malaise. She has not had a sore throat. She appears well. Her temp is 37.3 (99.1). A photograph (showing red cheeks) is shown. The rash over the chest and upper and lower extremities is symmetric, maculopapular, reticular, erythematous and nonconfluent. The remainder of the exam shows no abnormalities. Which of the following is the most appropriate next step in pharmacotherapy?
Acyclovir
Amoxicillin
Doxy
Prednisone
None indicated

I didn't realize that it was Parvovirus and slap cheek fever...easy question in hindsight.
yeah that would just be observation...for Parvovirus.
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  #225  
Old 07-27-2014
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Quote:
Originally Posted by Nixy View Post
How can it be psychogenic polydipsia if urine osmolality is 200! It should have been less than 100.
it should be less than 300 not 100 according to the same UW. take a trip back to that question. Q id 4643 UNa >20 Uosm <300
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  #226  
Old 07-28-2014
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1) 52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol----??
3)aspirin
4)dexamethasone
5) Indomethacin

1)2 hrs after emergency repair of gastric ulcer 75 yo woman has multifocal PVC. H/o CHF and treated with digoxin and diuretics?
2)55 yo woman with known metastatsis presents with confusion leading to obtundation in past 24 hrs?
1) decreased calcium
decreased mf
decreased k
decreased Na
increased ca
increased k
increased mg
increased Na

4 yo boy doesnt use his left arm, no known injury. confortable but resits movement of arm cos of pain. holds it with elbow flexed and forearm in pronation. radial pulses normal, sensation intact, next step?
notification to child prt services
supination of foream with elbow in slight flexion
x ray of elbow and forearm and skeletal survey
x ray of forearm and elbow only( i got this wrong)
aspiration for cytology

15 yo changes in behavios after joining new school-withdrawn sleeping poorly,daytime fatigue,4.5 kg wt loss,academics deterirated,maternal uncle and grandmother have depression,pt denies alcohol or illicit drug use?
learning disorder
major depressive disorder
malingering
substance abuse(y not?_
age appr behaviour

the q with graph of woman in labour with dilation of 3 cm at admission and vertex at -1 station. lab curver shows late deceleration and decreased variabilty, next step?
continued observation
admission to oxytocin
amnioinfusion
forceps(got it wrong)
C sec

72 yo woman with increase abd girth over past 2 months, 3.6 kg wt gain despite unable to finish a meal, one martini everyday after 3 mile walk,underwent lumpectomy nd radiation therapy for stage 1 breast cancer 4 yrs ago, been trated with tamoxifen since then. abd examniation shows fluid wave. pelvix exam shows 8 cm fixed non tender mass in cul de sac, labs are normal, next step?
iv albumin
iv antibiotics
iv cisplatin and paclitaxel
oral ACEI
Oral spironolactone
therapeutic paracenteses( got it wrong)
expl laprotomy

77 yo man after cough with large amnts of blood tinged sputum. long h/o COPD, recurrent pneumonia of rt lower lube, 15 minutes later bleeding stops. temp 98.6,pulse 110/min, rep-24/min, bp 110/70. bronchophony in r lateral lung, x ray-thin walled cystic spaces with air fluid level, most likely cause of findings

alveolar hypovantilation
defective sodium channels
destruction of distal airways
excess extravasculr fliud
fibrosis throught out lung
laryngeal penetration by food and liquids
small airway inflammation
thromboembolism

ECG graph- old man with substernal chest pain weakness dyspnea, sustained AMI 6 months ago, recurrent chestpain treated with nitroglycerin. BP 60/40, rep_22/min
AMI
Acyte pericarditis
acute pul embolus
atrial fib(got this wrong)
cardiac tamponade
hyperkalemia
hypertension
vent fib
vent tachy
wolf parkinson
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244/pass(1st attempt)/243/I month obsie inPeds nephro and 2 weeks IM/GC/2012 YOG
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  #227  
Old 07-28-2014
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health status survey compares clinical outcome of pat treated for hip fracture at 2 hospitals. total of 560 subj studied for 1 yr after sustaining hip fracture, adjusted for age and gender, level of functioning found low in pts treated at one hospital(p+0.02). which of the followong raises the most concern about this conclusion?
period of study too short
results not adjusted for c morbities
results not statistically significant
power is too low
survey instrument doesnt include clinical measures


32 yo woman 2 day h/o vomitting, diarrhea and rt sided pelvic pain, lmp 3 weeks, temp 102.2, rep-20, pluse-100, bp 120/70, RLQ tenderness, bowel sounds decreased, pelvic exam shows rt adnexal tenderness, preg test (-). Labs leucocytosis with 80% neutrophils

adnexal torsion(got this wrong)
appendicitis
bowel obst
corpus luteum cyst
degeration leiomyoma
ovarian ca
ovarian hyperstimulation syndrome
tubo ovarian absecc
UTI

87 yo man with 1 yr h/o of difficulty starting urinary stream and post void dribbling. nocturia. 30 yrs of DM, orthostatic hypotension. lisinopril and glyburide-current meds. BP 140/80 whil supine, 100/60 while standing, large prostate on examination, most appropriate med for pts urinary symptoms?
amlodipine
doxazocin
finasteride
metoprolol
oxybutinin

51 yo with 15 min acute rt sided chest pain and sob after insertion of subclavian catheter for hemodialysis. hospitalised for renal failur. pulse 92/min, bp 114/72. hb 9mg/dl, pulse ox-94%, xray shows 10% apical pneumothroax

observaion
ct scan of chest
removal of subclavian catheter
placement of chest tube
pleurodesis
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  #228  
Old 07-29-2014
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Default 18 year old primagrivid

18 yo primagrivid woman @ 37 wks gestation admittted in labor. Regular uterin contractions occur every 3 minutes. pregnancy has been complicated by severa episdoes of genital herpes. most recent episode was 6 wks ago. she says she had no lesions or prodromal symptoms since last episode. exam shows no lesions over external genitalia, perineum, vagina or cervix. membranes are intact. fetal movement has been appropriate. cervix is 100% effaced & 5cm dilaed. vertex is at -1 station. which of following is most appropriate next step in mgmt?

a. genital cultue for herpesvirus an tocolysis
b. iv acycvor therapy
c . amnioinfusion
d. amnionotmy and vaginal delivery
e. cesearena delivery

i chose a (but made mistake cuz was in hurry and didn't not pay attention to to tocolysis)....must read the question carefully...37 weeks is fine to deliver baby at that stage no problem about brain development....so should be B or E?

can anyone help me with the explanation? also, just as a side note, can she still breastfeed and no problem? her bishop score is good to deliver, no?

thanks in advance!
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Quote:
Originally Posted by microshara88 View Post
18 yo primagrivid woman @ 37 wks gestation admittted in labor. Regular uterin contractions occur every 3 minutes. pregnancy has been complicated by severa episdoes of genital herpes. most recent episode was 6 wks ago. she says she had no lesions or prodromal symptoms since last episode. exam shows no lesions over external genitalia, perineum, vagina or cervix. membranes are intact. fetal movement has been appropriate. cervix is 100% effaced & 5cm dilaed. vertex is at -1 station. which of following is most appropriate next step in mgmt?

a. genital cultue for herpesvirus an tocolysis
b. iv acycvor therapy
c . amnioinfusion
d. amnionotmy and vaginal delivery
e. cesearena delivery

i chose a (but made mistake cuz was in hurry and didn't not pay attention to to tocolysis)....must read the question carefully...37 weeks is fine to deliver baby at that stage no problem about brain development....so should be B or E?

can anyone help me with the explanation? also, just as a side note, can she still breastfeed and no problem? her bishop score is good to deliver, no?

thanks in advance!
Hey, I answered this with B and got it wrong. I am really struggling with whether it is D or E. HELP! and thank you!
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Originally Posted by ohgod View Post
Hey, I answered this with B and got it wrong. I am really struggling with whether it is D or E. HELP! and thank you!
its D, she doesnt have current vaginal lesions, so you can go ahead with normal vag delivery.
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Originally Posted by steps_8186 View Post
1) 52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol----??
3)aspirin
4)dexamethasone
5) Indomethacin

INDOMETHACIN... NSAIDS are first line then Steroids. Allupurinol is for chronic

1)2 hrs after emergency repair of gastric ulcer 75 yo woman has multifocal PVC. H/o CHF and treated with digoxin and diuretics?
2)55 yo woman with known metastatsis presents with confusion leading to obtundation in past 24 hrs?
1) decreased calcium
decreased mf
decreased k
decreased Na
increased ca
increased k
increased mg
increased Na

I believe its Decreased K, as Digoxin Toxicity as occured

4 yo boy doesnt use his left arm, no known injury. confortable but resits movement of arm cos of pain. holds it with elbow flexed and forearm in pronation. radial pulses normal, sensation intact, next step?
notification to child prt services
supination of foream with elbow in slight flexion
x ray of elbow and forearm and skeletal survey
x ray of forearm and elbow only( i got this wrong)
aspiration for cytology

Supination of forearm with elbow in slight flexion, I believe the child has subluxation of the radial bone (nursemaid )

15 yo changes in behavios after joining new school-withdrawn sleeping poorly,daytime fatigue,4.5 kg wt loss,academics deterirated,maternal uncle and grandmother have depression,pt denies alcohol or illicit drug use?
learning disorder
major depressive disorder
malingering
substance abuse(y not?_
age appr behaviour

Major depressive disorder , sleeping, fatigue, weight loss, change in school.

the q with graph of woman in labour with dilation of 3 cm at admission and vertex at -1 station. lab curver shows late deceleration and decreased variabilty, next step?
continued observation
admission to oxytocin
amnioinfusion
forceps(got it wrong)
C sec

Not sure

72 yo woman with increase abd girth over past 2 months, 3.6 kg wt gain despite unable to finish a meal, one martini everyday after 3 mile walk,underwent lumpectomy nd radiation therapy for stage 1 breast cancer 4 yrs ago, been trated with tamoxifen since then. abd examniation shows fluid wave. pelvix exam shows 8 cm fixed non tender mass in cul de sac, labs are normal, next step?
iv albumin
iv antibiotics
iv cisplatin and paclitaxel
oral ACEI
Oral spironolactone
therapeutic paracenteses( got it wrong)
expl laprotomy

Ive read people say G - Ex Lap, but im not too sure on this one


77 yo man after cough with large amnts of blood tinged sputum. long h/o COPD, recurrent pneumonia of rt lower lube, 15 minutes later bleeding stops. temp 98.6,pulse 110/min, rep-24/min, bp 110/70. bronchophony in r lateral lung, x ray-thin walled cystic spaces with air fluid level, most likely cause of findings

alveolar hypovantilation
defective sodium channels
destruction of distal airways
excess extravasculr fliud
fibrosis throught out lung
laryngeal penetration by food and liquids
small airway inflammation
thromboembolism

Dont remember

ECG graph- old man with substernal chest pain weakness dyspnea, sustained AMI 6 months ago, recurrent chestpain treated with nitroglycerin. BP 60/40, rep_22/min
AMI
Acyte pericarditis
acute pul embolus
atrial fib(got this wrong)
cardiac tamponade
hyperkalemia
hypertension
vent fib
vent tachy
wolf parkinson
Dont remember
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  #232  
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Originally Posted by Jfcap View Post
This is polygenic polydipsia. Requirements are Na <137, polyuria, low urine Na and low urine osm.
But that isn't a low urine Osm (should be <100), and 20mEq/L is the cutoff for low vs high Na in urine! That being said, I can vouch that NBME considers SIADH to be a wrong answer. Can anyone clarify?
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Originally Posted by starcrossed View Post
47 y/o m , constipation 9 mnths, hemorrhoids seen, next best step in mgmt?

anoscopy was wrong!
I think the answer was colonoscopy, which I assume was to to check for other tumors.
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Originally Posted by steps_8186 View Post
1) 52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol----??
3)aspirin
4)dexamethasone
5) Indomethacin

INDOMETHACIN... NSAIDS are first line then Steroids. Allupurinol is for chronic
True story

1)2 hrs after emergency repair of gastric ulcer 75 yo woman has multifocal PVC. H/o CHF and treated with digoxin and diuretics?
2)55 yo woman with known metastatsis presents with confusion leading to obtundation in past 24 hrs?
1) decreased calcium
decreased mf
decreased k
decreased Na
increased ca
increased k
increased mg
increased Na

I believe its Decreased K, as Digoxin Toxicity as occured
I got this wrong, but the answer is decreased K. Apparently you get HyperK in acute dig toxicity (blocks K going intracellularly by blocking Na/K pump) but you get HypoK in chronic dig toxicity from increased excretion (stays extracellular and then gets excreted). This would be compounded in a CHF patient on Lasix. Also you lose K from your stomach in perf since there is a lot of K in gastric fluid.

4 yo boy doesnt use his left arm, no known injury. confortable but resits movement of arm cos of pain. holds it with elbow flexed and forearm in pronation. radial pulses normal, sensation intact, next step?
notification to child prt services
supination of foream with elbow in slight flexion
x ray of elbow and forearm and skeletal survey
x ray of forearm and elbow only( i got this wrong)
aspiration for cytology

Supination of forearm with elbow in slight flexion, I believe the child has subluxation of the radial bone (nursemaid ) Truth, but I think most ER docs would get the xray

15 yo changes in behavios after joining new school-withdrawn sleeping poorly,daytime fatigue,4.5 kg wt loss,academics deterirated,maternal uncle and grandmother have depression,pt denies alcohol or illicit drug use?
learning disorder
major depressive disorder
malingering
substance abuse(y not?_
age appr behaviour

Major depressive disorder , sleeping, fatigue, weight loss, change in school.
yep

the q with graph of woman in labour with dilation of 3 cm at admission and vertex at -1 station. lab curver shows late deceleration and decreased variabilty, next step?
continued observation
admission to oxytocin
amnioinfusion
forceps(got it wrong)
C sec

Not sure
I think the answer is C-section bc of the late decels

72 yo woman with increase abd girth over past 2 months, 3.6 kg wt gain despite unable to finish a meal, one martini everyday after 3 mile walk,underwent lumpectomy nd radiation therapy for stage 1 breast cancer 4 yrs ago, been trated with tamoxifen since then. abd examniation shows fluid wave. pelvix exam shows 8 cm fixed non tender mass in cul de sac, labs are normal, next step?
iv albumin
iv antibiotics
iv cisplatin and paclitaxel
oral ACEI
Oral spironolactone
therapeutic paracenteses( got it wrong)
expl laprotomy

Ive read people say G - Ex Lap, but im not too sure on this one
No idea. I'd love to know. I can tell you that NBME says spironolactone is wrong. Maybe albumin?

77 yo man after cough with large amnts of blood tinged sputum. long h/o COPD, recurrent pneumonia of rt lower lube, 15 minutes later bleeding stops. temp 98.6,pulse 110/min, rep-24/min, bp 110/70. bronchophony in r lateral lung, x ray-thin walled cystic spaces with air fluid level, most likely cause of findings

alveolar hypovantilation
defective sodium channels
destruction of distal airways
excess extravasculr fliud
fibrosis throught out lung
laryngeal penetration by food and liquids
small airway inflammation
thromboembolism

Dont remember
Total guess, but I got it right with 'destruction of distal airways'. I was thinking some sort of emphysema? Not sure what to make of the air/fluid levels or large volume hemoptysis...

ECG graph- old man with substernal chest pain weakness dyspnea, sustained AMI 6 months ago, recurrent chestpain treated with nitroglycerin. BP 60/40, rep_22/min
AMI
Acyte pericarditis
acute pul embolus
atrial fib(got this wrong)
cardiac tamponade
hyperkalemia
hypertension
vent fib
vent tachy
wolf parkinson
Dont remember
Acute MI. You can see the ST-elevations in the pre-cordial leads
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Originally Posted by steps_8186 View Post
health status survey compares clinical outcome of pat treated for hip fracture at 2 hospitals. total of 560 subj studied for 1 yr after sustaining hip fracture, adjusted for age and gender, level of functioning found low in pts treated at one hospital(p+0.02). which of the followong raises the most concern about this conclusion?
period of study too short
results not adjusted for c morbities
results not statistically significant
power is too low
survey instrument doesnt include clinical measures

Not adjusted for comorbidities. Dumb question since it's adjusted for age and gender, but I guess they wanted it adjusted for more things.


32 yo woman 2 day h/o vomitting, diarrhea and rt sided pelvic pain, lmp 3 weeks, temp 102.2, rep-20, pluse-100, bp 120/70, RLQ tenderness, bowel sounds decreased, pelvic exam shows rt adnexal tenderness, preg test (-). Labs leucocytosis with 80% neutrophils

adnexal torsion(got this wrong)
appendicitis
bowel obst
corpus luteum cyst
degeration leiomyoma
ovarian ca
ovarian hyperstimulation syndrome
tubo ovarian absecc
UTI

I got it wrong w/Tubo-ovarian abscess, but I think it's an appy. Forgot to read the part about U/S ruling out any adnexal masses.

87 yo man with 1 yr h/o of difficulty starting urinary stream and post void dribbling. nocturia. 30 yrs of DM, orthostatic hypotension. lisinopril and glyburide-current meds. BP 140/80 whil supine, 100/60 while standing, large prostate on examination, most appropriate med for pts urinary symptoms?
amlodipine
doxazocin
finasteride
metoprolol
oxybutinin

Finasteride. Blocks conversion of testosterone into DHEA, which reduces prostate size in BPH.

51 yo with 15 min acute rt sided chest pain and sob after insertion of subclavian catheter for hemodialysis. hospitalised for renal failur. pulse 92/min, bp 114/72. hb 9mg/dl, pulse ox-94%, xray shows 10% apical pneumothroax

observaion
ct scan of chest
removal of subclavian catheter
placement of chest tube
pleurodesis

Observation
I have to put something in the text, so I'll just say that this NBME 7 left me very discouraged (first practice test, I take the real thing in 3 weeks).
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Quote:
Originally Posted by obinocle View Post
it should be less than 300 not 100 according to the same UW. take a trip back to that question. Q id 4643 UNa >20 Uosm <300
Everything I see online says it should be less than 100 in psychogenic polydipsia, which makes sense since the kidney can dilute urine to 50.

Here is the hyponatremia algorithm I was using on the wards last month doing Renal, which also says Uosm should be <100:

http://www.stellarishealth.org/PDFs/..._Algorithm.pdf
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Originally Posted by Nixy View Post
I think I did elevation of head of bed or may be B but it was correct. Sorry font remember but if you did either one of them and it was incorrect then the other one is correct.
It's A 'Elevation of the head of the bed' bc she had decreased muscle tone and was at increased risk of aspiration
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Originally Posted by CisternaChyli View Post
they aren't testing Type IV hypersensitivity here; The gastric aspirates show TB, but why isn't the PPD picking it up? Its because her T-cells aren't being made properly, so she can't fight the TB. Remember, Th1 cells combat Mycobacteria.
PPD doesn't pick it up, bc the red induration you see on the skin in a PPD is from T-cell activation and inflammation. That's why the criteria for a positive test are less in AIDS patients. No T-cells = negative PPD
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Originally Posted by microshara88 View Post
thanks!

also, for block 1: 72 yo woman with indigestion walking uphill....it would be echo since she did not have it related to eating?

Answer was Stress Test. I assume bc women are atypical and she has 'indigestion' related to exertion, which could be an anginal equivalent.

14 yo boy with 150/90 BP, recheck in 4 weeks?
yep

also, how do you approach the 42 yo woman with the meningioma who had the hypernatremia? im so bad with these types of q's!
I think it was diabetes insipitus (low Uosm, lots of urine output, plus you just messed with the brain)

thanks a bunch!
best of luck
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Originally Posted by davisjunge View Post
Thanks! Is it AIDS?
I don't think it's AIDS. It could be one of the congenital T-cell disorders
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Originally Posted by starcrossed View Post
what does an increased pulm a diastolic pressure signify in this question?
Cardiogenic shock, I think. Heart is not emptying R ventricle as much as it should
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but the x ray did not show a fracture i felt .. ?!

and she had dull pain over several continuos vertebra with paravertebral spasm !
I think there was a fx there. I didn't see it until I went back
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Originally Posted by dr mk View Post
Can some one plz ans and explain this ques-

A 27 year old nulligravid woman comes for a routine health maintenance examination. She is sexually active with one lifelong partner. She does not smoke. She has no history of stds. Pap smear now shows a high grade sq intraepithelial neoplasia. Prior pap smears have shown no abnormalities. Examination of the cervix and vagina shows no gross abnormalities. which of the following is the most appropriate next step in management?
A. repeat pap smear
B. HPV testing.
C. Colposcopy.
D. Cone biopsy of the cervix.
E. Random cervical biopsies.

my ans was colposcopy and it was wrong.
Thanx in advance.
I put colpo too and got it wrong. Kind of dumb since the guidelines online say to do either colpo or excision (which I assume would equate to cone bx?). Can someone who got this right confirm?
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Originally Posted by TheSsm View Post
Where was this question? For a craniopharyngeoma with symptoms, Trans-sphenoidal surgery is the answer. Let me know where you got it wrong. Or maybe the full question if you can . Thanks
I think the idea was that this was a PLoma even though the PL was only mildly elevated. She had bitemporal hemianopsia and breast discharge
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37 year old woman with sickle cell disease comes to physician because of a 24 hour history of fever, right upper abdominal pain after eating and nausea, last SC crisit was 5 months ago, only takes folic acid, 23BMI, T=100.8 pulse is 90 mild scleral icterus, abd distended, bowel sounds decreased, murphy sign present, ultrasonography shows cholelithiasis, pericholecystic fluid, normal commmonsized ZCBD,
Leuk=12,000
Bili=3
Alk phos=60
Amylase=90
Lipase=40
A. Acute cholecystitis
B. Acute pancreatitis
C. Acute viral hepatitis
D. Cholangitis (wrong)
E. Sickle cell crisis
A. acute cholecystits because she has increased bilirubin from hemolytic anemia (from her sickle cell disease) which formed pigment stones. (murphy sign is positive in cholecystits and cholangitis)

- I get that the answer is A, but why is the Alk Phos normal????? Shouldn't it be elevated in Acute Chole?
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Originally Posted by ninerfan36 View Post
I put colpo too and got it wrong. Kind of dumb since the guidelines online say to do either colpo or excision (which I assume would equate to cone bx?). Can someone who got this right confirm?
I don't remember what I have chosen. But answer should be Colpo. According to UWorld. This difference of answers in different sources is very annoying.
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I think the idea was that this was a PLoma even though the PL was only mildly elevated. She had bitemporal hemianopsia and breast discharge
I guess she would have had other symptoms like amenorrhea and all. Either way PLoma - Medical 1st then surgery. Rest of them, go for the knife directly.
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Originally Posted by ninerfan36 View Post
I put colpo too and got it wrong. Kind of dumb since the guidelines online say to do either colpo or excision (which I assume would equate to cone bx?). Can someone who got this right confirm?
its HPV testing first then colposcopy if + for cancer causing strains
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and doesnt a nursemaid elbow child hold the arm in extended and pronated? (from uworld) the qs says flexion and pronation here??
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[QUOTE=steps_8186;429258]its HPV testing first then colposcopy if + for cancer causing strains[/QUOT
M really sorry! HPV isnt the right answer for this q. I guess its biopsy then cos one of my friends put HPV and it was wrong
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Default block 4 incomplete

the link posted by Dr AGA does not have all of block 4. does anyone have a better offline form/answers?
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Default 42 Year old Graves

42 year old woman comes to the physician because of a 4 month history of fatigue, palpitations and anxiety. She has had 3 kg ( 7 lb) weight loss during this period. She has also noted heat intolerance and increasing frequency of bowel movements. She has a 10 year history of asthma well controlled with inhaled albuterol .Her temperature is 37 C ( 98.6 F ) , pulse is 110/min and regular and blood pressure is 150/70 mm Hg. Examination shows lid lag and exophthalmos. The thyroid gland is large and non-tender, a thyroid bruit is heard. Deep tendon reflexes are normal. Serum studies show and thyroid stimulating hormone concentration of less than 0.1 U/ml and thyroxine (T4) concentration of 16U/ml. A thyroid scan shows a diffuse increased uptake. Which of the following is the most appropriate initial step in management.
A) Intravenous cortisol therapy
B) Intravenous sodium iodide therapy
C) Oral 131 therapy
D) Oral propylthiouracil therapy
E) Oral terazosin
F) Subtotal thyroidectomy

Is there a reason oral 131is not given ? Could anyone who has taken it online please help ?


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Originally Posted by monilode View Post
42 year old woman comes to the physician because of a 4 month history of fatigue, palpitations and anxiety. She has had 3 kg ( 7 lb) weight loss during this period. She has also noted heat intolerance and increasing frequency of bowel movements. She has a 10 year history of asthma well controlled with inhaled albuterol .Her temperature is 37 C ( 98.6 F ) , pulse is 110/min and regular and blood pressure is 150/70 mm Hg. Examination shows lid lag and exophthalmos. The thyroid gland is large and non-tender, a thyroid bruit is heard. Deep tendon reflexes are normal. Serum studies show and thyroid stimulating hormone concentration of less than 0.1 U/ml and thyroxine (T4) concentration of 16U/ml. A thyroid scan shows a diffuse increased uptake. Which of the following is the most appropriate initial step in management.
A) Intravenous cortisol therapy
B) Intravenous sodium iodide therapy
C) Oral 131 therapy
D) Oral propylthiouracil therapy
E) Oral terazosin
F) Subtotal thyroidectomy

Is there a reason oral 131is not given ? Could anyone who has taken it online please help ?


I took it while ago so I don't really remember, but it might be trying to get you to pick IV cortisol, which you can give before the I-131 to reduce the chance of aggravating the opthalmopathy (best INITIAL step). Sounds like a nit-picky question to me.
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Originally Posted by ninerfan36 View Post
I took it while ago so I don't really remember, but it might be trying to get you to pick IV cortisol, which you can give before the I-131 to reduce the chance of aggravating the opthalmopathy (best INITIAL step). Sounds like a nit-picky question to me.
Give ptu or beta blockers first line, steroids second. Don't give 131 if severe ophthalmolopatht present that's a high yeild fActoid
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  #255  
Old 08-22-2014
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Thanks for the explanation.

Quote:
Originally Posted by 2cool4medschool View Post
Give ptu or beta blockers first line, steroids second. Don't give 131 if severe ophthalmolopatht present that's a high yeild fActoid
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  #256  
Old 08-22-2014
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Default 2 month old - immunization qs

2 month old girl routine health maintenance, she was born at 34 weeks, temp instability and slow feeding for 2 weeks, She recently had a runny nose and cough, growth and development is okay when corrected for gestational age. Temperature is 100 F. remainder vital signs in normal limits, Examination shows no abnormalities other than green rhinorrhea, what is most appropriate plan for immunizations ?
a. Avoid live immunizations during illness
b. Delay the immunization for 6 weeks to correct for prematurity
c. Delay all until her upper respiratory tract infection resolves
d. Give all recommended immunizations for age
e. Reduce the dose of immunizations according to gestational age

Why is A) wrong ? What is the correct answer ? an explanation would be very helpful !
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  #257  
Old 08-22-2014
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You do not avoid vaccines unless the child has some kind of anaphyLaxis with the vaccine. Or has a very high fever etc. The point he wants to stress is that even in prematurely born infants vaccines r given according to age and not delayed.
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  #258  
Old 08-22-2014
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Thank you. Very helpful.

Quote:
Originally Posted by steps_8186 View Post
You do not avoid vaccines unless the child has some kind of anaphyLaxis with the vaccine. Or has a very high fever etc. The point he wants to stress is that even in prematurely born infants vaccines r given according to age and not delayed.
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  #259  
Old 08-29-2014
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Default Nbme 7

There is a question about a 16 yr old girl who is found comatose next to a suicide note, unresponsive, pule 100/min, bp 100/60, doll's eye reflex present, Na 140, Cl 104, HCO3 6, k3.5, ph 7.32, pCO2 12. What is the causative agent?

acetaminophen
aspirin
diazepam
heroin
methanol

She had increased anion gap met acidosis so I wrote methanol, but its wrong. I am checking answers using the offline key. The answer there seems to be methanol, so i assume it is for this question. COuld any one tell me what the right answer could be?

Also, the question about a mass in the rectum, did not have options of colonoscopy or sigmoidoscopy. In such a case, if transanal sx was an option, we directly go for that? If all three options were given, which would be the best?
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  #260  
Old 08-29-2014
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Quote:
Originally Posted by steps_8186 View Post
and doesnt a nursemaid elbow child hold the arm in extended and pronated? (from uworld) the qs says flexion and pronation here??
I agree. I cancelled the supination option because of the way that child was holding his arm
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  #261  
Old 08-29-2014
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Quote:
Originally Posted by dr.baig22 View Post
1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)

Qs 42: can you have acute cholecyctitis with normal ALP? 60 is normal even in nbme (range 20-70)
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  #262  
Old 08-29-2014
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Quote:
Originally Posted by dr.baig22 View Post
1. zinc
2. destruction and dilatation distal airways (emphysema)
3. colposcopy
4. stasis dermatitis with ulcer
5. schizophrenia
6. hypovolemia
7. INC. LDH (?)
8. ?
9. Dopamine
10. oral PTU (graves)
11. transfuse FFP
12. external carotid artery
13. abruptio placenta
14. compression fracture
15. spinal dysraphism (clubfoot n loss of motor/sensory)
16. wiskott-aldrich syndrome
17. IV 0.9 saline
18. acute MI ( st elevation in v2 v3 v4)
19. V-TACH
20. vancomycin
21. Mg sulfate (tocolysis)
22. organophosphate
23. ?
24. laparoscopic nissen fundoplication
25. fibrosis of sternocledomastoid muscle (torticollis)
26. brochogenic ca
27. olanzapine therapy
28. PID
29. Interferon Alfa (hep c - cryroglubinemia)
30. give all recommended immunization for age
31. no intervention necessary
32. dec. renal blood flow
33. add lisinopril
34. pill-induced esophagitis (ibuprofen)
35. inappropriate ADH secretion (dec serum, osm Inc. urine osm)
36. Mitral valve incompetence (Rheumatic fever)
37. surreptitious administration of thyroxine
38. viral infection (tender thyroid)
39. right lower lobe pneumonia
40. riluzole rx for (ALS)
41. optic neuritis (affrent puppillary defect + central scotoma)
42. no Rx indicated at this time
43. appendicitis
44. finasteride (enlarge prostate oldy with obstructive sx-doxazosin wrong)
45. ?
46. CT scan of the chest

What is the rash in q42?

27 yr old male, involved in high speed RTA, unrestrained driver, brought 30 mins after, GCS 10, pulse 130, rr 36, bp 90/60, has rt pneumohemothorax with 300 ml in chest tube, unstable pelvic fracture, FAST no abnormalities, given 3l crystalloid,, still hypotensive and tachycardic. Next Step?


epinephrine
hexastarch
recombinant VII
ffp (wrong)
O bld grp PRBC

37 yr old man with 3 month h/o low back pain, NSAID provide moderate relief, forward flexion normal, hyperextension increases pain, musc strength 5/5 both LL, sensation, reflexes normal. Lateral XR shown. Most likely diagnosis is:
compression #
intervertebral disc space infection (wrong)
Paget's
osteoporosis
spondylolisthesis
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  #263  
Old 08-29-2014
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Correct Answer

Quote:
Originally Posted by jili1409 View Post
What is the rash in q42?

27 yr old male, involved in high speed RTA, unrestrained driver, brought 30 mins after, GCS 10, pulse 130, rr 36, bp 90/60, has rt pneumohemothorax with 300 ml in chest tube, unstable pelvic fracture, FAST no abnormalities, given 3l crystalloid,, still hypotensive and tachycardic. Next Step?


epinephrine
hexastarch
recombinant VII
ffp (wrong)
O bld grp PRBC

37 yr old man with 3 month h/o low back pain, NSAID provide moderate relief, forward flexion normal, hyperextension increases pain, musc strength 5/5 both LL, sensation, reflexes normal. Lateral XR shown. Most likely diagnosis is:
compression #
intervertebral disc space infection (wrong)
Paget's
osteoporosis
spondylolisthesis
The first answer should be epinephrine. I can't quote a source but I know that after 3 L of fluids we start alpha agonists along with the drips in case of shock.

I can't see the X-Ray. But from what I remember and it also looks like spondylolisthesis
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  #264  
Old 08-29-2014
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I think the rash is slapped cheek fever so all u can do is rest blah blah. The back pain one is spondylolisthesis, there is step off at l5-s1
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  #265  
Old 08-29-2014
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27 yo accident victim-the best thing wd be to do a blood transfusion.
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  #266  
Old 08-31-2014
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Quote:
Originally Posted by ninerfan36 View Post
I have to put something in the text, so I'll just say that this NBME 7 left me very discouraged (first practice test, I take the real thing in 3 weeks).

Won't an alpha blocker also work? so if they have both I thought an alpha blocker was the first choice.
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  #267  
Old 09-09-2014
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Quote:
Originally Posted by DrAGA View Post
i want to...i did nbme 7 today..and got 70 point more then nbm6....
i am looking for a answer keys but cant find it..
so lets see who did lets try to discuss and correct each other


its crazy timing but hope it went well wow!!!
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  #268  
Old 09-11-2014
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Quote:
Originally Posted by jili1409 View Post
There is a question about a 16 yr old girl who is found comatose next to a suicide note, unresponsive, pule 100/min, bp 100/60, doll's eye reflex present, Na 140, Cl 104, HCO3 6, k3.5, ph 7.32, pCO2 12. What is the causative agent?

acetaminophen
aspirin
diazepam
heroin
methanol

She had increased anion gap met acidosis so I wrote methanol, but its wrong. I am checking answers using the offline key. The answer there seems to be methanol, so i assume it is for this question. COuld any one tell me what the right answer could be?

Also, the question about a mass in the rectum, did not have options of colonoscopy or sigmoidoscopy. In such a case, if transanal sx was an option, we directly go for that? If all three options were given, which would be the best?
Most common suicide pill is ASPIRIN (and acetominophen). Aspirin causes HYPERventilation (low CO2) and causes metabolic acidosis WITH anion gap.

If you don't know the answer to a suicide question, pick aspirin or acetominophen.
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  #269  
Old 09-20-2014
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Hi, please.. can someone send me the link to the Complete NBME 7CK offline
I got the one that is missing a lot of questions in the block 4 and a couple in the other blocks
Thanks..
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  #270  
Old 09-20-2014
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Default comments and questions on Block 1 (nbme7)

Guys, i was going thru the answers, and I would like to ask you a few things and add a few from myself;
can someone please explain me the previously health boy of 6 with cramping pain. What happened to him? is the answer the surgery? or what?
The answer about gout and the exacerbation of it about a 52-year old man, you posted that the answer was "indomethacin" although I chose that answer and it turned out to be wrong. Can someone comment on that?
And one more; the answer for the food intoxication (outbreak after a picnic) - it is a poor refrigeration. I chose that answer, and it turned out to be right.
I dont post here the question numbers, as it turned out to be different from yours guys, no idea why, maybe because I chose the self-paced one.

Thanks
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  #271  
Old 09-21-2014
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Quote:
Originally Posted by Tokyoite View Post
Guys, i was going thru the answers, and I would like to ask you a few things and add a few from myself;
can someone please explain me the previously health boy of 6 with cramping pain. What happened to him? is the answer the surgery? or what?
The answer about gout and the exacerbation of it about a 52-year old man, you posted that the answer was "indomethacin" although I chose that answer and it turned out to be wrong. Can someone comment on that?
And one more; the answer for the food intoxication (outbreak after a picnic) - it is a poor refrigeration. I chose that answer, and it turned out to be right.
I dont post here the question numbers, as it turned out to be different from yours guys, no idea why, maybe because I chose the self-paced one.

Thanks
I think the cramping pain answer is strangulated hernia. I thought it was torsion testis n got usg wrong. It is imm sx or whatever ans option says sx.
i can't remember the gout answer or question.
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  #272  
Old 09-30-2014
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Default Corrections

Quote:
Originally Posted by dr.baig22 View Post

Corrections based on my own exam atleast 10 characters

1. angina = exercise stress test
2. fat emboli
3. repeat bp in 4 wk
4. Diabetes insipidus ( serum osm inc. urine osm dec.)
5. central retinal vein occlusion
6. small bowel obstruction
7. bilateral varicocele
8. alcoholic cirrhosis = Decrease Calcium
9. pilosebaceous follicles = Acne
10. Upper resp. infection ( same ques. frm nbme 6)
11. Haloperidol for acute psychosis
12. CT scan (meningitis picture ruleout intracranial patho hemorr/mass)
13. child abuse ( shaken baby syndrome)
14. thymoma
15. Impetigo - topical mupirocin
16. urinary stasis
17. PCP (b/l nystagmus hypertonia HTN)
18. zenker diverticulum - barium swallow
19. Myasthenia gravis = dec ach receptors
20. GBS = demyelination of axons ( assending weakness + absent DTRs)
21 ?
22. Thoracic aorta (blunt trauma + wide mediastinum + c5 facet fracture)
23. reassurance
24. ?
25. sarcoidosis = Increase Calcium
26. case-control study ( past)
*incorrect - RCT most reliable for trmt strategy
27. Bone Marrow aspiration
28. ?
29. encourage fluid intake
30. pericardial window
31. indomethacin
32. amniotomy + vaginal delivery
33. statin induced = Muscle
34. switch to s/c morphine
*incorrect. Not sure why.
35. bipolar disorder
36. osteoperosis
37. splencetomy
38. Increase IV fluids
39. Intravascular volume depletion
40. poor hygiene by food handlers (s. aureus = egg salad)
*incorrect - refrigeration
41. Ankylosing spondylitis
*incorrect - spondylolisthesis
42. compression fracture ( prednisone)
43. TGs ( gallstone pancreatitis)
44. T - lymphocytes (cellmediated immunity TB)
45. Latent TB ( PPD +ve CXR _ve) Rx 9m INH
My replies are in the list above
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  #273  
Old 09-30-2014
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Quote:
Originally Posted by dr.baig22 View Post
1. MDD
2. viridians step. (dental cleaning + prostatic valve)
3. amoxicillin (lyme)
4. Nursemaid elbow - suppination of forearm with elbow slight flexed
5. determine if pt. wants to discuss his decision with anyone else
6. wound dehiscence(rupture along suture,obesity, serosanguinous discharge)
7. Heat stroke
8. TTP
9. OCP ( protective for ovarian ,endometrial and colorectal cancer)
10. Osteoarthritis (20degree flexion hip contracture)
11. ERCP (cholangitis RUQpain, jaundice, fever)
12. Atropine ( organophosphate poisoning)
13. methamphetamine (tactile hallucination with cocaine n amphetamine)
14. intramuscular betamethasone
15. uterine atony
16. atrophic gastritis
17. B lymphocytes
18. neutrophils (CGD)
19. inc. GI absorption of oxalate
*incorrect - increased urinary excretion of calcium
20. EColi - gram neg. bacilli
21. genital herpes
22. cricothyrotomy
23. HOCM
24. ALS emg:fibrillation potentials in multiple muscles of multiple extremities
25. education abt puberty for child and parents (normal puberty)
26. alveolar hypoventilation
27. trial of omeprazole (GERD)
28. Rh incompatibility
29. anaphylactic transfusion reaction
30. pneumococal vaccine
31. analgesic therapy
32. hypoglycemia
33. capping of receptor sites on macula dense of JG apparatus
*incorrect - angiotensin
34. renal ultrasound
35. naloxone
36. botulism
37. urethral diverticulum
38. heparin treatment
*incorrect - intubate
39. enterotoxicgenic EColi - watery diarrhea
40. clomiphene
41. no treatment
42. HYPOkalemia
43. HYPOnatremia (cancer patients have electrolyte imbalance decNa)
*incorrect - i picked hyponatremia and got it wrong
44. carotid endarterectomy
45. abstinence from alcohol
46. CHF ( CXR perihilar densities and hazy with cephalization of pulmonary vasculature)
*not CHF - ARDS

Corrections above
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  #274  
Old 10-07-2014
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Hey guys can you please help with this question? NVM I found the answer!!!!

66 yo homeless with jaundice for 1 week, 9 kg weight loss past year. Alcoholic and PE suggestive of cirrhosis. Mg is low. Serum will show?

low calcitonin
low calcium +++
low TSH
high calcitonin
high calcium
high mag
high PTH
high TSH
high T3

Last edited by Silvis2013; 10-07-2014 at 07:45 PM.
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  #275  
Old 10-14-2014
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Quote:
Originally Posted by PinkPuffer View Post
Answer should be C. Varicocele is almost always bilateral and presents as an ill defined mass in the Upper half of the scrotum (above the testes).

Injury could cause a mass but it would most likely be unilateral.
C was my answer and it is incorrect
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  #276  
Old 10-15-2014
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Default questions

Quote:
Originally Posted by TheSsm View Post
I just took the NBME 7 and did a bit of research from my correct answers and yours. And there are a few I got correct and do not match with yours so I will change them here and post them.
Hi,Thanks for the answers
May I ask you to send the Questions to me please?

mona_p_r@yahoo.com
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  #277  
Old 10-15-2014
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Quote:
Originally Posted by Nixy View Post
I have written the answers with the questions in the box above.
Why I don't see the "above box"?
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  #278  
Old 10-15-2014
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Quote:
Originally Posted by dr ashour View Post
@drAGA
26>> the Q is about chosing a treatment starategy, so we need an interventional study (e- RCT)
40>> this quote from uptodate "S. aureus toxin is heat-stable and is often associated with the consumption of foods prepared by a food handler such as dairy, produce, meats, eggs, and salads [ 7 ]. The food handler usually contaminates the product; after the food is left at room temperature, the organisms multiply and can produce a substantial quantity of toxin."
so the answer should be e- poor hygiene of handlers
This answer is not right cause I chose it !and turn out to be wrong
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  #279  
Old 10-15-2014
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Default block2 q38

block2 q 38 Is it pulmonary embolus even thought patients lungs arent clear as they usually should be in this case?
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  #280  
Old 10-15-2014
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Quote:
Originally Posted by mona777 View Post
This answer is not right cause I chose it !and turn out to be wrong
which one are you talking about?
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  #281  
Old 10-21-2014
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Default comprehensive clinical science form 7

do anyone have the answers to this block 7. i am really in of the answrs to compare
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  #282  
Old 10-22-2014
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Default nbme block 6

does anyone have nbme ck2 block 6 questions would really appreciate it.
it can be emailed at joannajnbaptiste@yahoo.com
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  #283  
Old 12-12-2014
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Default Can someone please send me NBME Offline files

Hey all ... Can someone please send me a link or pdf file for the NBME Offline block questions that were posted here. The answers were posted but not the questions.

dochollywood222@gmail.com

Thanks!

Holly
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  #284  
Old 12-12-2014
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Default Hi

Quote:
Originally Posted by usmleck View Post
anyone wants to discuss nbme 7?
How far are u with prep?
When is your exam?
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  #285  
Old 12-12-2014
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Quote:
Originally Posted by usmle.2016 View Post
How far are u with prep?
When is your exam?
I am about 5 weeks from the exam and 2 months into it (on and off prep) between rotations. Using U_World and MTB ... Was using DIT vids but taking too much time.
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  #286  
Old 12-12-2014
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Quote:
Originally Posted by steps_8186 View Post
its HPV testing first then colposcopy if + for cancer causing strains
But the question said HSIL. Still HPV testing will be the next step?
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  #287  
Old 12-19-2014
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Default Tough question on Bacteria ... IMO - Anyone?

Hey gang ... Anyone get this question correct that someone posted? "D" is wrong. I was thinking "B" or "A". H. Influenzae is a coccoid (Per. FA) and E. Coli and Pseudo are both "Rods". Not sure if one falls under the term of Bacilli more than the other. But H. Influ would appear to more common than the rest ... Any input would be appreciated! Thanks

2. .... man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa (Wrong)
E. Strep pneumonia.
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  #288  
Old 12-20-2014
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Quote:
Originally Posted by thomasfx10 View Post
Hey gang ... Anyone get this question correct that someone posted? "D" is wrong. I was thinking "B" or "A". H. Influenzae is a coccoid (Per. FA) and E. Coli and Pseudo are both "Rods". Not sure if one falls under the term of Bacilli more than the other. But H. Influ would appear to more common than the rest ... Any input would be appreciated! Thanks

2. .... man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa (Wrong)
E. Strep pneumonia.
I put H. influenzae and that was right. It's community acquired, not nosocomial (more likely to be pseudomonas).
http://emedicine.medscape.com/article/234240-overview
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  #289  
Old 01-06-2015
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for question 10 , choice (A) is wrong. I am not sure about (C)
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  #290  
Old 01-09-2015
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Actually PCP does not do much regarding pupil. It can be either constricted or dilated. Df Dx is based on bilateral horizontal nystagmus, which is not part of opoids or amphetamines.
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  #291  
Old 01-13-2015
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Quote:
Originally Posted by Andante View Post
1. A 4 year-old boy develops chickenpox 8 hours after visiting his newborn sister in the nursery. Six other full-term newborns were also exposed; all of the mothers have a history of chickenpox prior to pregnancy. Which of the following is the most appropriate recommendation to prevent chickenpox in the newborns?

A) Acyclovir therapy for all exposed newborns
B) Administration of varicella vaccine to all exposed newborns
C) Administration of varicella vaccine to newborns with negative varicella titers
D) Isolation of the newborns from each other
E) No intervention is necessary

2. A 43 y/o man comes to the physician because of a 3-day history of temperatures to 38.4'C, left-sided chest pain, malaise, loss of appetite, and a cough produtive of yellow phlegm and a 36-hour history of increasing shortness of breath. He has smoked two packs of cigarettes daily for 25 years. His T 38.8'C, P 112/ min, R 22/min, and Bp 118/72 mm Hg, Crackles and wheezes are heard at the left base, breath sounds are decreased. There is increased left tactile fremitus and dullness to percussion at the left base. Examination shows no other abnormalities. X-rays of chest are shown. Gram stain of sputum shows small gram-negative bacilli and leukocytes. The most likely diagnosis is pneumonia casued by which of the following organisms?

A. E Coli
B. H. Influenzae
C. N. meningitis
D psedomonas aeruginosa
E. Strep pneumonia.

3.A 72 y/o man is hospitalized because of dyspnea for 6 weeks. He has a history of type 1 diabetes and angina pectoris. Medications include insulin and warfarin. During the past 4 months, he was hospitalized once for deep venous thrombosis and another time for pulmonary emboli. Examination shows jugular venous distention, ascites, and pitting pretibial edema of both lower extremities. An chest X-ray shows mild cardiomegaly and no evidence of pulmonary edema. Which of the following is the most likely casue of this patient's worsening condition?

A. aortic stenosis
B. Cor pulmonale
C. ischemic heart disease
D. Mitral regurgitation
E. viral cardiomyopathy

4. A 72-year-old man has decreased urine output 2 days after admission to the hospital for treatment of cholecystitis. His urine output has been 15 ml/h over the past 3 hours. On admission, results of laboratory studies were consistent with gram-negative bacteremia and disseminated intravascular coagulation. He is currently receiving intravenous fluids, cefoxitin, and gentamicin. His temperature is 38.5C (101.3F), pulse is 11O/min, respirations are 24/min, and blood pressure is 90/64 mm Hg. Abdominal examination shows mild right upper quadrant tenderness. His serum creatinine concentration has increased from 1.5 mg/dl days ago to 3 mg/dl .This patient is most likely to have which of the following sets of urinalysis findings?


Blood, protein, RBC, WBC, casts, other microscopic findings

A. none, none, none, none, hyaline, none
B. none, 4+, none, none, none, oval fat bodies
C. trace, 1+, 0-5,> 50, none, WBC clumps
D. 1+, 1+, 0-5, 0-5, pigmented granular, renal tubular epithelial cells
E. 1+, 1+, 5-10, 10-20, none, eosinophils
F. 3+, 1+, >50, none, RBC, none
G. 4+, 1+, none, none, pigmented granular, squamous epithelial cells
H. 4+, 1+, 10-20 dysmorphic, none, none, none.

Would you please let me know the correct answers to these 4 questions. I am very confused. Thank you so much.
I think the right answer is H, as DIC is a type of microangiopathic hemolysis and can cause dysmorphic RBC (schistiocytes) in blood smear or urine.
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  #292  
Old 01-16-2015
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Quote:
Originally Posted by dr.baig22 View Post
1. digestive enzyme deficiency
2. epidural hematoma
3. brisk rotatory nystagmus on left lateral gaze ??
4. Hypothyroid
5. thiamine
6. C1 esterase inhibitor
7. measurement of serum amylase activity
8. measure platelet count
9. femoropopliteal arteries
10. achalasia = dec persistalsis Inc. LES
11. lorazepam (MRI claustrophobia)
12. CXR
13. psychogenic polydipsia
14. HIV antibody testing (molluscum contigiosum pt.)
15. repeated microfracture at tendon insertion (osgood-schlatter)
16. duplex scan
17. reassurance
18. bartholin duct cyst
19. costochondritis
20. cardiogenic shock
21. calcium disodium edetate (lead poisoning)
22. exploratory laparotomy (ovarian cancer)
23. aortic stenosis
24. cor pulmonale (PE leading to right heart failure)
25. SLE ( dec c3 ANA positive protein positive)
26. paget diease of breast
27. ductal ectasia
28. methanol ( inc aniongap with met acidosis 140-110 = 30)
29. c-section
30. allergic bronchopulmonary aspergillosis
31. brief psychotic disorder
32. IV penicillin G (prophylaxis)
33. bromocriptine (microadenoma)
34. EBV
35. acute stress disorder
36. multiple myeloma - PCP (Strep pneumo???)
37. colonoscopy
38. IV labetalol ( aortic dissection)
39. ??
40. sensitivity INC. specificity Dec.
41. cutaneous larva migrans
42. acute cholecystitis
43. transanal excision of tumor (adenocarcinoma of rectum)
44. x-ray of left hip
45. nasogastric suction (GBS -aspiration)




firstly i think the sequence of questions is different for different people.. but blocks are same.
here question for question 7 you have written measurement of serum amylase.
the only question which had this option was about a pregnant lady with findings suggestive of preeclampsia. i think the answer is measurement of platelet count... considering HELLP syndrome.
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  #293  
Old 01-18-2015
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can someone please send me the questions

r.khanna58@yahoo.ca
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  #294  
Old 01-26-2015
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Section 2 question 13 of 46
A 37 year old woman with alcoholism is admitted to the intensive care unit for treatment of severe alcoholic pancreatitis. she had several episodes of vomiting 2 hours before admission. during the first 12 hours, ehr vitals have been following: pulse 100-130/min; respirations 28-36/min, and systolic blood pressure 90-110 mm Hg. fourteen litres of crystalloid solution have been infused to maintain a urine output of 30 mL/h. Because her arterial oxygen saturation has fallen into the 80% to 89% on 100% oxygen by face mask, she is intubated and being mechanically ventilated. one hour after intubation, her pulse is 110/min, bp is 90/60 mm Hg. the lungs are clear to auscultation. pulmonary artery catheterization shows: Cardiac index 4.2 L/min/m2 (N=2.5-4.2)
Central venous pressure 11cm H2O (N=5-8)
PCWP 10 mm Hg (N=5-16)

aRTERIAL BLOOD GAS Analysis on an FiO2 of 60% and PEEP of 10 cm H2O shows:

pH 7.32 PcO2 38 mmHg P02 78 mm Hg

An xray chest shows bilateral diffuse hazy densities with cephalization of the pulmonary vasculature and perihilar fullness. which of the following is the most likely diagnosis?
a. ARDS
b. Aspiration pneumonitis
c. Atelectasis
D. CHF
e. Fat embolism
f. Interstitial pneumonitis



I chose B and got it wrong.. but im pretty sure its ARDS... The patient has pulmonary edema with a normal PCWP that rules out CHF.
plus ARDS is a complication of pancreatitis.
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  #295  
Old 01-26-2015
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Section 3 item 14
Five days after undergoing an open cholecystectomy for immune thrombocytopenic purpura a 57 yr old woman has the onset of shortness of breath. during the operation, dissection of the hilum of spleen was difficult. her only medication is morphine. her temp is 99.2 F, pulse is 80/ min, respirations are 20/min, and blood pressure is 120/80 mm Hg. the surgical wound appears normal. breath sounds are decreased at the left lung base. her leukocyte count is 15,600/mm3, platelet count is 112,000/mm3, and serum amylase activity is 90 U/L. WHICH OF THE following is the most appropriate next step in management?

a. Xray chest
b. USG of abdomen
c. IV antibiotics
d. IV immuneglobulin
e. Systemic heparin therapy
f. Pulmonary angiography



I chose pulmoanr angiography but not that i think of it, its completely wrong. Chest xray seems the simplest option.
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  #296  
Old 01-26-2015
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Sections 4 item 7
A previously healthy 21 yr old woman comes to the physician 1 day after the sudden onset of severe right sided chest pain that increases with deep inspiration. during this period, she has had shortness of breath and difficulty taking deep breath. she has had no cough. yesterday, she returned from a 3 week vacation to the Andes Mountains. she does not smoke cigarettes, drink alcohol, or use illicit drugs. her temperature is 38 C (100.4F), pulse is 80/min, respirations are 14/min, and blood pressure is 100/70 mm Hg. examination shows a faint, erythematous, macular, nonpruritic rash over the cheeks and trunk. there is dullness to percussion at the right lung base and inspiratory rub with no crackles or wheezes. which of the following is the most likely diagnosis?

a.Allergic granulomatour angiitis (churg strauss syndrome)
b. Allergic pulmoany aspergillosis
c. Chronic bronchitis
d. Costochondritis
e. Emphysema
f. penumothorax
g. postinfectious bronchospasm
h. pulmonary embolism
i. sarcoidosis
j. viral pleurisy


The likely options to me are viral pleurisy or pulmoany embolsim. at that time however i chose churg strauss which is obviously incrorect
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  #297  
Old 01-26-2015
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Section 4 item 27
a 52 yr old woman comes to the physician because of a 2 week history of progressive shortness of breath with exertion. she becomes short of breath when walking across a room. eight yrs ago, she was diagnosed with breast cancer and underwent mastectomy followed by chemotherapy. annual examinations have shown no evidence of recurrence. her temperature is 37 C (98.6 F), pulse is 90/min, respirations are 24/min, and bp is 130/80 mm Hg. examination shows no JVD. there is dullness to percussion over the lower half of the right lung; the left lung is clear to auscultation. heart sounds are normal. there is no peripheral edema. which of the following is the most likely cause of this patient's dyspnea?

a. Hypothyroidism
b. Left ventricular dysfunction
c.Pericardial temponade
d. Plueral metastases
e. Right lower lobe penumonia


I chose e and got it wrong. don't know what was i thinking at that time. her prior history of breast cancer puts her at a high risk of pleural metastases. history of chemotherapy can lead to congestive heart failure. but in the absence of other signs like bilateral decreased breath sounds, crackles at lung bases, S3 gallop, peripheral edema; CHF is unlikely. that leaves pleural mets as the answer.
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  #298  
Old 01-26-2015
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section 4 item 28

a 51 yr old woman had a 15 minute episode of acute right sided chest pain and shortness of breath following insertion of a right subclavian catheter for hemodialysis. she is hospitalized for treatment of renal failure. her vitals =stable with no orthostatic hypotension. Hb 9. pulse oximetry = 94%. an xray chest shows 10% pneumothorax. the subclavian cathetar is in good position. which of the following is the most appropriate next step in management?
a. observation
b. CT scan of the chest
c. removal of the subclavian catheter
d. placement of chest tube
e. pleurodesis


I chose removal which was incorrect. given her normal OSats i think it should be observation. somebody said CT scan of chest.... please explain why?
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  #299  
Old 01-27-2015
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section 1 item 25..

a 17 yr old girl comes to the physicia because of a 4 month history of persistent rash over her face and upper back. and there was a photo of a rash. Which of the following structures is primarily involved in the development of this rash?

a. apocrine glands
b. dermis
c. epidermal-dermal junction
d. panniculus
e. pilosebaceous follicles

i chose epidermal-dermal junction and got it wrong....
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  #300  
Old 01-27-2015
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section 4 item 20

a 72 year old woman has hyponatremia 3 days after admission to the hospital following a cerebral infarction. she has been receiving 5% dextrose in 0.45% saline since admission. current medications are phenytoin and atenolol. she has expressive aphasia. her pulse is 86/min, respi 16/min, and blood pressure is 130/86 mm Hg. examination shows right dence hemiparesis. labs
serum Na 120 mEq/L
osmolarity 255 mOsm/KG
Urine
Na 50 mEq/L
Osmolality 358 mOsmol/kg


which of the following is most likely cause?

a. adverse effect of phenytoin
b. dehydration
c. diabetes insipidus
d. inappropriate ADH (vasopressin) secretion
e. water intoxication
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