Kim! Hi! It’s your dad!πŸ‘‹ ▪ Khalilah, I’m proud of you for taking a risk for your dream.Everyone’s explanations tend to be so on-point, and the commiseration makes me feel better, too!Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!                       want to add a fly-by? email us! 😊
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Step 2 CK Form 7 Answers

Question#2 (reveal difficulty score)
A 27-year-old man comes to the physician with ...
Bilateral varicocelesπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 52-year-old man comes to the physician ...
IndomethacinπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 14-month-old boy is brought for a ...
ReassuranceπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 24-year-old man has shortness of breath 2 ...
Fat embolism syndromeπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 4-year-old boy has had increasing fatigue ...
Bone marrow aspirationπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
Two days after beginning ACTH therapy for ...
HaloperidolπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
CT scan of the headπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 32-year-old woman is brought to the ...
TriglyceridesπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A previously healthy 42-year-old woman has ...
ThymomaπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A homeless 66-year-old man is admitted to the ...
Decreased calciumπŸ”,πŸ“Ί


Question#13 (reveal difficulty score)
Over the past month, a 72-year-old woman has ...
Exercise stress testπŸ”,πŸ“Ί



Question#16 (reveal difficulty score)
A 19-year-old man is brought to the emergency ...
PCPπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
SplenectomyπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
An 18-year-old primigravid woman at 37 weeks' ...
Amniotomy and vaginal deliveryπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 72-year-old man comes to the physician ...
MuscleπŸ”,πŸ“Ί



Question#22 (reveal difficulty score)
A 4-month-old infant is brought to the ...
Child abuseπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Family therapyπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A previously healthy 9-year-old boy is ...
Ankylosing spondylitisπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 15-year-old girl is brought to the ...
Compression fractureπŸ”,πŸ“Ί


Question#28 (reveal difficulty score)
A 47-year-old woman is brought to the ...
Thoracic aortaπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 6-month-old boy is brought to the physician ...
Mupirocin ointmentπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A previously healthy 62-year-old woman comes ...
Barium swallowπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 52-year-old woman is brought to the ...
Bipolar disorderπŸ”,πŸ“Ί



Question#35 (reveal difficulty score)
A 37-year-old man comes to the physician ...
Demyelination of axonsπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 37-year-old woman has had malaise, muscle ...
Culture for herpes simplexπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 22-year-old primigravid woman at term is ...
Urinary stasisπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 4-year-old girl is brought to the physician ...
T-lymphocyte dysfunctionπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
OsteoporosisπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 50-year-old woman with a 5-year history of ...
Pericardial windowπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
Small-bowel obstructionπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A previously healthy 26-year-old man comes to ...
Increased calciumπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 17-year-old girl comes to the physician ...
Pilosebaceous folliclesπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A previously healthy 6-year-old boy is ...
Operative procedureπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
One day after removal of a large meningioma, ...
Diabetes insipidusπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 75-year-old man is brought to the emergency ...
Heat strokeπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 54-year-old man comes to the physician ...
Carotid endarterectomyπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A sexually active 24-year-old man has had ...
Genital herpesπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 22-year-old man is brought to the emergency ...
AtropineπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
AmoxicillinπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 36-year-old woman, gravida 1, para 1, has ...
Uterine atonyπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
An afebrile 32-year-old woman comes to the ...
Enterotoxic Escherichia coliπŸ”,πŸ“Ί


Question#11 (reveal difficulty score)
Over the past 2 years, a 67-year-old man has ...
Abstinence from alcoholπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
Six hours after undergoing left thoracotomy ...
Analgesic therapyπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 27-year-old male physician is inadvertently ...
No treatment necessaryπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 32-year-old man with major depressive ...
MethamphetamineπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
An asymptomatic 22-year-old nulligravid woman ...
Oral contraceptive therapyπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician ...
Haemophilus influenzaeπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
Two hours after emergency repair of a ...
Decreased potassiumπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 55-year-old woman with known metastatic ...
Increased calciumπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 62-year-old woman is admitted to the ...
Renal ultrasonographyπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 57-year-old woman comes to the physician ...
OsteoarthritisπŸ”,πŸ“Ί


Question#23 (reveal difficulty score)
Four days after undergoing a right ...
Wound dehiscenceπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 37-year-old man comes to the physician ...
Alveolar hypoventilationπŸ”,πŸ“Ί


Question#26 (reveal difficulty score)
A 32-year-old nulligravid woman with ...
ClomipheneπŸ”,πŸ“Ί




Question#30 (reveal difficulty score)
A previously healthy 27-year-old man is ...
Vasovagal syncopeπŸ”,πŸ“Ί



Question#33 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Urethral diverticulumπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
An 8-hour-old newborn develops jaundice and ...
Rh incompatibilityπŸ”,πŸ“Ί




Question#38 (reveal difficulty score)
A 12-month-old boy is brought to the ...
B lymphocyteπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 12-month-old boy is brought to the ...
NeutrophilπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...
Major depressive disorderπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A previously healthy 57-year-old woman with ...
BotulismπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 72-year-old man is admitted to the hospital ...
Diuretic therapyπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
NaloxoneπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 17-year-old girl is brought to the ...
CricothyrotomyπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 50-year-old woman with a history of ...
Atrophic gastritisπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
An asymptomatic 27-year-old woman who is HIV ...
Pneumococcal vaccineπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 72-year-old man is hospitalized because of ...
Cor pulmonaleπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
Three days after undergoing total hip ...
Epidural hematomaπŸ”,πŸ“Ί



Question#5 (reveal difficulty score)
A 19-year-old African American man comes to ...
Digestive enzyme deficiencyπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Aortic stenosisπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 24-year-old primigravid woman at 38 weeks' ...
Intravenous penicillin GπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
An otherwise healthy 70-year-old woman comes ...
Paget disease of the breastπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
An otherwise healthy 40-year-old woman comes ...
Physiologic dischargeπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
An 18-year-old woman has had fever for 12 ...
MeningococcemiaπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 32-year-old man comes to the physician with ...
Acute stress disorderπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
Two days after admission to the hospital for ...
Vitamin B1 (thiamine)πŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 37-year-old woman, gravida 3, para 3, comes ...
Bartholin duct cystπŸ”,πŸ“Ί


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

Question#17 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Colonoscopy to the cecumπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
Three days after open reduction and internal ...
Duplex scanπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
Bromocriptine therapyπŸ”,πŸ“Ί


Question#21 (reveal difficulty score)
A 21-year-old primigravid woman at 37 weeks' ...
Measurement of platelet countπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 42-year-old man has had a pruritic rash on ...
Cutaneous larva migransπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
An otherwise healthy 42-year-old woman comes ...
ReassuranceπŸ”,πŸ“Ί


Question#26 (reveal difficulty score)
A 47-year-old man comes to the physician ...
ColonoscopyπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Femoropopliteal arteriesπŸ”,πŸ“Ί


Question#29 (reveal difficulty score)
A 42-year-old man is scheduled to undergo an ...
Lorazepam therapyπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
An 8-year-old boy is brought to the physician ...
C1 esterase inhibitorπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 34-year-old woman has had pain in the left ...
CostochondritisπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 37-year-old man comes to the physician ...
Calcium disodium edetateπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 27-year-old man comes to the physician ...
HIV antibody testingπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 72-year-old man comes to the physician for ...
Psychogenic polydipsiaπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 23-year-old man is brought to the physician ...
Brief psychotic disorderπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 72-year-old woman comes to the physician ...
Exploratory laparotomyπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Streptococcus pneumoniaeπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
Three hours after undergoing emergency repair ...
Cardiogenic shockπŸ”,πŸ“Ί


Question#42 (reveal difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Cesarean deliveryπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 37-year-old woman with sickle cell disease ...
Acute cholecystitisπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 14-year-old boy who has sickle cell trait ...
X-ray of the left hipπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A previously healthy 62-year-old man is ...
Intravenous labetalolπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 77-year-old man is brought to the physician ...
HypothyroidismπŸ”,πŸ“Ί



Question#3 (reveal difficulty score)
A 67-year-old man has had an ulcer on the ...
Stasis dermatitis with ulcerπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 62-year-old man comes to the physician ...
VancomycinπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 22-year-old college student is brought to ...
Olanzapine therapyπŸ”,πŸ“Ί


Question#10 (reveal difficulty score)
A previously healthy 27-year-old African ...
Abruptio placentaeπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 32-year-old woman, gravida 3, para 1, ...
Magnesium sulfateπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 42-year-old woman is brought to the ...
Optic neuritisπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
An 82-year-old man with congestive heart ...
Decreased renal blood flowπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
An otherwise healthy 37-year-old man comes to ...
SpondylolisthesisπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...
Wiskott-Aldrich syndromeπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Oral propylthiouracil therapyπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
An asymptomatic 60-year-old man comes for a ...
ObservationπŸ”,πŸ“Ί



Question#20 (reveal difficulty score)
A 52-year-old woman comes to the physician ...
Pleural metastasesπŸ”,πŸ“Ί



Question#23 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Viral infectionπŸ”,πŸ“Ί

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


Question#27 (reveal difficulty score)
A 17-year-old boy comes to the physician ...
Pill-induced esophagitisπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A previously healthy 21-year-old woman comes ...
Viral pleurisyπŸ”,πŸ“Ί



Question#31 (reveal difficulty score)
A 32-year-old woman is brought to the ...
AppendicitisπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 3-year-old girl is brought to the emergency ...
OrganophosphateπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A previously healthy 67-year-old man has had ...
Bronchogenic carcinomaπŸ”,πŸ“Ί


Question#35 (reveal difficulty score)
A 65-year-old man comes to the emergency ...
Internal carotid arteryπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 4-year-old boy develops chickenpox 8 hours ...
No intervention is necessaryπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
An 87-year-old man comes to the physician ...
FinasterideπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
An unconscious 22-year-old man is brought to ...
Intravenous 0.9% salineπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 20-year-old man is brought to the physician ...
SchizophreniaπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 47-year-old man comes to the emergency ...
HypovolemiaπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 27-year-old nulligravid woman comes for a ...
ColposcopyπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 51-year-old woman had a 15-minute episode ...
ObservationπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 56-year-old woman with short-bowel syndrome ...
ZincπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 32-year-old man is brought to the emergency ...
DopamineπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A male newborn has bilateral clubfoot ...
Spinal dysraphismπŸ”,πŸ“Ί




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



Question#13 (reveal difficulty score)
A 57-year-old man comes to the physician ...
Interferon-alphaπŸ”,πŸ“Ί




Recent comments ...

... seagull made a comment on step2ck_form7/block2/q#12 (Six hours after undergoing left thoracotomy for a...)
 +14 
submitted by seagull(1688)

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.

... athleticmedic made a comment on step2ck_form7/block2/q#7 (A 36-year-old woman, gravida 1, para 1, has had...)
 +9 
submitted by athleticmedic(13)

"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. +2
... yotsubato made a comment on step2ck_form7/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +7 
submitted by yotsubato(1088)

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 +1
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. +2
dreamyyn  I also chose Dexamethasone, but uptodate says the glucocorticoid choice is prednisone not dexamethasone. Indomethacin is typically the DOC, better than celecoxib. Not a good question, but a good review of details in the medication! +2
... buttercup made a comment on step2ck_form7/block1/q#33 (During examination prior to participation in school...)
 +7 
submitted by buttercup(20)

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.

... carolebaskin made a comment on step2ck_form7/block2/q#38 (A 12-month-old boy is brought to the emergency...)
 +7 
submitted by carolebaskin(85)

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. +2
... seagull made a comment on step2ck_form7/block4/q#14 (An otherwise healthy 37-year-old man comes to the...)
 +7 
submitted by seagull(1688)

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? +4
etherbunny  It's between the sacrum and L5. If you join a smooth curve along the posterior border of the lumbar vertebral bodies and the posterior border of the sacrum, L5 is clearly slipped anteriorly and doesn't sit on the curve. +2
... chris07 made a comment on step2ck_form7/block2/q#1 (A 75-year-old man is brought to the emergency...)
 +6 
submitted by chris07(64)

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. -_- +1
bluebul  Dude isn't red as a beet. Can't be anti-cholinergic poisoning. +2
... thajoker made a comment on step2ck_form7/block3/q#35 (A previously healthy 82-year-old woman comes to the...)
 +6 
submitted by thajoker(14)

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.

... study_dude_guy made a comment on step2ck_form7/block1/q#6 (A 4-year-old boy has had increasing fatigue since a...)
 +5 
submitted by study_dude_guy(8)

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#8 (A 47-year-old woman comes to the physician because...)
 +5 
submitted by step_prep5(198)
  • Patient presenting with signs/symptoms concerning for meningitis vs. subarachnoid hemorrhage who also has signs of increased intracranial pressure and should therefore have a CT scan performed before a lumbar puncture
  • Key idea: Optic fundi cannot be visualized = Papilledema = Increased intracranial pressure = Contraindication to lumbar puncture due to risk of cerebral herniation
  • Key idea: Both meningitis and subarachnoid hemorrhage can lead to fever and signs of meningismus (pain with neck flexion, Kernig sign, etc.)

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

... jesusisking made a comment on step2ck_form7/block1/q#26 (A 47-year-old woman comes to the physician because...)
 +5 
submitted by jesusisking(24)

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. +
... russnels made a comment on step2ck_form7/block1/q#42 (A previously healthy 26-year-old man comes to the...)
 +5 
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. +
... step_prep5 made a comment on step2ck_form7/block1/q#44 (A 17-year-old girl comes to the physician because of...)
 +5 
submitted by step_prep5(198)
  • 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#7 (A 36-year-old woman, gravida 1, para 1, has had...)
 +5 
submitted by yotsubato(1088)

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....

saffronshawty  They mentioned that the uterus is 3 cm above the umbilicus which is an indication that it's enlarged and hasn't returned to the normal post-partum size it should be, which is at the level of the umbilicus +/- 2 cm. +2
derpymd  So that +1cm is the distinction here? They misdirect to suggest there may be retained placental tissue, but tell us nothing truly valuable about the state of the uterus. I think this is a poor question. +
cinnapie  @derpymd i get what you are saying but they said that the placenta is torn but complete. I guess we need to take their word for it if they say the placenta is complete and there is absolutely NOTHING left behind to cause the symptoms +1
... seagull made a comment on step2ck_form7/block2/q#16 (A 43-year-old man comes to the physician because of...)
 +5 
submitted by seagull(1688)

I love these shit pictures. It's like some old angry dude opened a text book from the 1950s and took a picture with his razor phone then uploaded the picture using windows 99.

seagull  Also, I think pseudomonas would present with hemoptysis and a much worse clinical picture. +1
drmohandes  Community-acquired pneumonia. If it was a CF patient = pseudomonas. In a 25-year smoker (COPD?) = H. influenzae. +6
etherbunny  That'll be RAZR phone and Windows 98. FIFY, f**king millenials. :roll_eyes: ;) +3
... seagull made a comment on step2ck_form7/block2/q#43 (A 17-year-old boy is brought to the emergency...)
 +5 
submitted by seagull(1688)

This was so free I thought I wandered into a Canadian hospital for a minute.

... thomasalterman made a comment on step2ck_form7/block3/q#2 (Three days after undergoing total hip replacement, a...)
 +5 
submitted by thomasalterman(162)

this question would be a lot easier if the answer choice was worded "spinal epidural hematoma"

seagull  Yes! I chose dural lacerations. I quickly wrote off epidural hematoma since we usually think of it as head trauma. However, as history has shown. These authors are ass. +2
... thomasalterman made a comment on step2ck_form7/block3/q#21 (A 21-year-old primigravid woman at 37 weeks'...)
 +5 
submitted by thomasalterman(162)

My reasoning: We know she has preeclampsia, so what other information might be helpful? - platelets could evaluate for HELLP and AFLP - everything else has no indication. US pelvis is a weaker choice given patient has no documented signs of abruption (pelvic pain, vaginal bleeding, FHR abnormalities)

... seagull made a comment on step2ck_form7/block3/q#24 (An otherwise healthy 42-year-old woman comes to the...)
 +5 
submitted by seagull(1688)

If you're ever unsure and it seems like it's not cancer. You slam the "Reassure" answer choice with passion.

seagull  A subconjunctival hemorrhage occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva). The conjunctiva can't absorb blood very quickly, so the blood gets trapped. You may not even realize you have a subconjunctival hemorrhage until you look in the mirror and notice the white part of your eye is bright red. A subconjunctival hemorrhage often occurs without any obvious harm to your eye. Even a strong sneeze or cough can cause a blood vessel to break in the eye. You don't need to treat it. Your symptoms may worry you. But a subconjunctival hemorrhage is usually a harmless condition that disappears within two weeks or so. +2
... carolebaskin made a comment on step2ck_form7/block3/q#26 (A 47-year-old man comes to the physician because of...)
 +5 
submitted by carolebaskin(85)

Tricky! Yes, fecal occult blood test would pick up hemorrhoid blood and this is a male <50yo, so case closed right?

Wrong! Hematocrit = 35% --> hgb = 35/3 = 11.7 < 13.5 (normal)

Why is he anemic? Do a colonoscopy.

... carolebaskin made a comment on step2ck_form7/block3/q#44 (A 14-year-old boy who has sickle cell trait is...)
 +5 
submitted by carolebaskin(85)

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

... seagull made a comment on step2ck_form7/block1/q#20 (A previously healthy 4-year-old boy is brought to...)
 +4 
submitted by seagull(1688)

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

hpsauce90  chrome has default settings for flash set to "ask"...but it doesnt always ask. i guess you already figured it out, but a quick way to do it is to click the lock icon to the left of the website address. then just set the flash setting to allow +
... step_prep5 made a comment on step2ck_form7/block1/q#28 (A 47-year-old woman is brought to the emergency...)
 +4 
submitted by step_prep5(198)
  • 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/

... jaypat made a comment on step2ck_form7/block1/q#31 (An asymptomatic 23-year-old man comes to the...)
 +4 
submitted by jaypat(4)

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
... athleticmedic made a comment on step2ck_form7/block2/q#3 (A sexually active 24-year-old man has had...)
 +4 
submitted by athleticmedic(13)

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%."

derpymd  I'm with you on this one. I would expect to see more clustering + vesicular appearance from herpes. The topmost lesion in the image seems to have raised edges and central cavitation. Oof +
kingfriday  i put down chancroid too but i think that the dark area around the lesion are supposed to be the "red base" +
... seagull made a comment on step2ck_form7/block2/q#3 (A sexually active 24-year-old man has had...)
 +4 
submitted by seagull(1688)

im convinced you cannot differentiate this from chancroid

... yotsubato made a comment on step2ck_form7/block2/q#10 (A 67-year-old man comes to the emergency department...)
 +4 
submitted by yotsubato(1088)

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. +
... buttercup made a comment on step2ck_form7/block2/q#18 (A 55-year-old woman with known metastatic breast...)
 +4 
submitted by buttercup(20)

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.

... seagull made a comment on step2ck_form7/block2/q#18 (A 55-year-old woman with known metastatic breast...)
 +4 
submitted by seagull(1688)

Imagine a world where the author put things like kidney stones, constipation, altered mental status or GERD. But, no. We get the first level of hell where all these authors take fat Shits on the students. "Thank you sir - may I have another?"

nala_ula  your comments to BS questions <3 +
... carolebaskin made a comment on step2ck_form7/block2/q#25 (A 52-year-old woman comes to the emergency...)
 +4 
submitted by carolebaskin(85)

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.
etherbunny  Post cholecystectomy syndrome is characterized by early satiety, bloating and dyspepsia. Definitely NOT the clinical picture in this vignette! +1
jlbae  "Persistent or new abdominal symptoms following gallbladder removal. The pathophysiology is not yet fully understood, but it is thought to be due to alterations in the enterohepatic circulation of bile secondary to remaining biliary stones, biliary injury, or sphincter of Oddi dysfunction. Symptoms may include RUQ or epigastric pain, dyspepsia, nausea, vomiting, flatulence, bloating, and diarrhea." +2
... yotsubato made a comment on step2ck_form7/block3/q#5 (A 19-year-old African American man comes to the...)
 +4 
submitted by yotsubato(1088)

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" +1
seagull  I also choose Celiac's. "BuT RaCe AnD mEdICiNe DoN't Go ToGeThEr". +3
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. +3
... carolebaskin made a comment on step2ck_form7/block3/q#11 (An 18-year-old woman has had fever for 12 hours and...)
 +4 
submitted by carolebaskin(85)

TSS: sunburn like rash particularly on the palms and soles and very rare

Meningococemia fits better for a college-age girl who has been living in cabins/dorms and cannot be aroused/altered mental status

https://rarediseases.org/rare-diseases/toxic-shock-syndrome/

... carolebaskin made a comment on step2ck_form7/block3/q#35 (A previously healthy 82-year-old woman comes to the...)
 +4 
submitted by carolebaskin(85)

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?

etherbunny  What about tigers? Can tigers look up, Carole? +6
... step_prep5 made a comment on step2ck_form7/block3/q#39 (A 67-year-old man comes to the physician because of...)
 +4 
submitted by step_prep5(198)
  • Older patient with multiple myeloma (monoclonal spike on SPEP and bone marrow biopsy showing >50% plasma cells), which leads to impaired production of normal immunoglobulins, leading to increased risk for sinopulmonary infections (due to impaired IgA production) and encapsulated infections (due to impaired IgG –> impaired opsonization –> increased risk of encapsulated infections such as Strep pneumo, H. influenzae and Neisseria)

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

... step_prep5 made a comment on step2ck_form7/block3/q#42 (A 27-year-old primigravid woman at 39 weeks'...)
 +4 
submitted by step_prep5(198)
  • Category 3 fetal heart tracings (require immediate delivery): (1) Recurrent late decelerations + absent variability (2) Recurrent variable decelerations + absent variability (3) Bradycardia + absent variability (4) Sinusoidal pattern
  • Cervical dilation < 10 cm and need for immediate delivery –> C-section
  • Cervical dilation of 10 cm and need for immediate delivery –> Operative vaginal delivery (forceps delivery)
  • Key idea: Indications for C-section in the active phase (6-10 cm cervix) of labor (1) Active phase arrest with no cervical change for 4 hours with adequate contractions (>200 Montivideo units) or for 6 hours with inadequate contractions (2) Category 3 fetal HR tracing

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

... step_prep5 made a comment on step2ck_form7/block3/q#45 (A previously healthy 62-year-old man is brought to...)
 +4 
submitted by step_prep5(198)
  • Older male patient with tearing chest pain radiating to the pack, different upper extremity blood pressures, aortic regurgitation murmur and a widened mediastinum on CXR, all of which are consistent with aortic dissection
  • Key idea:Β Beta-blockers (such as labetalol) are particularly useful in setting of aortic dissection because the force of blood being ejected from the LV and hitting the aorta can further propagate the tear, with beta blockers leading to reduced contractility and reduced force of blood ejection against the aorta

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

... drmohandes made a comment on step2ck_form7/block4/q#3 (A 67-year-old man has had an ulcer on the anterior...)
 +4 
submitted by drmohandes(143)

pressure (decubitus) ulcers

  • over bony prominence
  • impaired mobility / abnormal mental status

arterial ulcers

  • most distal parts where blood flow is low (tips of toes)

diabetic foot ulcers

  • Charcot deformity
  • soles of feet under metatarsal heads
  • tops of toes

venous stasis ulcers

  • edema
  • stasis dermatitis
  • pretibial or above medial malleolus
... yotsubato made a comment on step2ck_form7/block4/q#37 (An 87-year-old man comes to the physician because of...)
 +4 
submitted by yotsubato(1088)

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

... step_prep5 made a comment on step2ck_form7/block4/q#38 (An unconscious 22-year-old man is brought to the...)
 +4 
submitted by step_prep5(198)
  • Patient engaging in intense physical activity presenting with signs of heat stroke (fever, seizure/encephalopathy, dry hot skin) and rhabdomyolysis (myoglobinuria), who should be treated with IV fluids to decrease the risk of myoglobin pigment stones precipitating kidney damage
  • Key idea: The major tenant of rhabdomyolysis management is aggressive IV fluid resuscitation because patients develop decreased effective circulating volume (due to fluid shifts into damaged muscle) and because patients are at risk for acute tubular necrosis secondary to myoglobinuria (with increased fluids helping to dilute these pigments and decrease the risk of tubular obstruction)

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

... hpsauce90 made a comment on step2ck_form7/block1/q#4 (A 14-month-old boy is brought for a well-child...)
 +3 
submitted by hpsauce90(6)

kids start to take first few independent steps by 12-18mo

... 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(20)

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 +4
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? +
... step_prep5 made a comment on step2ck_form7/block1/q#11 (A homeless 66-year-old man is admitted to the...)
 +3 
submitted by step_prep5(198)
  • Key idea: ON THE BOARDS, ALCOHOLISM = MALNUTRITION!
  • Hypomagnesemia –> Refractory hypokalemia and hypocalcemia
  • Key idea: In the setting of hypocalcemia, important to always check a magnesium level and a serum albumin level (low albumin –> low total calcium)

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

... deathbystep1 made a comment on step2ck_form7/block1/q#12 (A 62-year-old woman is admitted to the hospital...)
 +3 
submitted by deathbystep1(17)

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#12 (A 62-year-old woman is admitted to the hospital...)
 +3 
submitted by seagull(1688)

SO Pulmonary Angiography has dye that shouldn't be used in CKD.

Why does the question need to be like a book in length. I was balancing like 20 ideas with her F**King diabetes and HTN. WTF

nala_ula  literally +
... step_prep5 made a comment on step2ck_form7/block1/q#20 (A previously healthy 4-year-old boy is brought to...)
 +3 
submitted by step_prep5(198)
  • Did not have access to media player, but the patient’s presentation is consistent with a URI
  • CHF: Cyanosis, delayed capillary refill, etc.
  • Idiopathic pulmonary hypertension: Lower extremity edema, congestive hepatopathy, loud P2, RV heave
  • Pericarditis: Febrile, friction rub, etc.
  • VSD: Often asymptomatic until later age, will lead to a systolic ejection murmur in the lower left sternal border

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

... step_prep5 made a comment on step2ck_form7/block1/q#23 (A 16-year-old girl is brought to the physician by...)
 +3 
submitted by step_prep5(198)
  • Family therapy is appropriate in this case because the father, mother and daughter could benefit from improved communication and coping strategies
  • Note: Family therapy is also effective in the management of a patient with schizophrenia (helps to educate family about symptoms, course, etc.)

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

... step_prep4 made a comment on step2ck_form7/block1/q#25 (A 15-year-old girl is brought to the physician...)
 +3 
submitted by step_prep4(9)
  • Young girl with a history of chronic corticosteroid use and cushingoid appearance who presents with constant back pain with vertebral point tenderness with imaging showing vertebrae with increased lucency, most consistent with a compression fracture in the setting of steroid-induced osteoporosis
  • Key idea:Β Vertebral compression fracture comes in 2 flavorsΒ (1) Chronic fracture:Β Painless with progressive kyphosis and loss of statureΒ (2) Acute fracture:Β Low back pain with decreased spinal mobility + tenderness at affected level
  • Key idea: Causes of point tenderness over vertebral body includes compression vertebral fractures, osteomyelitis and metastatic disease to vertebral bone
  • Risk factors for osteoporosis –> compression fracture: Low weight (osteoporosis), increased age, women, chronic corticosteroid use or Cushing syndrome

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

seagull  Jesus dude, just take my virginity while you're at it/ +7
... step_prep5 made a comment on step2ck_form7/block1/q#26 (A 47-year-old woman comes to the physician because...)
 +3 
submitted by step_prep5(198)
  • 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/

antwon  Would this be stress hyperglycemia? meaning stress would lead to gluconeogenesis, glycogenolysis, and insulin resistance. Therefore more glucose in the urine and therefore glucosuria. +
... hpsauce90 made a comment on step2ck_form7/block1/q#33 (During examination prior to participation in school...)
 +3 
submitted by hpsauce90(6)

dx of htn in kids requires BP measurements at 3 different visits:

  • kids: β‰₯ 95 percentile

  • adolescents (β‰₯ 13y): β‰₯ 130/80

... step_prep5 made a comment on step2ck_form7/block1/q#38 (A 4-year-old girl is brought to the physician...)
 +3 
submitted by step_prep5(198)
  • 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)