This one made no sense. Celecoxib is already the strongest NSAID. I would rather give Dexamethasone. Which works along a seperate mechanism of action.
Is this sarcoidosis? I think that accounts for the erythema nodosum, hypercalcemia, and hilar findings.
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.
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.
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.
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.
"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.
OCPs offer significant protection against
IUDs only act locally
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.
Would this be x-linked agammaglobulinemia? With a BTK gene mutaiton?
Male (XY) + Encapsulated organisms = X linked (Bruton) agammaglobulinemia
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
Lactose Intolerant I guess? Not Celiac. Kind of a bullshit question.
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.
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
Bacterial meningitis... get a CT first due to signs of neurological deficit (R upper extremity + nystagmus). Otherwise lumbar puncture.
Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history
Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.
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.
Ill be the Cowboy.
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.
My understanding was that both IUDs and OCP can reduce risk of ovarian epithelial cancer. Anybody know why OCPs are better than IUDs?
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.
priority for AD patients is rate control. After controlling rate you can throw on something extra for pressure control but rate control comes first.
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.
Order of treatment for acute hyperthyroid symptoms
Beta Blocker --> PTU---> Radioactive Iodine
Beta blocker wasnt an answer option but would be correct if given.
"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/
Doxazosin is not given because he has a history of orthostatic hypotension.
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.
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.
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).
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.
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
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).
In 85 percent of patients with latent TB, the chest radiograph is normal.
Latent TB Treatment:
"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
. The immune response to M tuberculosis is T cell dependent. It comprises not only the conventional CD4 and CD8 T cells, but also γδ T cells and CD1 restricted T cells. γδ 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....
• Severe SBO presents with:
• ↓ 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) • Distended and tympanic abdomen • Postprandial pain • Pain relieved with vomiting (relieves some intra-abdominal pressure)
• SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds
Lets take a picture with a potato, JPEG the hell out of it and throw it on an exam .
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%."
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....
Welcome back to Step 1 minutae... Useless crap they make us memorize, hell not even memorize.