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Step 2 CK Form 7 Answers

Block/Question (7.0 difficulty score)
A 27-year-old man comes to the physician with ...
Bilateral varicocelesπŸ”

Block/Question (6.6 difficulty score)
A 52-year-old man comes to the physician ...
IndomethacinπŸ”

Block/Question (4.4 difficulty score)
A 14-month-old boy is brought for a ...
ReassuranceπŸ”

Block/Question (3.4 difficulty score)
A 24-year-old man has shortness of breath 2 ...
Fat embolism syndromeπŸ”

Block/Question (5.6 difficulty score)
A 4-year-old boy has had increasing fatigue ...
Bone marrow aspirationπŸ”

Block/Question (3.2 difficulty score)
Two days after beginning ACTH therapy for ...
HaloperidolπŸ”

Block/Question (4.0 difficulty score)
A 47-year-old woman comes to the physician ...
CT scan of the headπŸ”

Block/Question (3.2 difficulty score)
A 32-year-old woman is brought to the ...
TriglyceridesπŸ”

Block/Question (2.2 difficulty score)
A previously healthy 42-year-old woman has ...
ThymomaπŸ”

Block/Question (5.0 difficulty score)
A homeless 66-year-old man is admitted to the ...
Decreased calciumπŸ”

Block/Question (3.3 difficulty score)
A 62-year-old woman is admitted to the ...
Intravenous fluid therapyπŸ”

Block/Question (2.4 difficulty score)
Over the past month, a 72-year-old woman has ...
Exercise stress testπŸ”

Block/Question (3.4 difficulty score)
Six hours after coronary artery bypass ...
Surgical exploration of the mediastinumπŸ”

Block/Question (2.6 difficulty score)
A 42-year-old man comes to the emergency ...
Discharge and encourage fluid intakeπŸ”

Block/Question (3.5 difficulty score)
A 19-year-old man is brought to the emergency ...
PCPπŸ”

Block/Question (2.7 difficulty score)
An 18-year-old woman comes to the physician ...
SplenectomyπŸ”

Block/Question (4.5 difficulty score)
An 18-year-old primigravid woman at 37 weeks' ...
Amniotomy and vaginal deliveryπŸ”

Block/Question (2.8 difficulty score)
A 72-year-old man comes to the physician ...
MuscleπŸ”

Block/Question (3.3 difficulty score)
A previously healthy 4-year-old boy is ...
Upper respiratory tract infectionπŸ”

Block/Question (3.3 difficulty score)
An 82-year-old woman is brought to the ...
Central retinal vein occlusionπŸ”

Block/Question (1.8 difficulty score)
A 4-month-old infant is brought to the ...
Child abuseπŸ”

Block/Question (4.7 difficulty score)
A 16-year-old girl is brought to the ...
Family therapyπŸ”

Block/Question (3.6 difficulty score)
A previously healthy 9-year-old boy is ...
Ankylosing spondylitisπŸ”

Block/Question (2.8 difficulty score)
A 15-year-old girl is brought to the ...
Compression fractureπŸ”

Block/Question (5.6 difficulty score)
A 47-year-old woman comes to the physician ...
Intravascular volume depletionπŸ”

Block/Question (2.4 difficulty score)
A 47-year-old woman is brought to the ...
Thoracic aortaπŸ”

Block/Question (2.3 difficulty score)
A 6-month-old boy is brought to the physician ...
Mupirocin ointmentπŸ”

Block/Question (2.2 difficulty score)
A previously healthy 62-year-old woman comes ...
Barium swallowπŸ”

Block/Question (3.2 difficulty score)
An asymptomatic 23-year-old man comes to the ...
Treatment of latent tuberculosis nowπŸ”

Block/Question (2.4 difficulty score)
A 52-year-old woman is brought to the ...
Bipolar disorderπŸ”

Block/Question (3.1 difficulty score)
During examination prior to participation in ...
Repeat blood pressure measurement in 4 weeksπŸ”

Block/Question (2.0 difficulty score)
A previously healthy 24-year-old woman comes ...
Decreased acetylcholine receptorsπŸ”

Block/Question (1.8 difficulty score)
A 37-year-old man comes to the physician ...
Demyelination of axonsπŸ”

Block/Question (1.7 difficulty score)
A 37-year-old woman has had malaise, muscle ...
Culture for herpes simplexπŸ”

Block/Question (2.2 difficulty score)
A 22-year-old primigravid woman at term is ...
Urinary stasisπŸ”

Block/Question (3.8 difficulty score)
A 4-year-old girl is brought to the physician ...
T-lymphocyte dysfunctionπŸ”

Block/Question (1.8 difficulty score)
A 24-year-old woman comes to the physician ...
OsteoporosisπŸ”

Block/Question (3.1 difficulty score)
A 50-year-old woman with a 5-year history of ...
Pericardial windowπŸ”

Block/Question (3.0 difficulty score)
A 27-year-old woman comes to the physician ...
Small-bowel obstructionπŸ”

Block/Question (3.8 difficulty score)
A previously healthy 26-year-old man comes to ...
Increased calciumπŸ”

Block/Question (2.3 difficulty score)
A 17-year-old girl comes to the physician ...
Pilosebaceous folliclesπŸ”

Block/Question (3.7 difficulty score)
A previously healthy 6-year-old boy is ...
Operative procedureπŸ”

Block/Question (2.5 difficulty score)
One day after removal of a large meningioma, ...
Diabetes insipidusπŸ”

Block/Question (2.3 difficulty score)
A 75-year-old man is brought to the emergency ...
Heat strokeπŸ”

Block/Question (2.2 difficulty score)
A 54-year-old man comes to the physician ...
Carotid endarterectomyπŸ”

Block/Question (2.1 difficulty score)
A sexually active 24-year-old man has had ...
Genital herpesπŸ”

Block/Question (2.3 difficulty score)
A 22-year-old man is brought to the emergency ...
AtropineπŸ”

Block/Question (2.5 difficulty score)
A 32-year-old woman comes to the physician ...
AmoxicillinπŸ”

Block/Question (2.8 difficulty score)
A 36-year-old woman, gravida 1, para 1, has ...
Uterine atonyπŸ”

Block/Question (5.6 difficulty score)
A previously healthy 47-year-old man comes to ...
Fibrillation potentials in multiple muscles of multiple extremitiesπŸ”

Block/Question (2.4 difficulty score)
An afebrile 32-year-old woman comes to the ...
Enterotoxic Escherichia coliπŸ”

Block/Question (2.6 difficulty score)
A 67-year-old man comes to the emergency ...
No cleaving of C-terminal peptides on angiotensin IπŸ”

Block/Question (1.7 difficulty score)
Over the past 2 years, a 67-year-old man has ...
Abstinence from alcoholπŸ”

Block/Question (2.8 difficulty score)
Six hours after undergoing left thoracotomy ...
Analgesic therapyπŸ”

Block/Question (2.6 difficulty score)
A 27-year-old male physician is inadvertently ...
No treatment necessaryπŸ”

Block/Question (1.7 difficulty score)
A 32-year-old man with major depressive ...
MethamphetamineπŸ”

Block/Question (3.9 difficulty score)
An asymptomatic 22-year-old nulligravid woman ...
Oral contraceptive therapyπŸ”

Block/Question (3.6 difficulty score)
A 43-year-old man comes to the physician ...
Haemophilus influenzaeπŸ”

Block/Question (4.4 difficulty score)
Two hours after emergency repair of a ...
Decreased potassiumπŸ”

Block/Question (4.0 difficulty score)
A 55-year-old woman with known metastatic ...
Increased calciumπŸ”

Block/Question (1.9 difficulty score)
A previously healthy 32-year-old woman at 16 ...
Thrombotic thrombocytopenic purpuraπŸ”

Block/Question (3.1 difficulty score)
A 62-year-old woman is admitted to the ...
Renal ultrasonographyπŸ”

Block/Question (2.2 difficulty score)
A 57-year-old woman comes to the physician ...
OsteoarthritisπŸ”

Block/Question (2.3 difficulty score)
A previously healthy 57-year-old man comes to ...
Increased urinary excretion of calciumπŸ”

Block/Question (2.2 difficulty score)
Four days after undergoing a right ...
Wound dehiscenceπŸ”

Block/Question (1.7 difficulty score)
A 37-year-old man comes to the physician ...
Alveolar hypoventilationπŸ”

Block/Question (3.2 difficulty score)
A 52-year-old woman comes to the emergency ...
Endoscopic retrograde cholangiopancreatographyπŸ”

Block/Question (1.5 difficulty score)
A 32-year-old nulligravid woman with ...
ClomipheneπŸ”

Block/Question (2.2 difficulty score)
A 37-year-old woman with alcoholism is ...
Acute respiratory distress syndromeπŸ”

Block/Question (1.5 difficulty score)
A 7-year-old boy is brought for an ...
Viridans streptococcusπŸ”

Block/Question (3.0 difficulty score)
A 25-year-old primigravid woman at 27 weeks' ...
Intramuscular administration of betamethasoneπŸ”

Block/Question (1.4 difficulty score)
A previously healthy 27-year-old man is ...
Vasovagal syncopeπŸ”

Block/Question (1.5 difficulty score)
A 32-year-old man comes to the physician ...
Trial of omeprazole therapyπŸ”

Block/Question (1.3 difficulty score)
A 57-year-old woman with factor XI and IgA ...
Anaphylactic transfusion reactionπŸ”

Block/Question (2.2 difficulty score)
A 42-year-old woman comes to the physician ...
Urethral diverticulumπŸ”

Block/Question (4.1 difficulty score)
An 8-hour-old newborn develops jaundice and ...
Rh incompatibilityπŸ”

Block/Question (2.1 difficulty score)
A previously healthy 4-year-old boy is ...
Supination of the forearm with the elbow in slight flexionπŸ”

Block/Question (1.2 difficulty score)
A 32-year-old man is brought to the emergency ...
Hypertrophic obstructive cardiomyopathyπŸ”

Block/Question (1.3 difficulty score)
An 11-year-old girl is brought to the ...
Education about puberty for the child and parentsπŸ”

Block/Question (4.7 difficulty score)
A 12-month-old boy is brought to the ...
B lymphocyteπŸ”

Block/Question (3.7 difficulty score)
A 12-month-old boy is brought to the ...
NeutrophilπŸ”

Block/Question (1.3 difficulty score)
A 15-year-old boy is brought to the physician ...
Major depressive disorderπŸ”

Block/Question (2.1 difficulty score)
A previously healthy 57-year-old woman with ...
BotulismπŸ”

Block/Question (2.7 difficulty score)
A 72-year-old man is admitted to the hospital ...
Diuretic therapyπŸ”

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

Block/Question (2.4 difficulty score)
A 17-year-old girl is brought to the ...
CricothyrotomyπŸ”

Block/Question (1.8 difficulty score)
A 50-year-old woman with a history of ...
Atrophic gastritisπŸ”

Block/Question (3.3 difficulty score)
An asymptomatic 27-year-old woman who is HIV ...
Pneumococcal vaccineπŸ”

Block/Question (2.1 difficulty score)
A 72-year-old man is hospitalized because of ...
Cor pulmonaleπŸ”

Block/Question (2.1 difficulty score)
Three days after undergoing total hip ...
Epidural hematomaπŸ”

Block/Question (2.9 difficulty score)
Five days after undergoing an open ...
X-rays of the chestπŸ”

Block/Question (1.9 difficulty score)
Three days after hospitalization for ...
Elevation of the head of the bedπŸ”

Block/Question (3.7 difficulty score)
A 19-year-old African American man comes to ...
Digestive enzyme deficiencyπŸ”

Block/Question (2.3 difficulty score)
A previously healthy 14-year-old boy is ...
Repeated microfracture at the tendon insertionπŸ”

Block/Question (1.5 difficulty score)
A 72-year-old man comes to the physician ...
Aortic stenosisπŸ”

Block/Question (1.7 difficulty score)
A 24-year-old primigravid woman at 38 weeks' ...
Intravenous penicillin GπŸ”

Block/Question (2.2 difficulty score)
An otherwise healthy 70-year-old woman comes ...
Paget disease of the breastπŸ”

Block/Question (2.3 difficulty score)
An otherwise healthy 40-year-old woman comes ...
Physiologic dischargeπŸ”

Block/Question (2.3 difficulty score)
An 18-year-old woman has had fever for 12 ...
MeningococcemiaπŸ”

Block/Question (1.4 difficulty score)
A 32-year-old man comes to the physician with ...
Acute stress disorderπŸ”

Block/Question (1.3 difficulty score)
Two days after admission to the hospital for ...
Vitamin B1 (thiamine)πŸ”

Block/Question (1.7 difficulty score)
A 37-year-old woman, gravida 3, para 3, comes ...
Bartholin duct cystπŸ”

Block/Question (1.3 difficulty score)
An 18-year-old woman has had fever, mild ...
Epstein-Barr virus infectionπŸ”

Block/Question (2.7 difficulty score)
A 16-year-old girl is brought to the ...
AspirinπŸ”

Block/Question (2.7 difficulty score)
A 62-year-old man comes to the physician ...
Colonoscopy to the cecumπŸ”

Block/Question (1.9 difficulty score)
Three days after open reduction and internal ...
Duplex scanπŸ”

Block/Question (2.2 difficulty score)
A 37-year-old woman comes to the physician ...
Bromocriptine therapyπŸ”

Block/Question (2.0 difficulty score)
For 12 hours, a 25-year-old woman, gravida 2, ...
Measurement of serum amylase activityπŸ”

Block/Question (2.1 difficulty score)
A 21-year-old primigravid woman at 37 weeks' ...
Measurement of platelet countπŸ”

Block/Question (2.2 difficulty score)
A 42-year-old man has had a pruritic rash on ...
Cutaneous larva migransπŸ”

Block/Question (2.6 difficulty score)
An otherwise healthy 42-year-old woman comes ...
ReassuranceπŸ”

Block/Question (2.2 difficulty score)
A 32-year-old woman with asthma comes to the ...
Allergic bronchopulmonary aspergillosisπŸ”

Block/Question (2.5 difficulty score)
A 47-year-old man comes to the physician ...
ColonoscopyπŸ”

Block/Question (2.4 difficulty score)
A 67-year-old man comes to the physician ...
Femoropopliteal arteriesπŸ”

Block/Question (2.1 difficulty score)
A previously healthy 37-year-old woman comes ...
Esophageal peristalsis: decreased;
Lower esophageal sphincter tone: increased
πŸ”


Block/Question (2.0 difficulty score)
A 42-year-old man is scheduled to undergo an ...
Lorazepam therapyπŸ”

Block/Question (1.4 difficulty score)
An 8-year-old boy is brought to the physician ...
C1 esterase inhibitorπŸ”

Block/Question (1.5 difficulty score)
A 34-year-old woman has had pain in the left ...
CostochondritisπŸ”

Block/Question (1.3 difficulty score)
A 15-year-old girl is brought to the ...
Systemic lupus erythematosusπŸ”

Block/Question (2.2 difficulty score)
A 37-year-old man comes to the physician ...
Calcium disodium edetateπŸ”

Block/Question (1.5 difficulty score)
A 27-year-old man comes to the physician ...
HIV antibody testingπŸ”

Block/Question (4.3 difficulty score)
A previously healthy 82-year-old woman comes ...
Brisk rotatory nystagmus on left lateral gazeπŸ”

Block/Question (2.4 difficulty score)
A 72-year-old man comes to the physician for ...
Psychogenic polydipsiaπŸ”

Block/Question (2.0 difficulty score)
A 23-year-old man is brought to the physician ...
Brief psychotic disorderπŸ”

Block/Question (2.9 difficulty score)
A 72-year-old woman comes to the physician ...
Exploratory laparotomyπŸ”

Block/Question (3.0 difficulty score)
A 67-year-old man comes to the physician ...
Streptococcus pneumoniaeπŸ”

Block/Question (2.0 difficulty score)
Three hours after undergoing emergency repair ...
Cardiogenic shockπŸ”


Block/Question (2.3 difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Cesarean deliveryπŸ”

Block/Question (1.7 difficulty score)
A 37-year-old woman with sickle cell disease ...
Acute cholecystitisπŸ”

Block/Question (2.7 difficulty score)
A 14-year-old boy who has sickle cell trait ...
X-ray of the left hipπŸ”

Block/Question (2.0 difficulty score)
A previously healthy 62-year-old man is ...
Intravenous labetalolπŸ”

Block/Question (3.0 difficulty score)
A 77-year-old man is brought to the physician ...
HypothyroidismπŸ”

Block/Question (1.7 difficulty score)
A 16-year-old girl has had increasingly ...
Pelvic inflammatory diseaseπŸ”

Block/Question (3.1 difficulty score)
A 27-year-old man is brought to the emergency ...
Transfusion of group O, Rh-negative packed red blood cellsπŸ”

Block/Question (1.8 difficulty score)
A 67-year-old man has had an ulcer on the ...
Stasis dermatitis with ulcerπŸ”

Block/Question (1.6 difficulty score)
A 62-year-old man comes to the physician ...
VancomycinπŸ”

Block/Question (1.5 difficulty score)
A 22-year-old college student is brought to ...
Olanzapine therapyπŸ”

Block/Question (3.0 difficulty score)
A previously healthy 18-year-old woman comes ...
Increased serum lactate dehydrogenase activityπŸ”

Block/Question (1.7 difficulty score)
A previously healthy 27-year-old African ...
Abruptio placentaeπŸ”

Block/Question (2.1 difficulty score)
A 32-year-old woman, gravida 3, para 1, ...
Magnesium sulfateπŸ”

Block/Question (1.7 difficulty score)
A 42-year-old woman is brought to the ...
Optic neuritisπŸ”

Block/Question (3.5 difficulty score)
An 82-year-old man with congestive heart ...
Decreased renal blood flowπŸ”

Block/Question (2.3 difficulty score)
An otherwise healthy 37-year-old man comes to ...
SpondylolisthesisπŸ”

Block/Question (1.8 difficulty score)
A 7-month-old boy is brought to the physician ...
Wiskott-Aldrich syndromeπŸ”

Block/Question (2.0 difficulty score)
A 42-year-old woman comes to the physician ...
Oral propylthiouracil therapyπŸ”

Block/Question (2.3 difficulty score)
An asymptomatic 60-year-old man comes for a ...
ObservationπŸ”

Block/Question (2.9 difficulty score)
A previously healthy 10-year-old girl is ...
No pharmacotherapy is indicated at this timeπŸ”

Block/Question (1.5 difficulty score)
A 52-year-old woman with a 2-year history of ...
Add lisinopril to the medication regimenπŸ”

Block/Question (2.1 difficulty score)
A 52-year-old woman comes to the physician ...
Pleural metastasesπŸ”

Block/Question (2.0 difficulty score)
A 2-month-old girl is brought for a routine ...
Give all recommended immunizations for ageπŸ”

Block/Question (1.5 difficulty score)
A 25-year-old woman comes to the physician ...
Surreptitious administration of thyroxineπŸ”

Block/Question (1.6 difficulty score)
A 55-year-old man comes to the physician ...
Viral infectionπŸ”

Block/Question (2.8 difficulty score)
A 62-year-old woman is brought to the ...
Radiation therapyπŸ”

Block/Question (1.8 difficulty score)
A 6-week-old boy is brought to the physician ...
Fibrosis of the sternomastoid muscleπŸ”

Block/Question (1.7 difficulty score)
A 17-year-old boy comes to the physician ...
Pill-induced esophagitisπŸ”

Block/Question (2.3 difficulty score)
A previously healthy 21-year-old woman comes ...
Viral pleurisyπŸ”

Block/Question (1.4 difficulty score)
A previously healthy 68-year-old man is ...
Acute myocardial infarctionπŸ”

Block/Question (1.5 difficulty score)
A 70-year-old woman is brought to the ...
Ventricular tachycardiaπŸ”

Block/Question (2.0 difficulty score)
A 32-year-old woman is brought to the ...
AppendicitisπŸ”

Block/Question (1.2 difficulty score)
A 3-year-old girl is brought to the emergency ...
OrganophosphateπŸ”

Block/Question (2.4 difficulty score)
A previously healthy 67-year-old man has had ...
Bronchogenic carcinomaπŸ”

Block/Question (2.6 difficulty score)
A 77-year-old man is brought to the emergency ...
Destruction and dilation of distal airwaysπŸ”

Block/Question (1.7 difficulty score)
A 65-year-old man comes to the emergency ...
Internal carotid arteryπŸ”

Block/Question (3.8 difficulty score)
A 4-year-old boy develops chickenpox 8 hours ...
No intervention is necessaryπŸ”

Block/Question (2.3 difficulty score)
An 87-year-old man comes to the physician ...
FinasterideπŸ”

Block/Question (1.2 difficulty score)
An unconscious 22-year-old man is brought to ...
Intravenous 0.9% salineπŸ”

Block/Question (2.6 difficulty score)
A 20-year-old man is brought to the physician ...
SchizophreniaπŸ”

Block/Question (1.5 difficulty score)
A 10-year-old girl is admitted to the ...
Mitral valve incompetenceπŸ”

Block/Question (1.9 difficulty score)
A 47-year-old man comes to the emergency ...
HypovolemiaπŸ”

Block/Question (1.8 difficulty score)
A 27-year-old nulligravid woman comes for a ...
ColposcopyπŸ”

Block/Question (2.3 difficulty score)
A 51-year-old woman had a 15-minute episode ...
ObservationπŸ”

Block/Question (1.9 difficulty score)
A 56-year-old woman with short-bowel syndrome ...
ZincπŸ”

Block/Question (1.5 difficulty score)
A 32-year-old man is brought to the emergency ...
DopamineπŸ”

Block/Question (3.0 difficulty score)
A male newborn has bilateral clubfoot ...
Spinal dysraphismπŸ”

Block/Question (2.3 difficulty score)
An 82 year old woman with metastatic breast ...
Increase the frequency of dose to every 3 hoursπŸ”

Block/Question (1.2 difficulty score)
A 67-year-old man comes to the physician ...
Randomized, controlled clinical trialπŸ”

Block/Question (1.2 difficulty score)
A county health officer investigates an ...
Inadequate refrigeration of the implicated foodπŸ”

Block/Question (1.2 difficulty score)
A 27-year-old woman comes to the physician ...
Small bowel obstrutionπŸ”

Block/Question (1.2 difficulty score)
A 37-year-old man with end-stage Duchenne ...
Determine if the patient wants to discuss his decision with anyone elseπŸ”

Block/Question (0.7 difficulty score)
Four CAGE questions are used to screen for ...
Sensitivity: increased; Specificity: decreasedπŸ”

Block/Question (1.6 difficulty score)
A 57-year-old man comes to the physician ...
Interferon-alphaπŸ”

Block/Question (0.5 difficulty score)
A study is proposed to assess the ...
Coercion of a vulnerable populationπŸ”

Block/Question (1.0 difficulty score)
A 72-year-old woman has hyponatremia 3 days ...
Inappropriate ADH (vasopressin) secretionπŸ”

Block/Question (0.7 difficulty score)
A health status survey compares the clinical ...
The results are not adjusted for comorbiditiesπŸ”

Recent comments ...

... yotsubato made a comment on step2ck_form7/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +4 
submitted by yotsubato(965)

This one made no sense. Celecoxib is already the strongest NSAID. I would rather give Dexamethasone. Which works along a seperate mechanism of action.

jaypat  Indomethacin is typically the first choice NSAID for acute gout flares. Then glucocorticoids. Lastly Colchicine +
seagull  I also choose steroids since they were on a NSAID. fml +
creamy  Naw dawg. Celecoxib has anti-inflammatory efficacy hence the categorization as a NSAID. In fact, gout patients treated with Celecoxib have the same treatment response as Indomethacin. Celecoxib is actually listed as an alternative to nonselective NSAIDs for acute gouty flares. This was just a bumbass question. +1
... russnels made a comment on step2ck_form7/block1/q#42 (A previously healthy 26-year-old man comes to the...)
 +4 
submitted by russnels(13)

Is this sarcoidosis? I think that accounts for the erythema nodosum, hypercalcemia, and hilar findings.

step_prep5  Yes. See comment for more. +
... chris07 made a comment on step2ck_form7/block2/q#1 (A 75-year-old man is brought to the emergency...)
 +4 
submitted by chris07(54)

He's had heat stroke for 2 days???? I get the elevated CK and body temp (all pointing to heatstroke), but the fact that he was a temp of 106 and has been symptomatic for 2 DAYS makes the whole heat stroke diagnosis weird to me.

drmohandes  Exactly my thoughts. -_- +
... seagull made a comment on step2ck_form7/block2/q#12 (Six hours after undergoing left thoracotomy for a...)
 +4 
submitted by seagull(1392)

This is a great example of a poorly written question. Is the infant still sedated from the surgery or ventilated? What is even happening to the surgical site? Why is analgesic therapy not already on-board post surgery? Why is this author such a douche-bag?

Perhaps the world will never know.

... buttercup made a comment on step2ck_form7/block1/q#6 (A 4-year-old boy has had increasing fatigue since a...)
 +3 
submitted by buttercup(14)

Bone marrow examination is generally not required for the initial evaluation in most cases of unexplained isolated thrombocytopenia in children. This child has pancytopenia and therefore requires a bone marrow aspiration.

jesusisking  Why wouldn't it be platelet transfusion 1st? +
jesusisking  Just found the answer. Patient was stable and not actively bleeding w/ 30K platelet count. For this type of patient, start transfusing at <10K: https://www.aafp.org/afp/2011/0315/hi-res/afp20110315p719-t2.gif +3
deathbystep1  well the question said "his gums started bleeding when he brushed his teeth". So wouldn't that be considered active bleeding? I was aware about the aafp guidelines as there was a similar question in Uworld as well. The only reason i chose platelet transfusion was because he was "actively" bleeding from the gums. Otherwise it was clear that he had pancytopenia and you need to do a bone marrow biopsy. +
zalzale96  Isn't bone marrow aspiration considered an invasive procedure and thus we should transfuse since his platelets level is below 50k? +
... buttercup made a comment on step2ck_form7/block1/q#33 (During examination prior to participation in school...)
 +3 
submitted by buttercup(14)

To diagnose hypertension, there must be a hypertensive emergency >180/120, evidence of hypertension related end organ disease if greater than 160/100, or measurements in the office showing bp of greater than 130/80 at least three times. The measurements must be spaced over a period of weeks to months.

... athleticmedic made a comment on step2ck_form7/block2/q#7 (A 36-year-old woman, gravida 1, para 1, has had...)
 +3 
submitted by athleticmedic(4)

"Placenta appears complete but torn" - if it's torn and only appears complete, rather than being confirmed as complete, how can you rule out retained placental tissue? You wouldn't just assume it was complete at a complex delivery, it would require confirmation.

drmohandes  I feel you man, was guessing between the two answers as well. I think torn but complete means the whole placenta is there, but in pieces? Anyway classic scumbag NBME question writing. +
... carolebaskin made a comment on step2ck_form7/block2/q#15 (An asymptomatic 22-year-old nulligravid woman comes...)
 +3 
submitted by carolebaskin(31)

OCPs offer significant protection against

  • Ovarian cancer: decreased ovulation --> less damage
  • endometrial cancer: decreased endometrial proliferation
  • iron-deficiency anemia: decreased bleeding
  • reduced risk of benign breast disease

IUDs only act locally

... buttercup made a comment on step2ck_form7/block2/q#18 (A 55-year-old woman with known metastatic breast...)
 +3 
submitted by buttercup(14)

Breast cancers are one of the most common malignancies to be associated with hypercalcemia. Most often the hypercalcemia is due to osteolytic metastases and hence portends a bad prognosis. A significant number of the patients with breast cancers (up to 15%) show hypercalcemia in the absence of metastasis.

Hypercalcemia is relatively common in patients with cancer, occurring in approximately 20 to 30 percent of cases. It is the most common cause of hypercalcemia in the inpatient setting.

... russnels made a comment on step2ck_form7/block2/q#38 (A 12-month-old boy is brought to the emergency...)
 +3 
submitted by russnels(13)

Would this be x-linked agammaglobulinemia? With a BTK gene mutaiton?

misscorona  I would agree. X-linked agammaglobulinemia is associated with recurrent sinopulmonary infections with encapsulated organisms which are all the organisms mentioned in the question stem. +1
jaypat  Agreed. You need Ab to opsonize encapsulated bacteria. +
... carolebaskin made a comment on step2ck_form7/block2/q#38 (A 12-month-old boy is brought to the emergency...)
 +3 
submitted by carolebaskin(31)

Male (XY) + Encapsulated organisms = X linked (Bruton) agammaglobulinemia

  • First: S pneumoniae
  • Then: H influenza type B
  • And now... S pneumoniae again!

Remember: S pneumoniae is a gram positive lancet-shaped diplococcus and is the #1 cause of MOPS (meningitis, otitis media, pneumonia, sinusitis)

N meningitidis is a gram negative diploccocus

creamy  Thanks Carole. +1
... yotsubato made a comment on step2ck_form7/block3/q#5 (A 19-year-old African American man comes to the...)
 +3 
submitted by yotsubato(965)

Lactose Intolerant I guess? Not Celiac. Kind of a bullshit question.

study_dude_guy  Had the same reaction as you and then I learned that AA is a buzz word for lactose intolerance "African American and Asian ethnicities see a 75% - 95% lactose intolerance rate, while northern Europeans have a lower rate at 18% - 26% lactose intolerance" +
seagull  I also choose Celiac's. "BuT RaCe AnD mEdICiNe DoN't Go ToGeThEr". +
hayayah  I think a key part to differentiate between celiac's and lactose intolerance in this question isn't race, it's because of the part that says "he occasionally had diarrhea after meals since 12 years old and then it got worse since starting college". If he had celiac's he'd have GI symptoms (i.e. diarrhea) any time he ate something containing gluten (which would be every single time he had a meal) since he was 12. You'd also see signs of fat or vitamin malabsorption in celiac's patients and other autoimmune symptoms. Whereas in lactose intolerance, it's much more likely he'd once in a while eat a lot of dairy and have his symptoms triggered, and then he starts college and has even less of a well rounded diet and so his symptoms get worse. +2
... thajoker made a comment on step2ck_form7/block3/q#35 (A previously healthy 82-year-old woman comes to the...)
 +3 
submitted by thajoker(6)

Nystagmus is almost always pathological unless congenital. Especially gaze evoked nystagmus is almost always pathological.

BPPV btw is head movement induced nystagmus, which isn't the same as gaze evoked. Gaze just means moving eyes whereas bppv usually the nystagmus comes from moving the entire head.

The rest are normal findings for age, except e, which could be normal pupil size for any age.

... carolebaskin made a comment on step2ck_form7/block3/q#44 (A 14-year-old boy who has sickle cell trait is...)
 +3 
submitted by carolebaskin(31)

This is a normal x-ray!

Like veggievendor said, this is a kid with sickle cell disease and limited hip ROM, so check the hip for osteonecrosis

... russnels made a comment on step2ck_form7/block1/q#8 (A 47-year-old woman comes to the physician because...)
 +2 
submitted by russnels(13)

Bacterial meningitis... get a CT first due to signs of neurological deficit (R upper extremity + nystagmus). Otherwise lumbar puncture.

russnels  Also optic fundi not visible +
... jesusisking made a comment on step2ck_form7/block1/q#26 (A 47-year-old woman comes to the physician because...)
 +2 
submitted by jesusisking(15)

Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history

seagull  ya dude. +
... buttercup made a comment on step2ck_form7/block1/q#26 (A 47-year-old woman comes to the physician because...)
 +2 
submitted by buttercup(14)

Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.

russnels  What would cause the acute increase in blood glucose concentrations? +
study_dude_guy  I think this question is getting at HHS. The glucose levels are way lower than typical HHS but the patient has a fever and WBCs in the urine so MAYBE a UTI (even though it doesn't say anything about UTI symptoms) +
... buttercup made a comment on step2ck_form7/block1/q#40 (A 50-year-old woman with a 5-year history of...)
 +2 
submitted by buttercup(14)

Beck's triad: muffled heart sounds, jugular vein distension, and electrical alternans. This patient has cardiac tamponade. The fluid has to be removed.

A pericardial window is a cardiac surgical procedure to create a window from the pericardial space to the pleural cavity. The purpose of the window is to allow a pericardial effusion (usually malignant) to drain from the space surrounding the heart into the chest cavity.

... step_prep5 made a comment on step2ck_form7/block1/q#44 (A 17-year-old girl comes to the physician because of...)
 +2 
submitted by step_prep5(15)
  • Adolescent with a polymorphic facial rash with comedones and inflammatory papules, most consistent with acne which is due to pathology within pilosebaceous follicles
  • Apocrine glands associated with hidradenitis suppurativa, epidermal-dermal junction associated with bullous pemphigoid and panniculitis associated with erythema nodosum

https://step-prep.org/tutoring/

... yotsubato made a comment on step2ck_form7/block2/q#8 (A previously healthy 47-year-old man comes to the...)
 +2 
submitted by yotsubato(965)

Ill be the Cowboy.

Diagnosis: ALS

Multispike and fasciculation potentials Complex, repetitive discharges occur in ALS of long duration, as they do in other chronic neurogenic atrophic conditions. These are regularly discharging multispike potentials that are time-locked. Other than an EMG finding associated with a chronic neurogenic atrophic condition, this finding has no other unique significance.

Fasciculation potentials are seen frequently but not invariably in ALS. Their presence is not specific to ALS; they may occur in other conditions, some completely benign.

... russnels made a comment on step2ck_form7/block2/q#15 (An asymptomatic 22-year-old nulligravid woman comes...)
 +2 
submitted by russnels(13)

My understanding was that both IUDs and OCP can reduce risk of ovarian epithelial cancer. Anybody know why OCPs are better than IUDs?

... carolebaskin made a comment on step2ck_form7/block2/q#25 (A 52-year-old woman comes to the emergency...)
 +2 
submitted by carolebaskin(31)

Patients who complain of persistent RUQ pain after cholecystectomy should be evaluated for post-cholecystectomy syndrome

Evaluated via abdominal imaging (e.g. ultrasound) followed by direct visualization (e.g. ERCP, MRCP) to find and remove the stone.

etiologies include:

  • biliary (e.g. retained cystic duct stone, damage to the duct)
  • extra-biliary (e.g. pancreatitis) causes.
... carolebaskin made a comment on step2ck_form7/block3/q#35 (A previously healthy 82-year-old woman comes to the...)
 +2 
submitted by carolebaskin(31)

thajoker's comment is spot on

And: decreased upward gaze is a normal sign of aging, not always parinaud syndrome

https://pubmed.ncbi.nlm.nih.gov/15114040/

Can dogs look up?

... thomasalterman made a comment on step2ck_form7/block3/q#45 (A previously healthy 62-year-old man is brought to...)
 +2 
submitted by thomasalterman(147)

priority for AD patients is rate control. After controlling rate you can throw on something extra for pressure control but rate control comes first.

... seagull made a comment on step2ck_form7/block4/q#14 (An otherwise healthy 37-year-old man comes to the...)
 +2 
submitted by seagull(1392)

WTF is this x-ray. I would be better off pepper-spraying myself in the eyes and looking at a good x-ray than this shit.

I do not even begin to see spondlolololisthesis here.

drdoom  will you be my attending? +
... seagull made a comment on step2ck_form7/block4/q#16 (A 42-year-old woman comes to the physician because...)
 +2 
submitted by seagull(1392)

Order of treatment for acute hyperthyroid symptoms

Beta Blocker --> PTU---> Radioactive Iodine

Beta blocker wasnt an answer option but would be correct if given.

... jesusisking made a comment on step2ck_form7/block4/q#36 (A 4-year-old boy develops chickenpox 8 hours after...)
 +2 
submitted by jesusisking(15)

"I think there's no intervention necessary here. Newborns should have mom's antibodies. Related. Pay attention to the first bullet point, its a testable concept." reddit.com/r/medicalschool/nbme_7step_2_5_questions/

... yotsubato made a comment on step2ck_form7/block4/q#37 (An 87-year-old man comes to the physician because of...)
 +2 
submitted by yotsubato(965)

Doxazosin is not given because he has a history of orthostatic hypotension.

... russnels made a comment on step2ck_form7/block1/q#2 (A 27-year-old man comes to the physician with his...)
 +1 
submitted by russnels(13)

I'm not sure what they were going for on this question. Is it that bilateral varicoceles are the only answer correlated with decreased sperm count? Maybe testicular atrophy? Doesn't mention anything about the testes, so not sure what to think.

... study_dude_guy made a comment on step2ck_form7/block1/q#6 (A 4-year-old boy has had increasing fatigue since a...)
 +1 
submitted by study_dude_guy(2)

This question is actually a lot deeper than it looks. It is not about "when do you treat thrombocytopenia", which you DO treat when they have bleeding like in the question. This question is about management of ALL which has specific guidelines. According to uptodate, as long as platelet levels are about 20,000 in ALL, you are good to go for a bone biopsy.

drdoom  very nice +
... step_prep5 made a comment on step2ck_form7/block1/q#7 (Two days after beginning ACTH therapy for multiple...)
 +1 
submitted by step_prep5(15)
  • Key idea: Systemic steroids are associated with psychosis and this patient is receiving ACTH, which will stimulate the adrenal gland to release increased amounts of glucocorticoids/steroids, likely precipitating her psychosis (delusions, bizarre behaviors, etc.)
  • Alprazolam = Benzo (avoided in older patients due to risk of delirium)
  • Amitriptyline = TCA antidepressant (refractory depression, neuropathic pain, migraines)
  • Lithium = Bipolar disorder
  • Sertraline = SSRI (depression, PTSD, panic disorder, etc.)

https://step-prep.org/tutoring/

... new_user made a comment on step2ck_form7/block1/q#11 (A homeless 66-year-old man is admitted to the...)
 +1 
submitted by new_user(1)

Hypoalbuminemia results in apparent hypocalcemia. Free calcium is unchanged and the patients don't have sx of hypocalcemia, but total calcium stores are depleted (which is what the lab measures).

... deathbystep1 made a comment on step2ck_form7/block1/q#12 (A 62-year-old woman is admitted to the hospital...)
 +1 
submitted by deathbystep1(13)

IV contrast dye used for pulmonary angiography worsened the renal insufficiency(inc in serum CR). Adequate hydration before IV contrast in patient with renal insufficiency can prevent this.

... seagull made a comment on step2ck_form7/block1/q#20 (A previously healthy 4-year-old boy is brought to...)
 +1 
submitted by seagull(1392)

I came here to chew bubble gum and F**K this exam. Instead I got ran train on by all these questions.

Also, my media player didnt even work. I spent like 20 minutes trying to make it work. FML

... buttercup made a comment on step2ck_form7/block1/q#21 (An 82-year-old woman is brought to the emergency...)
 +1 
submitted by buttercup(14)

Retinal vein occlusion is the second most common cause of visual loss in older adults throughout the world. The first is diabetic retinopathy. Age, HTN, and diabetes are risk factors. This patient is a diabetic and the retinal veins are dilated (clear giveaway).

... step_prep5 made a comment on step2ck_form7/block1/q#21 (An 82-year-old woman is brought to the emergency...)
 +1 
submitted by step_prep5(15)
  • Unilateral vision loss + Dilated retinal veins and widespread retinal hemorrhages on fundoscopy (β€œblood and thunder” appearance) = Central retinal vein occlusion
  • Central retinal artery occlusion = Cherry-red spot on fundoscopy
  • Corneal abrasion = Positive Fluorescein staining, sensitivity to light, pain
  • Glaucoma = Bilateral lens opacity and glare from lights
  • HSV conjunctivitis = Dendritic ulcers
  • Optic neuritis = Optic disk pallor

https://step-prep.org/tutoring/

... step_prep5 made a comment on step2ck_form7/block1/q#26 (A 47-year-old woman comes to the physician because...)
 +1 
submitted by step_prep5(15)
  • Middle-aged woman with potential infectious disease (fever) leading to one week of uncontrolled hyperglycemia who has signs of orthostatic hypotension (drop in systolic BP >20 or diastolic BP >10 when moving from sitting to standing) and is found to have glucosuria, most consistent with intravascular volume depletion due to glucose acting as an osmotic agent and leading to polyuria
  • Key idea: Infections often lead to increased insulin requirement by causing a reactionary hyperglycemia

https://step-prep.org/tutoring/

... step_prep5 made a comment on step2ck_form7/block1/q#28 (A 47-year-old woman is brought to the emergency...)
 +1 
submitted by step_prep5(15)
  • Patient involved in a significant motor vehicle accident with acceleration-deceleration forces who develops neck pain and chest pain with bruising over the sternum and a widened mediastinum (almost always associated with aortic dissection or aortic injury), most consistent with blunt thoracic aortic injury leading to incomplete aortic rupture
  • Key idea: Involves the thoracic aorta because the aortic isthmus is tethered by the ligamentum arteriosum and is therefore not freely mobile and is prone to developing severe stretching/shearing forces in the setting of an acceleration-deceleration injury
  • https://www.nejm.org/doi/full/10.1056/NEJMra0706159

https://step-prep.org/tutoring/

... buttercup made a comment on step2ck_form7/block1/q#31 (An asymptomatic 23-year-old man comes to the...)
 +1 
submitted by buttercup(14)

In 85 percent of patients with latent TB, the chest radiograph is normal.

... jaypat made a comment on step2ck_form7/block1/q#31 (An asymptomatic 23-year-old man comes to the...)
 +1 
submitted by jaypat(1)

Latent TB Treatment:

  • β‰₯5mm – HIV; Immunocompromised; Previously healed TB; Recent contacts
  • β‰₯10mm – IV drug; Recent immigrants; High risk work or home; dz states (DM/Leukemia/ESRD); Kids < 4yrs
  • β‰₯15mm – treat everyone
... russnels made a comment on step2ck_form7/block1/q#38 (A 4-year-old girl is brought to the physician...)
 +1 
submitted by russnels(13)

"The response is a classical example of delayed-type hypersensitivity reaction (DTH), a type IV of hypersensitivities. T cells and myeloid cells are attracted to the site of reaction in the timeframe of 1-3 days and generate local inflammation." - Wikipedia

... yotsubato made a comment on step2ck_form7/block1/q#38 (A 4-year-old girl is brought to the physician...)
 +1 
submitted by yotsubato(965)

. The immune response to M tuberculosis is T cell dependent. It comprises not only the conventional CD4 and CD8 T cells, but also Ξ³Ξ΄ T cells and CD1 restricted T cells. Ξ³Ξ΄ T cells recognise phospholigands and no presentation molecules are known thus far. CD1 restricted T cells recognise glycolipids, which are highly abundant components of the mycobacterial cell wall. Although different T cells are required for optimum protection, the immune mechanisms known to have a role in acquired resistance can be associated with two major mechanisms: (a) activation of macrophages by cytokines; (b) direct cytolytic activity. In vivo granuloma formation, which is central to protection, is induced and sustained by cytokines. Mycobacteria are contained within granulomas and in this way are prevented from spreading all over the body.

So it looks like we just need to know this. Nevermind the fact the question stem doesnt even hint at any congenital problem in the girl....

... step_prep5 made a comment on step2ck_form7/block1/q#38 (A 4-year-old girl is brought to the physician...)
 +1 
submitted by step_prep5(15)
  • Young child with non-reactive skin testing for multiple antigens (which is a type 4 hypersensitivity process dependent upon T cells), raising concern for T lymphocyte dysfunction
  • Key idea: Patients with HIV can have a falsely-negative PPD in the setting of M. tuberculosis because they have low T cell function and impaired Type 4 HS reaction
  • Antibody deficiency = Bruton’s agammaglobulinemia = Recurrent infections with encapsulated infections
  • Complement deficiency = Recurrent Neisseria infections
  • Impaired chemotaxis = Leukocyte adhesion deficiency = Recurrent abscesses without pus, delayed wound healing, delayed umbilical cord separation
  • Impaired respiratory burst = chronic granulomatous disease = Recurrent skin abscesses and infections with catalase positive organisms (Staph, Pseudomonas, Aspergillus, Nocardia, Serratia, etc.)
  • Splenic dysfunction (sickle cell disease, trauma patient) = Encapsulated infections (Strep pneumo, H. influenzae, Neisseria)
... gh889 made a comment on step2ck_form7/block1/q#41 (A 27-year-old woman comes to the physician because...)
 +1 
submitted by gh889(115)

β€’ Severe SBO presents with:

β€’ ↓ bowel sounds when it is a complete block (hyperactive/high pitched when less than 100% b/c the body is trying to push pass it) β€’ Distended and tympanic abdomen β€’ Postprandial pain β€’ Pain relieved with vomiting (relieves some intra-abdominal pressure)

β€’ SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds

... step_prep5 made a comment on step2ck_form7/block1/q#42 (A previously healthy 26-year-old man comes to the...)
 +1 
submitted by step_prep5(15)
  • Young man presents with fever, erythema nodosum (painful, red, tender nodules on anterior shins) and bilateral hilar fullness, most consistent with sarcoidosis
  • Key idea: Sarcoidosis (like other forms of granulomatous disease) is associated with hypercalcemia because of increased activity of 1-alpha hydroxylase leading to increased production of activated vitamin D –> hypercalcemia, hyperphosphatemia
  • Ddx for erythema nodosum: Sarcoidosis, Strep infections, tuberculosis, inflammatory bowel disease, Behcet disease, endemic fungal disease (cocci, histo)
  • Key idea: If patient has erythema affecting both legs, then cellulitis is virtually ruled out! (bilateral cellulitis very rare)

https://step-prep.org/tutoring/

... yotsubato made a comment on step2ck_form7/block2/q#3 (A sexually active 24-year-old man has had...)
 +1 
submitted by yotsubato(965)

Lets take a picture with a potato, JPEG the hell out of it and throw it on an exam .

... athleticmedic made a comment on step2ck_form7/block2/q#3 (A sexually active 24-year-old man has had...)
 +1 
submitted by athleticmedic(4)

Can anyone who got this right explain how they ruled out chancroid? This is the definition I have for chancroid which I thought fit the image/text description (multiple increasingly painful sores and lymphadenopathy), but was incorrect:

"Patients present with extremely painful suppurative ulcers that may be single or multiple.Infection begins as a papule, which quickly progresses to a pustule and subsequent ulcer formation. Painful inguinal lymphadenopathy with subsequent ulceration, usually unilateral, develops in approximately 50%."

... yotsubato made a comment on step2ck_form7/block2/q#7 (A 36-year-old woman, gravida 1, para 1, has had...)
 +1 
submitted by yotsubato(965)

You know they could throw us a bone or something... Tell us the uterus is boggy at least, or hard, or ANYTHING AT ALL REALLY....

... jesusisking made a comment on step2ck_form7/block2/q#8 (A previously healthy 47-year-old man comes to the...)
 +1 
submitted by jesusisking(15)

Tumbleweed

drdoom  need more cowboys in these here parts .. +2
... yotsubato made a comment on step2ck_form7/block2/q#10 (A 67-year-old man comes to the emergency department...)
 +1 
submitted by yotsubato(965)

Welcome back to Step 1 minutae... Useless crap they make us memorize, hell not even memorize.

athleticmedic  I had no idea what this question was trying to get at. It makes sense looking back now, but at the time I had no idea what they were talking about. +