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Welcome to tinylilron’s page.
Contributor score: 5


Comments ...

 +0  (step2ck_form6#27)

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 +

 +0  (step2ck_form6#3)

Can anyone explain the correct answer for this one?


 +0  (step2ck_form6#5)

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. +
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +

 +0  (step2ck_form6#7)

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


 +1  (step2ck_form6#34)

Wernicke syndrome presents in patients with alcoholism thought to be due to Vitamin B1 deficiency

Classic Triad= confusion+ opthalmoplegia + ataxia


 +0  (step2ck_form6#45)

Does anyone have any ideas for this one???


 +1  (step2ck_form6#35)

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. +




Subcomments ...

can someone please explain this answer :D

szsnikaa  Brain abscesses are secondary to septic emboli via hematogenous spread. Edema often forms around these abscesses leading to a mass effect (+ Babinski & Mild Hemiparesis on the left). +7  
kingfriday  Guy has a valve replacement -> he then has a new murmur, fever, and FND - he probably has endocarditis due to staph epidermidis. Carotid artery occlusion wouldn't cause more issues (i think vision in particular would be included) in addition to more severe deficits. There would also be no fever. Venous sinus thrombosis would also not present with fever and also probably include vision problems Encephalitis would probably present with AMS and seizures - may or may not be nuchal rigidity Hydrocephalus: wet wacky wobbly- not seen here +2  
tinylilron  So the brain abscess would be due to staph epidermis rather than strep pyogenes, right? +  


submitted by medicalmike(38),

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? +  


submitted by shastri96(4),

LEAD POISONING IN ADULTS: GI Symptoms: abd pain, constipation (acute) Neuro: Cognitive deficit, Peripheral neuropathy (chronic) Hematological: Anemia

this patient has Signs of chronic lead poisoning: nonspecific symptoms (eg fatigue, irritability, insomnia), HTN, motor and sensory deficits, cognitive defect.

So we check for elevated venous Lead levels and give chelation therapy.

tinylilron  I was explaining his symptoms with his alcohol-use disorder but everything you said makes sense +  


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. +  


Don't forget your sketchy!

carbamazapine is the anti-epileptic associated with blood dyscrasias, such as aplastic anemia and agranulocytosis

tinylilron  Isn't possible for folic acid deficiency and suppression of bone marrow by alcohol to be potential causes of the patient's decreased leukocyte count? +  
keyseph  Folic acid deficiency would not explain the disproportionate decrease in neutrophils. Yes, this is leukopenia, but more specifically, this is agranulocytosis, which is a side effect of carbamazepine. +  


submitted by medgirl11(5),

Amoxicillin course has not resolved pain + down/lateral displacement of auricle = abscess symptoms... use CT to visualize

tinylilron  I was thinking mastoiditis +1  
keyseph  Persistent pain from AOM with displaced ear and postauricular pain suggests mastoiditis, which is evaluated with a head CT. +  


submitted by medicalmike(38),

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? +  


submitted by derpymd(2),

I somehow got this confused with which vaccines to give an unvaccinated pregnant woman with chronic hepatitis C (HAV and HBV).

Also I think "health maintenance regimen" was the key phrase here

tinylilron  This one confused me because I would also make sure she was vaccinated for all of these except Strep pyogenes (because I don't think that vaccination exists). Although, maybe you are correct, "health maintenance regimen" is the key phrase. +  


submitted by medicalmike(38),

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 +  


submitted by medicalmike(38),

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 +  


submitted by sasoo8888(1),

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 +1  
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. +  


Remember, thyroiditis also causes hyperlipidemia

Increased LDL receptors +/- triglycerides due to increased LPL activity

Post-partum + cholesterol + lethargy + boredom + sleep issues + memory = thyroid

Would also expect hypnatremia, weight gain

Postpartum thyroiditis usually hyperthyroid followed by hypothyroid

tinylilron  I was thinking about her palpitations. I wonder if that could be caused by her hyperthyroid state before her hypothyroid state. +  


submitted by medgirl11(5),

Patient has symptoms of SIADH = low Na, which presents with small cell carcinoma of the lung

tinylilron  I would think that SIADH can occur with ANY lung pathology. Thus making any of these etiologies plausible. However, First Aid Step 2 CK mentions that SIASH is present with small cell carcinoma. Therefore, I suppose small cell carcinoma has a greater association with SIADH. +  


Clue cells = gardnerella = grayish discharge and does change pH (>4.5)

Others

  • Ferning = pregnancy / rupture of membranes, but she does not have male partners, so less likely

  • Budding yeast = candida = grayish, but does not change the vaginal pH (<4.5)

  • leukocyte sheets = ? Maybe erosive lichen planus / lichenoid vaginitis ?

  • Trich = green discharge, does change pH (>4.5)


https://vulvovaginaldisorders.com/the-four-pillars-of-vulvovaginal-diagnosis/table-elevated-ph/#prettyPhoto[6]/0/

spiroskeet  Reason for pH >4.5 is that Gardnerella outcompete Lactobacilli fauna, which (as their name implies) pump out acid +  
tinylilron  seriously green discharge vs. gray discharge? :-/ +  


submitted by kingfriday(14),

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

tinylilron  I am confused as well. Is it because of the rapid nature of memory loss? +  
shastri96  Presbycusis presbyopia diminished ankle reflex Old age related tremor all are common old age conditions so they dont require urgent evaluation. +1  
nayyyy  Also that she felt well and was not concerned about it? Maybe.. lol +  


submitted by medicalmike(38),

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? +  


submitted by welpdedelp(227),

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 +  


submitted by medicalmike(38),

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? +  


submitted by medicalmike(38),

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? +  


submitted by medicalmike(38),

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? +  


PDA gives continuous machine like murmur that crescendos at S2, so loud S2

Agree with sugaplum;

widened pulse pressure => PDA in newborn or regurg in adult

To and fro murmur = wave like = swishing back and forth = PDA

close with indomethacin

tinylilron  why couldn't it be a Coarctation of the aorta? +