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Step 2 CK Form 6 Answers

Block/Question (6.4 difficulty score)
A 67-year-old man is examined 3 days after ...
Remove the urinary catheterπŸ”

Block/Question (5.2 difficulty score)
A 20-month-old girl is brought to the ...
Cystic fibrosisπŸ”

Block/Question (3.9 difficulty score)
A previously healthy 16-year-old boy is ...
Pulmonary tuberculosisπŸ”

Block/Question (2.1 difficulty score)
During the past 4 months, a 32-year-old woman ...
SjΓΆgren syndromeπŸ”

Block/Question (3.8 difficulty score)
A 5-year-old boy is brought to the emergency ...
Hyaline castsπŸ”

Block/Question (3.0 difficulty score)
A 3-year-old boy is brought to the physician ...
Impaired phagocytic oxidative metabolismπŸ”

Block/Question (3.3 difficulty score)
A 37-year-old woman comes to the physician ...
Pulmonary artery pressureπŸ”

Block/Question (1.9 difficulty score)
A 42-year-old man is brought to the emergency ...
Vitamin B1 (thiamine)πŸ”

Block/Question (2.0 difficulty score)
A 32-year-old woman comes to the physician ...
Histocompatibility human leukocyte antigen B27πŸ”

hypothyroid post_partum TSH pregnancy
Block/Question (2.5 difficulty score)
A 32-year-old woman comes to the physician ...
Thyroid-stimulating hormoneπŸ”

Block/Question (2.2 difficulty score)
An 18-month-old boy is brought to the ...
Passive hypersupination of the forearmπŸ”

postop surgery
Block/Question (2.6 difficulty score)
Four hours after undergoing a cesarean ...
Postoperative intra-abdominal hemorrhageπŸ”

Block/Question (1.9 difficulty score)
A 72-year-old man comes to the emergency ...
Corticosteroid therapyπŸ”

Block/Question (2.6 difficulty score)
A previously healthy 10-year-old boy is ...
Avoidance of the wooded areaπŸ”

Block/Question (2.3 difficulty score)
A 28-year-old woman at 28 weeks' gestation ...
Mitral stenosisπŸ”

cardio
Block/Question (2.6 difficulty score)
A 27-year-old man comes to the physician ...
Diffuse hypokinesia and dilation of the ventriclesπŸ”

Block/Question (2.1 difficulty score)
An otherwise healthy 4-month-old girl is ...
No intervention is necessaryπŸ”

Block/Question (2.9 difficulty score)
An asymptomatic 57-year-old man comes to the ...
Accumulation of lipids in the arterial wallπŸ”

Block/Question (1.5 difficulty score)
A 25-year-old woman comes to the physician ...
Borderline personality disorderπŸ”

Block/Question (3.4 difficulty score)
A 52-year-old woman comes to the physician ...
Decreased androgensπŸ”

Block/Question (2.4 difficulty score)
Two hours ago, a 24-year-old man had the ...
Tube thoracostomyπŸ”

Block/Question (2.4 difficulty score)
A 57-year-old man is brought to the emergency ...
Intravenous calcium gluconateπŸ”

Block/Question (1.6 difficulty score)
A healthy 18-year-old woman comes for a ...
Testing for Neisseria gonorrhoeae and Chlamydia trachomatisπŸ”

endocrine repro pcos infertility
Block/Question (2.3 difficulty score)
A 32-year-old woman comes to the physician ...
Polycystic ovarian syndromeπŸ”

Block/Question (2.0 difficulty score)
A 32-year-old man has had mild tremulousness, ...
Discontinuation of lorazepamπŸ”

Block/Question (2.1 difficulty score)
An 82-year-old woman is brought to the ...
Major depressive disorderπŸ”

Block/Question (1.8 difficulty score)
A 42-year-old computer science professor is ...
Huntington's diseaseπŸ”

Block/Question (2.9 difficulty score)
A 67-year-old woman is hospitalized because ...
Intramural hematoma of the proximal small bowelπŸ”

visualfielddefect visual_field_defect
Block/Question (2.5 difficulty score)
A 37-year-old woman is brought to the ...
Right optic nerveπŸ”

Block/Question (1.8 difficulty score)
A 24-year-old primigravid woman at 18 weeks' ...
Inflammatory bowel diseaseπŸ”

Block/Question (2.8 difficulty score)
A 15-year-old girl is brought to the ...
Negotiate a contract regarding medication complianceπŸ”

Block/Question (2.2 difficulty score)
A 25-year-old woman comes to the physician ...
Complete blood countπŸ”

Block/Question (2.2 difficulty score)
A 14-month-old girl is brought to the ...
Water-soluble contrast enemaπŸ”

Block/Question (3.0 difficulty score)
A 67-year-old man comes to the emergency ...
Right vertebralπŸ”

milestones
Block/Question (2.1 difficulty score)
A 2-month-old boy is brought to the physician ...
Language development: Normal; Psychosocial development: NormalπŸ”

Block/Question (2.7 difficulty score)
A previously healthy 32-year-old woman comes ...
Inhaled Ξ²2-adrenergic agonistπŸ”

Block/Question (3.5 difficulty score)
A 6-month-old girl is brought to the ...
Patent ductus arteriosusπŸ”

Block/Question (1.6 difficulty score)
A 20-year-old man comes for a routine health ...
Myotonic muscular dystrophyπŸ”

Block/Question (3.0 difficulty score)
A previously healthy 52-year-old man comes to ...
InsulinπŸ”

Block/Question (2.3 difficulty score)
A 24-year-old man is brought to the emergency ...
Observation in the emergency departmentπŸ”

Block/Question (3.3 difficulty score)
A 70-year-old woman has had increasing ...
Gram stain of abdominal fluidπŸ”

Block/Question (2.1 difficulty score)
A 4-year-old boy is brought to the emergency ...
Pulmonary contusionπŸ”

Block/Question (2.3 difficulty score)
A 77-year-old woman comes to the physician ...
Gallstone ileusπŸ”

Block/Question (1.5 difficulty score)
A 20-year-old man is brought to the emergency ...
Inadequate dissipation of body heatπŸ”

Block/Question (1.3 difficulty score)
A 23-year-old woman has pain, cramping, and ...
Hypercoagulable state of pregnancyπŸ”

Block/Question (2.0 difficulty score)
A 21-year-old college student comes to the ...
Topical retinoic acidπŸ”

Block/Question (2.3 difficulty score)
Four weeks after a low transverse cesarean ...
ReassuranceπŸ”

Block/Question (1.5 difficulty score)
A 37-year-old man is brought to the emergency ...
LaparotomyπŸ”

Block/Question (1.1 difficulty score)
A 67-year-old woman has had anorexia, ...
Multiple myelomaπŸ”

Block/Question (2.1 difficulty score)
A 62-year-old woman comes to the physician ...
Avoidance of analgesicsπŸ”

Block/Question (1.7 difficulty score)
A healthy 21-year-old college student comes ...
Pap smearπŸ”

Block/Question (1.7 difficulty score)
A 52-year-old woman comes to the physician ...
Adjustment disorder with anxietyπŸ”

Block/Question (1.9 difficulty score)
A 67-year-old man is brought to the emergency ...
Ruptured aortic aneurysmπŸ”

Block/Question (2.3 difficulty score)
A 37-year-old woman comes to the physician ...
Medication adverse effectπŸ”

Block/Question (1.8 difficulty score)
A 3-month-old boy is brought for a well-child ...
Glycogen storage disease, type II (Pompe's disease)πŸ”

Block/Question (2.0 difficulty score)
An 8-year-old girl with type 1 diabetes ...
Infusion of 0.9% salineπŸ”

Block/Question (1.8 difficulty score)
A 32-year-old woman is brought to the ...
HemothoraxπŸ”

Block/Question (1.1 difficulty score)
A 24-year-old woman comes to the physician ...
FibromyalgiaπŸ”

Block/Question (1.6 difficulty score)
A 35-year-old man is brought to the emergency ...
Na+: 140;
Cl-: 80;
K+: 2.5;
HCO3-: 40
πŸ”


Block/Question (1.4 difficulty score)
A 13-year-old girl is brought for a ...
Discussion of pregnancy preventionπŸ”

Block/Question (2.2 difficulty score)
A previously healthy 52-year-old man comes to ...
Fluid restrictionπŸ”

Block/Question (1.9 difficulty score)
A 42-year-old man comes to the physician ...
Constrictive pericarditisπŸ”

Block/Question (1.2 difficulty score)
A 5-week-old boy is brought to the physician ...
Hypertrophic pyloric stenosisπŸ”

Block/Question (1.4 difficulty score)
A 17-year-old boy comes to the physician ...
Inadequate production of insulinπŸ”

Block/Question (1.7 difficulty score)
After an uncomplicated laparoscopic ...
Reinsertion of a Foley catheterπŸ”

Block/Question (2.0 difficulty score)
A previously healthy 4-year-old boy is ...
Upper respiratory tract infectionπŸ”

Block/Question (1.3 difficulty score)
A previously healthy 4-year-old girl is ...
ArthrocentesisπŸ”

Block/Question (1.9 difficulty score)
A 25-year-old woman comes to the physician ...
Latex productsπŸ”

Block/Question (1.7 difficulty score)
A 32-year-old woman, gravida 2, para 2, comes ...
AnovulationπŸ”

Block/Question (1.2 difficulty score)
A 62-year-old woman is admitted to the ...
Glucocorticoid-induced demargination and storage pool release of segmented neutrophilsπŸ”

Block/Question (1.5 difficulty score)
A 5-month-old boy is brought for a follow-up ...
Compression of the airway by a vascular ringπŸ”

Block/Question (1.2 difficulty score)
A 25-year-old woman comes to the emergency ...
Idiopathic intracranial hypertensionπŸ”

Block/Question (1.7 difficulty score)
A 25-year-old man with a history of ...
Cryptococcal meningitisπŸ”

Block/Question (1.8 difficulty score)
A 7-year-old girl is brought to the physician ...
Throat cultureπŸ”

Block/Question (1.4 difficulty score)
A 27-year-old woman comes to the physician ...
Irritable bowel syndromeπŸ”

Block/Question (1.8 difficulty score)
A 22-year-old woman comes to the physician ...
Administration of hepatitis B vaccineπŸ”

Block/Question (1.7 difficulty score)
A previously healthy 16-year-old boy is ...
Viral infectionπŸ”

Block/Question (2.0 difficulty score)
A 57-year-old woman with breast cancer comes ...
Spinal cord decompression and cervical stabilizationπŸ”

Block/Question (1.6 difficulty score)
A previously healthy 44-year-old woman, ...
Stress incontinenceπŸ”

Block/Question (1.5 difficulty score)
One day after an uncomplicated spontaneous ...
Overflow incontinenceπŸ”

Block/Question (1.2 difficulty score)
An asymptomatic 32-year-old man comes for a ...
Selective IgA deficiencyπŸ”

Block/Question (1.0 difficulty score)
Five weeks after vaginal delivery of a ...
Admission to the hospital for treatmentπŸ”

Block/Question (1.6 difficulty score)
A 62-year-old man has had the gradual onset ...
Tricuspid regurgitationπŸ”

Block/Question (2.3 difficulty score)
An asymptomatic 47-year-old man comes for a ...
Serum lipid studies while fastingπŸ”

Block/Question (1.5 difficulty score)
An 87-year-old nursing home resident with ...
Decreased gag reflexπŸ”

Block/Question (1.3 difficulty score)
A 32-year-old woman who is HIV positive has a ...
Influenza virusπŸ”

Block/Question (1.5 difficulty score)
A 62-year-old woman comes to the physician ...
MalabsorptionπŸ”

Block/Question (1.8 difficulty score)
A 64-year-old woman has moderately severe ...
Patient-controlled intravenous morphineπŸ”

Block/Question (1.6 difficulty score)
An 18-year-old man comes for an examination ...
Germinal cell tumorπŸ”

Block/Question (1.2 difficulty score)
A 67-year-old man comes to the physician ...
ThymomaπŸ”

Block/Question (1.5 difficulty score)
A 16-year-old girl is brought to the ...
Aortic incompetenceπŸ”

Block/Question (2.3 difficulty score)
A 52-year-old man comes to the physician for ...
Exercise stress testπŸ”

Block/Question (1.2 difficulty score)
A newborn is in severe respiratory distress ...
Mother: O,Rh-negative; Newborn: O,Rh-positiveπŸ”

Block/Question (2.1 difficulty score)
A 50-year-old woman has had progressive ...
EchocardiographyπŸ”

Block/Question (1.2 difficulty score)
An asymptomatic 32-year-old woman comes for a ...
Weight-loss programπŸ”

Block/Question (2.5 difficulty score)
A 47-year-old man is admitted to the hospital ...
Haloperidol decanoateπŸ”

Block/Question (1.3 difficulty score)
A 38-year-old woman, gravida 2, para 1, at 38 ...
Nonstress testπŸ”

Block/Question (2.1 difficulty score)
A 42-year-old woman comes to the physician ...
Endoscopic retrograde cholangiopancreatographyπŸ”

Block/Question (1.6 difficulty score)
A 26-year-old woman is brought to the ...
ACTH stimulation testπŸ”

Block/Question (1.1 difficulty score)
An 18-year-old man comes to the physician for ...
Ask about suicidal feelingsπŸ”

Block/Question (1.0 difficulty score)
A 52-year-old woman comes to the physician ...
Intraductal papillomaπŸ”


Block/Question (2.0 difficulty score)
A 77-year-old woman is brought to the ...
Memory lossπŸ”

Block/Question (1.8 difficulty score)
A 47-year-old man comes to the physician ...
Carbamazepine therapyπŸ”

Block/Question (1.3 difficulty score)
A previously healthy 16-year-old high school ...
Eczema herpeticumπŸ”

Block/Question (1.1 difficulty score)
A 19-year-old man is brought to the emergency ...
LaparotomyπŸ”

Block/Question (1.6 difficulty score)
A 42-year-old woman comes to the physician ...
Autonomous production of aldosteroneπŸ”

Block/Question (0.9 difficulty score)
A 37-year-old woman, gravida 2, para 1, at 12 ...
Previous preterm deliveryπŸ”

Block/Question (1.2 difficulty score)
A 17-year-old boy is brought to the emergency ...
PCPπŸ”

Block/Question (1.4 difficulty score)
A 57-year-old man is brought to the emergency ...
Carotid ultrasonographyπŸ”

Block/Question (1.9 difficulty score)
A previously healthy 27-year-old woman is ...
Electromyography and nerve conduction studiesπŸ”

Block/Question (1.2 difficulty score)
A 32-year-old man receiving intensive ...
Pneumocystis jiroveci (formerly P. carinii)πŸ”

Block/Question (1.3 difficulty score)
A previously healthy 42-year-old carpenter ...
Median nerve at the wristπŸ”

Block/Question (1.4 difficulty score)
A previously healthy 37-year-old man comes to ...
Ulnar nerve at the elbowπŸ”

Block/Question (1.1 difficulty score)
Two days after admission to the hospital for ...
Acute tubular necrosisπŸ”

Block/Question (1.1 difficulty score)
A 32-year-old woman comes to the physician ...
Clue cellsπŸ”

Block/Question (1.0 difficulty score)
A 32-year-old man with alcoholism is brought ...
Vitamin B1 (thiamine)πŸ”

Block/Question (1.2 difficulty score)
A 67-year-old man has had shortness of breath ...
ThoracentesisπŸ”

Block/Question (1.9 difficulty score)
Three days after being hospitalized for ...
Heparin therapyπŸ”

Block/Question (1.9 difficulty score)
A 2-year-old boy is brought to the physician ...
Intravenous immunoglobulin infusionπŸ”

Block/Question (1.6 difficulty score)
A 3-year-old boy is brought for a follow-up ...
CT scan of the headπŸ”

Block/Question (1.5 difficulty score)
A previously healthy 62-year-old man comes to ...
CT scan of the abdomenπŸ”

Block/Question (2.0 difficulty score)
A 6-month-old girl is brought to the ...
Obstruction of cerebrospinal fluid flowπŸ”

Block/Question (1.0 difficulty score)
A 72-year-old man with hypertension has had ...
Metastatic prostate carcinomaπŸ”

Block/Question (1.5 difficulty score)
A 40-year-old man is brought to the emergency ...
Myocardial contusionπŸ”

Block/Question (1.2 difficulty score)
A previously healthy 67-year-old man is ...
Small cell carcinomaπŸ”

Block/Question (2.0 difficulty score)
A previously healthy 67-year-old man comes to ...
Daily exercise programπŸ”

Block/Question (1.0 difficulty score)
A 42-year-old man comes to the emergency ...
Amphotericin BπŸ”

Block/Question (1.3 difficulty score)
A 16-year-old boy with neurofibromatosis is ...
Catecholamine-producing tumorπŸ”

Block/Question (1.0 difficulty score)
A 32-year-old woman comes to the physician ...
Anesthetic ointment and stool softenersπŸ”

Block/Question (1.1 difficulty score)
A previously healthy 47-year-old woman comes ...
Gallstone pancreatitisπŸ”

Block/Question (0.8 difficulty score)
A 15-year-old boy is brought to the emergency ...
Hypertrophic obstructive cardiomyopathyπŸ”

Block/Question (1.0 difficulty score)
A 62-year-old woman is brought to the ...
Orthostatic hypotensionπŸ”

Block/Question (1.5 difficulty score)
A 70-year-old man comes to the physician ...
Outflow obstruction of the bladderπŸ”

Block/Question (1.0 difficulty score)
A 67-year-old woman comes for a routine ...
Measurement of serum parathyroid hormone concentrationπŸ”

Block/Question (2.1 difficulty score)
A 4-week-old newborn is brought to the ...
High pulmonary vascular resistanceπŸ”

Block/Question (1.1 difficulty score)
A 37-year-old primigravid woman at 9 weeks' ...
Antiemetic therapyπŸ”

Block/Question (1.4 difficulty score)
One month after undergoing an uneventful ...
Increased dosage of corticosteroidsπŸ”

Block/Question (1.6 difficulty score)
A 67-year-old man is brought to the emergency ...
Brain abscessπŸ”

Block/Question (1.2 difficulty score)
A 57-year-old man comes to the physician ...
IndomethacinπŸ”

Block/Question (1.5 difficulty score)
A healthy 24-year-old woman comes for a ...
Repeat examination in 2 weeksπŸ”

Block/Question (0.9 difficulty score)
A 57-year-old woman is brought to the ...
Osteoporotic compression fractureπŸ”

Block/Question (0.8 difficulty score)
A previously healthy 32-year-old plumber ...
Muscle strainπŸ”

Block/Question (1.1 difficulty score)
Over the past 3 months, a 30-year-old woman ...
Adrenal glandπŸ”

Block/Question (1.4 difficulty score)
A 20-year-old African American man with ...
Increased demand for folic acidπŸ”

Block/Question (1.1 difficulty score)
A healthy 23-year-old woman, gravida 1, para ...
Oral levonorgestrel now and again in 12 hoursπŸ”

Block/Question (0.9 difficulty score)
A previously healthy 52-year-old woman comes ...
SporotrichosisπŸ”

Block/Question (1.5 difficulty score)
An 18-year-old man comes to the physician 1 ...
Operative treatmentπŸ”

Block/Question (2.3 difficulty score)
A 62-year-old woman is brought to the ...
NitroprussideπŸ”

Block/Question (1.0 difficulty score)
A 42-year-old man comes to the physician ...
EmphysemaπŸ”

Block/Question (1.0 difficulty score)
Four days after undergoing resection of an ...
Central venous catheterπŸ”

Block/Question (1.8 difficulty score)
A 67-year-old woman has been intubated for 1 ...
Wean from the ventilatorπŸ”

Block/Question (0.8 difficulty score)
An 80-year-old woman has had bleeding gums ...
CπŸ”

Block/Question (1.5 difficulty score)
A 17-year-old boy sustains a head injury and ...
Acute respiratory distress syndromeπŸ”

Block/Question (1.0 difficulty score)
A 72-year-old man comes to the physician ...
Oral enalapril therapyπŸ”

Block/Question (0.8 difficulty score)
An asymptomatic 21-year-old woman is found to ...
Benign cystic teratomaπŸ”

Block/Question (1.0 difficulty score)
A 57-year-old man comes to the physician ...
Overflow incontinence from acontractile bladderπŸ”

Block/Question (1.4 difficulty score)
A 30-year-old woman comes to the physician ...
Serum thyroid-stimulating hormone concentrationπŸ”

Block/Question (1.2 difficulty score)
A 42-year-old man is brought to the physician ...
Complex partial seizuresπŸ”

Block/Question (1.0 difficulty score)
A 22-year-old primigravid woman at 16 weeks' ...
ChoriocarcinomaπŸ”

Block/Question (0.9 difficulty score)
A previously healthy 87-year-old woman comes ...
Lichen sclerosusπŸ”

Block/Question (0.9 difficulty score)
A 32-year-old man comes to the physician ...
Vitamin D deficiencyπŸ”

Block/Question (1.2 difficulty score)
A 45-year-old woman comes to the emergency ...
LorazepamπŸ”

Block/Question (0.9 difficulty score)
A 47-year-old woman comes to the physician ...
Gastric bypassπŸ”

Block/Question (1.2 difficulty score)
A 28-month-old boy has a history of cyanosis ...
Tetralogy of FallotπŸ”

Block/Question (1.1 difficulty score)
A previously healthy 3-month-old girl is ...
Dysmorphogenesis of the third and fourth pharyngeal pouchesπŸ”

Block/Question (2.3 difficulty score)
A 6-year-old boy is brought to the physician ...
An excess of very long chain fatty acidsπŸ”

Block/Question (0.9 difficulty score)
A 67-year-old woman is brought to the ...
Esophageal perforationπŸ”

Block/Question (1.4 difficulty score)
A 13-year-old boy is brought to the physician ...
No pharmacotherapy is indicatedπŸ”

Block/Question (1.5 difficulty score)
A 72-year-old man comes to the physician with ...
Measurement of blood lead concentrationπŸ”

Block/Question (1.4 difficulty score)
A 5-year-old girl is brought to the physician ...
EmpyemaπŸ”

pregnancy
Block/Question (1.5 difficulty score)
27-year-old primigravid at 38weekss gestation ...
Recommend autopsy of the infantπŸ”

Block/Question (1.1 difficulty score)
a program for the primary prevention of ...
IncidenceπŸ”

Block/Question (0.8 difficulty score)
A study is conducted to compare the ...
Confounding variablesπŸ”

Block/Question (0.1 difficulty score)
The genetic disease institute at a university ...
Positive Predictive Value DecreasesπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old man is brought to the physician ...
Withold the results as the patient wishesπŸ”

Recent comments ...

... carolebaskin made a comment on step2ck_form6/block1/q#15 (A previously healthy 10-year-old boy is brought to...)
 +2 
submitted by carolebaskin(31)

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

... beeip made a comment on step2ck_form6/block1/q#30 (A 67-year-old woman is hospitalized because of...)
 +2 
submitted by beeip(123)

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

... sugaplum made a comment on step2ck_form6/block1/q#36 (A 67-year-old man comes to the emergency department...)
 +2 
submitted by sugaplum(323)

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.

... sugaplum made a comment on step2ck_form6/block1/q#39 (A 6-month-old girl is brought to the physician...)
 +2 
submitted by sugaplum(323)

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

... carolebaskin made a comment on step2ck_form6/block1/q#44 (A 4-year-old boy is brought to the emergency...)
 +2 
submitted by carolebaskin(31)

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. +1
drdoom  no, wait .. i’m revising to peds specialty. probably peds nephro. final answer. +1
... medicalmike made a comment on step2ck_form6/block4/q#27 (A 67-year-old woman has been intubated for 1 week...)
 +2 
submitted by medicalmike(14)

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)
... tinydoc made a comment on step2ck_form6/block1/q#2 (A 67-year-old man is examined 3 days after...)
 +1 
submitted by tinydoc(223)

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. +1
... sugaplum made a comment on step2ck_form6/block1/q#3 (A 20-month-old girl is brought to the physician...)
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submitted by sugaplum(323)

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 +
... sugaplum made a comment on step2ck_form6/block1/q#6 (A 5-year-old boy is brought to the emergency...)
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submitted by sugaplum(323)

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

... sugaplum made a comment on step2ck_form6/block1/q#18 (A 27-year-old man comes to the physician because of...)
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submitted by sugaplum(323)

Viral myocarditis can lead to acute decompensated heart failure. can be d/t parvo, coxsackie or bacterial infections

... sugaplum made a comment on step2ck_form6/block1/q#26 (A 32-year-old woman comes to the physician because...)
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submitted by sugaplum(323)

Irregular periods, acne, and infertility line up with PCOS. Even though you don't palpate any masses on exam. The ovaries aren't necessarily palpably larger. I think of this like normal ovulation cysts that did not rupture properly, because they didn't get the correct signal (LH Surge)

... sugaplum made a comment on step2ck_form6/block1/q#31 (A 37-year-old woman is brought to the emergency...)
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submitted by sugaplum(323)

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#34 (A 25-year-old woman comes to the physician because...)
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submitted by sugaplum(323)

She has pica. Do a CBC to check for iron deficiency anemia. Microcytic low hgb hct

... sugaplum made a comment on step2ck_form6/block1/q#35 (A 14-month-old girl is brought to the physician...)
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submitted by sugaplum(323)

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...)
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submitted by sugaplum(323)

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

... carolebaskin made a comment on step2ck_form6/block1/q#39 (A 6-month-old girl is brought to the physician...)
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submitted by carolebaskin(31)

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

... sugaplum made a comment on step2ck_form6/block1/q#45 (A 77-year-old woman comes to the physician because...)
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submitted by sugaplum(323)

She has signs of a small bowel obstruction. no hx telling us any other cause. With air in the liver, we think that something has recently passed through to make the bile ducts dilate.

... carolebaskin made a comment on step2ck_form6/block1/q#45 (A 77-year-old woman comes to the physician because...)
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submitted by carolebaskin(31)

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/block2/q#12 (A 67-year-old man is brought to the emergency...)
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submitted by medicalmike(14)

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

... medicalmike made a comment on step2ck_form6/block2/q#15 (An 8-year-old girl with type 1 diabetes mellitus is...)
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submitted by medicalmike(14)

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#18 (A 35-year-old man is brought to the emergency...)
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submitted by medicalmike(14)

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.

... medicalmike made a comment on step2ck_form6/block2/q#40 (A previously healthy 44-year-old woman, gravida 4,...)
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submitted by medicalmike(14)

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

... carolebaskin made a comment on step2ck_form6/block3/q#15 (A 26-year-old woman is brought to the emergency...)
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submitted by carolebaskin(31)

Don't get Addison's confused with Cushing's!

Young woman with eosinophilia, hyponatremia, hyperkalemia, lethargy, confusion, hyperpigmentation, etc, etc

Think Addison's = Primary Adrenal Insufficiency

Test with ACTH stimulation test

vs Cushing's which you test with dexamethasone suppression test

... medicalmike made a comment on step2ck_form6/block3/q#36 (Three days after being hospitalized for treatment of...)
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submitted by medicalmike(14)

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.

... medgirl11 made a comment on step2ck_form6/block3/q#39 (A previously healthy 62-year-old man comes to the...)
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submitted by medgirl11(1)

This is diverticulitis (left lower quadrant, high WBC, fever) Best visualized with CT..I think even better with CT w/contrast :)

... medicalmike made a comment on step2ck_form6/block3/q#40 (A 6-month-old girl is brought to the physician for a...)
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submitted by medicalmike(14)

Myelomeningocele is associated with Chiari II malformation -> obstructive hydrocephalus

... medicalmike made a comment on step2ck_form6/block3/q#44 (A previously healthy 67-year-old man comes to the...)
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submitted by medicalmike(14)

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)

... medicalmike made a comment on step2ck_form6/block4/q#24 (A 62-year-old woman is brought to the physician by...)
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submitted by medicalmike(14)

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

... carolebaskin made a comment on step2ck_form6/block4/q#40 (A 28-month-old boy has a history of cyanosis since...)
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submitted by carolebaskin(31)

A classic

There are 4 murmur characteristics described and tetra logy of fallot has 4 problems (PROVe)

  1. P ulmonary infundibular stenosis
  2. R V hypertrophy
  3. O verriding aorta
  4. V SD --> holosystolic murmur + mid-diastolic at apex (due to increased MV flow) + thrill (in small VSD due to turbulence)

Single S1 from reduced pulmonic component (remember, MTAP, MT = S1, AP = S2)

... beeip made a comment on step2ck_form6/block1/q#4 (A previously healthy 16-year-old boy is brought to...)
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submitted by beeip(123)

Guess one needs to bank on "hilar lymphadenopathy with fever" here.

Lacking upper lobe findings, I got this one wrong.

boeboeboe  Patient likely has primary TB presenting with fever, chest pain. Lower lung fields are affected, but usually nothing seen on CXR. Secondary TB affects upper lobes, and is when cavitary lesions will be seen on CXR +
kingfriday  There's a uworld question that mirrors this presentation, it got me then- the adenopathy is huge +
... sugaplum made a comment on step2ck_form6/block1/q#4 (A previously healthy 16-year-old boy is brought to...)
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submitted by sugaplum(323)

I got this wrong too. but thinking more we should think about the travel hx, to TB endemic area. This isn't a hemorrage cuz its been happening for 2 weeks, aspergillous usually settles in TB cavities.

... sugaplum made a comment on step2ck_form6/block1/q#5 (During the past 4 months, a 32-year-old woman has...)
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submitted by sugaplum(323)

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

... sugaplum made a comment on step2ck_form6/block1/q#7 (A 3-year-old boy is brought to the physician because...)
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submitted by sugaplum(323)

This patient has NAPDH Oxidase deficiency which causes chronic granulation disease. You can trap the bacteria, but you can't make the ROS to kill it. So you just live with a bunch of full trash bags...of bacteria you collected... Most common bugs are catalase positive. S. aureus; Escherichia coli, Candida, Klebsiella, Pseudomonas, Aspergillus;

... sugaplum made a comment on step2ck_form6/block1/q#8 (A 37-year-old woman comes to the physician because...)
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submitted by sugaplum(323)

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) +3
... sugaplum made a comment on step2ck_form6/block1/q#9 (A 42-year-old man is brought to the emergency...)
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submitted by sugaplum(323)

This patient has wernicke's encephalopathy secondary to alcohol abuse. The tx is Thiamine, Vit b1. They also can have damage to their mamilary body

... medicalmike made a comment on step2ck_form6/block1/q#10 (A 32-year-old woman comes to the physician because...)
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submitted by medicalmike(14)

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#11 (A 32-year-old woman comes to the physician because...)
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submitted by sugaplum(323)

According to UTD Postpartum thyroiditis is similar clinically and pathogenetically to painless thyroiditis except that, by definition, it occurs in women within one year after parturition (or after spontaneous or induced abortion).

TSH makes sense because she is bradycardic and has poor concentration

... carolebaskin made a comment on step2ck_form6/block1/q#11 (A 32-year-old woman comes to the physician because...)
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submitted by carolebaskin(31)

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

... sugaplum made a comment on step2ck_form6/block1/q#12 (An 18-month-old boy is brought to the emergency...)
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submitted by sugaplum(323)

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...)
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submitted by sugaplum(323)

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

... sugaplum made a comment on step2ck_form6/block1/q#14 (A 72-year-old man comes to the emergency department...)
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submitted by sugaplum(323)

Giant cell arteritis. These people have inflammation of large and medium vessels, we think carotid arteries mostly, and their branches. The most immedieate concern for these patients is BLINDNESS which can be caused if the retinal artery gets blocked (branch of internal carotid). SO for these people you don't wait for a biopsy you start them on high dose steroids ASAP. mc in >50 white women. But sometimes they like to get interesting with the demographics.

... sugaplum made a comment on step2ck_form6/block1/q#17 (A 28-year-old woman at 28 weeks' gestation reports...)
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submitted by sugaplum(323)

They are taking my buzz words away.......:(

Opening SNAP plus a diastolic rumble.. this is mitral stenosis

... carolebaskin made a comment on step2ck_form6/block1/q#18 (A 27-year-old man comes to the physician because of...)
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submitted by carolebaskin(31)

This guy has a gallop, not a specific murmur, so it can't be (b) bicuspid AV or (e) MVP

SOB + peripheral edema + JVD + crackles = HF, so that rules out (a) and leaves (c) or (d)

(c): The hypokinesia of the LV apex would be more likely for a distal LAD occlusion or some other post MI HF, but this is a 27M and he had a recent "bad cold," so think viral

(c) diffuse hypokinesia and dilation of the ventricles describes dilated cardiomyopathy, which is especially common after cocksackie B

Treatment is supportive.

kingfriday  adding on, i believe dyskinesia of the LV apex [apical ballooning] can also occur in the setting of takatsubos (occurs after emotional stress) +