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Welcome to medicalmike’s page.
Contributor score: 38

Comments ...

 +1  (step2ck_form6#24)

Per FA - drugs for hypertensive emergency are clevidipine/nicardipine, fenoldopam (D1 agonist), labetalol, nitroprusside

 +0  (step2ck_form6#42)

This child has some sort of leukodystrophy, as evidenced by widespread white matter disease on MRI. Without having reviewed biochem recently, one can educated guess this question by recalling that fatty acids like to accumulate in white matter; white matter and peripheral nerve conduction will be messed up. Accumulation of VLCFAs specifically refers to adrenoleukodystrophy. Other diseases include metachromatic leukodystrophy, refsum, zellweger.

Abnormally decreased serum cholesterol and Acanthocytes = Abetalipoproteinemia (causes ADEK deficiency)

VitE deficiency damages spinocerebellar tract, dorsal columns, and peripheral nerves (same as Friederich Ataxia)

ht3  Good thing I know 0 biochem +1

 +2  (step2ck_form6#37)

This boy with recurrent bacterial infections, low lymphocyte count, and low levels of all Ig's has X-linked agammaglobulinemia ("two maternal uncles..."). Treatment is IVIG and antibiotic ppx.

SCID is treated with BMT, and presents earlier with failure to thrive and bacterial, fungal, and viral infections due to low B and T cells.

DiGeorge is treated with thymic transplant, and presents with low T cells and normal Ig's.

 +3  (step2ck_form6#27)

Criteria for weaning from ventilator:

  1. O2 sat >= 90% with FiO2<=40% and PEEP<=8
  2. pH>7.25
  3. Initiating breaths (SIMV allows patient to initiate breaths)
tinylilron  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? +

 +0  (step2ck_form6#29)

This kid has tons of lake water in his alveoli. This can trigger inflammatory response before the lungs can reabsorb all of it.

 +1  (step2ck_form6#14)

Workup of post-cholecystectomy RUQ pain is ERCP

 +0  (step2ck_form6#31)

For median and ulnar nerve injuries:

proximal injury = impaired flexion (this patient)

distal injury = impaired extension

mnemonic: 'd' is closer to 'e' in the alphabet, and 'f' corresponds to 'p'

nayyyy  This is likely cubital tunnel syndrome, it results in tingling and numbness in the ring and small fingers. Occurs due to stretching or compression of the ulnar nerve. +

 +0  (step2ck_form6#30)

Median nerve injury at wrist spares sensation in the palm since palmar cutaneous branch enters outside of carpal tunnel.

 +2  (step2ck_form6#36)

Normal V/Q scan rules out PE, regardless of pretest probability.

Low-risk V/Q scan in a low-risk patient rules out PE (unusual scenario for V/Q scan since D-dimer also appropriate)

High-risk V/Q scan in a high-risk patient confirms PE (this patient).

Any other combination warrants additional testing with CT angio.

 +3  (step2ck_form6#44)

ABI<0.9 is diagnostic of peripheral artery disease. First-line treatment is graded exercise program. Revascularization is only indicated for critical limb ischemia (rest pain, non-healing ulcers)

ronabobonafofona  Mad at myself. I picked this answer first but then got thrown off by the "pulse 0". Should've just focused on the ABI. Severe ABI <0.4. +

 +2  (step2ck_form6#40)

Myelomeningocele is associated with Chiari II malformation -> obstructive hydrocephalus

 +1  (step2ck_form6#12)

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +
tinylilron  does the decanoate make it a long-acting medication? +

 +0  (step2ck_form6#3)

First-line treatment of any mild acne is topical retinoids and benzoyl peroxide.

 +0  (step2ck_form6#36)

Most institutions require adequate titers of HBsAb prior to patient contact.

 +0  (step2ck_form6#11)

This patient with homophobia has some functional impairment (2-week leave of absence) within 2 months following a stressor, with anxiety surrounding a single 'issue'. I approach adjustment disorder by ruling out other answer choices:

PTSD/Acute stress are only diagnosed following life-threatening events.

GAD requires >6mo of symptoms and worry about multiple issues.

Panic disorder requires patient to actively avoid scenarios that may trigger panic attack.

 +1  (step2ck_form6#16)

Absent breath sounds and opacification on XR suggests fluid or atelectasis. Hemothorax is the only possible answer choice.

 +1  (step2ck_form6#30)

I think we've all been pimped on demargination reaction at some point...

 +0  (step2ck_form6#27)

Suspicion for septic arthritis warrants both diagnostic and therapeutic joint aspiration followed by empiric systemic antibiotics (covering S. aureus in this healthy child).

 +1  (step2ck_form6#20)

This patient with smoking history has euvolemic hyponatremia iso hilar mass, representing SIADH 2/2 SCLC. No signs of AMS so treat conservatively with water restriction. 3% saline is only indicated for symptomatic severe hypoNa.

Hiccups indicate phrenic nerve irritation.

tinylilron  Are the hiccups related to his SIADH? +

 +0  (step2ck_form6#13)

Itchy rash and eosinophilia suggests Type I hypersensitivty reaction, a side effect of sulfonamides.

ht3  But she has been taking tmp-smx for a whole year and the rash shows up 2 weeks ago.....?? +1

 +0  (step2ck_form6#28)

This distribution of rash in a medical assistant suggests urticaria (Type I HS) from wearing latex gloves.

happyyoyo  she has allergic contact dermatitis which is a type 4 hypersensitivity reaction. Urticaria is a type 1 hypersensitivity +
tinylilron  First Aid Step 2 CK says that Latex allergy is NOT a contact dermatitis--its a type 1 hypersensitivity reaction +

 +1  (step2ck_form6#18)

Intractable vomiting results in hypochloremic metabolic alkalosis due to loss of HCl. (B) is the only choice with elevated HCO3-. K+ is low due to elevated aldosterone activity from contraction alkalosis.

tinylilron  Is sodium not affected (140) because aldosterone is able to compensate? For some reason, I thought that one could lose sodium with intractable vomiting too? +

 +2  (step2ck_form6#15)

This patient with anemia and extreme hypotension following MVA is bleeding into her pelvis/thighs. She urgently needs isotonic fluids and blood products prior to further workup.

 +1  (step2ck_form6#4)

Breast engorgement is normal while a woman is breastfeeding. Mild tenderness is normal for several weeks following low-transverse C-section, a notoriously painful incision. This patient has resumed sexual activity and would benefit from contraception, but this is not an answer choice.

welpdedelp  U/S indicated if there was fluctuance, fever or marked leukocytosis +2

 +2  (step2ck_form6#12)

Calcifications in anterior lumbar spine = atherosclerosis in abdominal aorta, a risk factor for AAA. Acute onset pain indicates rupture or impending rupture. BP can be low-normal due to tamponade by retroperitoneal location of abdominal aorta.

note: calcifications in anterior lower thoracic spine = chronic pancreatitis

 +0  (step2ck_form6#38)

HSV encephalitis presents with non-specific symptoms of confusion/AMS, behavior changes, and focal seizures. CSF showing mildly elevated protein and lymphocytes with xanthochromia confirms the diagnosis.

 +1  (step2ck_form6#7)

Analgesic nephropathy (2/2 ASA, ibuprofen) can present with AIN, renal papillary necrosis, and ATN due to vasoconstrictive effects. Intrarenal pattern of injury (BUN/Cr<20) with granular casts suggests ATN.

 +0  (step2ck_form6#6)

Lytic bone lesions, hypercalcemia, anemia, and rouleaux = MM

 +0  (step2ck_form6#41)

High PVR indicates urinary retention -> overflow incontinence, likely 2/2 decreased detrusor contractility from residual effects of epidural anesthesia.

 +1  (step2ck_form6#40)

Cystourethrocele (herniation of bladder neck) indicates urethral hypermobility -> stress incontinence. Vaginal delivery is a risk factor.

 +0  (step2ck_form6#23)

This boy with AGMA and +ketones in serum has DKA, a common presenting symptom of T1DM due to inadequate insulin production. Serum sodium is normal after adjusting for hyperglycemia.

tinylilron  AGMA??? +1
nayyyy  Anion gap metabolic acidosis +

 +1  (step2ck_form6#31)

Vascular ring presents in infancy with biphasic stridor/wheezing that improves with neck extension. None of the other answer choices would persist for 5 months and still result in a happy, well-nourished baby.

tinylilron  I did not choose this one because I thought a vascular ring compressing the airway would result in stridor... :-/ +
tinylilron  I did not choose this one because I thought a vascular ring compressing the airway would result in stridor... :-/ Also, is the baby not demonstrating esophageal symptoms because he is only fed formula at this time? +

 +1  (step2ck_form6#21)

Radiation therapy is the second most common cause of constrictive pericarditis in the US (after viral/idiopathic)

 +1  (step2ck_form6#28)

This patient's subacute onset dementia and prominent memory issues with lack of concern point towards pseudodementia (dementia 2/2 MDD). She also meets criteria for MDD with flat affect, sleep changes, appetite changes, psychomotor retardation, concentration problems (repeating 3 numbers in sequence)

ronabobonafofona  Great points. Also, Alzheimer's would usually present over a longer time frame (months - years) rather than just 6 weeks. +

 +1  (step2ck_form6#10)

AS is strongly associated with HLA-B27 (however, not all patients with HLA-B27 serotype will develop AS)

Subcomments ...

submitted by tinydoc(233),

I got this based on the causes of post op fever. Mostly just a guess really.

The 5 "W's"

1-2 Days post op: WIND - Lungs - post op atelectasis

3-5 days post op: WATER - UTI

5+ days post op: WALKING - DVT/ PE

7 days post op: WOUND - wound infections

8-15 days post op: WONDER DRUGs - Drug fever

The question says pt is 3 days post op so I just went with prevention of UTI. Uworld says the best way to prevent UTI is to remove catheter as soon as it's not needed.

medicalmike  Other answer choices can be eliminated as follows: subQ heparin is unnecessary as the patient is now ambulating Patient should stay on furosemide since it appears this is a home med for his CHF Acid suppression is used for critically ill patients (he is extubated and on his way to recovery) Morphine can be continued as this patient just had his chest split open. He will be transitioned to PO opioids prior to discharge. +2  

submitted by sugaplum(376),

She is the classic demographic for pulmonary arterial hypertension. Slowly progressive disease. The PE findings support it

medicalmike  This patient's mitral opening snap and diastolic murmur are due to her mitral stenosis. Long-standing MS leads to elevated left atrial pressures which transmit to the pulmonary artery -> secondary pulmonary hypertension (not primary idiopathic PAH) +6  
ronabobonafofona  No worries @sugaplum. You've been right on for 99% of the other qs. +  

submitted by sugaplum(376),

I missed this the first time because I wasn't thinking about it right. This man has new onset Type 2 diabetes. This is characterized by Insulin resistance, so initially the patient's body will increase insulin production to combat the new diabetes

medicalmike  Does T2DM cause weight loss? I interpreted this older man with weight loss and new-onset T2DM as having pancreatic cancer. +  
kingfriday  i guess if you dont get the anabolic benefit of insulin, you can't build up your weight- at least that's how i took it +1  
ronabobonafofona  Did the same thing @sugaplum +