Kim! Hi! It’s your dad!πŸ‘‹ ▪ 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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Step 2 CK Form 6 Answers

Question#2 (reveal difficulty score)
A 67-year-old man is examined 3 days after ...
Remove the urinary catheterπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 20-month-old girl is brought to the ...
Cystic fibrosisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A previously healthy 16-year-old boy is ...
Pulmonary tuberculosisπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
During the past 4 months, a 32-year-old woman ...
SjΓΆgren syndromeπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 5-year-old boy is brought to the emergency ...
Hyaline castsπŸ”,πŸ“Ί


Question#8 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
Pulmonary artery pressureπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 42-year-old man is brought to the emergency ...
Vitamin B1 (thiamine)πŸ”,πŸ“Ί


hypothyroid post_partum TSH pregnancy
Question#11 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Thyroid-stimulating hormoneπŸ”,πŸ“Ί


postop surgery
Question#14 (reveal difficulty score)
A 72-year-old man comes to the emergency ...
Corticosteroid therapyπŸ”,πŸ“Ί


Question#17 (reveal difficulty score)
A 28-year-old woman at 28 weeks' gestation ...
Mitral stenosisπŸ”,πŸ“Ί

cardio



Question#22 (reveal difficulty score)
A 52-year-old woman comes to the physician ...
Decreased androgensπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
Two hours ago, a 24-year-old man had the ...
Tube thoracostomyπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 57-year-old man is brought to the emergency ...
Intravenous calcium gluconateπŸ”,πŸ“Ί


endocrine repro pcos infertility
Question#26 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Polycystic ovarian syndromeπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 32-year-old man has had mild tremulousness, ...
Discontinuation of lorazepamπŸ”,πŸ“Ί


Question#29 (reveal difficulty score)
A 42-year-old computer science professor is ...
Huntington's diseaseπŸ”,πŸ“Ί


visualfielddefect visual_field_defect
Question#31 (reveal difficulty score)
A 37-year-old woman is brought to the ...
Right optic nerveπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 24-year-old primigravid woman at 18 weeks' ...
Inflammatory bowel diseaseπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
A 25-year-old woman comes to the physician ...
Complete blood countπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 67-year-old man comes to the emergency ...
Right vertebralπŸ”,πŸ“Ί

milestones
Question#38 (reveal difficulty score)
A previously healthy 32-year-old woman comes ...
Inhaled Ξ²2-adrenergic agonistπŸ”,πŸ“Ί


Question#40 (reveal difficulty score)
A 20-year-old man comes for a routine health ...
Myotonic muscular dystrophyπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A previously healthy 52-year-old man comes to ...
InsulinπŸ”,πŸ“Ί



Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the emergency ...
Pulmonary contusionπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 77-year-old woman comes to the physician ...
Gallstone ileusπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 20-year-old man is brought to the emergency ...
Inadequate dissipation of body heatπŸ”,πŸ“Ί


Question#3 (reveal difficulty score)
A 21-year-old college student comes to the ...
Topical retinoic acidπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
Four weeks after a low transverse cesarean ...
ReassuranceπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...
LaparotomyπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 67-year-old woman has had anorexia, ...
Multiple myelomaπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Avoidance of analgesicsπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A healthy 21-year-old college student comes ...
Pap smearπŸ”,πŸ“Ί


Question#12 (reveal difficulty score)
A 67-year-old man is brought to the emergency ...
Ruptured aortic aneurysmπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
Medication adverse effectπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
An 8-year-old girl with type 1 diabetes ...
Infusion of 0.9% salineπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 32-year-old woman is brought to the ...
HemothoraxπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
FibromyalgiaπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 35-year-old man is brought to the emergency ...
Na+: 140;
Cl-: 80;
K+: 2.5;
HCO3-: 40
πŸ”
,πŸ“Ί


Question#20 (reveal difficulty score)
A previously healthy 52-year-old man comes to ...
Fluid restrictionπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Constrictive pericarditisπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 5-week-old boy is brought to the physician ...
Hypertrophic pyloric stenosisπŸ”,πŸ“Ί




Question#27 (reveal difficulty score)
A previously healthy 4-year-old girl is ...
ArthrocentesisπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 25-year-old woman comes to the physician ...
Latex productsπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 32-year-old woman, gravida 2, para 2, comes ...
AnovulationπŸ”,πŸ“Ί





Question#34 (reveal difficulty score)
A 7-year-old girl is brought to the physician ...
Throat cultureπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
Irritable bowel syndromeπŸ”,πŸ“Ί


Question#38 (reveal difficulty score)
A previously healthy 16-year-old boy is ...
Viral infectionπŸ”,πŸ“Ί


Question#40 (reveal difficulty score)
A previously healthy 44-year-old woman, ...
Stress incontinenceπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
One day after an uncomplicated spontaneous ...
Overflow incontinenceπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
An asymptomatic 32-year-old man comes for a ...
Selective IgA deficiencyπŸ”,πŸ“Ί


Question#44 (reveal difficulty score)
A 62-year-old man has had the gradual onset ...
Tricuspid regurgitationπŸ”,πŸ“Ί


Question#46 (reveal difficulty score)
An 87-year-old nursing home resident with ...
Decreased gag reflexπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 32-year-old woman who is HIV positive has a ...
Influenza virusπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
MalabsorptionπŸ”,πŸ“Ί


Question#4 (reveal difficulty score)
An 18-year-old man comes for an examination ...
Germinal cell tumorπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 67-year-old man comes to the physician ...
ThymomaπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Aortic incompetenceπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 52-year-old man comes to the physician for ...
Exercise stress testπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 50-year-old woman has had progressive ...
EchocardiographyπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
An asymptomatic 32-year-old woman comes for a ...
Weight-loss programπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 47-year-old man is admitted to the hospital ...
Haloperidol decanoateπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 38-year-old woman, gravida 2, para 1, at 38 ...
Nonstress testπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
A 26-year-old woman is brought to the ...
ACTH stimulation testπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
An 18-year-old man comes to the physician for ...
Ask about suicidal feelingsπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 52-year-old woman comes to the physician ...
Intraductal papillomaπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 77-year-old woman is brought to the ...
Memory lossπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Carbamazepine therapyπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A previously healthy 16-year-old high school ...
Eczema herpeticumπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 19-year-old man is brought to the emergency ...
LaparotomyπŸ”,πŸ“Ί


Question#25 (reveal difficulty score)
A 37-year-old woman, gravida 2, para 1, at 12 ...
Previous preterm deliveryπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
PCPπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 57-year-old man is brought to the emergency ...
Carotid ultrasonographyπŸ”,πŸ“Ί



Question#30 (reveal difficulty score)
A previously healthy 42-year-old carpenter ...
Median nerve at the wristπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A previously healthy 37-year-old man comes to ...
Ulnar nerve at the elbowπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
Two days after admission to the hospital for ...
Acute tubular necrosisπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Clue cellsπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 32-year-old man with alcoholism is brought ...
Vitamin B1 (thiamine)πŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 67-year-old man has had shortness of breath ...
ThoracentesisπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
Three days after being hospitalized for ...
Heparin therapyπŸ”,πŸ“Ί


Question#38 (reveal difficulty score)
A 3-year-old boy is brought for a follow-up ...
CT scan of the headπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A previously healthy 62-year-old man comes to ...
CT scan of the abdomenπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 72-year-old man with hypertension has had ...
Metastatic prostate carcinomaπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 40-year-old man is brought to the emergency ...
Myocardial contusionπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A previously healthy 67-year-old man is ...
Small cell carcinomaπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A previously healthy 67-year-old man comes to ...
Daily exercise programπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 42-year-old man comes to the emergency ...
Amphotericin BπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 16-year-old boy with neurofibromatosis is ...
Catecholamine-producing tumorπŸ”,πŸ“Ί


Question#4 (reveal difficulty score)
A previously healthy 47-year-old woman comes ...
Gallstone pancreatitisπŸ”,πŸ“Ί


Question#6 (reveal difficulty score)
A 62-year-old woman is brought to the ...
Orthostatic hypotensionπŸ”,πŸ“Ί




Question#10 (reveal difficulty score)
A 37-year-old primigravid woman at 9 weeks' ...
Antiemetic therapyπŸ”,πŸ“Ί


Question#13 (reveal difficulty score)
A 67-year-old man is brought to the emergency ...
Brain abscessπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 57-year-old man comes to the physician ...
IndomethacinπŸ”,πŸ“Ί



Question#17 (reveal difficulty score)
A previously healthy 32-year-old plumber ...
Muscle strainπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
Over the past 3 months, a 30-year-old woman ...
Adrenal glandπŸ”,πŸ“Ί



Question#21 (reveal difficulty score)
A previously healthy 52-year-old woman comes ...
SporotrichosisπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
An 18-year-old man comes to the physician 1 ...
Operative treatmentπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 62-year-old woman is brought to the ...
NitroprussideπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 42-year-old man comes to the physician ...
EmphysemaπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
Four days after undergoing resection of an ...
Central venous catheterπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 67-year-old woman has been intubated for 1 ...
Wean from the ventilatorπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
An 80-year-old woman has had bleeding gums ...
CπŸ”,πŸ“Ί


Question#30 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Oral enalapril therapyπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
An asymptomatic 21-year-old woman is found to ...
Benign cystic teratomaπŸ”,πŸ“Ί



Question#34 (reveal difficulty score)
A 42-year-old man is brought to the physician ...
Complex partial seizuresπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 22-year-old primigravid woman at 16 weeks' ...
ChoriocarcinomaπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A previously healthy 87-year-old woman comes ...
Lichen sclerosusπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 32-year-old man comes to the physician ...
Vitamin D deficiencyπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 45-year-old woman comes to the emergency ...
LorazepamπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Gastric bypassπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 28-month-old boy has a history of cyanosis ...
Tetralogy of FallotπŸ”,πŸ“Ί



Question#43 (reveal difficulty score)
A 67-year-old woman is brought to the ...
Esophageal perforationπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 13-year-old boy is brought to the physician ...
No pharmacotherapy is indicatedπŸ”,πŸ“Ί


Question#46 (reveal difficulty score)
A 5-year-old girl is brought to the physician ...
EmpyemaπŸ”,πŸ“Ί

pregnancy
Question#8 (reveal difficulty score)
27-year-old primigravid at 38weekss gestation ...
Recommend autopsy of the infantπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
a program for the primary prevention of ...
IncidenceπŸ”,πŸ“Ί





Recent comments ...

... szsnikaa made a comment on step2ck_form6/block3/q#4 (An 18-year-old man comes for an examination prior to...)
 +7 
submitted by szsnikaa(19)

This patient has a testicular mass. Let's examine a few differentials as we go through the answer choices.

Germinal Cell Tumor (Testicular Tumor)

  • Usually painless but dull/achy/heavy sensation; palpation of SOLID mass
  • No change in size when supine
  • No transillumination

Dilated pampiniform venous plexus (Varicocele)

  • Usually painless; "Bag of worms"
  • Reduced swelling when supine
  • No transillumination

Cystic Dilation of the effect ductules (Spermatocele)

  • Typically painless; fluctuant swelling of upper testicular pole
  • No change in size when supine
  • Does transilluminate

Fluid accumulation within the tunica vaginalis testis (Hydrocele)

  • Often painless; fluctuant swelling of scrotum
  • May/May not change in size wrt position
  • Does transilluminate

Vascular Trauma (Hematocele/Ruptured Testis)

  • Extremely painful & tender; visible hematoma
  • May/May not change in size wrt position
  • No transillumination

drdoom  your account has been upgraded to: ATTENDING +2
drmohandes  that's how you do an explanation. cheers m8 +1
... sugaplum made a comment on step2ck_form6/block1/q#36 (A 67-year-old man comes to the emergency department...)
 +5 
submitted by sugaplum(415)

This question is tricky. I used to always miss this presentation. This is laterally medullary syndrome- which most of us have memorizes is a PICA infarct. Fun fact, PICA comes off the vertebral artery.

This is how I remember the sx. If this helps at least one person I will be glad I am exposing my twisted brain.

3+5=8 & 9-11 & B-P.

3: Horner's syndrome 5:spinal trigeminal- ipsi face pain and temp loss 8: vestibular signs, vertigo diplopia

9-11: Nucleus ambiguous, diminshed gag, dysphagia B: Cerebellar - inferior cerebellar peduncle, ipsi ataxia P: Contra pain and temp, cuz this shit was so painful to memorize I throw it to the other side.

ronabobonafofona  Thank you for this. +
... sugaplum made a comment on step2ck_form6/block1/q#42 (A 24-year-old man is brought to the emergency...)
 +5 
submitted by sugaplum(415)

sclera injection and munchies

In the words of afroman. I was gonnna go to work....but then I got high...

drdoom  I was gonna get up and find the broom but then I got high .. +4
atypicalgowda  My room is still messed up and I know why +2
drdoom  (yeah-he-yeahhhh!) +2
ronabobonafofona  Omg this is so obvious when re-reading it. Can't believe I missed that. +1
jlbae  Woo, good morning, ladies +1
... carolebaskin made a comment on step2ck_form6/block1/q#45 (A 77-year-old woman comes to the physician because...)
 +5 
submitted by carolebaskin(85)

Cramping abdominal pain with distention, N/V should make you think SBO

Air-fluid levels in the small bowel but no gas in the colon tells you it's an upper GI issue

Hyperactive bowel sounds + pneumobilia = gallstone ileus

Very few things put air in the liver

... medicalmike made a comment on step2ck_form6/block3/q#44 (A previously healthy 67-year-old man comes to the...)
 +5 
submitted by medicalmike(68)

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. +
... sugaplum made a comment on step2ck_form6/block1/q#31 (A 37-year-old woman is brought to the emergency...)
 +4 
submitted by sugaplum(415)

since she has total blindness just in one eye, right optic nerve lesion makes sense. The poor reactivity to light supports this because eyes receive light through optic nerve (CN2)

... sugaplum made a comment on step2ck_form6/block1/q#39 (A 6-month-old girl is brought to the physician...)
 +4 
submitted by sugaplum(415)

Widened pulse pressure in an adult is regurg. Widened pulse pressure in a new born is PDA. because the blood is swishing back and forth

jlbae  I literally learned this from Divine last night. Only reason I got this one correct. Why has my medical school failed me so hard? +2
... carolebaskin made a comment on step2ck_form6/block1/q#44 (A 4-year-old boy is brought to the emergency...)
 +4 
submitted by carolebaskin(85)

Elimination

(a) ARDS is bilateral

(b) aspiration PNA is too quick (4 hours!) and is usually consolidated

(c) fat embolism is more common with long bone fractures (e.g., femur) -- if you hear chest is bruised, think chest first

(d) hemothorax is usually more acute, but I suppose possible especially if you're thinking flail chest with sharp ribs causing puncture. But, x-ray would be more consolidated

(e) pulmonary contusion fits. You have trauma, initially normal ABG, chest bruising, and unilateral diffuse consolidation a few hours later

drdoom  very neat. very structured. to-the-point, practical breakdowns. but also great use of typographical elements ... πŸ€” too neat for emergency medicine. maybe gen surg? too good natured for ob/gyn .. hmmm, maybe future peds surg? okay, that's my final answer: peds surg. +2
drdoom  no, wait .. i’m revising to peds specialty. probably peds nephro. final answer. +1
charcot_bouchard  One thing i like to add contusion can be U/L or B/L. ARDS develops within 6-72 a/c to uw (24-72 in one place) hours of trauma i.e not too early not too late. The use of diffuse made me pause for a bit. Contusion is within 24 hours. and can progress to ARDS +
... medicalmike made a comment on step2ck_form6/block2/q#30 (A 62-year-old woman is admitted to the hospital...)
 +4 
submitted by medicalmike(68)

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

... medicalmike made a comment on step2ck_form6/block4/q#27 (A 67-year-old woman has been intubated for 1 week...)
 +4 
submitted by medicalmike(68)

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? +
charcot_bouchard  Initial criteria for extubation readiness include - pH >7.25 Adequate oxygenation on minimal support (i.e FiO2 <40% and PEEP <5cm H2O) Intact inspiratory effort and sufficient mental alertness to protect the airway. Those who meet the criteria should undergo spontaneous breathing trial (Turn off ventilatory function while intubated). +
... carolebaskin made a comment on step2ck_form6/block1/q#15 (A previously healthy 10-year-old boy is brought to...)
 +3 
submitted by carolebaskin(85)

I hear woods and well demarcated, spreading, pruritic rash and I think poison ivy

Another way to get there: here's no fever but he is v v itchy, so think type IV HSR

Abrupt, sharp line of demarcation, no systemic signs, and mention of environmental exposure should make you think less of strep skin infections

So we're thinking some contact in the forest and we're back at poison ivy or some other allergen

Can treat with antihistamine, but what about prevention? Avoid the woods.

Google bullous poison ivy

... sugaplum made a comment on step2ck_form6/block1/q#21 (A 25-year-old woman comes to the physician for a...)
 +3 
submitted by sugaplum(415)

These people always have extreme unstable relationships. And do things to gain attention. Self harm, suicidal behavior, splitting. The buzz word for treatment is dialectaial behavioral therapy

I think of these as the people who seemed very cool in middle school because they could get a new boy friend every week

... carolebaskin made a comment on step2ck_form6/block1/q#22 (A 52-year-old woman comes to the physician because...)
 +3 
submitted by carolebaskin(85)

Androgens are responsible for libido in both sexes!

Also, can't be estrogen because they're on HRT and vagina is moist and rugated, indicating adequate estrogen

jlbae  "Androgens are responsible for libido in both sexes!" This is why you can give testosterone for arousal disorders +2
drdoom  There’s a great This American Life ep. all about this +1
daisy19  Am I the only one who got this wrong because of the incredibly poor grammar? "Which of the following is the most likely cause of these findings?" Technically speaking, they were just discussing the PE which showed a moist, well rugated vagina. So I assumed they wanted to know what was causing that. +
... qfever made a comment on step2ck_form6/block2/q#14 (A 3-month-old boy is brought for a well-child...)
 +3 
submitted by qfever(55)

Warmest welcome back to Step 1 by NBME lol

... szsnikaa made a comment on step2ck_form6/block2/q#17 (A 24-year-old woman comes to the physician because...)
 +3 
submitted by szsnikaa(19)

Mildly interesting question but worth taking the time to explore the differentials in this vignette.

Fibromyalgia. Prevalent in young - middle-aged & ♀ > β™‚. Chronic widespread pain with tender points. Symptoms of pain & stiffness prevalent but Pain > Stiffness. Associated with IBS, urge incontinence & palpitations. Labs tend to be normal. NSAID won't provide relief. This fits!


Polymyalgia Rheumatica. Just like Fibromyalgia, there are symptoms of both pain and stiffness. However, in polymyalgia rheumatica, Stiffness > Pain. The patients tend to be older (>50yr.) and systemic symptoms (fever, weight loss, night sweats, fatigue) tend to be more prevalent. Not seen in this vignette.

Polymyositis. In this diagnosis, proximal muscle weakness is often the chief complaint +/-- mild pain. Serology would show (+) antinuclear antibodies (ANA). The patient does not complain of weakness in this vignette.

Ankylosing Spondylitis. This is seen in β™‚ > ♀ (3:1) so it becomes less likely. While pain/stiffness is seen in the back, neck, shoulders of these patients, tenderness is primarily seen at the sacroiliac joints. Furthermore, activity tends to improve symptoms (of stiffness) & NSAIDS would provide some relief. We don't see that in this case.

Seronegative RA. In this vignette, Labs show (--)ANA & RF but patients with this disease would present with joint pain & stiffness particularly in the hands, elbows, knees, feet and ankles. NSAIDS would also provide some relief.

... kingfriday made a comment on step2ck_form6/block2/q#39 (A 57-year-old woman with breast cancer comes to the...)
 +3 
submitted by kingfriday(20)

Lady with mets and increased ca2+ (hypercalcemia of malignancy) at risk for cervical spine compression. She also has neurological impairment which makes her a candidate for surgery - decompress spinal cord and cervical stabilization.

I think this lady needs way more than a soft tissue collar and PT - more conservative therapy.

Mithramycin is evidently an antitumor drug used in testicular cancer

Tamoxifen therapy - treat her immediate neurological issues

... medicalmike made a comment on step2ck_form6/block2/q#40 (A previously healthy 44-year-old woman, gravida 4,...)
 +3 
submitted by medicalmike(68)

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

... medicalmike made a comment on step2ck_form6/block3/q#40 (A 6-month-old girl is brought to the physician for a...)
 +3 
submitted by medicalmike(68)

Myelomeningocele is associated with Chiari II malformation -> obstructive hydrocephalus

... keyseph made a comment on step2ck_form6/block4/q#9 (A 4-week-old newborn is brought to the physician...)
 +3 
submitted by keyseph(71)

Gonna write another answer to this since the other answer is so long.

Basically, holosystolic murmur over lower left sternal border in a newborn is most likely a VSD. The murmur from a VSD is due to left-to-right shunt from LV to RV.

In utero and early after birth, pulmonary arterial pressure is high, so the pressure gradient between LV and RV is low. The left-to-right shunt is therefore not that substantial.

As pulmonary growth progresses, the pulmonary arterial pressure decreases, which increases left-to-right shunting and increases the murmur.

... sugaplum made a comment on step2ck_form6/block1/q#3 (A 20-month-old girl is brought to the physician...)
 +2 
submitted by sugaplum(415)

CF, + family hx of norther european. Lungs with lots of gunk it in that is difficult to remove. recurrent infections

kingfriday  adding to this. kid also has poor growth which reflects poor pancreatic function +1
lubdub  And the clubbing indicating chronic hypoxia! +2
... sugaplum made a comment on step2ck_form6/block1/q#5 (During the past 4 months, a 32-year-old woman has...)
 +2 
submitted by sugaplum(415)

Sjogren syndrome destruction of the salivary glands, dental caries. I looked at UTD and there isn't anything about the vagina being involved, but there is probably some article out there that links it.

The other answer choices didn't make sense

lubdub  Other autoimmune (T1DM) and dry eyes point that way as well! +1
lindasmith462  IDK maybe the NBME got the types of "labial" involvement confused... +
... sugaplum made a comment on step2ck_form6/block1/q#6 (A 5-year-old boy is brought to the emergency...)
 +2 
submitted by sugaplum(415)

This kid has signs and sx of dehydration Hyaline casts due to hypovolemia resulting in concentrated urine

welpdedelp  I was thinking RBC cast due to GI illness, thought they were pointing to some sort of IgA nephritis (β•―Β°β–‘Β°)β•―οΈ΅ +
bigjimbo  hypovolemia causing ARF (pre-renal azotemia) leads to normal bland casts aka hyaline casts +
... sasoo8888 made a comment on step2ck_form6/block1/q#8 (A 37-year-old woman comes to the physician because...)
 +2 
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
... medicalmike made a comment on step2ck_form6/block1/q#10 (A 32-year-old woman comes to the physician because...)
 +2 
submitted by medicalmike(68)

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

... sugaplum made a comment on step2ck_form6/block1/q#12 (An 18-month-old boy is brought to the emergency...)
 +2 
submitted by sugaplum(415)

This kid has nursemaids elbow. Apparently a very simple fix

... sugaplum made a comment on step2ck_form6/block1/q#13 (Four hours after undergoing a cesarean delivery at...)
 +2 
submitted by sugaplum(415)

This patient has signs of internal bleeding Decreased breath sounds--> abdomen filling with fluid, so the diaphragm has to push against increased pressure to get a breath in. Abdominal distension, tachycardic, hypotensive.

hematocrit drop by 12%. think about this. 1% change in hematocrit is 3 units of blood. 1 unit is 500mL. So based on her calculated blood loss, she should have only dropped hct by (1%-2). So I mean it could be underestimated blood loss, but her PE signs point to hemorrage

ronabobonafofona  Correct. Could be a retroperitoneal hematoma. See Uworld QID: 16318 +2
jlbae  Yes to this and also - underestimated blood loss would not wait 4 hours to suddenly become symptomatic. +1
... atypicalgowda made a comment on step2ck_form6/block1/q#14 (A 72-year-old man comes to the emergency department...)
 +2 
submitted by atypicalgowda(7)

Threatened (eg, vision change) or confirmed vision loss in GCA requiresΒ high-dose intravenous glucocorticoidsΒ (eg, methylprednisolone 500-1,000 mg daily), followed by oral therapy with a slow taper over several months to prevent worsening or contralateral vision loss.Β  Temporal artery biopsy can confirm the diagnosis of GCA; however, therapy should be started immediately when the diagnosis is suspected and should not be withheld while awaiting confirmation. UWorld qid: 3164

... sugaplum made a comment on step2ck_form6/block1/q#19 (An otherwise healthy 4-month-old girl is brought to...)
 +2 
submitted by sugaplum(415)

This is a capillary hemangioma aka strawberry birth mark. They go away eventually, we dont really mess with them unless they are obstructing the kids vision or breathing somehow.

... welpdedelp made a comment on step2ck_form6/block1/q#24 (A 57-year-old man is brought to the emergency...)
 +2 
submitted by welpdedelp(242)

Ca Gluconate must be given immediately if K > 6.5; think of it as "no point in hydrating or pushing K into cells with insulin if they will die rn of an arrhythmia"

Ca will stabilize immediately, which is why its initial tx.

ronabobonafofona  I also generally use "are there ECG changes?" as a good marker of it you need to give it or not. +
... carolebaskin made a comment on step2ck_form6/block1/q#26 (A 32-year-old woman comes to the physician because...)
 +2 
submitted by carolebaskin(85)

This is tricky because of the normal hormone levels

Usually PCOS has LH:FSH > 3:1

But, both can still be within the reference ranges!

Normal for females

  • FSH: 4-30 premeno, 10-90 midcycle, 40-250 postmeno
  • LH: 5-30 follicular, 75-150 midcycle, 30-200 postmeno

Also, testosterone often, but not always, elevated

jlbae  Ooo that's dirty, dirty trick by our friends at the NBME. +3
... sugaplum made a comment on step2ck_form6/block1/q#27 (A 32-year-old man has had mild tremulousness,...)
 +2 
submitted by sugaplum(415)

These are symptoms of acute benzo withdrawl

drdoom  holy cow you are crushing it right now. frickin POWER SESSION +3
... beeip made a comment on step2ck_form6/block1/q#30 (A 67-year-old woman is hospitalized because of...)
 +2 
submitted by beeip(130)

A precipitous drop in Hgb effectively rules out malrotation. Overaggressive anticoagulation is associated with intramural hematoma.

... carolebaskin made a comment on step2ck_form6/block1/q#31 (A 37-year-old woman is brought to the emergency...)
 +2 
submitted by carolebaskin(85)

young woman with abrupt onset painful eye movements + decreased acuity + poor reactivity = optic neuritis = MS

Also notice they said the right pupil is poorly active to direct light

So maybe there's a Marcus Gunn pupil, which is when there's decreased bilateral pupillary constriction when light is shone directly into the affected eye, relative to the unaffected eye

jlbae  They might refer to MGP as "relative afferent pupil defect" on the NMBE +1
lindasmith462  is there anything differentiating this from acute angle closure glaucoma? She's a little young for ACG but a little old for MS. both would present w/ sudden painful vision loss and a pupil poorly responsive to light. (answer is still optic nerve though) +
... sugaplum made a comment on step2ck_form6/block1/q#35 (A 14-month-old girl is brought to the physician...)
 +2 
submitted by sugaplum(415)

this is intusseption, with current jelly stools and episodic abdominal pain. Treat with barium enema

... sugaplum made a comment on step2ck_form6/block1/q#37 (A 2-month-old boy is brought to the physician for a...)
 +2 
submitted by sugaplum(415)

2 months can just get their chest up and recognize moms voice. Apparently they can't grab things until 5 months.....glasses off your face

... sugaplum made a comment on step2ck_form6/block1/q#41 (A previously healthy 52-year-old man comes to the...)
 +2 
submitted by sugaplum(415)

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 +
... derpymd made a comment on step2ck_form6/block1/q#42 (A 24-year-old man is brought to the emergency...)
 +2 
submitted by derpymd(10)

Must've been really fucking stoned to end up in the ED πŸ˜‚

... medicalmike made a comment on step2ck_form6/block2/q#3 (A 21-year-old college student comes to the physician...)
 +2 
submitted by medicalmike(68)

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

... medicalmike made a comment on step2ck_form6/block2/q#4 (Four weeks after a low transverse cesarean delivery...)
 +2 
submitted by medicalmike(68)

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 +3
... drmohandes made a comment on step2ck_form6/block2/q#4 (Four weeks after a low transverse cesarean delivery...)
 +2 
submitted by drmohandes(143)

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.

... medicalmike made a comment on step2ck_form6/block2/q#11 (A 52-year-old woman comes to the physician because...)
 +2 
submitted by medicalmike(68)

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.

charcot_bouchard  still sounds lot better than others. Her son rocks though. "surprise u already don't know" +
... medicalmike made a comment on step2ck_form6/block2/q#12 (A 67-year-old man is brought to the emergency...)
 +2 
submitted by medicalmike(68)

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

medpsychosis  Just a clarification: It is anterior TO the lumbar spine or anterior TO the lower thoracic spine. These calcifications are not in the spine itself. +
... keyseph made a comment on step2ck_form6/block2/q#14 (A 3-month-old boy is brought for a well-child...)
 +2 
submitted by keyseph(71)

Congenital cardiomegaly (point of maximal impulse is deviated to the left) and hypotonia are both classic features of Pompe disease.

Although GM1 gangliosidosis can present with hepatomegaly and hypotonia, it is not associated with cardiomegaly.

... medicalmike made a comment on step2ck_form6/block2/q#15 (An 8-year-old girl with type 1 diabetes mellitus is...)
 +2 
submitted by medicalmike(68)

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.

... medicalmike made a comment on step2ck_form6/block2/q#21 (A 42-year-old man comes to the physician because of...)
 +2 
submitted by medicalmike(68)

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

lubdub  Early diastolic sound is knock +1
... szsnikaa made a comment on step2ck_form6/block2/q#34 (A 7-year-old girl is brought to the physician in...)
 +2 
submitted by szsnikaa(19)

This question is a rather interesting one. While pharyngitis with viral or bacterial etiologies have very similar clinical presentations, there are a few subtle hints that make Throat Culture the more likely answer regardless of the CENTOR score in this Vignette.

September. The seasonality of Group A Strep (GAS) pharyngitis is usually between winter & early spring. Viral pharyngitis, although all year round, is more common in the colder months.

The main objective of a primary care physician is distinguishing which patients have a higher likelihood of GAS infection vs. viral and because there is a significant overlap between the 2 etiologies, clinical judgment alone is not accurate in diagnosing GAS infections often leading to overtreatment with antimicrobial therapy.

Throat culture is the gold standard in diagnosing GAS. This is done in this scenario, despite the negative rapid test (Sensitivity 70% - 90%), because of the suspicion of viral etiology as well as the avoidance of overtreatment. Throat culture is the most appropriate next step in this case.

drdoom  😍😍😍 +
... medicalmike made a comment on step2ck_form6/block2/q#36 (A 22-year-old woman comes to the physician for a...)
 +2 
submitted by medicalmike(68)

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

... carolebaskin made a comment on step2ck_form6/block2/q#45 (An asymptomatic 47-year-old man comes for a...)
 +2 
submitted by carolebaskin(85)

Before starting statin therapy, measure LDL levels with FASTING lipid profile!

This person has borderline high cholesterol

... kingfriday made a comment on step2ck_form6/block2/q#45 (An asymptomatic 47-year-old man comes for a...)
 +2 
submitted by kingfriday(20)

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)
... keyseph made a comment on step2ck_form6/block3/q#3 (A 64-year-old woman has moderately severe...)
 +2 
submitted by keyseph(71)

Since this patient is 1 day out of surgery, PO medications are not recommended, since this patient is very likely to have decreased bowel movements from abdominal surgery.

Moderate/severe postoperative pain is usually managed with short-acting opioids, since long-acting opioids have a higher risk of overdose and misuse. Based on the answer choices, patient-controlled IV morphine fits this criteria.

jmorga75  You're right about the Long acting, but the journal of pain actually suggests PO pain meds as soon as possible postoperatively. Also, first time around i think i read Acetaminophen/Codeine the first time around instead of aspirin-codeine. I would think that this patient is still a bleeding risk and should avoid aspirin, but i may be wrong. https://www.jpain.org/action/showPdf?pii=S1526-5900%2815%2900995-5 +