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! 😊
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“Arrggg, here be fellow mateys seeking an explanation!”




... osler_weber_rendu is asking for clarification on step2ck_free120
 +0  upvote downvote
submitted by osler_weber_rendu(112)

Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway

len49  Pick the best answer of the choices, not necessarily what you would do in real life. +
... stunna216 is asking for clarification on free120
 -1  upvote downvote
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 +
... arthur_albuquerque is asking for clarification on nbme20
 +0  upvote downvote
submitted by arthur_albuquerque(1)

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!

... shaz464 is asking for clarification on step2ck_free120
 +0  upvote downvote
submitted by shaz464(1)

Still confused.. Can anyone rule out all other options please?

len49  A. Conducting a nursing in-service won't help because they do not have the ordering power, that should rest on the person writing prophylaxis prescriptions/orders. C. Not feasible for every patient (not every patient is well enough to be ambulatory. Moreover ambulation only helps so much; patients at high risk for thrombus (for instance like this patient who is hypercoagulable due to malignancy, recent surgery) need bigger guns. D. LMWH is not appropriate for all post-op patients. For instance, inappropriate for people who may be actively bleeding, patient with previous diagnosis of HIT, patients with ESRD as it is renally cleared E. It is not an isolated case, as you know DVT provoked from long hospitalizations and post-op patients is pretty high and taken pretty seriously. +
... sizario is asking for clarification on step2ck_form6
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submitted by sizario(1)

how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH?

... embeemee is asking for clarification on step2ck_form7
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submitted by embeemee(1)

what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately

... embeemee is asking for clarification on step2ck_form7
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submitted by embeemee(1)

i get the answer, but would a VB even be possible given her GBS+ status?

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 is asking for clarification on step2ck_form7
 +0  upvote downvote
submitted by embeemee(1)

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?

... justanotherimg is asking for clarification on nbme18
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submitted by justanotherimg(1)

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 ??

... skonys is asking for clarification on nbme23
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submitted by skonys(9)

So are we supposed to just yolo this one? wtf

... osler_weber_rendu is asking for clarification on step2ck_form6
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submitted by osler_weber_rendu(112)

Why is this not absence seizure?

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 is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by osler_weber_rendu(112)

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.

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 is asking for clarification on step2ck_form6
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submitted by charcot_bouchard(482)

I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue?

... skonys is asking for clarification on nbme23
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submitted by skonys(9)

Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients)

... brandoctor is asking for clarification on familymed2
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submitted by brandoctor(0)

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?

... brandoctor is asking for clarification on familymed2
 +0  upvote downvote
submitted by brandoctor(0)

Okay, but why aren't we concerned about the Benzo (and it's anticholonergic properties) in the 67yo F?

... brandoctor is asking for clarification on familymed2
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submitted by brandoctor(0)

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?

... jlbae is asking for clarification on step2ck_form8
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submitted by jlbae(68)

Y'aLL dOn'T KeEp BlEaCH uNdEr YoUr SiNkS??!?

lindasmith462  i would but I don't have room with my lamp oil down there +
... jlbae is asking for clarification on step2ck_form8
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submitted by jlbae(68)

What would make normal lochia the correct answer? Please help I suck at ob/gyn. Am I at the character limit yet?

... chaosawaits is asking for clarification on nbme15
 +0  upvote downvote
submitted by chaosawaits(11)

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?

... chaosawaits is asking for clarification on nbme15
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submitted by chaosawaits(11)

How does that picture help at all? Is it just for ruling out or can you rule in H. pylori with it?

... chaosawaits is asking for clarification on nbme15
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submitted by chaosawaits(11)

Wouldn't weight gain increase afterload due to increased peripheral resistance, which also increases AR?

... stinkysulfaeggs is asking for clarification on step2ck_form8
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submitted by stinkysulfaeggs(103)

Her BP is 160/90, why is that not being addressed by the question?

jmorga75  Alcohol is a risk factor for osteoporosis and hypertension. You get a twofer when you decrease the intake +
... ih8payingfordis is asking for clarification on nbme18
 +0  upvote downvote
submitted by ih8payingfordis(9)

Why can't this be renal artery stenosis?

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 is asking for clarification on nbme13
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submitted by specialist_jello(26)

I get HOT T Bone STEAK IL 1 for fever

but 90% neutrophils, why cant it be LTB4 neutrophil chemotaxis?

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 is asking for clarification on nbme23
 +0  upvote downvote
submitted by veryhungrycaterpillar(23)

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.

... abk93 is asking for clarification on nbme21
 +0  upvote downvote
submitted by abk93(1)

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.

... medstudenttears is asking for clarification on step2ck_form7
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submitted by medstudenttears(1)

Was anyone else thinking bath salts? Why cant it be bath salt intox & withdrawal?

... lm4 is asking for clarification on step2ck_form8
 +1  upvote downvote
submitted by lm4(15)

okay soooo 40 participants is too low of a sample size- but 80 back in the new B-adrenergic drug vs. albuterol question was fine? is there like a magic sample number that is considered large enough?

... thrawn is asking for clarification on nbme18
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submitted by thrawn(3)

Why skills training???????????????????????????

... goverbeek16 is asking for clarification on nbme17
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submitted by goverbeek16(3)

What I don't get is that the anterior hypothalamus is responsible for cooling and this involves the parasympathetic nervous system. So, how is the parasympathetic nervous system not active in this person as well?

... jlbae is asking for clarification on step2ck_form6
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submitted by jlbae(68)

What's going on here? Thought this was lactose intolerance → secretory process??

lubdub  Yea, this one made me think more than I'd hope lactose intolerance would have. If the lactose can't be broken down (by the lactase in the brush boarder) then it stays in the lumen (malabsorption) letting all the gut bugs digest it (make gas) and allowing for osmotic diarrhea. Osmotic =/= secretory +3
jlbae  Ah ok, ty. That makes sense. It's kinda coming back to me from M2 GI lectures now lol. So then an example of secretory would be a viral gastroenteritis where electrolytes are being actively secreted into the GI lumen. +
... yousif7000 is asking for clarification on nbme22
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submitted by yousif7000(5)

I chose bradycardia because I thought he was prescribed beta-blocker, why did we exclude beta-blockers?

... bgreen27 is asking for clarification on nbme21
 +0  upvote downvote
submitted by bgreen27(5)

Can someone help a brother out? My thinking was that increased fluid in the interstitial leads to increased lymph, so I thought they were looking for something to simulates high altitude pulmonary edema or arterial pulmonary HTN, which I am pretty sure both lead to pulmonary edema. Where did I go wrong?

... osler_weber_rendu is asking for clarification on step2ck_form7
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submitted by osler_weber_rendu(112)

Why in the world was the Xray taken from that angle?

... osler_weber_rendu is asking for clarification on step2ck_form7
 +1  upvote downvote
submitted by osler_weber_rendu(112)

Am I the only one who heard an S3 in the pulmonic area?

sizario  I believe it was a splitting of S2. It occurred during inspiration causing increase preload and delay closure of P2 +
... osler_weber_rendu is asking for clarification on step2ck_form7
 +0  upvote downvote
submitted by osler_weber_rendu(112)

Arent we supposed to use PCR for Herpes Simplex?

... aaftabsethi1 is asking for clarification on free120
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submitted by aaftabsethi1(5)

Can anyone tell how a hair dye affected her forearm ?

vetafig692  lmao good question! +
... shakakaka is asking for clarification on nbme20
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submitted by shakakaka(11)

Anyone can explain why IgG is not correct answer ?

drdoom  Newborn immune system will not produce a robust IgG response before about 6 months of age! +1
... shakakaka is asking for clarification on nbme20
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submitted by shakakaka(11)

I understood that it was transitional cell carcinoma, and a smoking is a risk factor ( as it contains aromatic amines ) , but how about arylamine exposure? Its exposure also associated with blader cancer.

... sassy_vulpix is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by sassy_vulpix(13)

What about acute intermittent porphyria 2/2 alcohol? It also has painful abdomen, polyneuropathy

jmorga75  Most of the time AIP questions mention a positive family history for it, and symptoms that worsen with fasting. +
satanicdo  they have similar symptoms because lead can disrupt heme synthesis (similar pathophysiology), but AIP causes discrete attacks of pain rather than continuous symptoms. also, lead poisoning can lead to microcytic anemia and hypertension +
charcot_bouchard  Both shares neuropathy, abdominal pain and neuropsych symptoms. But AIP pains are intermittent and can be very severe. Anemia push towards lead poisoning. Absent of urine color change also push towards lead. And make ur booze in your garage/celler Heck Ya Lead poisoning +
... sassy_vulpix is asking for clarification on step2ck_form6
 +1  upvote downvote
submitted by sassy_vulpix(13)

Why is ALP increased? .

... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(13)

TOF is the only cyanotic disease out of the lot. RV heave is prob due to RV hypertrophy. Single S2 cuz of diminished pulmonic component, systolic murmur d/t VSD what does the systolic click signify? Pulmonic stenosis?

... sassy_vulpix is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by sassy_vulpix(13)

Isn't pulmonary angiography the gold standard for PE detection?

lubdub  Yep, but not needed if the pretest probability is high (think wells) and the V/Q is suggestive of PE. Thats enough evidence to treat. +1
... sassy_vulpix is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by sassy_vulpix(13)

what does blood pressure in 40/palpable mm Hg mean? i saw it in another question too

drdoom  systolic registered @ 40 by cuff but diastolic too low to be detected; “palpable” as in a pulse is palpable (but diastolic too low for detection) +3
... xw1984 is asking for clarification on free120
 +0  upvote downvote
submitted by xw1984(5)

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

... drmohandes is asking for clarification on step2ck_form6
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submitted by drmohandes(143)

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.

sassy_vulpix  She has weight gain & sleep disturbances (? not sure if this is current or before medication) +2
drmohandes  True, that information could point at hypoT. +1
... bharatpillai is asking for clarification on step2ck_form8
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submitted by bharatpillai(34)

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?

stinkysulfaeggs  But he doesn't have pancytopenia, his WBC is 22,000. +1
... ranchistotallylegal is asking for clarification on step2ck_form7
 +1  upvote downvote
submitted by ranchistotallylegal(1)

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

... rahmanu is asking for clarification on nbme22
 +1  upvote downvote
submitted by rahmanu(1)

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?

... tinylilron is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by tinylilron(32)

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?

nayyyy  UWorld QID 16112 +3
rkd  BNB video on mechanical ventilation is too good. +
... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(32)

Can anyone explain the correct answer for this one?

... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(32)

The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy?

drmohandes  Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +1
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +1
lubdub  Agreed. I him-hawed about it, but figured the free air should tell us what to do. +1
... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(32)

Is it just me, or is this question phrased strangely?

... chosened is asking for clarification on step2ck_form6
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submitted by chosened(2)

Why not hydralazine? treats hypertensive emergency per sketchy!

ddub  for eclampsia/severe pre-eclampsia (ie pregnancy) +1
... chosened is asking for clarification on step2ck_form6
 +1  upvote downvote
submitted by chosened(2)

Can someone explain why this wouldn't be fat embolism and hence supportive treatment (via mechanical ventilation/ intubation)?

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. +2
jlbae  The femur is a long bone, but I agree with everything else you said +1
lubdub  Feel free to judge, but I just realized in the last few weeks that when they say 'broke her hip' they're talking about the femur not the pelvis. +1
jmorga75  I was going to make a comment about how Fat emboli don't usually present until a at least 24 hours after surgery, but on review it seems Uworld is inconsistent. Qid 3503/4561/12173/16061 - 24-72 hours after injury, Qid 4234 and Amboss- 12-24 hours after injury. Furthermore, being pedantic has lost me more points that it has ever gotten me. +
... shastri96 is asking for clarification on step2ck_form6
 +1  upvote downvote
submitted by shastri96(11)

can someone please explain this ? why would we negotiate a contract with a minor ?

ronabobonafofona  Process of elimination question for me. The only other decent choice was A, but you wouldn't recommend "punishing" the patient if she doesn't comply. Maybe you just wouldn't offer her reward. Therefore, B makes the most sense. I think of it like trying to bargain with the girl -- "if you take the medication, then we'll do x for you". Something to incentivize good compliance. +1
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. +1
jlbae  Also, we're talking about a 15F here. If you were a 15F and your physician basically said, "hey, let's write up a plan so that if you take your meds as scheduled for a week, then your mom and dad will give you a $20 Amazon gift card to save up for some new shoes" then you would hold your parents to it. YOU HAVE TO BUY ME NEW SHOES NOW BECAUSE DR. X SAID YOU WOULD IF I TAKE MY ASTHMA MEDS MOM!!!! +1
lindasmith462  its kind of a weird answer - medication contracts are typically utilized for controlled substances. its not a legal document - they're really just a written agreement btwn a physician and pt about their meds and treatment regimen, the pros/cons of adhering/non adhering to said regimen, and the actions that will be taken if the contract is broken (aka if you come in and don't piss positive for the opioids I prescribe I stop prescribing them/fire you from the practice). Probably not totally appropriate for an adolescent who doesnt have full decision making capacity yet. I think it's getting at the underlying principals of adolescent non-adherance which is that as they go through normal behavioral changes with being more autonomous in their life they attempt to "take control" of their health through non-adherance. Therefore to improve adherence it is best to "contract" with the patient and make a plan together putting them in more control over their health. +
lindasmith462  also while mental health issues may increase risk of medication non adherence in adolescents it is a normal behavioral age related change +
lindasmith462  parents rewarding/punishing her still keeps the control of her treatment out of her own hands. obvi not enough signs of other mental health conditions to start any of the meds +
daniyal_ishtiaq  what if the child breaks the contract or lies about taking the meds. there was a similar question in step1 UW and some assessment forms that said that studies shows in adolescents the best approach is to join them up in a similar group as they learn a lot from their peers. +
... torticollis is asking for clarification on nbme16
 +3  upvote downvote
submitted by torticollis(3)

If she ain't taking beta blocker... why this patient does not present any symptomatology before during hypoglycemic episode?

... tinylilron is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by tinylilron(32)

Does anyone have any ideas for this one???

lubdub  I think the homemade whisky is supposed to tip us off that he's got some goofy exposure. +2
... tinylilron is asking for clarification on step2ck_form6
 +1  upvote downvote
submitted by tinylilron(32)

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)???

ronabobonafofona  This tripped me up too. I was thinking intermittent SBO due to the prior surgeries. Guess we just gotta remember to go for "what's most common in young woman with alternating diarrhea/constipation" which would be IBS unless they're making some statement that makes something else very obvious. +1
... sasoo8888 is asking for clarification on step2ck_form6
 +2  upvote downvote
submitted by sasoo8888(2)

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?

tinylilron  you have a good point +2
ronabobonafofona  I also thought this. But I knew for sure that Pulmonary artery pressure would go up, so I just went with what I was sure of. +1
lubdub  HR's fast. 100 bpm.. No time for filling there! The lack of filling time contributes to the pathology. +2
jlbae  If I had the power to, I would dub lubdub the resident cardiologist of this forum. +2
... aaa1 is asking for clarification on nbme15
 +1  upvote downvote
submitted by aaa1(6)

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?

... sassy_vulpix is asking for clarification on step2ck_form7
 +1  upvote downvote
submitted by sassy_vulpix(13)

why is there no seagull comment on this?

... an_improved_me is asking for clarification on nbme21
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submitted by an_improved_me(65)

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.

... an_improved_me is asking for clarification on nbme21
 -1  upvote downvote
submitted by an_improved_me(65)

Honest question: Why does it matter what pattern of inheritance it has? For all we know, its multi-factorial/can't be determined.

I feel like the easiest way to answer it is: acknowledging it is "uniformly fatal to males in-utero" = 0% chance for males; and legit just counting the fraction of females in generation III that have the disease = 4/6 ~50%.

... helen is asking for clarification on nbme16
 +0  upvote downvote
submitted by helen(0)

I chose G. How do you know it's corticospinal tract deficit? Why the deficit not in the ventral horn? somebody plz explain.

neurotic999  That is a good doubt. The thought process probably should be that since both upper and lower extremities are involved the lesion is higher up (section of spinal chord also seems to be cervical). If it was the ventral horn area, the paralysis would probably be limited to a smaller area supplied by the nerve. However, CST lesion makes it more likely to have a more widespread area of affection. I think! +1
neurotic999  Also, G & H most likely are to be indicating the AST. Ventral horn would be within the gray matter. +1
... an_improved_me is asking for clarification on nbme21
 +1  upvote downvote
submitted by an_improved_me(65)

Might be a dumb question but... Can patients normally breathin on their own if givne succinylcholine?

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 is asking for clarification on nbme20
 +1  upvote downvote
submitted by trazobone(59)

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.

utap2001  It is important to differentiate the function of recurrent branch of median nerve and deep branch of ulnar nerve. Thumb opponens function is innervated by recurrent branch of median n. Adductor of thumb is innervated by deep branch of ulnar n. +
... trazobone is asking for clarification on nbme20
 +1  upvote downvote
submitted by trazobone(59)

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.

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 is asking for clarification on nbme21
 +0  upvote downvote
submitted by an_improved_me(65)

Since AgII also affects the proximal tubular Na+/H+ antiport, would (A) also be a correct answer if it didn't say "most effected"?

... aakb is asking for clarification on nbme23
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submitted by aakb(24)

can someone explain to me why 0% basophils is incorrect?

... an_improved_me is asking for clarification on nbme21
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submitted by an_improved_me(65)

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?

... daisy is asking for clarification on nbme24
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submitted by daisy(0)

How will cerebral edema develope if there is increased ECF osmolality ie dehydration? Shouldn't it drag fluid out of the tissues?

... an_improved_me is asking for clarification on nbme24
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submitted by an_improved_me(65)

What's all that anechoic stuff on the left side of the CT?

... an_improved_me is asking for clarification on nbme24
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submitted by an_improved_me(65)

I'm sorry but... where in the cytoscopy are the fibrovascular cores demonstrated? Are they visible?

an_improved_me  ok... i'm blind. it is literally just the projections... i thought I was missing some fine detail. +1
... brise is asking for clarification on free120
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submitted by brise(65)

Does anyone know why decreased left ventricular stroke volume work is wrong? Would'n stroke volume decrease with increased afterload?

brise  WOW, OMG IT SAYS STROKE WORK -_- NEVERMIND UGH +2
helppls  I put down stroke work because I was thinking about decompensated heart failure, could this not be a potential answer? +
... myriad is asking for clarification on free120
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submitted by myriad(0)

Just wondering, could this patient's presentation also be the result of an Imperforate Hymen or Transverse Vaginal Septum? I was looking for those in the answer choices, and thought Ectodermal Dysplasia might be referring to either of those.

zolotar4  so was curious, found on wiki - "If untreated or unrecognized before puberty, an imperforate hymen can lead to peritonitis or endometriosis due to retrograde bleeding." - our patient has no symptoms besides never having a menstrual period and probably would've been seen in the clinical presentation. +
jj375  Also I think that if it was imperforate hymen or Transverse Vaginal Septum then the patient would have normal axillary and pubic hair. But the lack of these things made me think it was more hormonal +
... myriad is asking for clarification on free120
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submitted by myriad(0)

I was vacillating between this patient having Bacillus Anthracis vs. Clostridium Perfringes. What exactly pushes it over the edge for C Perf? Is it the crepitus?

sgold11  Yep! +
... bharatpillai is asking for clarification on step2ck_form6
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submitted by bharatpillai(34)

Aren't Pl effusions due to CHF ALWAYS bilteral??

tinylilron  no more likely to be bilateral but can be unilateral... if unilateral it is more likely to present on the right side. +1
jlbae  IIRC pulmonary edema is bilateral but effusion can be either unilateral or bilateral +2
... shieldmaiden is asking for clarification on nbme19
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submitted by shieldmaiden(18)

How do the h/o renal cell carcinoma and removal of one kidney/adrenal correlate with occlusion of the hepatic vein?

an_improved_me  looks like RCC may extend into the IVC with tumor thrombus leading to hepatic vein occlusion https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193735/ +2
an_improved_me  In general though, i don't think you need to know that... I think the important things are that: tells you there is widening of hepatic venules (which one can imagine is due to increased pressure) tells you that hepatic wedge pressure (estimate of portal pressure) is 30; portal pressure should be less than 5. therefore, elevated portal pressure in the absence of RA pressure indicates obstruction before the heart (in this case, budd chiari). Compare that to cardiac cirrhosis, which would have increased RA pressures AND increased portal venous pressures. +1
an_improved_me  Shit, and finally, since there are only mild increases in billi, AlkPhos, AST/ALT, i think that rules out cirrhosis. +1
an_improved_me  Add the fact that he doesn't have risk factors for cirrhosis (no drinking, smoking cigs, [would have loved to see a negative serology panel...], i think that also brings cirrhosis further down on your DDx +1
an_improved_me  Add the fact that he doesn't have risk factors for cirrhosis (no drinking, smoking cigs, [would have loved to see a negative serology panel...], i think that also brings cirrhosis further down on your DDx +1
an1  I had it down to the 2 options too. and I went with hepatic venues because I know that's related to BC more than it is to cirrhosis per say. But another way to approach this could be that due to renal removal, he may be taking exogenous EPO, which can lead to thrombosis (often seen with poly vera; which also happen to be ht eMCC of BC) +
... foodi is asking for clarification on nbme20
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submitted by foodi(0)

why can't this be OCD? fits the time frame, his obsessions are checking his temp and he relieves these with calling the physician (compulsions)...

hiroshimi  According to DSM-5, with OCD, the disturbance is not better explained by the symptoms of another mental disorder such as preoccupation with having an illness, as in illness anxiety disorder. In his case, he was previously dx with cancer, treated, then develop these anxieties that he may have missed some sign is more fitted with illness anxiety disorder. Moreover, OCD is characterized by ego-dystonic, which is "thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept", which clearly doesn't apply to the pt case, as checking the temperature is actually meaningful and goal-directed. +1
utap2001  I think the most important hints are stressor and timeframe. I believe the description in the Q stem have some distractor. Maybe the definition of OCD should be no reason. A stressor and <3 month time make adjustment disorder more likely. +
... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

Multinodular goiter! Say it five times fast. Feels good, doesn’t it? The first half describes blatant hyperthyroidism. The thyroid scan is now demonstrating an enlarged gland with multiple nodules (“areas”), some avid/hyperfunctioning and other relatively depressed (either not “hyper”-functioning and thus relatively cold or actually cold, most commonly filled with colloid).

... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

You know what causes sudden onset headache and neck stiffness? Subarachnoid hemorrhage. The first episode can be transient, the so-called sentinel bleed before a catastrophic aneurysmal bleed.

... shakakaka is asking for clarification on nbme16
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submitted by shakakaka(11)

Why not N.meningitidis ? Penicillin and ceftriaxone are treatment chooses for N.meningitidis and it's encapsulated.. If I'm not mistaken macrolides and ceftriaxone are treatment for S.pneumo , not penicillin

shieldmaiden  This is prophylactic treatment, and penicillin is the one recommended by the AAP and CDC +
... eghafoor is asking for clarification on nbme16
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submitted by eghafoor(4)

Anyone else got thrown off by the wording of "......each kidney" when the question is referring to A (singular) horseshoe kidney?

... welpdedelp is asking for clarification on step2ck_form6
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submitted by welpdedelp(242)

She met the Centor criteria for empiric antibiotics, why was is culture?

tinylilron  I think that if you do a rapid test for group A strep if it is negative you have to follow it up with a throat culture... I remember this from my pediatric rotation... the culture is supposed to be more sensitive(?) than the rapid test. https://www.uofmhealth.org/health-library/hw204006#:~:text=A%20t +
sassy_vulpix  As per UWorld : Adults : Centor Criteria : 0-1 : viral,No test reqd; 2-3 : RSAT, if positive antibiotics, if negative, we assume it to be viral so nothing; 4 : penicillin/amoxiciliin whereas for kids, we always need to follow up a negative RSAT with a throat culture. In adults, there is no need. +
... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

How many people with sats in 80s have you seen not getting O2?

... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

This is a potentially fatal decision. Patients can choose to deny care, but when someone is making the “wrong” choice, it’s important to make sure they have the capacity to do so: do they understand their situation, their options, and the possible consequences of their actions? If so, that’s fine.

... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

Source control followed by symptomatic relief. Have you seriously ever heard of anyone doing any of that other crazy stuff?

etherbunny  I was fooled into an ophthal consult by the "dusky" orbit. +1
len49  @etherbunny, never consult anyone on NBME lol +
... trazobone is asking for clarification on nbme13
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submitted by trazobone(59)

SMH it all boiled down to what does tyrosine kinase do? Kinase phosphorylates stuff. So therefore the homodimer would still form but since the key thing thats being messed up here is the kinase, it’s the phosphorylation process that gets disrupted.

trazobone  SMH it all boiled down to what does tyrosine kinase do? Kinase phosphorylates stuff. So therefore the homodimer would still form but since the key thing thats being messed up here is the kinase, it’s the phosphorylation process that gets disrupted. +1
... kingfriday is asking for clarification on step2ck_form6
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submitted by kingfriday(20)

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?

ddub  H2-rec blocking agent is not a PPI +3
... whoopthereitis is asking for clarification on nbme19
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submitted by whoopthereitis(1)

can anyone elaborate why they chose this 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" +1
... misrao is asking for clarification on nbme21
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submitted by misrao(3)

Can someone explain the correlation between 450 mOsmol/day and needing to excrete 1 L of water? Thanks

trazobone  This is my second time doing this question TY COVID. The definition of an Osm is the number of osmoles of solute per liter of solvent. The stem tells you the highest she can concentrate her urine is 450 mOsmol/kg H2O, and she takes in 450 mOsmol/day. She also loses 1000 mL from sweat, feces, etc.. The mOsmol variables are NOT related to the 1000 mL. It is going to take 1 liter to concentrate that 450 mOsmol urine, and she also loses a separate unrelated 1 liter. Together, the minimum amount of H2O needed is going to be 2 liters. +
... llpierso is asking for clarification on nbme22
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submitted by llpierso(0)

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?

llpierso  Nevermind, thought about this more: DKA causes an anion gap acidosis (hence normal chloride and elevated keto-anions). +
... lickmyass is asking for clarification on nbme20
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submitted by lickmyass(0)

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.

hiroshimi  I think hyperplastic arteriosclerosis meaning that the wall of the artery is thicker, and that narrows the lumen, making it more "stiff" and reduce compliance. It's exactly what you see in patient with HTN. Think about pt with aortic stenosis, it's similar. In contrast, in aneurysm, the wall of the artery is actually thinner, the wall is weakened, that's why it's easier to rupture, think about the aortic aneurysm, it's more likely to rupture if's not treated. +
... brise is asking for clarification on nbme23
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submitted by brise(65)

How do you rule out LSD? It also causes tachycardia!

... ht3 is asking for clarification on step2ck_form7
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submitted by ht3(20)

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??

cinnapie  Contraction of right SCM moves your chin to the left. I know its weird to think that the SCM kinda pushes the chin away but its how the origin and insertion of the muscle is. +3
fkstpashls  If you're slouching in bed with your mouth open wondering why you get rammed by another question, tense up your SCM on one side and you'll feel your jaw move to the opposite. +
... brise is asking for clarification on nbme23
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submitted by brise(65)

I chose anything that would help show a relationship strength: got rid of anything with specificity and sensitivity in it. Leaving only D and F: Temporal relationship sounds more in line with relationship than consistency of other studied. Also how would the consistency of other studies prove anything for the relationship between intervention and child language score in this study?

... benwhite_dotcom is asking for clarification on step2ck_free120
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submitted by benwhite_dotcom(588)

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.

qfever  I don't think it's Wegener's. It should be Churg-Strauss since there is asthma, peripheral neuropathy and so on +
wutuwantbruv  I agree with @qfever. This is more likely to be Churg-Strauss since the neuropathy described is possibly mononeuritis multiplex. The asthma would indicate some sort of eosinophilic process consistent with Churg-Strauss. +
... brise is asking for clarification on nbme23
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submitted by brise(65)

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

brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1
meja2  Acetaminophen is not anti-inflammatory, only provides antipyretic & ani-pain effects. +