NBME Explanations

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NBME Explanations

NBME 4 Questions and Answers

Discussion in 'USMLE Step 2 CK' started by orthopod, May 24, 2015.

  • by orthopod, May 24, 2015 at 7:17 PM
  • orthopod

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    Below you will find the questions (in my own words) and answers in case anyone has a question regarding one. Please post any questions you may have!
     
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Discussion in 'USMLE Step 2 CK' started by orthopod, May 24, 2015.

  1. orthopod
    I've added the answers in the qutoes above, as well as here below (in case it's easier for you to read this way).

    Why Metronidazole over vancomycin?
    - IV vancomycin is NEVER the right answer. Oral vancomycin is reserved for more severe cases, particularly when WBC > 15k and creatinine is >1.5x the patient's baseline. In cases when the WBC is <15k, oral metronidazole is the correct answer. Remember that in patient's with WBC >20k, lactacte >2.2, toxic megacolon and/or severe ileus, the patient will need emergent surgery

    Why not normal saline?
    - Normal saline is reserved for asymptomatic patients with minor elevation in Na concentration. Here, the patient has low O2 saturation, and has deteriorating kidney function (Cr of 2.1). the best choice would be to decrease the patient's sodium by giving half-normal saline.

    What does she have?

    - I'm not really sure, but it's important to decompress the GI system in patients with recent abdominal surgery + new onset nausea vomiting. This is a typical 'next step' question.

    Why vitamin D, her vegetarian diet shouldn't affect vitamin D levels?
    - Neonates have a tendency to be vitamin D deficient. They can receive some through breast milk.

    What does this treatment accomplish?
    - First, you need to recognize she is demonstrating signs and symptoms of a small bowel obstruction (SBO). Hx of abdominal surgery = adhesions. In patients with SBO, they need to be decompressed immediately, in order to minimize the need for surgery. Regardless, this patient might need surgery to relieve the obstruction if decompression + fluids doesn't help. In addition, in a patient with these signs and vomiting, it's wise to decompress just from a management standpoint so that the patient doesn't aspirate.

    Why intubation over steroids ?
    - This girl is suffering from . She is in severe distress, breathing 42 times/min and only with an o2 saturation of 82%. She needs IMMEDIATE help. steroids will take time to kick in, so she needs to be intubated before she goes into respiratory failure! Intubation is almost always the correct answer here.

    What drug side effect is this? Akithisia vs acute dystonia vs something else?
    - Sounds like this patient is experiencing neuroleptic malignant syndrome. rigidity, clammy extremities...

    Does she have mesenteric ischemia? Why not endoscopy due to suspicion of ulcer?
    - What in the history suggests an ulcer? She has severe claudication and hx of HTN. She certainly has some athersclerosis of her GI vasculature, likely her mesenteric arteries. Classic symptoms of mesenteric ischemia as well. Make sure to review this topic, it is often tested.


    Good luck with your studies, and let me know if you have any other questions!
    SunnysideUp likes this.
  2. Woogli
    Thank you very much!
  3. Marisiyahu
    It should be MI
  4. kingme
    Six hours after surgical excision of the distal colon for cancer, 77yo M has decreased urine output. Lost 500 mL, transfusion of 1 unit pRBC. 10-yr Hx of hypertension. Pulse oximetry on 2L/min of oxygen via nasal cannula shows an oxygen saturation of 89%. Hct 24%, Na conc 140, Cr 2.1. Next step?
    - 0.45% Saline


    Answer is actually pRBC
    I got this correct on the NBME I just took. pRBC is better answer because he is symptomatic. If you give .45% saline, you will hemodilute which will worsen his symptoms. And you never want to use 1/2NS for hemorrhage replacement.
  5. kingme
    37yo F with left leg pain for 2 days. Medications include an oral contraceptive and calcium supplementation. Subcutaneous, palpable, hard, cord-like structure within a 6 x 1-cm, warm, erythematous area just proximal to the ankle. Scatterred varicose veins. Next step?
    - Use of compression stockings
    I am pretty sure I put enoxaparin and it didn't show up as wrong, but everywhere I am reading says that your answer is right, so I don't know what is going on with this question


    46. 23yo primigravid at 10 weeks' gesteration for first prenatal visit. Vegetarian diet and eats no meat or fish. Intends to breast-feed her newborn. Which additional supplemental vitamin during pregnancy and lactation?
    - D
    This should be B12, she would not be deficient as a vegetarian in vitamin D, although her breastfed baby would be. I put B12 and it did not show up as incorrect.


    Thanks for putting this together. It is really helpful. Hopefully it will be easier now that NBME has the right answer highlighted on expanded feedback section.
  6. drsidoffwork
    Thank you so much for putting up the questions. I think there are a few corrections.

    block 2 part 2 q no.32:I marked packed cells and got it right. HCT<25,old age with heart disease-indication for transfusion. couldve been a confusion if 0.9%NS is in the options. 0.45%NS hemodilutes;reduces the already reduced HCT and worsens the condition.

    block 2 part 2 q no.42:I marked SC enoxaparin and got it right. I think it is thromboplebhitis with the given history(OCpills) and presentation(thick cord like vein subcutaneously).

    block 2 part 2 q no.43:I marked MI and got it right. HTN is a high risk factor for MI; HTN causes parenchymal hemorrhages,less likely to result in subarachnoid hemorrhage.

    block 4 part 2 q no.46:I marked b12 and got it right. I think b12 is more important because neurological development is maximum during the earliest stages of life.
  7. ChinaPaw
    many people dont follow these rules. The new people dont bother read it. So, you should automatically redirect them after joining to a welcome page with all the rules.
  8. ChinaPaw
    Hi, Mark:
    The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?
  9. ChinaPaw
    Hi, Mark:
    The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?
  10. ChinaPaw
    Hi, Mark:
    The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?
  11. Geraldces
    Mosts chapters have exercises but I have not provided solutions on the CD because I would like the reader to have a go.



    So, if you have questions, ideas, answers please post here.



    I will give solutions in stages...
  12. ChinaPaw
    Currently there is multiple bugs with doing this with the 3ds, assumeing that you can work out the buhs, how will you adapt to the newest game? Aka: X and y? and maybe Z
  13. ChinaPaw
    Hi, Mark:
    The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?
  14. ChinaPaw
    Hi, Mark:
    The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

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