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Discussion in 'USMLE Step 2 CK' started by orthopod, May 16, 2015.

  • by orthopod, May 16, 2015 at 8:02 PM
  • orthopod

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    If you find an incorrect answer, or an answer that I have not included here, let me know, and I'll make the change. A correct answer means that you correctly selected it on your version and it did not show up in your 'extended feedback.' You can discuss question topics here, or in a separate thread. It’ll take some time to transcribe all the questions, so I’ll continue to edit/update/add questions over the next few days.

    Block 1 part 1
    1. 22yo Primi admitted in labor. Pregnancy was complicated by 3 UTIs, the last one at 22 weeks gestation. She’s now taking daily nitrofurantoin. Pt is otherwise healthy. What’s causing the recurrent UTIs?
    - Urinary Stasis

    2. 4yo boy with 3-day hx of cough, fever, runny nose. No wheezing, vomiting, or diarrhea. 75th %ile for height, and 10th %ile for weight. T 37.5. Cap refill is 2 sec. Exam shows clear rhinorrhea. Breath sounds normal. There is a media tab to view the cardiac exam. Dx?
    - URI

    3. 42yo woman with generalized weakness, lethargy, and double vision for 2 weeks. Chest X-ray shows upper anterior mediastinal mass. Dx?
    - Thymoma

    4. 4mo old brought to ER after an apparent seizure. Pt has vomiting 6 times over the last 2 days, feeding poorly, and sleeping more than usual. Pt is lethargic and afebrile. Anterior fontanel is tense, bilateral retinal hemorrhages. Dx?
    - Child abuse

    5. 52yo man with excruciating pain/swelling of his great toe since undergoing appendectomy 10 days ago. Celecoxib has provided no relief. Temp is 37.6. Exam shows red/swelling great toe and tender MTP joint. Most appropriate next step?
    - Indomethacin

    6. During a sports physical, a healthy 14-yo boy has a BP of 150/90. Previous BP checks have been normal. 6 ft 2 in and weights 180 lb. BMI is 24. Exam is normal otherwise. Most appropriate next step?
    - Repeat BP check in 4 weeks

    7. 19yo man brought to ER by police after found standing in his neighbor’s living room in the middle of the night. He is conscious but remains mute during questioning. Temp 37C, respirations 18/min, BP 160/95. Exam shows bilateral nystagmus, constricted pupils, hypertonia, and decreased sensation to pinprick. Substance?
    - PCP

    8. Officer investigates an outbreak of illness at a picnic. Onset of nausea and vomiting 3 to 4 hours after attending the picnic. All those affected recover without Rx. Egg salad was the vehicle of transmission. What is the factor most commonly contributing to an outbreak of this type?
    - Inadequate refrigeration of implicated food

    9. 2 days after beginning ACTH therapy for MS, a 47yo woman exhibits bizarre behavior. She is easily angered and thinks the nurses are terrorists. She’s been pulling out her IV and walking down the halls at night. Muscle strength in lower extremities is 2/5. On mental status exam, she is fidgety, labile affect, and is easily distracted. Oriented to person, but not place or time. Most appropriate Rx?
    - Haloperidol

    10. 50yo F with 5-year Hx of metastatic breast cancer has SOB for 8 hours. Pulse 116/min, resp 32/min, BP 90/60. End-inspiratory crackles heard at base of both lungs. JVD present. Distant heart sounds. ABG shows: pH 7.50; Pco2 28; Po2 78. XR shows cardiomegaly, ECG shows alternating QRS amplitude patterns. Echo shows paradoximal motion of the interventricular septum and a pericardial effusion. Most appropriate next step?
    - Pericardial window.

    11. 14 month boy brought in for well-child exam. Mother is worried because he is not yet walking on his own. He will stand for several seconds before falling. He can empty raisins from a cup and tries to eat with a spoon. 25th %ile for length and 30th %ile for weight. Exam shows no abnormalities. Most appropriate next step?
    - Reassurance

    12. Asymptomatic 23yo M in for preemplyoment evaluation. Exam shows normal findings. PPD shows 16 mm of induration & erythema. He has had no previous PPD tests and hasn’t been exposed to anyone with active TB. XR shows no abnormalities. Sputum contains no acid fast bacilli. Most appropriate next step?
    - Treat latent TB now

    13. Previously healthy 26yo M in ER with SOB for 3 weeks and painful bumps on his legs for 1 week. T 38.2, P 80/min, BP 140/85. Exam shows 2- to 3-cm tender, red nodules on anterior shins. CXR shows bilateral hilar fullness. Which serum abnormalities is most likely in this patient?
    - Increased calcium

    14. 47yo F with fever, nausea, vomiting, and severe headache for 24 hours. T 39. Exam shows weakness of right upper extremity and nystagmus, optic fundi cannot be visualized. Kernig sign is present. Most appropriate next step in diagnosis?
    - CT of head

    15. 47yo F brought to ER 30 minutes after a MVC, unrestrained driver. Severe neck pain and mild chest and abdominal pain. P 95/min, Respirations 20/min, and BP 120/80. Exam shows severe tenderness of the cervical spine at C5. Bruise and mild tenderness over lower sternum and upper abdomen. Neuro exam is normal. CXR is normal except for slightly widened mediastinum. Cervical spine XR shows C5 facet fracture. Abdominal XR is normal. Most likely location of the life-threatening cardiovascular injury?
    - Thoracic aorta

    16. 18yo primi at 37 weeks’ gestation admitted in labor. Regular contractions every 3 minutes. Pregnancy complicated by several episodes of genital herpes, most recent episode 6 weeks ago. No lesions or prodromal symptoms since last episode. Vaginal exam shows no lesions. Membranes are intact. Fetal movement has been appropriate. Cervix 100% effaced, 5cm dilated, vertex at -1 station. Most appropriate next step?
    - Amniotomy and vaginal delivery

    17. 4yo girl with 5lb weight loss during the last 2 months. No Hx of illness, on no medications, immunizations up to date. 50th %ile for height, 25th %ile for weight. Occasional crackles over right middle lung field. Intradermal testing with PPD, tetanus, and antigens for candida and trichophyton is nonreactive at 72 hours. WBC count is 5100. Nucleic acid hybridization testing of gastric aspirates shows TB. Most likely explanation?
    - T lymphocyte dysfunction

    18. 27yo F with 5 day history of headache, severe, diffuse abdominal pain, nausea, vomiting. Pain is exacerbated by eating and relieved by vomiting. Vomitus originally had semisolid content with green fluid, and now only contains clear yellow fluid. Hx of Crohn dz treated with prednisone, tapered over the last 2 weeks, mesalamine, and azathioprine. LMP 7 weeks ago. Sex w/ 1 partner, use condoms inconsistently. Temp 38.4, P 120/min, Resp 22/min, BP 90/50. Dry oral mucosa, pale conjunctiva, distended abdomen, diffusely tender and tympanic. Decreased bowel sounds. Pelvic exam is normal. Labs: HCT 31% WBC 15k, amylase 300, lipase 9. Dx?
    - SBO

    19. 37yo F with malaise, muscle aches, painful vulvar blisters, vaginal discharge, and dysuria for 3 days. Had sex with new partner 7 days ago. T 38. Exam shows bilateral painful inguinal lymphadenopathy and numerous 1-3 mm vesicles and ulcers on labia majora and minora, perineum, vulva, mons pubis. Next step in diagnosing these lesions?
    - Cx for herpes

    20. 52yo F with personality change since death of close friend 2 weeks ago. Irritable, less sleep, speaks rapidly, jumping from topic to topic. She’s had past episodes excessive sleeping, decreased energy, and loss of interest, but never thought these symptoms were severe enough to seek medical attention. Mental status exam shows loud, rapid speech, and flight of ideas. She says she is not sad, but rather uplifted by her friend’s death. She hears her friend’s voice and communicates with her. Dx?
    - Bipolar d/o

    21. 6 hours after CABG, 62yo experiences drop in BP from 120/80 to 100/85. Urine output decreases from 60 to 10 mL/h, and cardiac output decreases from 6 to 3 L/min. Pulmonary artery diastolic pressure has decreased . CXR shows widened mediastinum. Most appropriate next step?
    - Surgical exploration of mediastinum

    22. Homeless 66yo M with jaundice for 1 week. Eats irregularly, 20lb weight loss, over the past year. 20-year Hx of alcoholism. Icteric sclerae, palmar erythema, and spider angiomata. Serum Mg is 0.8. Serum studies most likely to show?
    - Decreased Calcium

    23. 24yo F with amenorrhea for 7 days. 8-year Hx of anorexia. Compared to other women her age, she has an increased risk for?
    - Osteoporosis
     
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Comments

Discussion in 'USMLE Step 2 CK' started by orthopod, May 16, 2015.

  1. Princess
    URGENT PLEASE.

    Will clinical shelf exam 7 the self assessment flash required/ includes media item from form 6.

    Is it the same as above questions we have?
  2. aba
  3. aba
    1.
    An asymptomatic 60-year-old man comes for a follow-up examination 2 months after an episode of upper gastrointestinal bleeding from a salicylate-induced ulcer. An upper gastrointestinal series shows a healed ulcer and a type 1 (sliding) hiatal hernia. Which of the following is the most appropriate next step in management of the hernia?

    A Observation

    B Prescription for antacids

    C H2-receptor antagonist therapy

    D Laparoscopic Nissen fundoplication: wrong

    E Transthoracic hernia repair



    @orthopod : B is wrong, is it A or C?

    Thanks!
  4. aba
    A 62 y o man comes to the physician because of a 12 h history of fever and generalized muscle pain. he has leukemia treated intermittently w chemo through a right subclavian catheter. his temp is 39C (102.2 F). Exam shows a yellowish discharge at the catheter insertion site. a gram stain of the discharge shows gram-pos. cocci in clusters. cultures are ordered. In addition to removing the cath, which of the following is the most appropriate antibiotic tx for this pt?

    A azithromycin
    B clindamycin
    C extended-spectrum cephalosporin
    D gentamicin
    E vancomycin

    C is wrong.

    @orthopod Thanks
  5. aba
    A 56-y o woman w/ short-bowel syndrome caused by mesenteric infarction has had a diffuse maculopapular rash and hair loss since a 2-week hospital stay for total parenteral nutrition (TPN) . The pharmacy had inadvertently excluded the trace element supplement to her TPN. a deficiency of which of the following trace elements is most likely responsible for the clinical findings?

    A copper
    B iron
    C Manganese
    D selenium
    E zinc

    B is wrong.

    @orthopod Thanks!
  6. aba
    32 year old man comes to the doc with his wife with changes in behavior during past 2 wks. Four weeks ago, he witnessed a close friend die in car accident. On the evening of collision, pt offered to drive friend home after they had a few beers but friend declined. As the friend walked away from pt’s car, he was struck by a truck.the pt doesn’t remember much about the incident. During the past 2 weeks the wife reports that he has been awakening nightly in sweat and shouting “watch out” he has become emotionally distance and doesn’t want to socialize with his friends.he hasn’t driven his car in 10 d.he has difficulty sleeping and concentrating and says “things don’t seem real at times.” He says he used to drinkalcohol only rarely but lately he has been drinking 2 beers nightly for 3 wks to help him calm his mind and sleep. His temp is normal, pulse, resp, but bp is 145/80. No abnormalities on physical exam. He has a flat affect but is also irritable.he has not been feeling much of anything lately. He has thought about death frequently in the last 2 wks but doesn’t want to kill himself. What is most likely diagnosis?

    Acute stress disorder the criteria
    Adjustment disorder
    Bereavement (wrong)
    Dissociative identity disorder
    MDD
    Panic disorder
    Substance induced mood disorder.

    @orthopod Thank you
  7. orthopod
    Answer should then be E, vancomycin. At least until cultures return and you can tailor abx

    If B is wrong, answer must be E, zinc.


    I am unsure of the correct answer here.


    Then answer should be C, H-2 Rx


    Also, please do NOT post your same posts multiple times, it causes unnecessary clutter. Additionally, you can place multiple questions into one single post (as I did with my answers).
  8. bonesandbeers

    32 year old man comes to the doc with his wife with changes in behavior during past 2 wks. Four weeks ago, he witnessed a close friend die in car accident. On the evening of collision, pt offered to drive friend home after they had a few beers but friend declined. As the friend walked away from pt’s car, he was struck by a truck.the pt doesn’t remember much about the incident. During the past 2 weeks the wife reports that he has been awakening nightly in sweat and shouting “watch out” he has become emotionally distance and doesn’t want to socialize with his friends.he hasn’t driven his car in 10 d.he has difficulty sleeping and concentrating and says “things don’t seem real at times.” He says he used to drinkalcohol only rarely but lately he has been drinking 2 beers nightly for 3 wks to help him calm his mind and sleep. His temp is normal, pulse, resp, but bp is 145/80. No abnormalities on physical exam. He has a flat affect but is also irritable.he has not been feeling much of anything lately. He has thought about death frequently in the last 2 wks but doesn’t want to kill himself. What is most likely diagnosis?

    Acute stress disorder the criteria
    Adjustment disorder
    Bereavement (wrong)
    Dissociative identity disorder
    MDD
    Panic disorder
    Substance induced mood disorder.

    @orthopod Thank you
    I am unsure of the correct answer here. I put acute stress and it was correct. Let me know if you want me to explain.



    1.
    An asymptomatic 60-year-old man comes for a follow-up examination 2 months after an episode of upper gastrointestinal bleeding from a salicylate-induced ulcer. An upper gastrointestinal series shows a healed ulcer and a type 1 (sliding) hiatal hernia. Which of the following is the most appropriate next step in management of the hernia?

    A Observation

    B Prescription for antacids

    C H2-receptor antagonist therapy

    D Laparoscopic Nissen fundoplication: wrong

    E Transthoracic hernia repair



    @orthopod : B is wrong, is it A or C?

    Thanks!
    Then answer should be C, H-2 Rx . I put omeprazole and it was correct.
  9. bonesandbeers
    Was there every a consensus on the breast cancer question --> obtundation in 24 hours (Na vs Ca, high vs low)

    Why do you use IFN alpha in the hep C/Cryoglobulinemia question?

    What med do you use for BPH if doxazosin can't be used (I think the patient had severe orthostatic hypotension)?

    Patient with metastatic breast cancer, back pain and leg pain for 5 days: her pain was so acute, why is it ok to just giver her more morphine before a workup?

    Patient with DVT, PE, dyspnea, leg edema, JVD, and ascites and the answer was cor pulmonale... I thought cor pulmonale was from LEFT heart failure and this question stated that the xray showed NO pulmonary edema which indicated no LHF to me. So how is my thinking wrong?

    Patient had obvious signs of an aortic dissection and really high blood pressure, how to treat?

    Thanks!
  10. orthomyxovirus
    Yes, earlier there was a post confirming High Ca from breast cancer, someone selected that and got it right.

    My question: 28. Sexually active 24yo M with painful sores on his penis for the past 5 days. There’s lymphadenopathy. No fever/chills. Lesions are shown. Dx?
    -Genital herpes

    Why is it not chancroid (haemophilus ducreyi)? Also consists of painful ulcers.
  11. usmle-riss
    @orthopod
    Hi, I was wondering if perhaps you were aware of the answer for the following question and if you could explain why it's the answer. THANKS!

    Question from block 3 that was not posted:

    8yo boy with facial swelling in the setting of URI sx and hx of multiple such events with tracheal intubation for two prior occurrences. One event of swelling occurred after patient fell and cut lip on the sidewalk. Hx of similar events in father, paternal aunts, paternal cousins. Exam: HR110, otherwise VS WNL. non-tender swelling of lips and tongue with stridor on exam. What is the likely serum abnormality?
    a. antinuclear antibodies
    b. C1 esterase inhibitor
    c. C8
    d. Eosinophil count
    e. IgA
    f. IgE
  12. neurohero
    This patient has a C1 esterase deficiency, also called hereditary angioedema, an "autosomal-dominant disorder with recurrent episodes of angioedema lasting 2-72 hours and provoed by stress or trauma. Can lead to life-threatening airway edema." FA for Step2 7th ed, Pediatrics, Immunodeficiencies, table 2.13

    History of trauma and random lip swelling is a hint.

    '...similar events in father, paternal aunts...' is saying that it is autosomal dominant.

    'stridor on exam' is the imminent life-threatening airway edema.

    Alternative question stem: history of episodes of abdominal pain. The angioedema may also occur in the bowel resulting in pain. But they must give you some sort of facial swelling history for the most part, not just abdominal pain episodes in an otherwise healthy young adult / child.
    Other/tx: don't give this person an ACE-I
  13. usmle
    i think ans is D, coz he was hypotensive.. ARF, tubular necrosis
  14. youngbigpoppa
    Block 4 Q 16. Previously healthy 10yoF w descending itchy rash for 2d. Had fever, headache, malaise 2wk ago. No pharyngitis. Picture shows erythematous cheeks with perioral sparing. Similar rash throughout body. What to do next?

    Correct answer: No pharmacotherapy.


    What does this patient actually have??? Thanks!
  15. usmle
    this is a case of parvovirus b19? slapped cheek appearance. no treatment, only supportive theray given
  16. VIRUS93
  17. Adims J
    Well done please could you post NBME 8 step 2 answers and explanation. thank you
  18. Adims J
    @orthopod , could you please post NBME 8 answers and explanation. thank you

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