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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. orthopod
    Thanks! Can you provide an explanation for us?
  2. Sauga
    Bartholin's cyst is only a blockage of Bartholin's duct and Bartholin's cyst in turn can become infected and form an abscess (Bartholinitis/Bartholin Gland Abscess) symptoms (pain) and treatment usually depends on the size of the abscess.
    In case anyone else wants to add anything to this Q/A, these were the other options in the question;

    Episiotomy inclusin cyst
    Mesonephric (wolffian duct cyst)
    Sabaceous cyst
    Vestibular gland cyst
  3. orthopod
    So how come the question reports a nontender mass, whereas a Bartholin cyst would be painful...?
  4. SmashUSMLE
    First of all, thank you so much for the post, its defo been very helpful.
    The correct answer for cancer patient is HyperCa- I got it correct online.

    Can you explain why we do Renal USG in the 62 yo lady admitted for Ovarian tumor, who had 11 kg wt loss, exam showing adnexal mass, BUN 80, Cr 5.7 with trace protein in urine? Doesn't this look like some intrinsic cause of renal failure?

    The question about MG- pt with droopy eyes and not being able to abduct right and adduct left eye- and of which was decreased Ach receptors- I have 1 querry. So MG can affect eye muscles also? Which one didn't affect eye muscle? Was it botulism? Probly not since Botulism is not releasing Ach. But there certainly was something.

    Please shed some light in the 4 yo girl with cough wt loss, Crackles right mid lung field with gastric aspirate showing MTB. Answer of which was T-lympho dysfxn.

    Why do we discharge the 42 yo man who had 50-100 RBC just encouraging fluid intake and not giving him Abx? Thou there was no fever or sig WBC in urine, he had costovertebral angle tenderness.

    PCP intoxication should be belligerent right? Why is this guy mute? Perhaps the nystagmus part was give away here.

    So Methamphetamine has crawling hallucinations too? I thought that was for LSD.

    An 18 yo woman has had fever 12 hrs and obtundation 4 hrs. She had been attending a summer camp with 120 other students and was well until yesterday, when she developed a sore throat and nonproductive cough; this morning she couldn't be aroused. T= 101.5, P= 120, RR= 30, BP= 80/50. Extremities cool. Skin lesion shown over her extremities, chest and abdomen. Hsct 41%, leuko 21200 with shift to left. Dx?
    A. Acute lyme disease
    B. Cocaine OD
    C. Meningococcemia
    D. Pseudomonal sepsis
    E. TSS- is wrong.

    Previously healthy 82 yo woman comes because she is concerned she has Parkinson Disease. Over 6 months, she has had occ difficulty finding word that she wants to use, her ability to distinguish smells has decreased. She reports that her reaction time to shifts in posture seems slow, and she needs to use a handrail to steady herself while walking on stairs. She loves alond, able to manage her own finances. Pupils 3 mm, mild reduction of upward gaze andbrisk rotatory nystagmus on left lateral gaze. Audio- high frequency hearing loss. No tremor or rigidity. Gait is normal. MMSE 29/30. Which of following warrants further evaluation?
    A. Brisk rotatory nystagmus on left lateral gaze
    B. Dec sense of smell- is wrong
    C. Dec upward gaze
    D. High- pitched tone hearing loss
    E. Small symmetric pupils.

    The achalasia question: Is it dec esophageal peristalsis and increase LES tone in manometry?

    A 32 yo man brought to ED by a firend because of sudden onset of confusion and agitation. He has long-standing H/O schizoaffective disorder, depressed type. 5 days ago, a new med was added to his regimen because of auditory hallucinations, but he is not sure what it is. He rarely drinks alcohol and does not use illicit drugs. He is confused and does not know why he is at ED. His T 103.1, P 110, RR 28, BP 160/100. Neuro exam shows muscle rigidity. His leukocyte count in 15000 CK 950. Which of the following NT is most likely responsible for this pt's condition?
    A. GABA
    B. Dopa
    C. Glutamate
    D. Histamine
    E. NE
    F. Serotonin
    Should be Dopamine? I always get confused with Serotonin syndrome and this one.

    What was the answer to Type I sliding hiatal hernia Mx?

    72 yo woman has hypoNa 3 days after admission to hospital after cerebral infarction. She has been receiving 5% Dex in 0.45% saline since admission. urrent med are phenytoin and atenolol. She has expressive aphasia. P= 86, RR- 16, BP 130/86, Exam shows right dense hemiparesis. Lab: Na: 120, Os:255. Urine Na: 50, Osm 358. Is it d/t SIADH? What's the cause of SIADH?

    4 yo boy develops chickenpox 8 hrs after visiting his NB sister in nursery. Six other full term NB were also exposed, all of the mothers have a H/O chickenpox prior to pregnancy. Which of the following is most appropriate recommendation to prevent chickenpox in NB?
    A. Acyclovir for all exposed
    B. Varicella vaccine to all exposed
    C. Vacine to NB with negative varicella titers
    D. Isolation of NB from each other
    E. No intervention is necessary.

    A 67 yo man has had an ulcer on ant surface of leg just above ankle for 2 wks. He had MV replacement 15 yrs ago because of Rheumatic valvular disease. Takes furosemide for CHF and oral hypoglycemic for DM II. Exam- 5 cm ulcer with 3 mm red border. There is moderate edema from toes to midcalf bilaterally; his feet are warm, pulses weakly palpable. Scattered crackles are heard at lung bases B/L. Dx?
    A. Arterial insuff
    B. Endocarditis with metastatic infection
    C. Meleney ulcer
    D. Mucormycosis
    E. Stasis dermatitis with ulcer

    6 wk old forceps delivery, torticollis. 2 cm hard, nontender, oval mass is palpated in right side of neck. Most likely cause?
    A. Abscess of cervical LN
    B. Fibrosis of SCM
    C. # of clavicle
    D. Hemivertebra of - spine
    E. Mal tumor
  5. SmashUSMLE
    Few more qsns

    52 yo woman 2 wk H/O progressive SOB. SOB when walking across room. 8 yrs ago, Dx of breast cancer, underwent mastectomy followed by chemo. Annual exam- no recurrence. T= 98.6, P= 90, RR- 24, NP- 130/80. Exam shows no JvD. Dullness to percussion over lower half of Right lung. Left lung is clear to auscultation. Heart sounds normal. No peripheral edema. Which of the following is like cause of dyspnea?
    A. Hypothyroid
    B. LV dysfxn
    C. Pericardial tamponade
    D. Pleural mets
    E. Rt lower lobe pneumonia

    NB with B/L clubfoot deformity. Born at term following uncomplicated preg and delivery. Did not more his lower extremities immediately after birth, did not cry when he receied a needlestick in his feet. On exam, he is vigorous and moves his upper extremirites but not his lower extremities. Bladder is palpable and full, Dx?
    A. Cerebral palsy
    B. Congenital hip dysplasia
    C. GBS
    D. Muscular dystrophy
    E. Spinal dysraphism

    22 yo college student is brought by friend for 1 month H/O difficulty sleeping and increasing paranoia. His friend reports that the pt has become suspicious of his roommates and has expresse concerns about effects of dorm food on his health. He often stays awake until 3 am watching for strangers in the vicinity of his building. His school performance has deteriorated, and he has become socially withdrawn. He admits to occ use of marijuana. He appears tense and restless. P/E- no abn. Mental status exam- anxious mood and audtory hallucinations. Urine toxicology screening is negative. Next step in Mx?
    A. Biofeedback
    B. Carbamazepine
    C. Clonazepam
    D. Clonidine
    E. EEG
    F. Exposure therapy
    G. Lithium carbonate
    H. Midaz
    I. Olanzapine
    J. Pentobarb
    K. Sertraline

    47 yo man comes to ED for 3 day H/O N/V, buning nonradiating epigastric pain. He notes that hte vomitus was initially yellowish, but last 2 episodes were darker. He consumed 1 pint of whiskey 4 days ago. Takes no medications. On arrival, he is awake and confused. T= 99.3, P= 128, RR- 12, BP- 90/50. Skin is cool and clammy. Cardiopulmonary exam shows no abn. Ab exam- diffuse tenderness w/o rebound. Neuro- no focal or sensorimotor abn. FOBT-ve. CXR- fine. ECG- sinus tachy. Cause of abn vital signs?
    A. Cardiogenic shock
    B. Eso rupture
    C. Hypovol
    D. Pulm emboli
    E. Septic shock

    New vaccine for HIV, tested on prisoners, Early parole. Concern?
    A. Coercion of vulnerable population
    B. Conflict of interest
    C. Failure to use an app placebo
    D. Inadequate informed consent
    E. Lack of generalizability

    10 yo girl fever and joint pain 5 days. T= 103, P = 120, RR= 24, BP= 110/70. Precordial heave. Gallop and grade 3/6 holosystolic murmur in 4th IC space at midclavucular line. Elbow and knee tender. GAS, ASO increased. Should be Mitral regurg, realized the midclavicular line while typing it here.
  6. orthopod
    I've answered your questions in the text above, in bold.
  7. orthopod
    Answers are bolded above.
  8. SmashUSMLE
    Thank you for your reply Orthopod! By FA do you mean FA Step 1?
  9. orthopod
    I mean FA Step 2. The relevant clinical info from FA step 1 should be in FA2 as well. I found FA1 to be pretty useless for step2 studying, but that's just me. If you need help with resource selection, check out the other threads in this forum.

    Let me know if you have any other questions!
  10. pnf306414
    HI, thank you for this post!

    Do you mind explaining? What's the Dx here?

    THanks!
    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
  11. orthopod
    Thanks for the post, @pnf306414

    Sarcoidosis. Tender skin nodules = erythema nodosum. The lung further suggests sarcoidosis. You should know the common labs associated with sarcoidosis. I know that you expect sarcoidosis in a 50yo AA female, but you can see it in others too!
    Rashyda O likes this.
  12. pnf306414
    you're right thanks!! the male patient confused me
  13. orthopod
    Don't be scared to go with your gut!

    Don't forget to keep posting any questions you have, and post your exam experience in the exam thread after your test! Good luck!
  14. pnf306414
    Thanks!
    I got these right:

    20. 55yo F with metastatic breast cancer admitted for confusion progressing to obtundation over past 24 hours. Barely arousable. Most likely abnormal serum concentration?

    - NOT Increased sodium

    - May be decreased sodium (by way of SIADH), or increased calcium (PTHrP). Someone please let me know if they got this question correct.


    Answer is increased calcium (PTHrP)


    16. 24yo F primi at 38 weeks' gestation admitted in labor. Spontaneous ROM 2 hrs ago. Contractions are moderate and occur every 5-6 min. Was treated at 20 wks with ampicilin for GBS UTI. Temp 37C, p 82/min, resp 18/min, BP 122/74. Cervix 2 cm dilated and 80% effaced; vertex at -1 station. Most appropriate rx to prevent GBS infection in the newborn?

    - ?? Answer is NOT 'No prophylaxis indicated' so it might be IV penicillin G


    Answer is IV pencillin G (it could be penicillin G or Ampicillin)
  15. orthopod
    Thanks @pnf306414 , hopefully you can contribute more questions/answers as I post more questions in the various threads
  16. Kagman
    Hey orthopod, I just joined this site & I really appreciate your posts and explanations.

    I had some doubts with these qns. Could you help me out ?

    Q]
    47yo M with 9-mo Hx of constipation and 2-mo hx of blood in stool. Sx partially relieved by stool softeners and laxatives. Has hypercholesterolemia rx with atorvastatin, and had appendectomy at age 26. Vitals normal. Cardiopulmonary, abdomen exam normal. Rectal exam shows external hemorrrhoids. Positive occult blood test. HCT is 35%. Most appropriate next step in management?

    Why is it colonoscopy ? Cause of the FOBT ? I thought FOBT would be positive even with Hemorrhoids ? or is it also cause his Hct is way too low to be caused by just Hemorrhoids in 2 months ?

    Q]30. 72yo M with SOB for 3 days. Hx of HTN and CAD. Receiving 2 L/min of O2 via nasal canula. Temp 37C, P 110/min, resp 20/min, BP 150/80. Bilateral crackles and wheezes. HCT is 28%, leukocyte count is 8000. Pulmonary artery cath shows cardiac index of 2 L/min (N = 2.5 – 4.2) and a pulmonary artery occlusion pressure of 28. ABG shows pH 7.49; Pco2 30; Po2 58. Most appropriate next step in management?

    Its obviously pulmonary edema. But wouldn't you want to first intubate him since he is hypoxemic and by following ABC ?
  17. usmleuser
    Thank you so much for posting these. You are amazing. Could someone help me with these?

    Block 3 questions:

    2. 14yo boy with 6-month Hx of left knee pain exacerbated by activity. No Hx of injury. He has grown 3 inches over the past 6 months. His older brother had similar Sx at the age of 13 years. Normal gait, ROM is normal. Tenderness over left tibial tubercle. No joint effusion, knee joint is stable. Mechanism?
    - Repeated microfracture at the tendon insertion


    Very confused how I was supposed to know this answer? It says no history of injury?

    7. 67yo M with fatigability & generalized weakness for 3 mo and chest pain for 1 mo, which is worse on deep inspiration. He appears slightly pale. Tenderness over left 8th and 9th ribs. HCT 28%. SPEP and UPEP show monoclonal spike. BM biopsy shows greater than 50% plasma cells. CXR shows 1.5cm areas of radiolucency in 8th/9th ribs. He's most susceptible to infection with?
    - S. Pneumoniae

    why is someone with MM more susceptible to strep pneumo? Is it because he is susceptible to PNA? And strep pneumo is the most common cause?

    29. Five days after open splenectomy for ITP, 57yo F has SOB. Only med is morphine. Temp 37.3C, p 80/min, resp 20/min, BP 120/80. Surgical wound appears normal. BS decreased at left lung base. WBC 15.6K, platelets 112k, amylase is 90U/L. Most appropriate next step in management?
    - CXR

    what are we thinking here? I was thinking pulmonary embolism?
  18. usmleuser
    I had a question that isn't on here from Block 3:
    a 37 yo M persistent numbness in hands/feet for 10 months, weakness in L wrist for 3 weeks. He renovates old houses. he has abdominal pain and diagnosed with gastritis. BP is 135/95. mucous mb pale. Neuro exam shows weakness with dorsiflexion of L wrist and loss of sensation in stocking glove distribution. He has low hematocrit and BUN is 35. Blood smear shows microcytic hypochromic erythrocytes. Early tx with what would have prevented him?

    It sounds like B12 deficiency, but choices were Ca disodium edetate, disulfiram, iron sulfate with vitamin C, predinisone and cyclophosphamide, B1 and B6.

    Not sure why B6 is wrong, because it can cause a peripheral neuropathy.

    Another q from Block 4:

    patient with cryoglobunemia and hep C. biopsy confirmed. ALT AST elevated. hep C virus RNA positive and Ab to hep C positive. Tx with ?
    azathioprine, cyclophosphamide, inferonalfa, IL2, nelfinavir( WRONG) or prednisone?

    not sure if hep C is negative?

    11. 47 yo man comes to ED for 3 day H/O N/V, burning nonradiating epigastric pain. He notes that hte vomitus was initially yellowish, but last 2 episodes were darker. He consumed 1 pint of whiskey 4 days ago. Takes no medications. On arrival, he is awake and confused. T= 99.3, P= 128, RR- 12, BP- 90/50. Skin is cool and clammy. Cardiopulmonary exam shows no abn. Ab exam- diffuse tenderness w/o rebound. Neuro- no focal or sensorimotor abn. FOBT-ve. CXR- fine. ECG- sinus tachy. Cause of abn vital signs?
    - Hypovolemia

    for this one, how do you know it's hypovolemia and not cardiogenic shock? in septic shock, would the skin be warm not cool and clammy?
  19. orthopod
    1. Positive fobt in anyone close to 50 years of age buys them a colonoscopy. You do NOT want to miss colon cancer!! Low HCT may further suggest colon cancer, but that's not the main point here.

    2. Why would you intubate her? Intubating involves sedation, a tube down your throat, etc... It's not like she's coding, or that she's going to die in the next few minutes that she needs intubation (Plus, intubation won't even get rid of her pulmonary edema...diuretics will).

    Hope that helped!
  20. orthopod
    2. Osgood–Schlatter disease is classic for this presentation! No Hx of injury, and wirh the right age and rapid growth spurt, this is an easy one. Make sure you know the causes of orthopedic pain in kids (transient synovitis, aseptic hip, SCFE, growing pains, etc...)

    7. S pnuemo IS the most common cause of community acquired pnuemonia. MM causes you to overproduce useless antibodies, so you don't have any good ones lying around, leaving you more prone to infection! The mechanism is more step 1 related, but you should know all the signs/Sx of MM and the complications of MM!

    29. What made you think of a PE? And even if you did, a CXR is still the first step.

    Hope that helped!

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