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Recent comments (see more)

... xw1984 made a comment (free120)
 +0  submitted by xw1984(5)

Per FA, should aminoglycosides be used in gram negative infection? S.viridans are Gram positive.

... mrclean83 made a comment (nbme20)
 +0  submitted by mrclean83(0)

Black person here. Curly facial hair tends to curve back towards the skin a day or two after shaving. Hence the "pseudo" folliculitis. Not an infection but an inflammation from sharp edge of the hair growing into the skin. And yes it hurts! Generally sensitive to touch as well

... shieldmaiden made a comment (nbme15)
 +0  submitted by shieldmaiden(8)

I was between these two (cytarabine and imatinib) because I couldn't point out if it was AML or CML. I learned all of the usual clues for each one but I forgot about the fundamental difference of blasts vs mature forms (and that bands are bound to appear in CML too). If they give you a CML in the blast crisis, then look for Auer rods. Anyways, got it wrong and hope that won't happen again.

Now, understanding this I can see how the pharmacology works.

Cytarabine - AML (mostly -blasts and pro-cytes)

Antimetabolite, a purine analog, S-phase specific, inhibit DNA synthesis

Potent enough for the crazy proliferation going on

Imatinib - CML (mostly -cytes and a lot of basophils)

Tyrosine kinase inhibitor of bcr-abl and c-kit tumors

Antimetabolites can also be used, but the best answer is imatinib because it's the most specific for this type of cancer, as it turns off the pro-cancer switch (bcr-abl).

... mrizzle made a comment (nbme22)
 +0  submitted by mrizzle(0)

This book chapter describes this stuff well if you can access it through the library.

Regional Nerve Blocks in Anesthesia and Pain Therapy Traditional and Ultrasound-Guided Techniques pg.707

... shieldmaiden made a comment (nbme15)
 +0  submitted by shieldmaiden(8)

Irradiated blood destroys all nucleated cells, like in this case, we wouldn't want him to have foreign lymphocytes because it would cause GVHD for sure

Washed Blood eliminates plasma proteins, which is beneficial for patients with IgA deficiency for example

... feralbaskin made a comment (nbme20)
 +0  submitted by feralbaskin(0)

Shigella is the most likely causal organism over E. coli due to the vignette specifically stating the patient has had "bloody MUCOID stools with tenesmus."

Page 144 FA 2019 GI manifestations: Fever, crampy abdominal pain -> tenesmus, blood mucoid stools (bacillary dysentery).

Please correct me if I'm wrong, but I don't remember Sketchy mentioning bloody mucoid stools for E. coli and that detail doesn't seem to appear in FA.

... uic_23 made a comment (step2ck_form6)
 +0  submitted by uic_23(0)

This is acute rejection as stated in the question which is most commonly due to lack of proper immunosuppresion so you would increase the sterroid dose. If it was hyperacute or chronic it would be to remove the organ!

... yobo13 made a comment (step2ck_free120)
 +0  submitted by yobo13(2)

Bernard Soulier Syndrome has thrombocytopenia, otherwise looks similar to vWD

... cv020496 made a comment (nbme15)
 +0  submitted by cv020496(0)

Allergic contact dermatitis: Type IV hypersensitivity reaction that follows exposure to allergen. Lesions occur at site of contact (eg, nickel D, poison ivy, neomycin E ).

... idontlikemedschool made a comment (nbme18)
 +0  submitted by idontlikemedschool(0)

His lips are dry. Vaseline creates a barrier that prevents moisture from evaporating, which improves his dry lip symptoms.

In practice, it is often used to cheaply retain moisture in many dry skin conditions. A doc I once worked with recommended that you put it on psoriasis before bed, wrap it in plastic wrap to prevent it from rubbing off, and bam you're good to go.

... drmohandes made a comment (step2ck_form6)
 +0  submitted by drmohandes(100)

FYI, her triglycerides are also high (300 mg/dl), but need to be >1000 to be able to cause pancreatitis.

... drmohandes made a comment (step2ck_form6)
 +0  submitted by drmohandes(100)

I did not understand why you don't check renal function.

Doesn't lithium affect both thyroid and kidney? Also, she has no clinical signs of hypothyroidism, so I figured we need to check her renal function.

... cv020496 made a comment (nbme15)
 +0  submitted by cv020496(0)

Disregard for and violation of rights of others with lack of remorse, criminality, impulsivity; males > females; must be ≥ 18 years old and have history of conduct disorder before age 15. Conduct disorder if < 18 years old.

... shieldmaiden made a comment (nbme17)
 +0  submitted by shieldmaiden(8)

Itraconazole is given in an encapsulated formula which depends on an acidic pH to dissolve. PPIs like omeprazole increase the stomach's pH, thus decreasing the amount of itraconazole absorbed. Poor absorption does not allow itraconazole to reach its therapeutic plasma concentration. A solution for this would be to give the itraconazole via oral solution or IV.

... drmohandes made a comment (step2ck_form6)
 +0  submitted by drmohandes(100)

The pulling feeling weeks after incision is just scar tissue remodelling.

She only has mild tenderness w/ deep palpation , no pain, no fever, no redness, etc.

... drbubs made a comment (step2ck_form7)
 +1  submitted by drbubs(1)
  1. As other comments pointed out, since she has metastatic breast cancer she likely has a poor prognosis and pain management becomes the most important aspect of her care.

  2. 1mg SubQ morphine q3h is less morphine than she is receiving currently with 5mg morphine q4h PO.

Morphine equivalents for PO:IV morphine is 3:1. Let's assume IV and subQ are equivalent so the ratio remains 3:1. (Idk if they are or not, but IV would definitely be the most potent)

5mg PO morphine q4h = 30mg daily orally. So you would need 10mg daily either IV or subQ to match her current pain regimen.

1mg subQ morphine q3h = 8mg daily via subQ.

Thus, **the only answer choice that increases her morphine dose is increasing the frequency of her PO dosign to q3h.

... drmohandes made a comment (step2ck_form6)
 +0  submitted by drmohandes(100)

Patient with a recent URI, now a persistent productive cough without fever and clean CXR.

This is classic acute bronchitis.

Tx = supportive (NSAIDs + bronchodilators)

... bharatpillai made a comment (step2ck_form8)
 +0  submitted by bharatpillai(23)

Oh absolutely not. Primary myelofibrosis ALSO presents with splenomegaly, pancytopenia and immature myeloid cells in the periphery. WBC counts for CML are typically >50,000. WTF is this question?

... ranchistotallylegal made a comment (step2ck_form7)
 +0  submitted by ranchistotallylegal(0)

Why not HIDA? not therapeutic (ERCP is both dx + tx) + it is only used for suspected cholecystitis (not cholangitis) when U/S is equivocal.

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Help your fellow humans! (see more)

xw1984 asks (free120):
Per FA, should aminoglycosides be used in gram negative infection? S.viridans are Gram positive. help answer!
drmohandes asks (step2ck_form6):
I did not understand why you don't check renal function. Doesn't lithium affect both thyroid and kidney? Also, she has no clinical signs of hypothyroidism, so I figured we need to check her renal function. help answer!
bharatpillai asks (step2ck_form8):
Oh absolutely not. Primary myelofibrosis ALSO presents with splenomegaly, pancytopenia and immature myeloid cells in the periphery. WBC counts for CML are typically >50,000. WTF is this question? help answer!
ranchistotallylegal asks (step2ck_form7):
Why not HIDA? not therapeutic (ERCP is both dx + tx) + it is only used for suspected cholecystitis (not cholangitis) when U/S is equivocal. help answer!
rahmanu asks (nbme22):
How do you Ddx this and allergic reaction to the sun? I answered "first degree burn" in a more or less similar q in another nbme but got it wrong lol. WTH am I missing? help answer!
tinylilron asks (step2ck_form6):
Where can I find this information? I have not had my ICU rotation yet. I see in First Aid Step 2CK there is some information in the Pulmonary chapter but it is a long list and what is the high yield to remember? What is a good, fast, easy to understand source that I can use? help answer!
tinylilron asks (step2ck_form6):
Can anyone explain the correct answer for this one? help answer!
tinylilron asks (step2ck_form6):
The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy? help answer!
drmohandes  Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +
tinylilron asks (step2ck_form6):
Is it just me, or is this question phrased strangely? help answer!
chosened asks (step2ck_form6):
Why not hydralazine? treats hypertensive emergency per sketchy! help answer!
chosened asks (step2ck_form6):
Can someone explain why this wouldn't be fat embolism and hence supportive treatment (via mechanical ventilation/ intubation)? help answer!
keyseph  Fat emboli usually occur from long bone fractures, not hip fractures. Altered mental status is also a common symptom of fat emboli, which is not seen here. Petechiae can also be present, but are not necessary to make the diagnosis. Regardless of this, this patient has a Wells score of at least 4 (HR >100, ≥3 days of immobilization, hemoptysis). If you think PE is the most likely diagnosis (I personally did), then this patient has a Wells score of 7. For any patient with dyspnea and a Wells score of ≥4, PE is likely, so you would heparinize and conduct a CTA or V/Q scan. +1
shastri96 asks (step2ck_form6):
can someone please explain this ? why would we negotiate a contract with a minor ? help answer!
keyseph  I agree that it was mainly by process of elimination to get to the right answer. Negotiating a contract is also the only answer that has some leeway to talk to the patient about why she doesn't believe she needs the medication. +
torticollis asks (nbme16):
If she ain't taking beta blocker... why this patient does not present any symptomatology before during hypoglycemic episode? help answer!
tinylilron asks (step2ck_form6):
Does anyone have any ideas for this one??? help answer!
tinylilron asks (step2ck_form6):
The foul-smelling stools tripped me up. I chose Crohn's disease but I suppose that you would expect to see more systemic symptoms with Crohn's (ie. weight loss and fever)??? help answer!
sasoo8888 asks (step2ck_form6):
I was confused why diastolic filling time wouldn't be correct. Hx of Mitral stenosis should mean that it takes longer for her left ventricle to fill up, right, so increased diastolic filling time? help answer!
tinylilron  you have a good point +1
aaa1 asks (nbme15):
I think I understand (idk tho). I think they are referring to E. coli Lipopolysaccharides are responsible for triggering the immune response, in gram negative bacteria. So I guess she went into septic shock? help answer!
sassy_vulpix asks (step2ck_form7):
why is there no seagull comment on this? help answer!
an_improved_me asks (nbme21):
Question: even if this pt did have myocardial rupture... is that even a cause of death? I feel like like the mechanism of death in myocardial rupture is cardiogenic shock; blow a hole in your heart, and suddenly it aint pumping so well. Just asking for future reference. help answer!
helen asks (nbme16):
I chose G. How do you know it's corticospinal tract deficit? Why the deficit not in the ventral horn? somebody plz explain. help answer!
an_improved_me asks (nbme21):
Might be a dumb question but... Can patients normally breathin on their own if givne succinylcholine? help answer!
trazobone  Yes! Normal people will have an adequate level of pseudocholinesterase to break down the succinylcholine and eventually cease its effects. But if your question is, will succinylcholine still inhibit breathing in a normal person, yes it will. It will work to paralyze muscles (like your diaphragm) in both a normal person and in someone with the pseudocholinesterase deficiency. The main issue is the ability to eventually break down the succinylcholine and come out of the paralysis +
trazobone asks (nbme20):
Why has no one commented about recurrent branch of median? Recurrent branch of the median nerve innervates all thenar muscles, with the exception of the adductor polis which is innervated by the ulnar. Also the recurrent branch does not innervate interosseous muscles, that’s ulnar. Also also Froment’s sign tests thumb adduction. help answer!
trazobone asks (nbme20):
What is partial oxidation lmao. Is it beta oxidation? Is it FAs that has been partially oxidized? Is it FAs that have been partially beta oxidized? Please advise. help answer!
trazobone  Ok after regrouping with myself, if you ignore the “partial” part of the answer choice, it makes sense. And you can eliminate everything else. +
an_improved_me asks (nbme21):
Since AgII also affects the proximal tubular Na+/H+ antiport, would (A) also be a correct answer if it didn't say "most effected"? help answer!
aakb asks (nbme23):
can someone explain to me why 0% basophils is incorrect? help answer!
an_improved_me asks (nbme21):
Question: based on what we know about the hypothalamic nuclei, would the effect mostly be ont he posterior or anterior nuclei? Posterior = Heating, so is it being stimulated? Anterior = Cooling, so is it being inhibited? help answer!

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