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NBME Step 2 CK Free 120 Answers

step2ck_free120/Block 2/Question#68 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Ibuprofen therapy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—lm4(23)

FYI: apthos ulcers are not a contraindication to NSAIDs- regular GI ulcers are

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submitted by โˆ—notyasupreme(48)

This is hilarious, did anyone else think it could be viral pericarditis, which in another question required prompt evaluation with an echo. I initially thought EKG, then echo, then NSAIDs as the order. Apparently, we just skip the diagnosis and go straight to NSAIDs in these patients now. Unbelievable.

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submitted by โˆ—bwdc(697)

Pleurisy (or potentially costochondritis) secondary associated with a URI, either way, treat with NSAIDs.

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tinylilron  so PE was on my differential... why do we immediately jump to pleurisy??? +
etherbunny  ...and if aspirin doesn't work, what are the chances of ibuprofen doing much better? +
len49  Stone cold normal vital signs and recent viral infxn symptoms points significantly towards viral pleurisy. Aspirin did relieve the symptoms a bit as well. She gets zero points on the Well's criteria, not sure why PE would be super high on someone's differential. +
dnazmzm  What is "splinting"....? +1
lilmonkey  Respiratory splinting is defined as reduced inspiratory effort as a result of sharp pain upon inspiration (severe pleuritic chest pain). +
charcot_bouchard  Post viral pericardial effusion should be on someone differential!! I pick EKG. +1
charcot_bouchard  even in amboss says do a EKG to rule out other cause like peri effusion +
charcot_bouchard  Replace all pericardial effusion with Pericarditis. Thats what was in my head +
charcot_bouchard  Ok. i got my answer. sx is unilateral. if it was pericardial shit would be in middle on cardiac exam no abnormalities. pericarditis would have scracthing sounds chest xray showed no abnormalities than means no pleural effusion either if it was in someones mind. +1
notyasupreme  ^^ i guess that makes sense but this q makes me mad +

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