Kim! Hi! It’s your dad!👋 ▪ Khalilah, I’m proud of you for taking a risk for your dream.Everyone’s explanations tend to be so on-point, and the commiseration makes me feel better, too!Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!                       want to add a fly-by? email us! 😊
share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
search for anything NEW!
That other exam …
=> Step 2 CK Free 120
=> Step 2 CK Form 6
=> Step 2 CK Form 7
=> Step 2 CK Form 8

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

Recent comments (see more)

... stunna216 made a comment (free120)
 -1  submitted by stunna216(0)

why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion?

csalib2  heads up, i think you’re in the wrong question thread +
... an1 made a comment (nbme20)
 +0  submitted by an1(4)

the child was in a daycare, sonnei and rotavirus are the ones to keep in mind. sonnei can also be due to unwashed veggies too. and the inflammatory stool (neutrophils) also indicates sonnei. the lack of exposure (undercooked meat for EHEC) helps to rule out E.Coli. dirty water (ETEC and EIEC) aren't possible because of this kids bloody stool. Also for this to be HUS (the only possible E.Coli with bloody diarrhea), we should have seen the triad or at least something about it (anemia + thrombocytpoenia + Acute Renal Insuff.). Also, "mucoid stools" is right from the FA chart for shigella.

... an1 made a comment (nbme20)
 +0  submitted by an1(4)

I just used common sense to rune out the answers here. Firstly, knowing that cortisol is increased during times of stress (starvation; like this stem). Insulin causes hypoglycaemia so the body wouldn't produce more in a stressful state (expect glycogen to be higher). IGF-1 acts like GH and these states of growth require energy which this man clearly doesn't have. There wasn't enough to support testosterone and T3 changes so those were ruled out pretty quick.

... chj7 made a comment (nbme20)
 +0  submitted by chj7(1)

Side note for those of you who hate familial dyslipidemias: don't usually watch dirty USMLE videos but I couldn't keep the familial dyslipidemias straight in my head and someone on reddit recommended his video on this. Personally found it really helped.

... failingnbme made a comment (nbme20)
 +0  submitted by failingnbme(1)

scary crying old ostrich man that's all I can see :O

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

This man likely has ALS-> weight loss, progressive weakness causing him to now be in wheelchair, dysphagia, no PMH, fasciculations. It is a mix of upper and lower motor neuron deficit and MOTOR ONLY. Because muscles will not be stimulated, they will atrophy. "USE IT OR LOSE IT"

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

SUBACUTE COMBINED DEGENERATION (B12 deficiency):

Spinocerebellar tract -- Unconcious proprioceptive sensation. 'tingling'

Lateral Corticospinal tract -- Controls ipsilateral limb fine motion. 'weakness of extensors and flexor muscles. exaggerated reflexes'

Dorsal Column -- White matter in posterior. Made of gracille and cuneatus fasciculi. Gracile is for lower body sensory and cuneate is upper body sensory. 'decreased sensation to vibration and position'

-initially i put B6 because of descriptions of peripheral neuropathy, but the decreased vibration/proprioception was the key differentiator

... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

This homing phenomenon may be related to tumour cell recognition of specific “exit sites” from the circulation or to awareness of a particularly favourable—or forbidding—“soil” of another tissue. This may occur because of an affinity that exists between receptor proteins on the surface of cancer cells and molecules that are abundant in specific tissues.


FA 2020, pg 221, "Hallmarks of Cancer"

Metastasis is defined by distant spread via blood/lymphatics --> binding to endothelium --> extravasation & homing.

Since metastasis to only one organ has been affected, it's safe to say this liver cell surface antibody has affected "homing" towards the liver.

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

ACE inhibitors are associated with oligohydramnios, renal failure, hypocalvaria. - FA2019 pg600; FA2020 pg 614

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

"Ileal (Meckel) diverticulum occurs when a remnant of the vitelline duct persists, thereby forming a blind pouch on the antimesenteric border of the ileum. It is often asymptomatic but can become inflamed if it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration. It is typically found 2 feet from the ileocecal junction, are 2 inches long, and appears in 2% of the population."

Kaplan 2020 Book.

Antimesenteric seems to be a buzzword for Meckels, saw this in UWorld as well (might have been one of the UWSA).

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

Damage to orbital floor can lead to impaired vertical gaze (ocular movement is restricted)via entrapped inferior rectus, numbness and paresthesia of the upper cheek/lip/gingiva, enophthalmos. UWORLD qid:11742, same concept

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

According to UW qid:839 "The membranous segment is relatively unsupported by the adjacent tissues and is the weakest point of the posterior urethra. Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the bulbomembranous junction." The presence of a pelvic fracture and presence of blood at the urethral meatus are key signs of urethral injury.

... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(2)

the MAIN SUPPLY IS FROM THE INFERIOR THYROID ARTERIES. the little bit of blood received from the collateral (superior thyroid from external carotid) keeps them alive but now they sense low ca2+ --->>> so release tons of PTH... if the superior was knocked out = not a big deal --> not main supply to the glands.

** I copied @mistermbg explanation because he explains it really well!

... justanotherimg made a comment (free120)
 +0  submitted by justanotherimg(1)

why is the answer not choristoma?!!

... cassdawg made a comment (free120)
 +0  submitted by cassdawg(1390)

Atropine reverses acetylcholinesterase poisoning due to organophosphates

Bethanechol is an M3 agonist used to treat urinary retention

Physostigmine is an antidote for anticholinergic toxicity

... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(2)

This is the stupid way I've ever seen anyone ask a question

... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(2)

Di- and Tri- peptides can enter into enterocytes via PepT1 transporters and be broken down to amino acids within the enterocytes. Hence why the lumen is not the best answer

... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

Top 1/3: Esophageal branches of inferior thyroid artery, which is a branch of the thyrocervical trunk (option E)

Middle 1/3: Esophageal branches of thoracic part of aorta (option B)

Bottom 1/3: Esophageal branches of left gastric artery (which is branch of celiac trunk, which is branch of aorta) (option A)


FA 2020 pg 364: abdominal aorta --> celiac trunk --> left gastric --> esophageal arteries

... humbertodiaz93 made a comment (step2ck_free120)
 +0  submitted by humbertodiaz93(1)

This question has changed. Sept 23rd 2020. 2-day-old female with murmur. Next step in management: Observation only.

Some notes
❧ Comments submitted this year are scramble–resistant (Scramble–resistant Staphylocomment aureus)
leaderboard does not pay membership fee

2020 MVPs

The results are in.
Here are your undisputed, heavyweight champions of the world:

Help your fellow humans! (see more)

stunna216 asks (free120):
why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion? help answer!
csalib2  heads up, i think you’re in the wrong question thread +
arthur_albuquerque asks (nbme20):
What helped me to answer this one quite easily was the following rationale: Hypercalcemia + high PTH -> "primary hyperparathyroidism" How do high PTH lead to hypercalcemia? Increasing osteoclast activity! help answer!
shaz464 asks (step2ck_free120):
Still confused.. Can anyone rule out all other options please? help answer!
sizario asks (step2ck_form6):
how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH? help answer!
embeemee asks (step2ck_form7):
what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately help answer!
embeemee asks (step2ck_form7):
i get the answer, but would a VB even be possible given her GBS+ status? help answer!
usmile1  Yes, being GBS+ is very common and is not a contrainidcation for vaginal delivery. just give intrapartum IV PCN to prevent infection in the newborn +
embeemee asks (step2ck_form7):
the change from green liquid to yellow liquid threw me off. i was thinking gastric outlet obstruction that initially let out bile until it progressed further until letting out only stomach acid? help answer!
justanotherimg asks (nbme18):
This doesn't make sense to me at all. What will change by the time of the next appoinment ???? Or are they trying to say that his behaviour is normal ??? Isn't it excessive ?? help answer!
skonys asks (nbme23):
So are we supposed to just yolo this one? wtf help answer!
osler_weber_rendu asks (step2ck_form6):
Why is this not absence seizure? help answer!
yb_26  automatisms (lip-smacking, picking at his shirt collar) are seen in complex partial seizures. Also absence seizure lasts 10-20sec, not 1-2 minutes. +
osler_weber_rendu asks (step2ck_form6):
Why not paracentesis? Sharp chest pain, JVD, enlarged globular cardiac silhouette, and nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade. help answer!
aneurysmclip  Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +
charcot_bouchard asks (step2ck_form6):
I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue? help answer!
skonys asks (nbme23):
Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients) help answer!
brandoctor asks (familymed2):
I think this is pretty clearly HSV-2 genital herpes. Just to confirm though, the blister fluid culture was negative... so that just means the test isn't very sensitive I guess, yeah? help answer!
brandoctor asks (familymed2):
Okay, but why aren't we concerned about the Benzo (and it's anticholonergic properties) in the 67yo F? help answer!
brandoctor asks (familymed2):
Why not low NPV? Since you can't say that you DON'T have strep throat if the test is negative... Does this have to do this prevalence altering NPV? help answer!
jlbae asks (step2ck_form8):
Y'aLL dOn'T KeEp BlEaCH uNdEr YoUr SiNkS??!? help answer!
lindasmith462  i would but I don't have room with my lamp oil down there +
jlbae asks (step2ck_form8):
What would make normal lochia the correct answer? Please help I suck at ob/gyn. Am I at the character limit yet? help answer!
chaosawaits asks (nbme15):
Minor question: but isn't the anatomical snuff box the triangle between the extensor pollicis brevis and the EXTENSOR pollicis longus, not the ABDUCTOR pollicis longus? help answer!
chaosawaits asks (nbme15):
How does that picture help at all? Is it just for ruling out or can you rule in H. pylori with it? help answer!
chaosawaits asks (nbme15):
Wouldn't weight gain increase afterload due to increased peripheral resistance, which also increases AR? help answer!
stinkysulfaeggs asks (step2ck_form8):
Her BP is 160/90, why is that not being addressed by the question? help answer!
jmorga75  Alcohol is a risk factor for osteoporosis and hypertension. You get a twofer when you decrease the intake +
ih8payingfordis asks (nbme18):
Why can't this be renal artery stenosis? help answer!
ngill  Renal artery stenosis in females is commonly due to fibromuscular dysplasia. You would see hypertrophy in the unaffected side, assuming it's unilateral. Additionally, the person would like have HTN with activation of the RAAS due to the stenosed side. This would increase renin and then increase aldosterone which should lower potassium. +
jbrito718  renal artery stenosis is a cause of prerenal azotemia. the main cause here is the diuretic leading to volume depletion thus causing the azotemia. Renal artery stenosis is not implicated in this question +
specialist_jello asks (nbme13):
I get HOT T Bone STEAK IL 1 for fever but 90% neutrophils, why cant it be LTB4 neutrophil chemotaxis? help answer!
dentist  i picked LTB4 i guess the question itself is "which causes the patient's fever and leukocytosis" LTB4 wouldn't be a direct cause of fever. dumb question +
veryhungrycaterpillar asks (nbme23):
I used reverso logic. Terazosin is an alpha blocker, helps with urinary retention by relaxing sphincter smooth muscle. What would help constrict the same muscle? Stimulating the same receptor. Ez pz. help answer!
abk93 asks (nbme21):
Specifically, what is the purpose of Il-1 in this question? is it just that macrophages make Il-1? doesn't appear to be involved in granuloma formation. help answer!

Tag directory (see more)
vitamins visual_field_defect visualfielddefect vascular TSH transfusion syphilis surgery stroke skin SIADH schizotypal Saline rituximab restriction_enzymes Respiratory respiratory reproductive Repro repro renal RAAS psych protein_folding process_of_elimination prevalence pressure pregnancy post_partum postop porphyria Poorly_written_question physio physics phototherapy pharyngeal_arch pharmacology pharm personality_disorders penis

Some shelves are here, too!
=> Medicine 4
=> Family Medicine 2
=> Family Medicine 1

Leaderboard (see more)
  1. seagull
  2. sympathetikey
  3. cassdawg
  4. hungrybox
  5. hayayah
  6. yotsubato
  7. drdoom
Mercury Rising