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Step 2 CK Form 8 Answers

Block/Question (8.3 difficulty score)
A 57-year-old woman comes to the physician ...
Toxin-induced inflammation of the colonic mucosaπŸ”,πŸ“Ί

Block/Question (5.1 difficulty score)
An asymptomatic 37-year-old woman comes to ...
Discontinue the oral contraceptiveπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
A 52-year-old woman with a 40-year history of ...
Abnormal pressure distribution caused by sensory neuropathyπŸ”,πŸ“Ί

Block/Question (6.7 difficulty score)
A 67-year-old woman comes to the physician ...
Pulmonary function testsπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 37-year-old woman, gravida 2, para 2, comes ...
AdenomyosisπŸ”,πŸ“Ί

Block/Question (4.6 difficulty score)
A 27-year-old man with schizophrenia is ...
Adverse effect of haloperidolπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
An asymptomatic 27-year-old man comes to the ...
Influenza virus, 23-valent pneumococcal, and hepatitis B vaccinesπŸ”,πŸ“Ί

Block/Question (6.2 difficulty score)
A 62-year-old man comes for evaluation prior ...
Parenteral cefazolinπŸ”,πŸ“Ί

Block/Question (4.6 difficulty score)
An otherwise healthy 37-year-old woman comes ...
Endometrial biopsyπŸ”,πŸ“Ί

Block/Question (4.3 difficulty score)
A 72-year-old man is transferred to the ...
Arterial embolusπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
An 87-year-old man comes to the physician ...
Normal agingπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
A 37-year-old nulligravid woman comes to the ...
Intraductal papillomaπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 47-year-old man comes to the emergency ...
Air embolismπŸ”,πŸ“Ί

Block/Question (4.7 difficulty score)
A 19-year-old man is brought to the emergency ...
Psychogenic polydipsiaπŸ”,πŸ“Ί

Block/Question (5.6 difficulty score)
A 52-year-old man comes to the physician ...
Proliferation of hematopoietic progenitor cellsπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A previously healthy 23-year-old man comes to ...
Consistent use of condomsπŸ”,πŸ“Ί

Block/Question (4.8 difficulty score)
A 16-year-old girl comes for a routine health ...
Transesophageal echocardiographyπŸ”,πŸ“Ί

Block/Question (3.7 difficulty score)
A 32-year-old man comes to the physician ...
PropranololπŸ”,πŸ“Ί

Block/Question (3.9 difficulty score)
A 77-year-old man is brought to the physician ...
Begin isoniazid and vitamin B6 therapyπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A 22-year-old woman comes to the physician ...
Deficiency of serum glucuronosyltransferaseπŸ”,πŸ“Ί

Block/Question (2.2 difficulty score)
A 12-year-old boy with Marfan syndrome is ...
Mitral valve prolapseπŸ”,πŸ“Ί

Block/Question (2.8 difficulty score)
A 3-year-old girl is brought to the emergency ...
Intramuscular epinephrineπŸ”,πŸ“Ί

Block/Question (5.2 difficulty score)
Twelve days after undergoing an orthotopic ...
Allograft rejectionπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
A 9-year-old girl is brought to the physician ...
SertralineπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
A previously healthy 52-year-old man is ...
Second-degree atrioventricular blockπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 7-year boy is brought to the physician ...
Topical antibiotic therapyπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 52-year-old man is brought to the emergency ...
Thoracoabdominal aortic dissectionπŸ”,πŸ“Ί

Block/Question (3.9 difficulty score)
A previously healthy 72-year-old man comes to ...
PneumoconiosisπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A comatose 29-year-old woman is brought to ...
PneumothoraxπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 37-year-old woman comes to the physician ...
Use of a wrist splintπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
The physician reads a news report about a 50% ...
Relative risk reductionπŸ”,πŸ“Ί

Block/Question (4.8 difficulty score)
A 25-year-old man is brought to the emergency ...
AspirinπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 27-year-old man comes to the physician ...
AIDSπŸ”,πŸ“Ί

Block/Question (5.5 difficulty score)
A 72-year-old woman with chronic obstructive ...
Constriction of vessels in the lungsπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 72-year-old woman is undergoing inpatient ...
Flaccid neurogenic bladderπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A 9-year-old boy is brought to the physician ...
Tourette disorderπŸ”,πŸ“Ί

Block/Question (4.7 difficulty score)
A 72-year-old man with lung cancer comes to ...
Repetitive nerve stimulationπŸ”,πŸ“Ί

Block/Question (3.9 difficulty score)
A 42-year-old man comes to the physician ...
Nothing here right nowπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
A previously healthy 32-year-old woman comes ...
Irritable bowel syndomeπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 42-year-old woman, gravida 4, para 4, comes ...
Detrusor hyperactivityπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A 42-year-old woman comes to the physician ...
Nonalcoholic steatohepatitisπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 25-year-old man comes to the physician 6 ...
MRI of the thoracolumbar spineπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 37-year-old woman comes to the emergency ...
Cardiac tamponadeπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 25-year-old woman comes to the physician to ...
Nothing here right nowπŸ”,πŸ“Ί

Block/Question (5.0 difficulty score)
A 2-month-old boy is brought to the physician ...
Use of protective clothingπŸ”,πŸ“Ί

Block/Question (5.5 difficulty score)
A 37-year-old man comes to the emergency ...
EchocardiographyπŸ”,πŸ“Ί

Block/Question (4.3 difficulty score)
A previously healthy 22-year-old man is ...
Exogenous ingestion of an organic acidπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
A 37-year-old man is brought to the emergency ...
Substance-induced psychotic disorderπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 32-year-old woman has had fatigue, fever ...
Penicillin G benzathineπŸ”,πŸ“Ί

Block/Question (2.4 difficulty score)
A 37-year-old man comes to the physician 24 ...
Small-bowel strictureπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A previously healthy 17-year-old girl is ...
Spiral CT scan of the chestπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 1-day-old male newborn had the onset of ...
Pancreatic enzymeπŸ”,πŸ“Ί

Block/Question (5.4 difficulty score)
A 32-year-old woman comes to the physician ...
Interferon beta therapyπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 30-year-old primigravid woman with systemic ...
Complete atrioventricular blockπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 52-year-old man who is HIV positive comes ...
Squamous cell carcinomaπŸ”,πŸ“Ί

Block/Question (3.1 difficulty score)
A 19-year-old woman comes to the university ...
Blood: Trace / Protein: 1+ / RBC: 0-5 / WBC: >50 / Casts: None / Other: WBC clumpsπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 52-year-old woman with type 2 diabetes ...
HyperosmolalityπŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
A 20-year-old man is brought to the emergency ...
Retrograde urethrographyπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 2-year-old African girl is brought to the ...
Serum niacin concentrationπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 4-year-old girl is brought to the physician ...
MedulloblastomaπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 32-year-old woman comes to the physician ...
Lumbar radiculopathyπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
A study is conducted to determine if a ...
Positive predictive value is 88%πŸ”,πŸ“Ί

Block/Question (1.7 difficulty score)
Two days after undergoing internal fixation ...
Fat embolismπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 21-year-old woman comes to the physician ...
Epstein-Barr virusπŸ”,πŸ“Ί

Block/Question (2.8 difficulty score)
A previously healthy 18-year-old man is ...
Diabetic ketoacidosisπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A 17-year-old boy is brought to the emergency ...
Subclavian arteryπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A 57-year-old man comes to the physician for ...
Fluid restrictionπŸ”,πŸ“Ί

Block/Question (2.4 difficulty score)
A previously healthy 62-year-old man comes to ...
Degenerative joint diseaseπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 72-year-old woman comes to the physician ...
CataractsπŸ”,πŸ“Ί

Block/Question (5.1 difficulty score)
A 16-year-old boy is brought to the emergency ...
Peripheral muscarinic receptorsπŸ”,πŸ“Ί

Block/Question (4.6 difficulty score)
A 9-year-old boy is brought to the physician ...
FEV1: Decreased / FVC: Normal / TLC: IncreasedπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 20-year-old man comes to the student health ...
Ceftriaxone and azithromycin therapyπŸ”,πŸ“Ί

Block/Question (4.4 difficulty score)
A 32-year-old primigravid woman at 27 weeks’ ...
Cervical cancerπŸ”,πŸ“Ί

Block/Question (4.3 difficulty score)
An 18-year-old man is brought to the ...
Rocky Mountain spotted feverπŸ”,πŸ“Ί

Block/Question (1.3 difficulty score)
Hmmmm, well, this is embarrassing
Nothing here right nowπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
An otherwise healthy 25-year-old nurse comes ...
Hepatitis B immune globulin and hepatitis vaccineπŸ”,πŸ“Ί

Block/Question (2.8 difficulty score)
A 47-year-old woman comes to the physician ...
Chronic obstructive pulmonary diseaseπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 3-month-old boy is brought to the physician ...
Tetralogy of FallotπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A biotechnology company sponsors a ...
Selection biasπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
An 11-month-old boy with Werdnig-Hoffmann spinal
Nothing here right nowπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
A study is conducted to assess the accuracy ...
95%πŸ”,πŸ“Ί

Block/Question (2.1 difficulty score)
A 52-year-old man is brought to the emergency ...
Perforation of the esophagusπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
A previously healthy 47-year-old woman comes ...
Plantar fasciitisπŸ”,πŸ“Ί

Block/Question (5.7 difficulty score)
A 3-day-old newborn is brought to the ...
Closure of the ductus arteriosusπŸ”,πŸ“Ί

Block/Question (5.1 difficulty score)
A previously healthy 32-year-old woman comes ...
LymphangitisπŸ”,πŸ“Ί

Block/Question (1.9 difficulty score)
A 16-year-old girl comes to the physician for ...
ACE inhibitor therapyπŸ”,πŸ“Ί

Block/Question (4.3 difficulty score)
Two hours after vaginal delivery at term ...
Supplemental oxygenπŸ”,πŸ“Ί

Block/Question (4.5 difficulty score)
Eight hours after a total abdominal ...
Ureteral ligationπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 7-year-old girl is brought to the physician ...
Topical mupirocinπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
A 5-year-old boy is brought to the physician ...
Factor VIII deficiencyπŸ”,πŸ“Ί

Block/Question (5.9 difficulty score)
A 2-hour-old female newborn has the onset of ...
Intravenous administration of ampicillin and gentamicinπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A randomized, double-blind, controlled study ...
Variability among observersπŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 52-year-old woman comes to the physician ...
Decreased lactase activity in the brush borderπŸ”,πŸ“Ί

Block/Question (2.2 difficulty score)
A 22-year-old primigravid woman delivers a ...
21-HydroxylaseπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
A 25-year-old nurse comes to the physician 2 ...
Isoniazid (INH) therapy onlyπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A 42-year-old woman comes to the physician ...
Serum antinuclear antibody assayπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A 23-year-old woman comes to the physician ...
Switch to a different method of contraceptionπŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
A 67-year-old woman comes to the physician ...
Chronic inflammationπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 23-year-old woman comes to the physician ...
Postviral myocarditisπŸ”,πŸ“Ί

Block/Question (2.2 difficulty score)
A 19-year-old man comes to the emergency ...
DopamineπŸ”,πŸ“Ί

Block/Question (1.9 difficulty score)
A 37-year-old woman with type 1 diabetes ...
Infection with Pseudomonas aeruginosaπŸ”,πŸ“Ί

Block/Question (5.5 difficulty score)
A previously healthy 67-year-old woman comes ...
Carotid duplex ultrasonographyπŸ”,πŸ“Ί

Block/Question (4.9 difficulty score)
A 12-year-old boy has the sudden onset of ...
CT scan of the abdomenπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
A 22-year-old primigravid woman at 10 weeks’ ...
Lidocaine therapyπŸ”,πŸ“Ί

Block/Question (1.6 difficulty score)
A 72-year-old man comes to the physician ...
Increased parathyroid hormone-related peptide concentrationπŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
An 87-year-old woman is brought to the ...
ClindamycinπŸ”,πŸ“Ί

Block/Question (1.8 difficulty score)
An 18-year-old woman has had difficulty ...
AchalasiaπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
A 37-year-old woman comes to the physician ...
Increased catecholamine productionπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A 3-year-old girl is admitted to the hospital ...
Intravenous immune globulinπŸ”,πŸ“Ί

Block/Question (3.1 difficulty score)
A 47-year-old man comes to the physician ...
HistoplasmosisπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 13-year-old boy is brought to the physician ...
Reassurance that the patient’s pubertal development is normalπŸ”,πŸ“Ί

Block/Question (2.7 difficulty score)
A 32-year-old man comes to the physician ...
Abnormal chloride channel in airway epitheliumπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
A 42-year-old man is brought to the physician ...
Caudate nucleusπŸ”,πŸ“Ί

Block/Question (2.2 difficulty score)
A randomized trial is conducted to assess the ...
There is a 95% probability that the difference between the two cure rates is between 8% and 26%πŸ”,πŸ“Ί

Block/Question (5.9 difficulty score)
A 17-month-old infant with sickle cell ...
Ceftriaxone, parenterallyπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
An obese 14-year-old boy is brought to the ...
Pin fixationπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
A 77-year-old man is brought to the physician ...
Assessment for suicide riskπŸ”,πŸ“Ί

Block/Question (5.6 difficulty score)
A 57-year-old woman comes to the physician ...
Superficial thrombophlebitisπŸ”,πŸ“Ί

Block/Question (2.8 difficulty score)
A previously healthy 47-year-old woman comes ...
Graves diseaseπŸ”,πŸ“Ί

Block/Question (1.8 difficulty score)
A 62-year-old man comes to the physician ...
Calculation of ankle brachial indexπŸ”,πŸ“Ί

Block/Question (1.9 difficulty score)
A 54-year-old man comes to the physician ...
Increased iron stores in hepatocytesπŸ”,πŸ“Ί

Block/Question (2.7 difficulty score)
A 23-year-old woman comes to the physician ...
Diabetes mellitusπŸ”,πŸ“Ί

Block/Question (3.7 difficulty score)
An 82-year-old woman comes to the emergency ...
Heparin therapyπŸ”,πŸ“Ί

Block/Question (6.5 difficulty score)
A 12-year-old boy is brought to the physician ...
Restrict his intake of phosphorousπŸ”,πŸ“Ί

Block/Question (2.7 difficulty score)
A 37-year-old woman, gravida 4, para 4, has ...
Genital tract lacerationπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 67-year-old man comes to the physician 2 ...
Excisional biopsy with narrow marginπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
A healthy 4-month-old boy is brought to the ...
Family historyπŸ”,πŸ“Ί

Block/Question (4.1 difficulty score)
A previously healthy 27-year-old man comes to ...
Release of preformed thyroid hormoneπŸ”,πŸ“Ί

Block/Question (2.8 difficulty score)
A 62-year-old man has dyspnea on exertion and ...
Polyvalent influenza vaccine, annuallyπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
A 42-year-old woman comes to the physician ...
Biopsy and culture of the sinus mucosa for fungusπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
A 22-year-old woman comes to the emergency ...
Methotrexate therapyπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
A 10-year-old boy is brought for a routine ...
Vitamin B12 (cyanocobalamin)πŸ”,πŸ“Ί

Block/Question (4.8 difficulty score)
A 13-year-old boy is brought to the physician ...
Exposure to high-decibel soundπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 57-year-old woman comes to the physician ...
OsteophytesπŸ”,πŸ“Ί

Block/Question (5.0 difficulty score)
A 3-year-old girl is brought to the physician ...
UveitisπŸ”,πŸ“Ί

Block/Question (1.6 difficulty score)
A 21-year-old college student comes to the ...
β€œTell me more about what you want to knowβ€πŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 25-year-old man comes to the physician ...
X-ray of the sacroiliac jointsπŸ”,πŸ“Ί

Block/Question (3.9 difficulty score)
A study is done to determine the effect of ...
Low statistical powerπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
A 15-year-old boy is brought to the physician ...
BupropionπŸ”,πŸ“Ί

Block/Question (3.7 difficulty score)
A 67-year-old man comes to the physician ...
Postrenal obstructive uropathyπŸ”,πŸ“Ί

Block/Question (4.7 difficulty score)
A 42-year-old woman comes to the physician ...
Resistant of kidneys to ADH (vasopressin)πŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 52-year-old man comes to the physician for ...
MR angiography of the renal arteriesπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 32-year-old primigravid woman at 10 weeks’ ...
Abruptio placentaeπŸ”,πŸ“Ί

Block/Question (4.6 difficulty score)
A 32-year-old woman, gravida 3, para 2, at 30 ...
Placenta accretaπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
A 57-year-old woman is brought to the ...
Rectus sheath hematomaπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
A 32-year-old man comes to the physician ...
Primary sclerosing cholangitisπŸ”,πŸ“Ί

Block/Question (3.0 difficulty score)
After an uncomplicated pregnancy, a ...
Gonadal dysgenesis 45,X (Turner syndrome)πŸ”,πŸ“Ί

Block/Question (2.5 difficulty score)
A 5-year-old girl is brought to the physician ...
Poststreptococcal glomerulonephritisπŸ”,πŸ“Ί

Block/Question (2.7 difficulty score)
A healthy 37-year-old woman, gravida 4, para ...
Ectopic pregnancyπŸ”,πŸ“Ί

Block/Question (3.7 difficulty score)
A healthy 52-year-old woman, gravida 3, para ...
ReassuranceπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 52-year-old woman comes to the physician ...
Oral acyclovirπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
A previously healthy 5-year-old boy is ...
Septic arthritisπŸ”,πŸ“Ί

Block/Question (3.1 difficulty score)
A 52-year-old man is brought to the physician ...
Surgical debridementπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A 57-year-old man is brought to the emergency ...
Acute respiratory failure onlyπŸ”,πŸ“Ί

Block/Question (4.2 difficulty score)
An 82-year-old woman is brought to the ...
Acute myocardial infarctionπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
A 62-year-old woman with hypertension comes ...
Decreasing circulating angiotensin II concentrationπŸ”,πŸ“Ί

Block/Question (5.1 difficulty score)
A 2977-g (6-lb 9-oz) female newborn is ...
Intravenous administration of prostaglandinπŸ”,πŸ“Ί

Block/Question (5.5 difficulty score)
A 57-year-old man is brought to the emergency ...
HypertensionπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 27-year-old man comes to the physician ...
Toxic megacolonπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
A 15-year-old boy is brought to the physician ...
Trichophyton rubrumπŸ”,πŸ“Ί

Block/Question (2.0 difficulty score)
A 38-year-old woman has had severe nausea, ...
Staphylococcus aureusπŸ”,πŸ“Ί

Block/Question (4.8 difficulty score)
A 62-year-old man comes to the physician to ...
The aneurysm should not be repaired because of the patient’s poor prognosisπŸ”,πŸ“Ί

Block/Question (2.9 difficulty score)
A 25-year-old woman comes to the physician ...
Chlamydia trachomatis infectionπŸ”,πŸ“Ί

Block/Question (3.2 difficulty score)
A 37-year-old woman comes to the physician ...
Renovascular hypertensionπŸ”,πŸ“Ί

Block/Question (4.4 difficulty score)
A 27-year-old woman at 6 weeks’ gestation ...
Switch to insulinπŸ”,πŸ“Ί

Block/Question (5.3 difficulty score)
A 42-year-old woman, gravida 5, para 4, at 14 ...
Blighted ovumπŸ”,πŸ“Ί

Block/Question (3.9 difficulty score)
A 66-year-old woman has had lower abdominal ...
DiverticulitisπŸ”,πŸ“Ί

Block/Question (1.6 difficulty score)
A 72-year-old man comes to the physician ...
Spinal stenosisπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
An 82-year-old nursing home resident is ...
Peripheral vasodilationπŸ”,πŸ“Ί

Block/Question (2.6 difficulty score)
A 52-year-old woman comes to the physician as ...
Decreased intake of alcoholπŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
A 20-year-old man with a 2-year history of ...
ZincπŸ”,πŸ“Ί

Block/Question (2.7 difficulty score)
A full-term 8-hour-old male newborn ...
Insertion of a radiopaque nasogastric tubeπŸ”,πŸ“Ί

Block/Question (3.4 difficulty score)
A 19-year-old woman, gravida 2, para 1, comes ...
Ultrasonography to confirm gestational ageπŸ”,πŸ“Ί

Block/Question (5.8 difficulty score)
A previously healthy 2-year-old boy is ...
Drain cleanerπŸ”,πŸ“Ί

Block/Question (2.3 difficulty score)
A 2-week-old newborn is brought to the ...
Normal thymusπŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
A 22-year-old woman has had heavy menstrual ...
Presence of anti-platelet IgG antibodiesπŸ”,πŸ“Ί

Block/Question (4.0 difficulty score)
A 47-year-old man comes to the physician for ...
Schedule a follow-up examination in 1 monthπŸ”,πŸ“Ί

Block/Question (4.8 difficulty score)
A previously healthy 21-year-old man is ...
Psychiatric assessmentπŸ”,πŸ“Ί

Block/Question (5.6 difficulty score)
A 42-year-old woman comes to the physician ...
Fine-needle aspiration biopsyπŸ”,πŸ“Ί

Block/Question (2.4 difficulty score)
A 52-year-old man comes to the physician ...
PolysomnographyπŸ”,πŸ“Ί

Block/Question (3.6 difficulty score)
A 16-year-old boy comes to the physician ...
β€œCircumcision cannot be done without the consent of your parentsβ€πŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A 67-year-old woman comes to the physician 6 ...
Carotid duplex ultrasonographyπŸ”,πŸ“Ί

Block/Question (3.5 difficulty score)
A previously healthy 22-year-old woman comes ...
Inflammation within the first dorsal extensor tendon compartmentπŸ”,πŸ“Ί

Block/Question (3.8 difficulty score)
A previously healthy 4-year-old boy is ...
Upper respiratory tract infectionπŸ”,πŸ“Ί

Recent comments ...

... seagull made a comment on step2ck_form8/block2/q#39 (A previously healthy 32-year-old woman comes to the)
 +4 
submitted by seagull(1573)

I was desperately looking for cellulitis. I never did see it. Some say I'm still looking for it to this day.

welpdedelp  Same lol. A question I had was I thought lymphangitis was supposed to precede some sort of injury, obv not lol but was the lymph node the main giveaway? +
keyseph  I think the key distinguishing features are the red streaks leading to an area of local lymphadenopathy. Otherwise, cellulitis would be a viable option if given. +
... seagull made a comment on step2ck_form8/block3/q#10 (A previously healthy 67-year-old woman comes to the...)
 +4 
submitted by seagull(1573)

"No bruits are heard over the neck"

I swear I cannot bang my face hard enough against a wall.

letsdothis  Me too. Un-friggin-believable +
cinnapie  Yo @seagull I am a huge fan. I am a huge fan. I think we gave step 1 around the same time and now Step 2 CK. Anyway, keep up the good work, we need someone like you to add some humor to this fucking shit. Not all heroes wear capes!!!! +3
... seagull made a comment on step2ck_form8/block4/q#36 (A previously healthy 2-year-old boy is brought to...)
 +4 
submitted by seagull(1573)

I'm relatively sure that most people were 50:50 between bleach and drain cleaner.

letsdothis  Yeah, I spent maybe like 20 seconds on this question. I knew I wouldn't be able to reason this one out. +
... step_prep made a comment on step2ck_form8/block1/q#8 (A 62-year-old man comes for evaluation prior to...)
 +3 
submitted by step_prep(53)
  • Current guidelines recommend cefazolin or cefuroxime administered within 60 minutes of skin incision as prophylaxis during hip or knee arthroplasty and should be discontinued within 24 hours
  • Key idea: Antibiotic prophylaxis to prevent surgical site infections are given in certain procedures, most commonly major/long surgeries

https://www.aafp.org/afp/2011/0301/p585.html

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#4 (A 67-year-old woman comes to the physician for...)
 +2 
submitted by step_prep(53)
  • Tricky, nuanced question because contraindication to patient receiving a lung resection is if their residual FEV1 will be less than 800 mL following the surgery

  • Normal FEV1 in a healthy woman is typically around 3 L, so in this patient is likely close to 750 mL since she has an FEV1 that is 25% of predicted; therefore, this patient would likely not be able to tolerate any sort of lung resection because she is already barely hanging on in terms of her ventilatory capabilities

  • Could also approach this question through process of elimination because ABG shows mild CO2 retention (seen in many COPD patients), ejection fraction cut-off for surgery often <35%, cardiac stress test was normal and patient has had DVTs for a long time

https://step-prep.org/

drdoom  very nice +2
... step_prep made a comment on step2ck_form8/block1/q#15 (A 52-year-old man comes to the physician because of...)
 +2 
submitted by step_prep(53)
  • Middle-aged man with fever, lymphadenopathy and splenomegaly found to have elevated leukocyte count with increased eosinophils, myeloblasts, metamyelocytes and myelocytes most concerning for chronic myeloid leukemia
  • Key idea: Ways to differentiate between chronic myeloid leukemia and a leukemoid reaction include leukocyte alkaline phosphatase (LAP) levels (elevated in leukemoid reaction and decreased in CML), looking for basophilia (present in CML) and looking at the types of neutrophil precursors present (metamyelocytes > myelocytes in leukemoid reaction and metamyelocytes < myelocytes in CML)
  • Note: Metamyelocytes are more mature than myelocytes
  • Key idea: Can often tell they type of leukemia based on patient demographics with ALL seen in patients 0-14, AML seen in patients 15-60, CLL seen in patients 60+ and CML seen in patients 40-59

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#16 (A previously healthy 23-year-old man comes to the...)
 +2 
submitted by step_prep(53)
  • Young patient with high-risk sexual behavior who presents with fever, malaise, maculopapular rash over the palms and soles and diffuse lymphadenopathy, which is most consistent with syphilis
  • Key idea: 3 major infectious causes of rash over the palms and soles can be remembered with CaRS (Coxsackie A, Rickettsia Rickettsii (Rocky Mountain Spotted Fever) and Syphilis)
  • Important to contrast syphilis and Rocky Mountain Spotted Fever, with syphilis more commonly leading to a maculopapular rash and diffuse lymphadenopathy (with epitrochlear lymphadenopathy basically being pathognomonic) and Rocky Mountain spotted fever commonly leading to a purpuric rash that spreads from the hands/feet to the trunk

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#17 (A 16-year-old girl comes for a routine health...)
 +2 
submitted by step_prep(53)
  • 16 year old girl with primary amenorrhea (girl without secondary sexual changes by 13 or menarche by 15), short stature, and concern for coarctation of the aorta (hypertension, upper extremity pulses > lower extremity pulses, systolic murmur), most consistent with Turner syndrome
  • Coarctation of the aorta needs to be worked up with an echocardiography and then operatively repaired

https://step-prep.org

... carolebaskin made a comment on step2ck_form8/block1/q#29 (A comatose 29-year-old woman is brought to the emergency)
 +2 
submitted by carolebaskin(48)

(E) Pneumothorax

Benzo overdose --> intubation --> airway trauma --> pneumothorax


Wrong answers

(A) Aspiration PNA is possible with individuals prone to loss of consciousness, but would not be so acute! She was intubated then crashed 20 minutes later.

(B) Kerley B lines are indicative of pulmonary edema

(C) Pericardial effusion is characterized by Beck's Triad of hypotension, distended neck veins, and muffled heart sounds. And would not explain unilateral diminished breath sounds.

(D) pleural-based hump-shaped density probably describes a Hampton hump, which a wedge-shaped opacity in peripheral lung with its base at a thoracic wall. Caused by pulmonary infarction.

... step_prep made a comment on step2ck_form8/block2/q#37 (A previously healthy 47-year-old woman comes to the)
 +2 
submitted by step_prep(53)
  • Key idea: History of heel pain that is worst with first steps in morning and pain with passive dorsiflexion of toes is classic for plantar fasciitis; plantar fasciitis also commonly associated with bone spur on plantar surface of foot
  • Differential for heel pain: (1) Plantar fasciitis (2) Bone infection or metastasis (constant pain that is worst at night) (3) Calcaneal stress fracture (worse with activity and palpation) (4) Tarsal tunnel syndrome (percussion tenderness and paresthesias over posterior tibial nerve in tarsal tunnel) (5) Achilles tendinopathy (pain/tenderness at posterior heel with palpable thickening of tendon that can be reproduced with foot dorsiflexion)

https://step-prep.org

seagull  I like this ddx explanation. well done +1
... step_prep2 made a comment on step2ck_form8/block3/q#26 (A 57-year-old woman comes to the physician because of a)
 +2 
submitted by step_prep2(18)
  • Middle-aged patient with smoking history who has developed tenderness, induration, erythema and thickening in a linear distribution on the extremities, most consistent with superficial thrombophlebitis in the setting of pancreatic cancer
  • Key idea: Pancreatic cancer patient will almost always be a smoker in NBME question stem and unique signs/symptoms associated with pancreatic cancer include (1) Back pain + weight loss (2) Migratory thrombophlebitis (Trousseau syndrome) (3) Obstructive jaundice with palpable, non-tender gallbladder (Courvoisier sign) (4) Diabetes in a patient without other risk factors (older patient who is losing weight but develops diabetes)
  • Lymphangitis would also lead to streaks, but would be less likely to lead to thickening/induration and more likely to lead to fever/chills
  • Varicose veins can be sensitive, but are not often tender or erythematous

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

danielle359x  You don't have to reach that far to get to the answer. There's nothing to suggest she has pancreatic cancer besides the risk factor of smoking, and there's nothing to suggest this is migratory thrombophlebitis. The biggest risk factor for superficial thrombophlebitis is varicose veins, which is described in the stem as "superficial varicosities" +1
... step_prep3 made a comment on step2ck_form8/block4/q#36 (A previously healthy 2-year-old boy is brought to...)
 +2 
submitted by step_prep3(11)
  • Key idea: Ingestion of household bleach is often considered a benign ingestion, whereas ingestion of industrial-grade bleach is very severe/morbid

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

... step_prep made a comment on step2ck_form8/block1/q#2 (An asymptomatic 37-year-old woman comes to the physician)
 +1 
submitted by step_prep(53)

Contraindications to combined contraception includes:

  1. Women > 35 yo who smoke (which is case with this patient)
  2. Migraines with aura
  3. Hypercoagulable risk factors (<3 weeks postpartum, prolonged immobilization, history of DVT/PE, blood disorders [factor V leiden, etc.])
  4. Active breast cancer
  5. Liver disease (liver involved in metabolizing estrogen)

https://step-prep.org/

... step_prep made a comment on step2ck_form8/block1/q#6 (A 27-year-old man with schizophrenia is brought to the)
 +1 
submitted by step_prep(53)
  • Young man who recently started treatment with haloperidol presents with rigidity, neck rigidity and oculogyric crisis (eyes displaced upwards) most consistent with acute dystonia
  • Key idea: Important to contrast with neuroleptic malignant syndrome, which would lead to constellation of symptoms remembered with Malignant FEVER (Myoglobinuria, Fever, Encephalopathy, Vitals unstable, increased CK Enzymes and Rigidity)
  • Key idea: 4 main extrapyramidal effects of antipsychotic use, especially with high potency antipsychotics such as haloperidol, are (1) Acute dystonia (2) Akathisia (3) Parkinsonism (4) Tardive dyskinesia

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#7 (An asymptomatic 27-year-old man comes to the physician 1)
 +1 
submitted by step_prep(53)
  • All patients (HIV or not) should receive an annual influenza vaccine
  • Patients with HIV should receive Strep PneumoΒ PCV13 followed by the 23-valent PPSV23 8 weeks later and again in 5 years and atΒ age 65
  • Based on patient’s serologies (negative Hep B surface antibody), he needs to be vaccinated against hepatitis B
  • Note: Patients are not given PCP prophylaxis until CD4 < 200 and T. gondii prophylaxis until CD4 < 100

https://step-prep.org

... arnoldchiari made a comment on step2ck_form8/block1/q#8 (A 62-year-old man comes for evaluation prior to...)
 +1 
submitted by arnoldchiari(1)

Orthopedic, neurological, cardiac, and vascular cases are all "clean" wounds that require abx prophylaxis with cefazolin first line. Alternatives include vancomycin and clindamycin

... step_prep made a comment on step2ck_form8/block1/q#9 (An otherwise healthy 37-year-old woman comes to the...)
 +1 
submitted by step_prep(53)
  • Young woman with a strong family history of cancer compatible with Lynch syndrome (colon cancer, endometrial cancer, ovarian cancer) who has developed irrregular, heavy vaginal bleeding concerning for possible endometrial cancer
  • Indications for endometrial biopsy include (1) Woman over 45 years old with abnormal uterine bleeding or postmenopausal bleeding (2) Woman under 45 with abnormal uterine bleeding with unopposed estrogen (PCOS, obesity), failed medical management or Lynch syndrome

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#11 (An 87-year-old man comes to the physician because of...)
 +1 
submitted by step_prep(53)
  • 87 year old man who is independent in ADLs (eating, bathing, toileting, transferring, getting dressed) and iADLs (shopping, using phone, driving, handling finances, etc.), A&O x 3, recalls 2/3 objects after 5 minutes and has no focal neurologic findings most consistent with normal aging or mild cognitive impairment
  • Key idea: Patients with mild cognitive impairment will have mild decline in at least 1 cognitive domain, but will have normal functioning in all activities of daily living with compensation (taking a list to the store), whereas patients with dementia will have global cognitive impairment and marked functional impairment
  • To differentiate between Alzheimer’s and vascular dementia, look for other neurologic features (pronator drift, weakness, etc.) which is more consistent with vascular dementia

https://step-prep.org

kingfriday  DDx: - Capgras syndrome: someone close to them or a loved one has been replaced by an imposter. Not what's going on here - Dimentia with Lewy Bodys -> would have hallucinations and features of parkinsonism also not seen here (mneumonic: ha-lewy-cinations) - Dimentia, Alzheimers type -> question stem would almost always mention something about the person getting lost in neighborhoods or unable to find their way as part of the pathology - MDD: doesn't meet the criteria of SIGECAPS - Metastatic prostate cancer -> typically presents with back pain which is not seen here Multi infart vascular dimentia -> often a stepwise decline (at 6 months x happened, then at 4 months y happened, and at 2 months z started happening) +
... step_prep made a comment on step2ck_form8/block1/q#12 (A 37-year-old nulligravid woman comes to the physician)
 +1 
submitted by step_prep(53)
  • Most common cause of unilateral, bloody breast discharge is intraductal papilloma
  • Key idea: Intraductal papilloma often does not have a mass on physical exam or mammography findings

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#14 (A 19-year-old man is brought to the emergency department)
 +1 
submitted by step_prep(53)
  • Young male with excessive thirst and urination for 6 months who presents with seizures found to have hypo-osmolar hyponatremia, most consistent with psychogenic polydipsia
  • Key idea: This demographic is classically when signs/symptoms of schizophrenia develop, and patients with schizophrenia are at increased risk for psychogenic polydipsia
  • Key idea: If patient has hypo-osmolar hyponatremia and a urine osmolality < 100, then they almost certainly have psychogenic polydipsia or beer potomania

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#18 (A 32-year-old man comes to the physician because of)
 +1 
submitted by step_prep(53)
  • Young man with history compatible with migraines (throbbing headaches associated with aura [nausea, vomiting, photophobia]) that are increasing in frequency and are refractory to abortive/acute treatments, making this patient a good candidate for prophylactic migraine medication
  • Key idea: Indications for migraine prophylactic medications include (1) Headaches > 4 times per month or long-lasting [>12 hours] (2) Disabling symptoms (missing work) (3) Refractory to abortive medications
  • Key idea: Potential prophylactic migraine medications include Topiramate, Valproate, Beta blockers (such as propranolol), calcium channel blockers or amitriptyline (TCA antidepressant)

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#28 (A previously healthy 72-year-old man comes to the...)
 +1 
submitted by step_prep(53)
  • Elderly man with significant smoking history and occupational history of being a coal miner who presents with clubbing and hypoxia with bilateral upper lobe masses and areas of consolidation on chest x-ray most consistent with COPD and/or coal workers’ pneumoconiosis
  • Key idea: Of the common pneumoconioses, the majority affect the upper lobes (silicosis, coal workers’ lung, berylliosis) except for asbestosis (lower-lobe predominant)
  • Tuberculosis can also lead to upper lobe opacities, but it would more commonly lead to acute fever, night sweats and weight loss in a patient with exposure

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#32 (A 25-year-old man is brought to the emergency department)
 +1 
submitted by step_prep(53)
  • Young healthy man who presents with chest pain and ST-elevation in an anterior distribution after using crack cocaine, most consistent with cocaine-induced MI
  • Key idea: Cocaine induced MI treated the same way as atherosclerotic MI, except that beta blockers are not used (due to theoretical risk of unopposed alpha-agonism) and benzodiazepines are used
  • Key idea: Cocaine use is associated with myocardial infarction (due to spasm of the coronary arteries) and aortic dissection (due to increased blood pressure), but this presentation more consistent with pure MI because patient has normal BP in both arms (although this is commonly seen in aortic dissections in real life, test writers often will say blood pressures are unequal) and no tearing chest pain into the back

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#34 (A 72-year-old woman with chronic obstructive pulmonary)
 +1 
submitted by step_prep(53)
  • Elderly woman with chronic COPD history presents with weight loss, progressive shortness of breath and light-headedness found to have JVD with RV heave and loud S2 (all components of pulmonary hypertension) and signs of congestive hepatopathy, all consistent with Group 3 pulmonary hypertension
  • Key idea: In most capillary beds of the body, decreased oxygen leads to vasodilation in order to facilitate more bloodflow to the area to maintain perfusion, but the lungs are the one exception in which decreased oxygen leads to constriction of blood vessels feeding that area so that blood is preferentially sent to well-oxygenated portions of the lung to minimize V/Q mismatch, but can lead to cor pulmonale in patients with COPD because their entire lungs are poorly oxygenated, leading to diffuse vasoconstriction and increased afterload on right ventricle

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#38 (A 42-year-old man comes to the physician because of...)
 +1 
submitted by step_prep(53)
  • Patient with small cell lung cancer (uniform, small round cells with dark nuclei), which is often initially treated with chemotherapy followed by radiation and/or surgery
  • Patient is young and has no signs of metastasis so palliative care isn’t appropriate, hormone therapy most used for breast cancer and prostate cancer, and surgical resection is NOT used in small cell lung cancer specifically (β€œthe cells are too small for the surgeon to see!”)

https://step-prep.org

killuashi  initially treated with ...... and/or surgery .... surgical resection is NOT used. Very contradicting +1
wutuwantbruv  Surgery can be considered in very small, resectable lesions. It is not incorrect to say this, but for the majority of SCLC, they are indeed unresectable. +1
... step_prep made a comment on step2ck_form8/block1/q#44 (A 25-year-old woman comes to the physician to discuss)
 +1 
submitted by step_prep(53)
  • Key idea: 2 most important risk factors for Alzheimer’s is (1) Increased age (2) Family history of early-onset dementia (often due to mutation in Amyloid precursor protein or presinilin-1/2)
  • Key idea: Early-onset Alzheimer’s defined by symptoms appearing age 65 or younger

https://step-prep.org

... step_prep made a comment on step2ck_form8/block1/q#46 (A 37-year-old man comes to the emergency department)
 +1 
submitted by step_prep(53)
  • Young man with recent URI presents with sharp substernal chest pain, fever and ECG with diffuse ST elevations and PR depressions most consistent with viral pericarditis which can be diagnosed with echocardiography because it is often complicated by pericardial effusion

https://step-prep.org

... step_prep made a comment on step2ck_form8/block2/q#1 (A previously healthy 22-year-old man is brought to...)
 +1 
submitted by step_prep(53)
  • Young man presents with altered mental status found to have a severe anion-gap metabolic acidosis (142 – 102 – 12 = 28 > 12), with exogenous ingestion of an organic acid being the only answer that corresponds with this acid-base disturbance
  • Excessive loss of bicarbonate = Type 2 renal tubular acidosis (non-anion gap metabolic acidosis)

https://step-prep.org

... step_prep made a comment on step2ck_form8/block2/q#20 (A 17-year-old boy is brought to the emergency department)
 +1 
submitted by step_prep(53)
  • Patient with a pulsatile hematoma = damage to an arterial structure
  • Based on location at the base of the neck, the most likely vessel involved is the subclavian artery
  • Note: If the thoracic aorta were damaged, the patient would likely have more severe hemodynamic collapse due to the amount of bleeding that would be produced

https://step-prep.org

... step_prep made a comment on step2ck_form8/block2/q#24 (A 16-year-old boy is brought to the emergency department)
 +1 
submitted by step_prep(53)
  • Organophosphates work by inhibiting acetylcholinesterase, thus leading to increased levels of acetylcholine that lead to overstimulation of parasympathetic functions and sweating (DUMBBELSS: Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm, Emesis, Lacrimation, Sweating, Salivation) by binding to Muscarinic receptors and lead to neuromuscular overstimulation and eventual blockade due to binding to nicotinic receptors

https://step-prep.org

... step_prep made a comment on step2ck_form8/block2/q#30 (An otherwise healthy 25-year-old nurse comes to the...)
 +1 
submitted by step_prep(53)
  • Patient who has never received vaccination against hepatitis B is stuck with a needle by a patient with labs consistent with active hepatitis B infection, so patient should receive both hepatitis B vaccination series and hep B immune globulin
  • Infections that need to be treated with immunoglobulin: Dangerous infections To Be Healed Very Rapidly (Diphtheria, Tetanus, Botulism, Hepatitis B, Varicella, Rabies

https://step-prep.org

... step_prep made a comment on step2ck_form8/block2/q#39 (A previously healthy 32-year-old woman comes to the)
 +1 
submitted by step_prep(53)
  • Patient with an inflammed area of the distal radius with red streaks extending from the area towards the elbow, most consistent with lymphangitis
  • Key idea: Most common pathogens are MSSA and Group A strep, and therefore empiric treatment is cephalexin

https://step-prep.org

... seagull made a comment on step2ck_form8/block3/q#3 (A 25-year-old nurse comes to the physician 2 days...)
 +1 
submitted by seagull(1573)

I swear this changes on who you ask. I've seen it as either Isoniazid or Isoniazid + rifampin.

EDIT: 2 answers are correct here (thanks NBME!)

Per CDC

"As of 2018, there are four CDC-recommended treatment regimens for latent TB infection that use isoniazid (INH), rifapentine (RPT), and/or rifampin (RIF). All the regimens are effective."

https://www.cdc.gov/tb/topic/treatment/decideltbi.htm#:~:text=As%20of%202018%2C%20there%20are,All%20the%20regimens%20are%20effective.

letsdothis  Yes, I was going to say the same thing. Per uworld, you can do dual treatment with rifampin with isonizid for 4 months. +1
... step_prep made a comment on step2ck_form8/block3/q#6 (A 67-year-old woman comes to the physician because...)
 +1 
submitted by step_prep(53)
  • Elderly woman with rheumatoid arthritis presents with pallor and is found to have a microcytic anemia with a decreased TIBC (indicative of increased ferritin stores), most consistent with anemia of chronic disease
  • Iron deficiency (microcytic anemia): Iron labs show low iron, increased TIBC and decreased ferritin (often seen in young women due to menses and in older patient is colon cancer until proven otherwise)
  • Lead poisoning (microcytic anemia): Patient with exposure who has abdominal pain, neurologic symptoms, etc.
  • Key idea: While rheumatoid arthritis can be associated with anemia of chronic disease, osteoarthritis is NOT associated with anemia of chronic disease

https://step-prep.org

... step_prep2 made a comment on step2ck_form8/block3/q#10 (A previously healthy 67-year-old woman comes to the...)
 +1 
submitted by step_prep2(18)
  • Elderly woman who presents after an episode of amaurosis fugax (painless transient monocular vision loss caused by a small embolus in the ophthalmic artery) with hollenhorst plaques and an area of ischemia in the optic disc
  • Key idea: Amaurosis fugax is highly associated with carotid artery stenosis with resulting embolization, so patients should be worked up with a carotid artery ultrasound

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

... step_prep2 made a comment on step2ck_form8/block3/q#32 (A 12-year-old boy is brought to the physician for a...)
 +1 
submitted by step_prep2(18)
  • Normally the kidneys can handle phosphorous, but in setting of renal failure they cannot and it can lead to build-up of phosphorous that can lead to a variety of deleterious effects, such as metastatic calcification (which can increase risk of stroke, heart attack, etc.) and weak bones (because phosphorous pulls calcium out of bones); these complications are particularly important for kids because they progress chronically over time

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

... kingfriday made a comment on step2ck_form8/block3/q#32 (A 12-year-old boy is brought to the physician for a...)
 +1 
submitted by kingfriday(14)

Why would increasing fluids be incorrect?

kingfriday  nvm, someone whose kidneys dont work means they not able to get rid of fluids anyway so giving them fluids can make things worse +1
letsdothis  Yeah, I feel like increasing fluid in any chronic renal conditions is always correct, but I like the steppreps explanation. +
... step_prep2 made a comment on step2ck_form8/block3/q#33 (A 37-year-old woman, gravida 4, para 4, has...)
 +1 
submitted by step_prep2(18)
  • Most common cause of post-delivery bleeding is uterine atony (especially in setting of prolonged, difficult delivery), but the uterine fundus would be described as soft and boggy rather than firm; therefore the next most common cause given that the placenta has been delivered would be trauma (especially with difficult delivery)
  • Causes of post-delivery bleeding is 4 T’s: (1) aTony (most common) (2) Trauma (3) Thrombin (coagulopathy) (4) Tissue (retained placenta, etc.)

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

... step_prep2 made a comment on step2ck_form8/block3/q#35 (A healthy 4-month-old boy is brought to the...)
 +1 
submitted by step_prep2(18)
  • Key idea: Risk factors for asthma include (1) Family history of atopy (2) Environmental exposures (second-hand smoke, pollution, etc.)

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

thajoker  So to be clear, Family history is the number one risk factor, all the other exposures are secondary risk factors? +
... step_prep2 made a comment on step2ck_form8/block3/q#40 (A 10-year-old boy is brought for a routine...)
 +1 
submitted by step_prep2(18)
  • Child with resection of ileum (which is responsible for absorption of the ) who presents with macrocytic anemia, most consistent with vitamin B12 deficiency
  • Key idea: To remember the sections of small intestine and pertinent nutrient absorbed in each, use mnemonic Iron Fist Bro for Iron (duodenum), Folate (jejunum) and B12 (ileum)
  • Key idea: Ileum also responsible for absorption of bile salts, which are responsible for fat absorption and absorption of fat-soluble vitamins (A, D, E and K)

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

kingfriday  I personally like the "I fu*ked brittany" mneumonic +2
... step_prep2 made a comment on step2ck_form8/block4/q#1 (A 15-year-old boy is brought to the physician by his...)
 +1 
submitted by step_prep2(18)
  • Patient with signs of major depressive disorder (too severe of a presentation for simple adjustment disorder), who should be treated with an anti-depressant, with Bupropion being the only antidepressant listed
  • First-line antidepressants: SSRIs, SNRIs, Bupropion, Mirtazapine
  • Benefits of bupropion: Mild stimulant effects, patient with comorbid cigarette use, helps patients with weight loss, favorable sexual side effect profile

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

... step_prep2 made a comment on step2ck_form8/block4/q#10 (A 5-year-old girl is brought to the physician...)
 +1 
submitted by step_prep2(18)
  • Young child who had strep throat 2 weeks ago who presents with periorbital edema, gross hematuria, proteinuria and RBC casts (consistent with glomerulonephritis), most consistent with post-strep glomerulonephritis
  • Both IgA and PSGN can lead to gross hematuria associated with an upper URI, with differences being (1) Acute PSGN:Β SeenΒ 2-4 weeksΒ after infection of pharynx or skin, Seen in children (often age 6-10), leads toΒ low complement levels, patient will haveΒ subepithelial immune complex humps (2) IgA nephropathy:Β SeenΒ concurrentlyΒ with respiratory or GI infection, more common in young adult men (age 20-30), complement levelsΒ unaffected, patient will haveΒ IgA-based deposits in mesangium
  • Key idea: Treating strep throat will reduce risk of rheumatic fever, but does not reduce risk of post-strep glomerulonephritis

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

... letsdothis made a comment on step2ck_form8/block4/q#10 (A 5-year-old girl is brought to the physician...)
 +1 
submitted by letsdothis(5)

Anyone else get thrown off by the laboratory abnormalities (hyponatremia, hyperkalemia, hyperchloremia, metabolic acidosis)?

... step_prep2 made a comment on step2ck_form8/block4/q#16 (A 57-year-old man is brought to the emergency...)
 +1 
submitted by step_prep2(18)
  • Middle-aged man with myasthenia gravis presenting with marked bilateral ptosis, progressive lethargy and decreased breath sounds (all of which point to a myasthenic crisis that would lead to respiratory insufficiency and CO2 retention), who has acid-base findings of acidemia with increased PCO2 and normal HCO3, consistent with an uncompensated respiratory acidosis
  • Key idea: If patient had chronic respiratory failure, HCO3 would be elevated because it would have had time to compensate over time

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

... step_prep3 made a comment on step2ck_form8/block4/q#19 (A 2977-g (6-lb 9-oz) female newborn is cyanotic 1...)
 +1 
submitted by step_prep3(11)
  • Newborn with cyanosis found to have a heart murmur and hypoxia unresponsive to supplemental oxygen, which is consistent with a severe intracardiac shunt)
  • Patient should be treated with alprostadil (or another prostaglandin analog) in order to keep the PDA open until the heart defect can be operatively managed

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

seagull  Doesn't it take like 2-7 days for the duct to close? Why is this hour old newborn already cyanotic? +
kingfriday  early cyanosis might be consistent with transposition of the great vessels and those can be associated with ejection murmurs and a loud S2 +1
welpdedelp  Following ABCs, why wouldn't you intubate first? I understand shunt doesn't get corrected, but it would seem you would still take control of airway since kid seems to be crashing. +
quaranqueen  I think that intubation wouldn't make a difference if it's transposition of the great arteries because the oxygenated blood would just end up going back to the right heart and back through its closed circuit +
... step_prep3 made a comment on step2ck_form8/block4/q#27 (A 27-year-old woman at 6 weeks’ gestation comes to...)
 +1 
submitted by step_prep3(11)
  • Pregnant patient with type 2 diabetes with signs of poorly controlled blood glucose while on metformin, therefore requiring step-up in therapy to include insulin
  • Target blood glucose levels in gestational diabetes mellitus are fasting glucose < 95, 1-hour postprandial glucose < 140 and 2-hour postprandial glucose < 120
  • Key idea: Treatment options in gestational diabetes are (1st-line) Dietary modification (2nd-line) Insulin, metformin

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

... seagull made a comment on step2ck_form8/block4/q#35 (A 19-year-old woman, gravida 2, para 1, comes for a...)
 +1 
submitted by seagull(1573)

Weird question. This is a follow-up - Why would you not have an ultrasound from the previous visit? Perhaps she needs a better doctor.

... seagull made a comment on step2ck_form8/block4/q#40 (A previously healthy 21-year-old man is brought to the)
 +1 
submitted by seagull(1573)

Am I the only one always see conversion disorder of UWORLD as reassure and follow-up. This test is giving me conversion disorder.

seagull  I looked it up in UWORLD. THey say treatment is "Education, CBT, and Physical THerapy". +
seagull  I looked it up in UWORLD. THey say treatment is "Education, CBT, and Physical THerapy". +
bobson150  Gotta get a formal assessment before you treat I guess +2
... step_prep3 made a comment on step2ck_form8/block4/q#41 (A 42-year-old woman comes to the physician because of a)
 +1 
submitted by step_prep3(11)
  • Young woman with a nontender thyroid mass/nodule that is 2 cm in size, requiring fine needle aspiration biopsy
  • Key idea:Β All thyroid nodules should be worked up with a TSH and thyroid ultrasound, with thyroid nodulesΒ greater than 2 cm in diameterΒ or thyroid nodulesΒ greater than 1 cm with high-risk sonographic featuresΒ (irregular markings, microcalcifications, etc.) should undergoΒ fine needle aspiration biopsy
  • Key idea: The thyroid gland is highly vascular, which is why you would always use a fine-needle aspiration biopsy for evaluation
  • Key idea: Mass in the neck that moves with swallowing = Thyroid or thyroglossal duct cyst
  • Key idea: Hypofunctional or β€œcold” thyroid nodule has aΒ higher risk of malignancyΒ as compared to a hyperfunctional β€œhot” thyroid nodule

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

ht3  sooo you're saying to get TSH first...so why would the answer not be thyroid function tests..? +2
nbmesuxugh  I thought that too but the question is asking to establish the diagnosis not the next best step! just be careful on test because I have seen tricky questions like that +2
... step_prep4 made a comment on step2ck_form8/block4/q#46 (A previously healthy 4-year-old boy is brought to...)
 +1 
submitted by step_prep4(5)
  • Unable to access audio, but patient has classic symptoms of a URI (fever, cough, rhinorrhea) and likely normal heart sounds (or a soft systolic ejection murmur)

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

seagull  I also could not access the audio. I expect my refund in the mail since my assessment is compromised. ThAnKs NbMe +1
kingfriday  I got to the audio, it was just physiologic splitting of heart sounds with breathing (inspiration). Made no impact to the answer. +