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=> Step 2 CK Free 120
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Recent comments (see more)

... studentdoc1996 made a comment (free120)
 +0  submitted by studentdoc1996(0)

Aminoglycosides are synergistic with beta lactam antibiotics (and penecillin is a type of beta lactam antibiotics). The question is saying "what will make this work faster?" basically

... ht3 made a comment (step2ck_form6)
 +0  submitted by ht3(10)

why can't this be chronic bacterial prostatis?...ughh the gram stain and leukocytes on UA threw me off

ht3  according to Uworld, chronic prostatitis* could be nontender +
... godby made a comment (nbme18)
 +0  submitted by godby(0)

Motor + Sensory + rapid progress :: may be R/O Acute inflammatory demyelinating polyradiculopathy

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

i think this was tested in a similar way in another question in this form. the patients have a right to know or not know their resuts.

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

MM will be induced a AL(primary amyloidosis).

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

Draw out your 4/4 box.

Note that prevalence does not change specificity or sensitivity and that's why you can eliminate C and D right off the bat.

so with low prevalence, you decrease the amount of people with the disease and if you write out for formulas for PPV and NPV you can see that PPV has its variable in the numerator and denominator decrease (decrease overall) while the NPV only has its numerator in the denominator decrease. i wish I could draw it out i hate typing out math

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

Pathoma 2018 pg. 53. Chemotherapy hurts neutrophils the most. Radiation hurts lymphocytes the most.

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

honestly someone explain this one to me other than the memory loss is her newest thing and needs to be evaluated. pls

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)
  • Catecholamine producing tumor -> not likely since the presentation would be more of an intemittent episode of HTN and other sympathetic symptoms
  • Decreased distensibility caused by atherosclerosis: could be describing RAS which is discounted by the lack of abdominal bruits
  • Execess production of ANP -> can be seen in volume overload states and would also result in a reduction of Na+ in the serum due to the actions of ANP- maximal point of impulse not displaced, no edema, low-normal resp.
  • Juxtaglomeular cell hypertrophy and sclerosis -> this would suggest findings of diabetic nephropathy. Patient doesnt have hx or HTN.
  • along with patients labs suggesting high aldosterone state - answer is most likely pointing toward autonomous production of aldosterone.
... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

Patient does NOT currently have back pain- asking for how to prevent her back pain from occuring.

Being obese is the most important risk factor in back pain and osteoarthritis (step-prep)

USMLE

  • Acute pain (< 4 weeks)
  • treat with NSAID/acetaminophen, maintain activity, consider muscle relaxants or spinal manipulation
  • Subacute (4-12) or Chronic (>12 weeks)
  • Intermittent use of NSAIDs or acetaminophen (decreased freq. in comparison to acute pain), Exercise therapy (stretching/strengthening - which is what i put because i thought the patient was currently in pain), and tricyclics or duloxetine

Secondary prevention also includes exercise therapy and education, and according to this NBME weight loss as well.

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

HBsAb = HBs Antibody = negative... so give the vaccine

.___. wow

... okokok1 made a comment (nbme16)
 +0  submitted by okokok1(0)

Why it's not the other choices:

Cystic hygroma: if you see this, associate it with Turners.

Thyroglossal duct cyst: moves up and down with swallowing and doesnt cause the sx presented in this stem.

Tracheomalacia: In tracheomalacia, the cartilage of the windpipe does not develop properly in utero, leaving them weak and flaccid. The weakened walls are likely to collapse and cause an obstruction of the airway. Yes it can cause stridor but has no relation or association with maternal Graves as the cause and also doesnt present as a neck mass.

Vascular ring: occurs when the aorta or its branches form a complete ring around the trachea and the esophagus. This happens when certain parts of the aorta that normally disappear during fetal development persist abnormally. Sx are dysphagia and cough. Most sx are so mild that children who have it often go years without diagnosis. Also doesnt present as a neck mass.

... okokok1 made a comment (nbme16)
 +0  submitted by okokok1(0)

A way to differentiate between a leukemoid reaction vs CML is that CML has a very low leukocyte alkaline phosphatase (LAP) as a result of low activity in malignant neutrophils, vs benign neutrophilia (leukemoid reaction) in which LAP is  due to  leukocyte count with neutrophilia in response to stressors (eg, infections, medications, severe hemorrhage).

Also some helpful hints is that his temperature is raised as well as his leukocyte count. So an infection from his cut.

I think "leukoclastic response" was just there to trip you up. The closest thing I could find to that term online was: Leukocytoclastic vasculitis (LCV), which refers to small blood vessel inflammation.

Leukopenia is LOW leukocyte count.

Leukoplakia is that "white plaque" you see with Bowens disease (squamous cell CA of penis) and can also be seen in vulvar CA.

Leukotrienes deal with your immune system and are synthesized and released on demand from basophils.

... okokok1 made a comment (nbme16)
 +0  submitted by okokok1(0)

γ-aminobutyric acid =GABA, so not a neurotransmitter dealing with pain. deals with excitability and movement.

dopamine: think of parkinson's (too little of it) and schizophrenia (too much of it), either way doesn't deal with pain reception.

Enkephalin: related to a type of opioid receptor. It closes presynaptic Ca2+ channels, open postsynaptic K+channels and thus decreases synaptic transmission. It actually inhibits the release of ACh, norepinephrine, 5-HT, glutamate, substance P.

Serotonin: think of depression. again, doesnt deal with pain reception.

Substance P: even if you didn't know exactly what it did, you could rule out the others. you could also remember the pathophysiology of migraines: "Due to irritation of CN V, meninges, or blood vessels (release of vasoactive neuropeptides [eg, substance P, calcitonin gene-related peptide]) causing the immense pain of migraines."

For completeness sake: "Muscle nociceptors contain neuropeptides, including substance P (SP) and calcitonin-gene-related peptide (CGRP). These peptides are released when nerve endings are activated and induce local edema by dilating the local blood vessels and increasing their permeability." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696782/

also, good to know aprepitant is an anti-emetic that is Substance P antagonist. Blocks NK1(neurokinin-1) receptors in brain. yes, theres no mention of "pain" in that FA definition but Substance P got its hands in a lot of cookie jars ok

... okokok1 made a comment (nbme16)
 +0  submitted by okokok1(0)

Albinism: Normal melanocyte number with DECREASED melanin production due to decreased tyrosinase activity or defective tyrosine transport. risk of skin cancer.

... drmohandes made a comment (step2ck_form7)
 +0  submitted by drmohandes(84)

pressure (decubitus) ulcers

  • over bony prominence
  • impaired mobility / abnormal mental status

arterial ulcers

  • most distal parts where blood flow is low (tips of toes)

diabetic foot ulcers

  • Charcot deformity
  • soles of feet under metatarsal heads
  • tops of toes

venous stasis ulcers

  • edema
  • stasis dermatitis
  • pretibial or above medial malleolus
... mariame made a comment (nbme24)
 +0  submitted by mariame(0)

Histamine causes endothelial contraction, this increases vascular permeability and leakage of protein-rich fluid from the postcapillary venules into the interstitial space -> increases interstitial oncotic pressure. (choice C).

Due to this it also increases capillary filtration rate, because the endothelial contracts. (choice A)

Because there is more fluid in the interstitial space, there is more lymph flow. (choice E).

FA19, pg 213

... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

The only variable that changes with diet is the triglycerides (goljan)

The formula for total cholesterol:

  • Total = HDL + LDL + VLDL
  • VLDL = TG/5
  • Total = HDL + LDL + TG/5

We need this patient to be fasting to get an appropriate Total cholesterol level.

  • need to do step 1 diet (decrease fats, calories, cholesterol etc.) before moving to step 2 diet (more aggressive diet than step 1)
... kingfriday made a comment (step2ck_form6)
 +0  submitted by kingfriday(3)

This one got me :( i had the right answer but i switched because i kept getting hung up on his PPI treatment (rereading the stem now, it seems he's off treatment)

but can someone explain to me what the answer would be if the guy were on a PPI and had intractible vomiting?

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Help your fellow humans! (see more)

kingfriday asks (step2ck_form6):
This one got me :( i had the right answer but i switched because i kept getting hung up on his PPI treatment (rereading the stem now, it seems he's off treatment) but can someone explain to me what the answer would be if the guy were on a PPI and had intractible vomiting? help answer!
whoopthereitis asks (nbme19):
can anyone elaborate why they chose this answer? help answer!
hiroshimi  Even though legally the wife has the right to make the decision first, then the adult children. However, it's still best the wife and children come to a consensus that reflects pt's wish. If there is a disagreement between them that can't be resolved, then the doctor will need to follow what the wife said. In these difficult situations, you are not only treating the patient, but also the whole family so you would try to integrated the family into the process. In short, i feel like the point of this question is don't be an asshole, and don't choose answer that have absolute words in it like "only" +
misrao asks (nbme21):
Can someone explain the correlation between 450 mOsmol/day and needing to excrete 1 L of water? Thanks help answer!
llpierso asks (nbme22):
I understand why K+ is increased. But why isn't chloride also increased? This is a metabolic acidosis, so bicarb will be low and H+ will be high. You need an ion to balance charges --> increased chloride? help answer!
lickmyass asks (nbme20):
Why not Multiple renal artery aneurysms? I was thrown off by the description of hyperplastic arteriolosclerosis and so I went with this choice. I thought hyperplastic arteriolosclerosis may lead to fibrinoid necrosis of the vessel wall with hemorrhage. help answer!
brise asks (nbme23):
How do you rule out LSD? It also causes tachycardia! help answer!
ht3 asks (step2ck_form7):
If the chin is deviated to the right, then wouldn't the "mass" (which I assume is the tight SCM muscle) be on the LEFT side of the neck?? help answer!
benwhite_dotcom asks (step2ck_free120):
You know that granulomatosis with polyangiitis (née Wegener’s) causes lung disease, but did you know it also causes peripheral neuropathy? Keep in mind that “not all that wheezes is asthma.” Wheezing is a sign of obstructive lung disease, not a diagnostic feature, so consider asthma alternatives in adults. Hemoptysis and fever change the game. help answer!
brise asks (nbme23):
Why is it that you can use acetaminophen in aspirin induced asthma and not here? I literally chose acetaminophen bc in another nbme it said to use it in aspirin induced asthma help answer!
brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1
carolebaskin asks (step2ck_free120):
Eeaaasy there, partner. They said they don't want insulin and you're gonna kick them to the curb? One step at a time, bud. Offer the insulin, let them refuse (they seem to have capacity), but who ever said anything about discharging them. Where would they go!? Haven't they been through enough? help answer!
carolebaskin asks (step2ck_free120):
Hypercalcemia + lytic spinal lesions = multiple myeloma What about the fever, leukocytosis, and consolidation? MM predisposes to infection! It's PNA. help answer!
letsdothis asks (step2ck_form8):
Anyone else get thrown off by the laboratory abnormalities (hyponatremia, hyperkalemia, hyperchloremia, metabolic acidosis)? help answer!
brise asks (nbme22):
Can anyone explain why complement C5-9 is listed? help answer!
drdoom  don't have the stem in front of me but the Fc “handle” of antibody allows for opsonization (by macrophages and other APCs) but more immediately it activates circulating complement -> terminating in the formation of the Membrane Attack Complex. MAC is great way to kill nonself intruders without having to wait for macrophages to mature or neutrophils to arrive. FAST ACTIN’ TANACTIN! +1
brise  Thank you so much! +1
faus305 asks (nbme24):
You know why I don't get chronic granulomas? Because I've got NADPH Oxidase. It makes OXYGEN FREE RADICALS THAT WIPE AWAY STAINS. AND THAT'S THE POWER OF OXY-CLEAN. help answer!
kingfriday asks (step2ck_form8):
Why would increasing fluids be incorrect? help answer!
kingfriday  nvm, someone whose kidneys dont work means they not able to get rid of fluids anyway so giving them fluids can make things worse +
letsdothis  Yeah, I feel like increasing fluid in any chronic renal conditions is always correct, but I like the steppreps explanation. +
carolebaskin asks (step2ck_form7):
Tricky! Yes, fecal occult blood test would pick up hemorrhoid blood and this is a male <50yo, so case closed right? Wrong! Hematocrit = 35% --> hgb = 35/3 = 11.7 < 13.5 (normal) Why is he anemic? Do a colonoscopy. help answer!
carolebaskin asks (step2ck_form7):
thajoker's comment is spot on And: decreased upward gaze is a normal sign of aging, not always parinaud syndrome https://pubmed.ncbi.nlm.nih.gov/15114040/ Can dogs look up? help answer!
faus305 asks (nbme24):
Was I wrong to just pick the only answer with the word nociceptor in it? help answer!
meryen13 asks (nbme16):
am i the only one who forgot what was lamellar bodies? :D lamellar bodies (otherwise known as lamellar granules, membrane-coating granules (MCGs), keratinosomes or Odland bodies) are secretory organelles found in type II alveolar cells in the lungs, and in keratinocytes in the skin help answer!
veggievendor asks (step2ck_form7):
Can someone please enlighten me why this is hypothyroidism? help answer!
veggievendor asks (step2ck_form7):
Is this because its a patient with SCD and you are worried about osteonecrosis? help answer!
seagull asks (step2ck_form8):
Weird question. This is a follow-up - Why would you not have an ultrasound from the previous visit? Perhaps she needs a better doctor. help answer!
mishudishu asks (nbme22):
Who else chose reassurance thinking this was a question about raising the child's self confidence? help answer!
rina asks (nbme16):
why isn't it serum cortisol concentration though. Couldn't that help you identify a pituitary adenoma (i.e. because increased ACTH --> increased cortisol concentration)? help answer!
rina  is it because she's showing no symptoms or something? +
castlblack asks (free120):
I picked A, but what is wrong with B? Which type of immunization works faster? help answer!
seagull asks (step2ck_form7):
My understanding is that occult blood is commonly due to an upper GI bleed. Wouldn't the colon produce gross blood? I'm hopelessly lost in these matters. help answer!
krewfoo99  Yeah I am lost in this one too. Maybe colonoscopy is the right answer to rule out other serious causes of GI Bleeding (Ex: Cancer). +

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