share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Step 2 CK Free 120 Answers

Question#1 (5.0 difficulty score)
A 16-year-old girl is brought to the ...
Systemic lupus erythematosusπŸ”,πŸ“Ί

Question#2 (3.2 difficulty score)
A 67-year-old woman comes to the physician ...
Compression of the lateral femoral cutaneous nerveπŸ”,πŸ“Ί

Question#3 (2.6 difficulty score)
A 5-year-old boy is brought to the physician ...
Impaired phagocytic oxidative metabolismπŸ”,πŸ“Ί

Question#4 (3.7 difficulty score)
A 42-year-old woman is brought to the ...
LaparotomyπŸ”,πŸ“Ί

Question#5 (3.6 difficulty score)
A 42-year-old woman comes to the physician ...
AlcoholπŸ”,πŸ“Ί

Question#6 (3.2 difficulty score)
A 37-year-old woman comes to the emergency ...
Nasogastric intubationπŸ”,πŸ“Ί

Question#7 (2.5 difficulty score)
A 9-year-old boy is brought to the physician ...
DermatomyositisπŸ”,πŸ“Ί

Question#2 (2.9 difficulty score)
A 56-year-old man has had the painful weeping ...
Herpes ZosterπŸ”,πŸ“Ί

Question#3 (2.3 difficulty score)
A sexually active 20-year-old woman has had ...
Haemophilus ducreyiπŸ”,πŸ“Ί

Question#4 (2.3 difficulty score)
A 67-year-old woman comes to thy physician 1 ...
Excision of the lesionπŸ”,πŸ“Ί

Question#5 (2.5 difficulty score)
A 67-year-old man is brought to the emergency ...
Adverse effect of medicationsπŸ”,πŸ“Ί

Question#7 (1.6 difficulty score)
A 2-week-old newborn is brought to the ...
ReassuranceπŸ”,πŸ“Ί

Question#8 (1.8 difficulty score)
An obese 33-year-old woman has had four ...
Ultrasonography of the upper abdomenπŸ”,πŸ“Ί

Question#9 (1.8 difficulty score)
Five years after being shot in the right ...
Arteriovenous fistulaπŸ”,πŸ“Ί

Question#10 (1.6 difficulty score)
An 18-year-old primigravid woman comes for ...
UltrasonographyπŸ”,πŸ“Ί

Question#11 (2.0 difficulty score)
A previously healthy 34-year-old woman is ...
Thrombotic thrombocytopenic purpuraπŸ”,πŸ“Ί

Question#12 (1.1 difficulty score)
A 16-year-old girl is brought to the ...
Systemic lupus erythematosusπŸ”,πŸ“Ί

Question#13 (1.7 difficulty score)
A 27-year-old nurse comes to the emergency ...
Measurement of serum insulin and C-peptide concentrationsπŸ”,πŸ“Ί

Question#14 (1.9 difficulty score)
A 15-year-old girl is brought to the ...
Exercise and weight reduction programπŸ”,πŸ“Ί

Question#15 (1.3 difficulty score)
A 3-year-old girl is brought to the physician ...
MastoiditisπŸ”,πŸ“Ί

Question#16 (1.9 difficulty score)
A 62-year-old man comes to the physician ...
VasculitisπŸ”,πŸ“Ί

Question#17 (2.8 difficulty score)
A 2-month-old boy is brought to the physician ...
Decreased gluconeogenesisπŸ”,πŸ“Ί

Question#18 (1.9 difficulty score)
A previously healthy 42-year-old man is ...
Ventilation-perfusion mismatchπŸ”,πŸ“Ί

Question#19 (1.8 difficulty score)
A 36-year-old nulligravid woman with primary ...
EndometriosisπŸ”,πŸ“Ί

Question#20 (1.2 difficulty score)
A 55-year-old man has had crushing substernal ...
Decreasing myocardial contractilityπŸ”,πŸ“Ί

Question#21 (1.2 difficulty score)
Four days after undergoing open reduction and ...
Alcohol withdrawalπŸ”,πŸ“Ί

Question#30 (1.4 difficulty score)
A 67-year-old woman has had fatigue, dry ...
Chronic lymphocytic thyroiditis (Hashimoto disease)πŸ”,πŸ“Ί

Question#33 (2.3 difficulty score)
A 67-year-old woman comes to the physician ...
Bone marrow aspirationπŸ”,πŸ“Ί

Question#37 (2.4 difficulty score)
A 4-year-old boy with asthma becomes limp ...
Decrease in cardiac outputπŸ”,πŸ“Ί

Question#1 (2.7 difficulty score)
A 67-year-old woman comes to the physician ...
Adjusting her medication regimenπŸ”,πŸ“Ί

Question#15 (1.3 difficulty score)
A 77-year-old man is brought to the physician ...
CT scan of the headπŸ”,πŸ“Ί

Question#18 (1.3 difficulty score)
A 14-year-old boy is brought to the office ...
Approve basketball participationπŸ”,πŸ“Ί

Question#24 (1.8 difficulty score)
A 32-year-old man who is a jackhammer ...
Axillary-subclavian venous thrombosisπŸ”,πŸ“Ί

Question#28 (1.6 difficulty score)
A 6-year-old girl is brought to the physician ...
Topical corticosteroid therapyπŸ”,πŸ“Ί

Question#33 (1.7 difficulty score)
A 27-year-old woman comes to the office because of
Pulmonary embolismπŸ”,πŸ“Ί

Question#35 (2.1 difficulty score)
An 82-year-old woman with a 20-year history ...
Detrusor instabilityπŸ”,πŸ“Ί

Question#37 (2.1 difficulty score)
A 70-year-old man comes to the physician ...
Multiple myelomaπŸ”,πŸ“Ί

Question#20 (2.1 difficulty score)
Three days after hospitalization for diabetic ...
Offer insulin but allow the patient to refuse itπŸ”,πŸ“Ί

Question#40 (2.5 difficulty score)
A 27-year-old woman comes to the physician because
NortriptylineπŸ”,πŸ“Ί

Question#1 (1.9 difficulty score)
A 68-year-old man is brought to the emergency ...
Oral lactulose therapyπŸ”,πŸ“Ί

Question#2 (3.0 difficulty score)
A 45-year-old woman comes to the emergency ...
Serum antineutrophil cytoplasmic autoantibody assayπŸ”,πŸ“Ί

Question#3 (1.6 difficulty score)
An 87-year-old woman, gravida 6, para 6, is ...
Urinary retentionπŸ”,πŸ“Ί

Question#4 (1.7 difficulty score)
A 25-year-old woman is admitted to the ...
MethimazoleπŸ”,πŸ“Ί

Question#5 (1.8 difficulty score)
A 16-year-old boy is brought to the emergency ...
Antibiotic therapyπŸ”,πŸ“Ί

Question#6 (1.8 difficulty score)
A previously healthy 29-year-old woman is ...
Adherence to immunization guidelinesπŸ”,πŸ“Ί

Question#7 (1.4 difficulty score)
A 27-year-old primigravid woman comes to the ...
HIVπŸ”,πŸ“Ί

Question#8 (1.2 difficulty score)
An investigator would like to decrease the ...
Withdraw from the study nowπŸ”,πŸ“Ί

Question#9 (2.3 difficulty score)
A 70-year-old man comes to the clinic because ...
Measurement of postvoid residual volumeπŸ”,πŸ“Ί

Question#10 (1.8 difficulty score)
A 52-year-old woman comes to the physician ...
VancomycinπŸ”,πŸ“Ί

Question#11 (1.4 difficulty score)
A 52-year-old man with hepatic cirrhosis ...
5 (five)πŸ”,πŸ“Ί

Question#12 (1.6 difficulty score)
Which of the following most strongly limits ...
EPCS is available only at specialty centersπŸ”,πŸ“Ί


Question#14 (1.7 difficulty score)
A 42-year-old man comes to the office as a ...
Cardiovascular diseaseπŸ”,πŸ“Ί

Question#15 (1.2 difficulty score)
A 40-year-old divorced woman comes to the ...
Education on sleep hygieneπŸ”,πŸ“Ί

Question#16 (1.2 difficulty score)
A 58-year-old woman is brought to the office ...
Measurement of cerebrospinal fluid 14-3-3 protein concentrationπŸ”,πŸ“Ί

Question#17 (2.1 difficulty score)
A 38-year-old woman is brought to the ...
Submerge the feet in a moderately warm whirlpoolπŸ”,πŸ“Ί

Question#18 (2.1 difficulty score)
A 52-year-old woman comes to the emergency ...
Prednisone therapyπŸ”,πŸ“Ί

Question#19 (1.8 difficulty score)
A 13-year-old boy is brought to the emergency ...
MyocarditisπŸ”,πŸ“Ί

Question#20 (1.9 difficulty score)
A 10-day-old female newborn is brought to the ...
VolvulusπŸ”,πŸ“Ί

Question#21 (2.6 difficulty score)
An 85-year-old man with severe dementia, ...
Absence of resource stewardshipπŸ”,πŸ“Ί

Question#22 (1.9 difficulty score)
A 62-year-old woman with myasthenia gravis ...
Assessment of medical decision-making capacityπŸ”,πŸ“Ί

Question#23 (1.7 difficulty score)
A 55-year-old man is brought to the emergency ...
Vitamin B1 (thiamine)πŸ”,πŸ“Ί

Question#24 (1.0 difficulty score)
A 16-year-old boy is brought to the emergency ...
Testicular torsionπŸ”,πŸ“Ί

Question#25 (1.4 difficulty score)
A 5-year-old boy is brought to the emergency ...
Discuss the family’s goals for the patientπŸ”,πŸ“Ί

Question#26 (1.7 difficulty score)
A 50-year-old woman comes to the office ...
SarcoidosisπŸ”,πŸ“Ί

Question#27 (1.2 difficulty score)
A 64-year-old man comes to the clinic because ...
Serum creatine kinase activityπŸ”,πŸ“Ί

Question#28 (2.1 difficulty score)
A 23-year-old man who is on active duty in ...
Cleanse the site and apply iceπŸ”,πŸ“Ί

Question#29 (1.4 difficulty score)
A 32-year-old man is brought to the emergency ...
Electroconvulsive therapyπŸ”,πŸ“Ί

Question#30 (1.5 difficulty score)
A 60-year-old woman comes to the office as a ...
Hepatitis CπŸ”,πŸ“Ί

Question#31 (1.4 difficulty score)
A 12-year-old girl is brought to the ...
Use of a nonpenicillin antibiotic to treat the pharyngitisπŸ”,πŸ“Ί

Question#32 (1.2 difficulty score)
A 45-year-old woman is hospitalized for ...
Encourage questions from all team membersπŸ”,πŸ“Ί

Question#33 (1.1 difficulty score)
An 82-year-old man comes to the physician 1 ...
KeratoacanthomaπŸ”,πŸ“Ί

Question#34 (1.3 difficulty score)
A 37-year-old man comes to the physician for ...
Serum lipid studiesπŸ”,πŸ“Ί

Question#35 (1.9 difficulty score)
A 35-year-old woman is evaluated for a ...
CT scan of the abdomenπŸ”,πŸ“Ί

Question#36 (1.7 difficulty score)
A 23-year-old man is being evaluated in the ...
Begin a continuous infusion of norepinephrineπŸ”,πŸ“Ί

Question#37 (1.3 difficulty score)
A 32-year-old nulligravid woman comes to the ...
Gestational diabetesπŸ”,πŸ“Ί

Question#38 (1.1 difficulty score)
A 17-year-old girl is brought to the ...
Inform the parents that the physician cannot deceive the patientπŸ”,πŸ“Ί

Question#39 (1.7 difficulty score)
A 52-year-old woman with type 2 diabetes ...
Acute kidney injuryπŸ”,πŸ“Ί

Question#40 (1.2 difficulty score)
A 15-year-old girl is brought to the ...
Osteogenesis imperfectaπŸ”,πŸ“Ί

Question#41 (1.2 difficulty score)
A 22-year-old primigravid woman at 10 weeks’ ...
β€œHow do you think he will react?β€πŸ”,πŸ“Ί

Question#42 (2.1 difficulty score)
Five days after admission to the hospital for ...
Aortic embolismπŸ”,πŸ“Ί

Question#43 (1.4 difficulty score)
A 75-year-old man comes to the clinic because ...
High-resolution CT scan of the chestπŸ”,πŸ“Ί

Question#44 (1.0 difficulty score)
A previously healthy 20-year-old woman, who ...
K+: decreased; Cl-: decreased; HCO3-: increasedπŸ”,πŸ“Ί

Question#45 (1.0 difficulty score)
A 58-year-old man comes to the clinic for a ...
CystoscopyπŸ”,πŸ“Ί

Question#46 (1.0 difficulty score)
A 32-year-old woman is brought to the ...
Operative reduction and internal fixationπŸ”,πŸ“Ί

Question#47 (1.4 difficulty score)
A 57-year-old man comes to the physician 1 ...
Antihypertensive therapyπŸ”,πŸ“Ί

Question#48 (1.7 difficulty score)
A 27-year-old primigravid woman at 21 weeks’ ...
Influenza A virusπŸ”,πŸ“Ί

Question#49 (1.5 difficulty score)
A 7-year-old boy is brought to the physician ...
Learning disorderπŸ”,πŸ“Ί

Question#50 (0.9 difficulty score)
A 23-year-old woman who is an active-duty ...
Otitis externaπŸ”,πŸ“Ί

Question#52 (2.0 difficulty score)
A 16-year-old boy with VATER syndrome is ...
Tracheal collapseπŸ”,πŸ“Ί

Question#51 (1.8 difficulty score)
A 34-year-old woman who is on active duty in ...
Ibuprofen and decongestant therapyπŸ”,πŸ“Ί

Question#57 (1.2 difficulty score)
A 68-year-old woman comes to the office ...
No additional diagnostic studies are indicatedπŸ”,πŸ“Ί

Question#56 (1.5 difficulty score)
A 33-year-old woman is admitted to the ...
MRI of the brainπŸ”,πŸ“Ί


Question#54 (1.1 difficulty score)
Echocardiography shows a small pericardial ...
Ibuprofen and colchicine therapyπŸ”,πŸ“Ί

Question#53 (1.4 difficulty score)
A 44-year-old man comes to the emergency ...
EchocardiographyπŸ”,πŸ“Ί

Question#58 (1.4 difficulty score)
A 55-year-old man with major depressive ...
Discontinue paroxetine and duloxetineπŸ”,πŸ“Ί

Question#59 (1.3 difficulty score)
A 32-year-old man comes to the office for a ...
Determine whether the patient has had thoughts of harming othersπŸ”,πŸ“Ί

Question#60 (1.9 difficulty score)
A 40-year-old woman is admitted to the ...
Acyclovir therapyπŸ”,πŸ“Ί

Question#61 (1.7 difficulty score)
An 87-year-old woman, gravida 2, para 2, is ...
Vulvar carcinomaπŸ”,πŸ“Ί

Question#62 (1.3 difficulty score)
A 47-year-old woman comes to the office for a ...
Ultrasonography of the thyroid glandπŸ”,πŸ“Ί

Question#63 (1.1 difficulty score)
A 1-hour-old male newborn is examined in the ...
Zidovudine (AZT)πŸ”,πŸ“Ί

Question#64 (1.2 difficulty score)
A 25-year-old woman comes to the office ...
Cabergoline therapyπŸ”,πŸ“Ί

Question#65 (1.4 difficulty score)
A 2-week-old boy is evaluated in the neonatal ...
X-ray of the abdomenπŸ”,πŸ“Ί


Question#67 (1.8 difficulty score)
A 25-year-old woman is brought to the ...
Video EEG monitoringπŸ”,πŸ“Ί

Question#68 (1.8 difficulty score)
A 32-year-old woman comes to the emergency ...
Ibuprofen therapyπŸ”,πŸ“Ί

Question#69 (1.5 difficulty score)
A 30-year-old nulligravid woman, who is a ...
Hypothalamic hypogonadismπŸ”,πŸ“Ί

Question#70 (1.0 difficulty score)
A 45-year-old woman comes to the office ...
Follicle-stimulating hormoneπŸ”,πŸ“Ί

Question#71 (1.3 difficulty score)
A 2-month-old girl is brought to the office ...
Oral prophylactic penicillin therapyπŸ”,πŸ“Ί

Question#72 (1.2 difficulty score)
A 3-week-old boy is brought to the physician ...
Ultrasonography of the abdomenπŸ”,πŸ“Ί

Question#73 (0.8 difficulty score)
A 52-year-old woman comes to the physician ...
Discontinuation of lisinoprilπŸ”,πŸ“Ί

Question#74 (1.1 difficulty score)
A 27-year-old primigravid woman at 41 weeks' ...
Neonatal respiratory depressionπŸ”,πŸ“Ί

Question#75 (1.2 difficulty score)
A 7-year-old girl is brought to the clinic by ...
PolysomnographyπŸ”,πŸ“Ί

Question#76 (1.8 difficulty score)
A 52-year-old man comes to the emergency ...
Immobilization of the right foot in a posterior splintπŸ”,πŸ“Ί

Question#77 (0.9 difficulty score)
An 8-year-old boy is brought to the emergency ...
Proceed with the blood transfusion while obtaining an emergency telephone court orderπŸ”,πŸ“Ί

Question#78 (1.1 difficulty score)
A female newborn has the onset of tachypnea 4 ...
Intravenous alprostadil (prostaglandin E1)πŸ”,πŸ“Ί

Question#79 (1.5 difficulty score)
A 43-year-old woman comes to the office for a ...
DiltiazemπŸ”,πŸ“Ί

Question#80 (1.2 difficulty score)
A 67-year-old man is brought to the emergency ...
Mobitz type II (second-degree) atrioventricular blockπŸ”,πŸ“Ί

Question#81 (1.4 difficulty score)
A 35-year-old woman is brought to the ...
Alcohol use disorderπŸ”,πŸ“Ί

Question#82 (1.5 difficulty score)
A 76-year-old woman, who is receiving home ...
Administer intravenous morphineπŸ”,πŸ“Ί

Question#83 (0.9 difficulty score)
A 42-year-old woman comes to the physician ...
Medullary thyroid carcinomaπŸ”,πŸ“Ί

Question#84 (1.3 difficulty score)
A 26-year-old woman with common variable ...
Lymph node biopsyπŸ”,πŸ“Ί

Question#85 (2.1 difficulty score)
A 9-month-old boy is brought to the office by ...
Skeletal surveyπŸ”,πŸ“Ί

Question#86 (1.3 difficulty score)
A 62-year-old woman is admitted to the ...
Ultrasonography of the right upper abdominal quadrantπŸ”,πŸ“Ί

Question#87 (1.6 difficulty score)
A 28-year-old woman, gravida 2, para 1, at 39 ...
Umbilical cord prolapseπŸ”,πŸ“Ί

Question#88 (1.9 difficulty score)
A 63-year-old man with chronic obstructive ...
Titrated oxygen therapyπŸ”,πŸ“Ί

Question#89 (1.0 difficulty score)
A 49-year-old man returns to the office for ...
Adenocarcinoma of the colonπŸ”,πŸ“Ί

Question#90 (1.7 difficulty score)
A 27-year-old man is examined in the ...
Decreased uptake of glucose by insulin-sensitive tissuesπŸ”,πŸ“Ί

Question#91 (1.1 difficulty score)
A 72-year-old woman is evaluated in the acute ...
Discharge the patient with a plan for home health care and physical therapyπŸ”,πŸ“Ί

Question#92 (1.1 difficulty score)
A 46-year-old woman comes to the office for ...
HyperaldosteronismπŸ”,πŸ“Ί

Question#93 (1.3 difficulty score)
A 50-year-old woman is brought to the ...
Necrotizing fasciitisπŸ”,πŸ“Ί

Question#94 (1.2 difficulty score)
A 37-year-old woman comes to the office for a ...
Using a respirator at workπŸ”,πŸ“Ί

Question#95 (1.2 difficulty score)
A 57-year-old man with alcohol use disorder ...
SpironolactoneπŸ”,πŸ“Ί

Question#96 (1.0 difficulty score)
A 48-year-old man is admitted to the hospital ...
Gemfibrozil therapyπŸ”,πŸ“Ί

Question#97 (0.8 difficulty score)
A 57-year-old man is admitted to the hospital ...
Vitamin B1 (thiamine)πŸ”,πŸ“Ί

Question#98 (0.9 difficulty score)
Three days after an operation for uterine ...
Develop an institutional policy with standardized orders for DVT prophylaxisπŸ”,πŸ“Ί

Question#99 (0.8 difficulty score)
A clinical trial is performed to assess the ...
Absolute risk reduction is 1%πŸ”,πŸ“Ί


Question#101 (1.2 difficulty score)
A 52-year-old man is brought to the emergency ...
Application of positive end-expiratory pressureπŸ”,πŸ“Ί

Question#102 (0.8 difficulty score)
A 14-year-old boy is brought to the emergency ...
Cardiac monitoringπŸ”,πŸ“Ί

Question#103 (1.1 difficulty score)
A 65-year-old man with mild hypertension ...
Duplex ultrasonography of the abdomenπŸ”,πŸ“Ί

Question#104 (1.1 difficulty score)
A 57-year-old man comes to the physician ...
Serum protein electrophoresisπŸ”,πŸ“Ί

Question#105 (0.9 difficulty score)
A 38-year-old woman, gravida 1, para 1, comes ...
OsteoporosisπŸ”,πŸ“Ί

Question#106 (1.2 difficulty score)
A 27-year-old man comes to the physician ...
von Willebrand diseaseπŸ”,πŸ“Ί

Question#107 (1.3 difficulty score)
A previously healthy 57-year-old woman comes ...
Right hemicolectomyπŸ”,πŸ“Ί

Question#108 (1.0 difficulty score)
A 37-year-old woman comes to the office for a ...
Generalized anxiety disorderπŸ”,πŸ“Ί

Question#109 (1.4 difficulty score)
A 55-year-old man comes to the emergency ...
CefotaximeπŸ”,πŸ“Ί

Question#110 (1.5 difficulty score)
A 45-year-old man is brought to the emergency ...
Vitamin DπŸ”,πŸ“Ί

Question#111 (0.9 difficulty score)
A 32-year-old man comes to the office because ...
Ketorolac 0.5% solution, 1 drop in right eye, four times dailyπŸ”,πŸ“Ί

Question#112 (1.1 difficulty score)
A 14-year-old girl is brought to the ...
Pubic hair development: normal; Breast development: normalπŸ”,πŸ“Ί

Question#113 (0.8 difficulty score)
A healthy 19-year-old woman comes to the ...
Subdermal contraceptive implantπŸ”,πŸ“Ί

Question#114 (1.2 difficulty score)
A 56-year-old man with adenocarcinoma of the ...
Increased total protein concentrationπŸ”,πŸ“Ί

Question#115 (0.9 difficulty score)
A previously healthy 17-year-old girl comes ...
Tubo-ovarian abscessπŸ”,πŸ“Ί

Question#116 (0.9 difficulty score)
A 15-year-old girl is brought to the office ...
GonadectomyπŸ”,πŸ“Ί

Question#117 (1.1 difficulty score)
A 50-year-old man returns to the office for a ...
HydrochlorothiazideπŸ”,πŸ“Ί

Question#118 (1.4 difficulty score)
A 23-year-old woman is brought to the ...
Reaction to food additiveπŸ”,πŸ“Ί


Question#120 (1.2 difficulty score)
A 47-year-old woman comes to the office ...
S1 radiculopathyπŸ”,πŸ“Ί

Question#8 (1.6 difficulty score)
A 37-year-old man with type 1 diabetes ...
Adhere to the patient's wishes and discuss home-care optionsπŸ”,πŸ“Ί

Question#10 (0.8 difficulty score)
A previously healthy 22-year-old college ...
Herpes simplex encephalitisπŸ”,πŸ“Ί

Question#10 (1.3 difficulty score)
A 32-year-old woman comes to the physician ...
Iron deficiencyπŸ”,πŸ“Ί

Question#12 (1.0 difficulty score)
A previously healthy 37-year-old woman comes ...
ParoxetineπŸ”,πŸ“Ί

Question#13 (1.0 difficulty score)
A 19-year-old college student comes to the ...
Combination oral contraceptiveπŸ”,πŸ“Ί

Question#14 (0.7 difficulty score)
A 72-year-old woman with unresectable small ...
Nonphysiologic ADH (vasopressin) secretionπŸ”,πŸ“Ί

Question#15 (0.8 difficulty score)
During the past month, a 37-year-old woman ...
Na+: 130; K+: 2.8; Cl-: 88; HCO3-: 32πŸ”,πŸ“Ί

Question#17 (1.6 difficulty score)
A 37-year-old woman comes to the physician ...
Streptococcus pneumoniaeπŸ”,πŸ“Ί

Question#18 (1.2 difficulty score)
An 18-year-old man with a 12-year history of ...
Diabetic nephropathyπŸ”,πŸ“Ί

Question#19 (1.9 difficulty score)
A cohort study is conducted to compare the ...
Selection biasπŸ”,πŸ“Ί

Question#21 (0.8 difficulty score)
A 17-year-old girl comes to the physician for ...
Potassium: decreased; Bicarbonate: increasedπŸ”,πŸ“Ί

Question#22 (0.9 difficulty score)
A previously healthy 27-year-old nulligravid ...
Incision and drainageπŸ”,πŸ“Ί

Question#23 (0.8 difficulty score)
A 30-year-old woman comes to the physician ...
Adrenal medullaπŸ”,πŸ“Ί

Question#24 (0.6 difficulty score)
A 4-year-old boy is brought to the physician ...
Intravenous immune globulinπŸ”,πŸ“Ί

Question#25 (0.8 difficulty score)
A 57-year-old woman is brought to the ...
History of gastrectomyπŸ”,πŸ“Ί

Question#27 (0.8 difficulty score)
Six hours after delivery, a 1200-g (2-lb ...
Pulmonary surfactant deficiencyπŸ”,πŸ“Ί

Question#29 (1.0 difficulty score)
A 47-year-old man is brought to the emergency ...
Aortic dissectionπŸ”,πŸ“Ί

Question#31 (1.0 difficulty score)
A 67-year-old woman comes to the physician ...
Inquiry about an egg allergyπŸ”,πŸ“Ί

Question#33 (0.8 difficulty score)
A 57-year-old woman comes to the physician ...
Paroxetine therapyπŸ”,πŸ“Ί

Question#34 (1.4 difficulty score)
Two days after admission to the hospital for ...
WBC: 20,000; Crystals: needle-shaped; Gram stain: no organismsπŸ”,πŸ“Ί

Question#36 (1.3 difficulty score)
A 52-year-old woman comes to the emergency ...
CT scan of the abdomen with contrastπŸ”,πŸ“Ί

Question#37 (0.7 difficulty score)
A 32-year-old man comes to the physician ...
Bipolar disorderπŸ”,πŸ“Ί

Question#38 (0.8 difficulty score)
A 32-year-old woman, gravida 3, para 2, at 41 ...
Amniotic fluid embolismπŸ”,πŸ“Ί

Question#40 (1.2 difficulty score)
A 60-year-old man has had painful skin with ...
Toxic epidermal necrolysisπŸ”,πŸ“Ί

Question#41 (1.1 difficulty score)
A hospitalized 57-year-old man has had severe ...
PseudogoutπŸ”,πŸ“Ί

Question#42 (0.8 difficulty score)
A 47-year-old woman with end-stage renal ...
Metabolic acidosis, respiratory compensationπŸ”,πŸ“Ί

Question#44 (1.1 difficulty score)
A 37-year-old woman with AIDS comes to the ...
Cryptosporidium parvumπŸ”,πŸ“Ί

Question#45 (0.6 difficulty score)
A previously healthy 19-year-old college ...
CeftriaxoneπŸ”,πŸ“Ί

Question#46 (1.5 difficulty score)
A 64-year-old woman comes to the physician ...
Non-small cell lung carcinomaπŸ”,πŸ“Ί

Question#47 (1.1 difficulty score)
A healthy 4-year-old girl is brought for a ...
Atrial septal defectπŸ”,πŸ“Ί

Question#48 (0.9 difficulty score)
A previously healthy 47-year-old man comes to ...
ColonoscopyπŸ”,πŸ“Ί

Question#50 (0.7 difficulty score)
A 22-year-old man comes to the physician for ...
Persistence of a patent processus vaginalisπŸ”,πŸ“Ί

Question#52 (0.7 difficulty score)
A 38-year-old woman comes to the physician ...
Interstitial nephropathyπŸ”,πŸ“Ί

Question#53 (0.7 difficulty score)
A 25-year-old man is brought to the emergency ...
HeroinπŸ”,πŸ“Ί

Question#55 (0.6 difficulty score)
A 5-year-old boy is brought to the physician ...
The findings are clinically insignificant but statistically significantπŸ”,πŸ“Ί

Question#56 (1.4 difficulty score)
A 22-year-old man is brought to the emergency ...
Left tube thoracostomyπŸ”,πŸ“Ί

Question#57 (1.5 difficulty score)
A 19-year-old man comes to the physician ...
Intravenous methylprednisoloneπŸ”,πŸ“Ί

Question#58 (1.4 difficulty score)
A previously healthy 17-year-old girl comes ...
AsthmaπŸ”,πŸ“Ί

Question#59 (1.0 difficulty score)
A 62-year-old white man comes to the ...
PhlebotomyπŸ”,πŸ“Ί

Question#60 (0.7 difficulty score)
A 32-year-old man who is a jackhammer ...
Axillary-subclavian venous thrombosisπŸ”,πŸ“Ί

Question#62 (0.9 difficulty score)
A 62-year-old woman comes to the physician ...
HypothyroidismπŸ”,πŸ“Ί


Question#64 (0.8 difficulty score)
A 6-year-old boy is brought to the emergency ...
Attention-deficit/hyperactivity disorderπŸ”,πŸ“Ί

Question#65 (0.5 difficulty score)
A previously healthy 18-year-old man is ...
Diabetic ketoacidosisπŸ”,πŸ“Ί

Question#66 (1.0 difficulty score)
A 42-year-old woman comes to the physician ...
Endometrial biopsyπŸ”,πŸ“Ί

Question#67 (1.0 difficulty score)
A 15-year-old boy is brought to the physician ...
Exercise programπŸ”,πŸ“Ί

Question#68 (1.5 difficulty score)
A 5-year-old girl is brought to the physician ...
EchocardiographyπŸ”,πŸ“Ί

Question#69 (0.8 difficulty score)
A 35-year-old woman comes to the physician ...
Meniere’s diseaseπŸ”,πŸ“Ί

Question#70 (1.7 difficulty score)
A previously healthy 15-year-old boy is ...
Administer intravenous fluidsπŸ”,πŸ“Ί

Question#71 (1.1 difficulty score)
A 27-year-old man comes to the physician for ...
Decreased conjugation of bilirubinπŸ”,πŸ“Ί

Question#72 (0.5 difficulty score)
A 52-year-old woman has had dyspnea and ...
Mitral valve stenosisπŸ”,πŸ“Ί

Question#73 (0.5 difficulty score)
A 21-year-old woman comes to the physician ...
Beginning folic acid supplementation prior to conceptionπŸ”,πŸ“Ί

Question#75 (0.5 difficulty score)
A 72-year-old woman with advanced ovarian ...
Assess for suicidal ideationπŸ”,πŸ“Ί

Question#76 (1.1 difficulty score)
A previously healthy 24-year-old woman comes ...
ErythromycinπŸ”,πŸ“Ί

Question#78 (0.8 difficulty score)
For 8 weeks, a 52-year-old man with a 5-year ...
Femoral popliteal stenosisπŸ”,πŸ“Ί

Question#82 (0.6 difficulty score)
A 37-year-old man comes to the physician ...
Regular activityπŸ”,πŸ“Ί

Question#83 (0.5 difficulty score)
A 19-year-old woman noticed a mass in her ...
FibroadenomaπŸ”,πŸ“Ί

Question#85 (0.6 difficulty score)
A 2-week-old newborn is brought to the ...
Tetralogy of FallotπŸ”,πŸ“Ί

Question#87 (1.1 difficulty score)
A 27-year-old woman, gravida 2, para 1, at 12 ...
Oral amoxicillin therapyπŸ”,πŸ“Ί

Question#88 (1.3 difficulty score)
A 47-year-old man comes to the physician 12 ...
Subarachnoid hemorrhageπŸ”,πŸ“Ί

Question#89 (0.8 difficulty score)
A 72-year-old man comes to the physician ...
Presynaptic neuromuscular junctionπŸ”,πŸ“Ί

Question#90 (0.5 difficulty score)
A 65-year-old man who is quadriplegic as a ...
Frequent turningπŸ”,πŸ“Ί

Question#91 (0.5 difficulty score)
A 45-year-old woman has a 2-week history of ...
Acute stress disorderπŸ”,πŸ“Ί

Question#92 (0.6 difficulty score)
An 87-year-old woman is brought to the ...
Cholinesterase inhibitorπŸ”,πŸ“Ί

Question#93 (0.9 difficulty score)
A 37-year-old woman, gravida 5, para 4, at 34 ...
Placenta previaπŸ”,πŸ“Ί

Question#94 (0.6 difficulty score)
A previously healthy 14-year-old girl is ...
ArthrocentesisπŸ”,πŸ“Ί

Question#96 (0.7 difficulty score)
A 62-year-old man comes to the physician ...
Impaired contractility of the left ventricleπŸ”,πŸ“Ί

Question#97 (0.5 difficulty score)
A 19-year-old college student comes to the ...
CandidiasisπŸ”,πŸ“Ί

Question#99 (1.3 difficulty score)
A 65-year-old woman has a 6-month history of ...
Multinodular goiterπŸ”,πŸ“Ί

Question#100 (0.4 difficulty score)
A 52-year-old man comes to the physician with ...
PolysomnographyπŸ”,πŸ“Ί

Question#101 (0.5 difficulty score)
A 22-year-old woman comes to the physician in ...
Influenza virus vaccineπŸ”,πŸ“Ί

Question#102 (0.4 difficulty score)
A 47-year-old woman comes to the physician ...
Increased serum bradykinin concentrationsπŸ”,πŸ“Ί

Question#103 (0.5 difficulty score)
A 42-year-old woman comes to the physician ...
Abdominal ultrasonography of the right upper quadrantπŸ”,πŸ“Ί

Question#104 (1.1 difficulty score)
A 4-year-old boy is brought for a follow-up ...
Epithelial tissue proliferationπŸ”,πŸ“Ί

Question#106 (0.5 difficulty score)
A 10-year-old boy is brought for a follow-up ...
Carrying self-injectable epinephrineπŸ”,πŸ“Ί

Question#107 (0.7 difficulty score)
A previously healthy 17-year-old girl comes ...
Intramuscular ceftriaxone and oral doxycyclineπŸ”,πŸ“Ί

Question#108 (0.6 difficulty score)
A 32-year-old woman, gravida 2, para 1, at 8 ...
Preterm labor and deliveryπŸ”,πŸ“Ί

Question#111 (0.9 difficulty score)
An 18-year-old man is brought to the ...
PericardiocentesisπŸ”,πŸ“Ί

Question#112 (0.9 difficulty score)
A 42-year-old man comes to the physician ...
Begin ganciclovir therapyπŸ”,πŸ“Ί

Question#113 (0.5 difficulty score)
A 42-year-old man comes to the physician ...
Ulnar nerve at the elbowπŸ”,πŸ“Ί

Question#114 (1.0 difficulty score)
A previously healthy 27-year-old man comes to ...
CryotherapyπŸ”,πŸ“Ί

Question#115 (0.6 difficulty score)
A 20-year-old man has had frequent upper ...
Sweat chloride testπŸ”,πŸ“Ί

Question#116 (0.5 difficulty score)
A 27-year-old man is brought to the emergency ...
Neuroleptic malignant syndromeπŸ”,πŸ“Ί

Question#118 (1.0 difficulty score)
A 57-year-old man comes to the emergency ...
Vitamin D deficiencyπŸ”,πŸ“Ί

Question#119 (0.8 difficulty score)
A 37-year-old woman is brought to the ...
Acute tubular necrosisπŸ”,πŸ“Ί

Question#120 (1.1 difficulty score)
A study is conducted to assess the ...
Chance of a type II errorπŸ”,πŸ“Ί

Question#38 (1.0 difficulty score)
A 77-year-old man comes to the office as a ...
Aortic stenosisπŸ”,πŸ“Ί

Recent comments ...

... carolebaskin made a comment on step2ck_free120/block1/q#2 (A 56-year-old man has had the painful weeping rash...)
 +2 
submitted by carolebaskin(78)

Dewdrop on a rose petal appearance in a CN V1 dermatomal distribution. Rash is painful and weeping. Immunocompromised host (s/p chemo)


Wrong answers

Impetigo: honey colored crusting lesion related to group A strep infection

Pyoderma gangrenosum: think green cheese; usually a single large round ulcer. Rapidly progresses from small papule or pustule to large painful ulcer with purulent, violaceous border. Associated with IBD (crohn disease, UC, RA, trauma). Most commonly lower limbs.

Syphilis: Causes a few types of skin lesions: chancre, gummas, etc. Chancre: most common, painless, genital. Doesn't really fit the story here anyway.

SLE: doesn't fit

yankee2222  Thank-you for going through each ans choice, that's very helpful in identifying the why, appreciate it! +
... benwhite_dotcom made a comment on step2ck_free120/block1/q#8 (An obese 33-year-old woman has had four 12-hour...)
 +2 
submitted by benwhite_dotcom(573)

Again, acute RUQ pain (especially in an obese woman) should set off the gallstone alarms. Fever and other systemic signs, white count, etc lead you down the acute cholecystitis. Simple pain leads you to symptomatic cholelithiasis. Either way the first step is to get a RUQ sono to see those stones! HIDA is used as an adjunctive study in cases of cholelithiasis to assess for cystic duct obstruction (and thus likely acute cholecystitis) in equivocal cases.

... carolebaskin made a comment on step2ck_free120/block1/q#11 (A previously healthy 34-year-old woman is brought to...)
 +2 
submitted by carolebaskin(78)

Meets the 5 FAT RN criteria:

  • fever
  • anemia
  • thrombocytopenia
  • renal symptoms
  • neuro symptoms

Also, Indirect hyperbilirubinemia and increased LDH should tip you off to MAHA

... benwhite_dotcom made a comment on step2ck_free120/block1/q#9 (A 70-year-old man comes to the clinic because of a...)
 +2 
submitted by benwhite_dotcom(573)

When old men stop peeing so well, consider the poorly designed straw-crusher, the prostate. Chronic outlet obstruction isn’t so great, but it also predisposes to acute prostatitis which in turn can further worsen said obstruction when the gland swells. First thing to do is see how much the gentlemen is backed up, which in turn tells us if he has earned catheterization. Old people and UTIs go together like [insert your own clever comparison].

tinylilron  so we should work him up for post-void obstruction BEFORE we treat his UTI???? +1
... derpymd made a comment on step2ck_free120/block2/q#58 (A previously healthy 17-year-old girl comes to the...)
 +2 
submitted by derpymd(7)

FEV1/FVC will be > 80% in mild or intermittent asthma

tomatoeandspinach  OME notes - between attacks, lungs sound normal. pt. looks normal. PND is mcc of chronic cough is non-smoking patient, however, this patient has exertional cough. PND is more c/w night-time cough. The labs/imaging also c/w intermittent asthma, FEV1/FVC >80%. +
... benwhite_dotcom made a comment on step2ck_free120/block2/q#63 (A previously healthy 32-year-old man is brought to...)
 +2 
submitted by benwhite_dotcom(573)

Organ donation is a complex organizational dance, and the regional procurement organization manages the nitty-gritty aspects.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#2 (A 67-year-old woman comes to the physician for a...)
 +1 
submitted by benwhite_dotcom(573)

Anesthesia to the anterolateral thigh is the distribution of the lateral femoral cutaneous nerve. LFC neuropathy can be caused by compression near the inguinal ligament (say, from a hematoma). Note that it’s the compression of the nerve that causes decreased sensation, not the hematoma itself.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#4 (A 42-year-old woman is brought to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

Unstable and hypotensive patients after blunt trauma get laparotomies (don’t put an unstable patient in the CT scanner). In addition to saline and blood products, definitive surgery is how you address the C in ABC.

tinylilron  Why not a Thoracotomy??? +2
... benwhite_dotcom made a comment on step2ck_free120/block1/q#3 (A sexually active 20-year-old woman has had fever,...)
 +1 
submitted by benwhite_dotcom(573)

The STD that forms a painful ulcer aka chancroid = H ducreyi (ducreyi makes you cry, as they say).

ishockk  Since when did ducreyi start causing pustules? and satellite lesions? This fits with Strep pyogenes much more than ducreyi +1
tinylilron  First aid says papule/pustule-->ulcer/chancroid +
tinylilron  I wanted to choose HSV but it was not an option +
... carolebaskin made a comment on step2ck_free120/block1/q#4 (A 67-year-old woman comes to thy physician 1 month...)
 +1 
submitted by carolebaskin(78)

This is a keratoacanthoma.

It's a cup shaped squamous cell carcinoma that's filled with keratin debris. It rapidly grows then usually spontaneously regresses. But, it's still an SCC, so we should excise.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#4 (A 67-year-old woman comes to thy physician 1 month...)
 +1 
submitted by benwhite_dotcom(573)

The thing you do with things that look like skin cancer is excise them completely.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#9 (Five years after being shot in the right thigh, a...)
 +1 
submitted by benwhite_dotcom(573)

Post-traumatic AV fistula! Just like dialysis AV fistulae have bruits and thrills, so do non-purposefully created ones. These can take a long time to form but can be associated with steal syndromes due to decreased perfusion to the distal extremity, venous incompetence, varicosities, and eventually stenoses due to unreasonably high flow, and even high-output heart failure.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#10 (An 18-year-old primigravid woman comes for her initial)
 +1 
submitted by benwhite_dotcom(573)

We can only put the laboratory tests into context if we have an accurate gestational age. Since her LMP is unreliable (totally unknown), we need an ultrasound to date her pregnancy. The most common cause of an abnormal MSAFP is wrong dates.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#11 (A previously healthy 34-year-old woman is brought to...)
 +1 
submitted by benwhite_dotcom(573)

TTP always seems like too many disparate symptoms but just remember the pentad: thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal failure, and fever. If the symptoms list seems super long, keep TTP in mind.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#13 (A 27-year-old nurse comes to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

Working up serious hypoglycemia involves measurement of both insulin and C-peptide (the cleaved by-product of endogenous proinsulin) to assess for hyperinsulinemia and distinguish endogenous (e.g. insulinoma) from exogenous (e.g. Munchausen’s) causes. β€œNurse” is a common Munchausen tip-off (someone with the know-how and skills to pull it off well).

... benwhite_dotcom made a comment on step2ck_free120/block1/q#17 (A 2-month-old boy is brought to the physician...)
 +1 
submitted by benwhite_dotcom(573)

These questions can be a true pain of biochemistry on the Step 1 or relatively straightforward depending on how well you know it. This patient has classical Galactosemia, caused by a deficiency in galactose-1-P uridyl transferase deficiency, the enzyme that converts galactose and lactose to glucose. Intolerance to dairy, hepatomegaly/liver disease/jaundice with hypoglycemia due to decreased gluconeogenesis, and reducing substances in urine are classic. Listlessness and lethargy ensue with mental retardation and eventually death if untreated. Cataracts are also common. If you didn’t get to galactosemia (or thought it was Von Gierke’s disease, which isn’t all that unreasonable), the answer is still A. By process of elimination, given the serum hypoglycemia but no urine glucose, the issue is the inability to make glucose from stores (not to absorb it).

... carolebaskin made a comment on step2ck_free120/block2/q#24 (A 32-year-old man who is a jackhammer operator comes...)
 +1 
submitted by carolebaskin(78)

This is Paget-Schroetter disease

An upper extremity thrombosis triggered by extreme activity.

He's a fit young jackhammerer just trying to do his jackhammer thing

... benwhite_dotcom made a comment on step2ck_free120/block2/q#28 (A 6-year-old girl is brought to the physician because)
 +1 
submitted by benwhite_dotcom(573)

Atopic dermatitis (eczema) is the β€œitch that rashes.” It’s one leg of the allergic triad: asthma, allergic rhinitis, and atopic dermatitis. Treatment is with topical steroids and rigorous emollient therapy.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#35 (An 82-year-old woman with a 20-year history of urinary)
 +1 
submitted by benwhite_dotcom(573)

This patient has urge incontinence, which is commonly caused by detrusor instability (and can be treated with anticholinergics like oxybutynin). This is opposed to stress incontinence, the other most common type, which is worsened by abdominal pressure/coughing/laughing/etc and can be caused by pelvic floor prolapse secondary to multiple childbirths etc. Neurogenic bladder can cause overflow incontinence.

... carolebaskin made a comment on step2ck_free120/block2/q#37 (A 70-year-old man comes to the physician because of...)
 +1 
submitted by carolebaskin(78)

Hypercalcemia + lytic spinal lesions = multiple myeloma

What about the fever, leukocytosis, and consolidation?

MM predisposes to infection! It's PNA.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#37 (A 70-year-old man comes to the physician because of...)
 +1 
submitted by benwhite_dotcom(573)

Multiple lytic bone lesions equals multiple myeloma. Blastic/sclerotic lesions should make you think of metastatic prostate cancer (in men) and breast cancer (in women).

... carolebaskin made a comment on step2ck_free120/block3/q#20 (Three days after hospitalization for diabetic...)
 +1 
submitted by carolebaskin(78)

Eeaaasy there, partner. They said they don't want insulin and you're gonna kick them to the curb?

One step at a time, bud.

Offer the insulin, let them refuse (they seem to have capacity), but who ever said anything about discharging them.

Where would they go!?

Haven't they been through enough?

... benwhite_dotcom made a comment on step2ck_free120/block3/q#20 (Three days after hospitalization for diabetic...)
 +1 
submitted by benwhite_dotcom(573)

Patients who have the capacity to make medical decisions are allowed to refuse life-saving medical treatment. You should offer it but accept her refusal.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#11 (A 52-year-old man with hepatic cirrhosis comes to...)
 +1 
submitted by benwhite_dotcom(573)

We have event rates of 35% for EST and 15% for EPCS, and the number needed to treat (NNT) is the inverse of the absolute risk reduction or 1/ARR. ARR = Control event rate minus experiment event rate. So, we have ARR = 0.35 – 0.15 = 0.2, and therefore NNT = 1/0.2 = 5. Boom, math.

tinylilron  Yey!!! +
... benwhite_dotcom made a comment on step2ck_free120/block1/q#16 (A 58-year-old woman is brought to the office by her...)
 +1 
submitted by benwhite_dotcom(573)

Rapidly progressive dementia (with or without personality changes, psychiatric disturbances, and sudden/jerk movements) raises the possibility of Creutzfeldt-Jakob disease, for which CSF protein 14-3-3 is an important marker.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#17 (A 38-year-old woman is brought to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

Slow submersion warming is key when dealing with frostbite. Air and towels/dressings are poor conductors of temperature.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#23 (A 55-year-old man is brought to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

The banana bag! You might be thinking of Flumazenil to reverse his benzo use, but be wary of using in an otherwise stable chronic user as this can precipitate seizures. He’s also probably drunk, but that we’ll just wait out. In this case, he’s awake and protecting his airway but he’s encephalopathic. When an alcoholic is encephalopathic, think Wernicke’s and give thiamine. Even if they’re just plain ole drunk you’re not going to hurt them.

etherbunny  Especially give thiamine before giving dextrose to correct his low glucose level, which is probably the cause of his AMS! Glucose before/without thiamine can exacerbate Wernicke's. +
... benwhite_dotcom made a comment on step2ck_free120/block1/q#25 (A 5-year-old boy is brought to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

This is a diffuse pontine glioma, a death sentence. You don’t really need to know that, because the stem tells you of the poor prognosis. Whenever someone is presented with a serious diagnosis, any treatment discussion starts with establishing a baseline understanding of the disease process and then discussing goals of care.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#26 (A 50-year-old woman comes to the office because of a...)
 +1 
submitted by benwhite_dotcom(573)

We have a middle-aged black female as the setup. Pulmonary disease with CXR showing bilateral hilar adenopathy. She has cutaneous involvement of the face. Cutaneous involvement is present in 1/3 of systemic cases but can have a variety of appearances.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#28 (A 23-year-old man who is on active duty in the US...)
 +1 
submitted by benwhite_dotcom(573)

Source control followed by symptomatic relief. Have you seriously ever heard of anyone doing any of that other crazy stuff?

etherbunny  I was fooled into an ophthal consult by the "dusky" orbit. +
... benwhite_dotcom made a comment on step2ck_free120/block1/q#30 (A 60-year-old woman comes to the office as a new...)
 +1 
submitted by benwhite_dotcom(573)

USPSTF recommends clinicians screen all adults age 18-79 for hepatitis C infection.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#34 (A 37-year-old man comes to the physician for a...)
 +1 
submitted by benwhite_dotcom(573)

USPSTF recommends all men 35 and older (women 45 and older) are screened for lipid disorders, and age 20+ for those with increased risk of CAD.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#41 (A 22-year-old primigravid woman at 10 weeks’...)
 +1 
submitted by benwhite_dotcom(573)

The goal is to hopefully make sure she is safe (and if she is at-risk for partner abuse to provide her with resources). On a related note, unlike for children and elders, there is no reporting mechanism for partner abuse.

... benwhite_dotcom made a comment on step2ck_free120/block3/q#82 (A 76-year-old woman, who is receiving home hospice...)
 +1 
submitted by benwhite_dotcom(573)

Help her feel better. That’s the point of hospice.

... benwhite_dotcom made a comment on step2ck_free120/block3/q#87 (A 28-year-old woman, gravida 2, para 1, at 39 weeks’...)
 +1 
submitted by benwhite_dotcom(573)

Tracing shows late decels: the bad kind, a response to poor blood flow to the fetus during contractions. One cause, particularly common after AROM, is umbilical cord prolapse, where the fetal head compresses the umbilical cord, limiting blood flow as it’s squeezed inferiorly by the contracting uterus. Vertex station doesn’t actually matter as once previously thought, but a nondilated cervix (less than 6 cm) is a risk factor.

wutuwantbruv  I was a bit confused by this one because umbilical cord prolapse is normally associated with variable decelerations. Uteroplacental insufficiency is associated with late decelerations. Also, I am not even sure I would call this a late deceleration (since it never returns). There is a similar FHT on UWorld in which the there was fetal anemia due to vasa previa causing a step-down pattern on the tracing. My thought process was that since it looking similar to the UWorld one it must have something to do with the umbilical cord but this is probably a flawed thought process. Any other thoughts as to this question? +
shaz464  Exactly my thinking... I was also thinking late deceleration being UPI. +
... benwhite_dotcom made a comment on step2ck_free120/block3/q#90 (A 27-year-old man is examined in the intensive care...)
 +1 
submitted by benwhite_dotcom(573)

Trauma and critical illness can cause acute insulin resistance.

tinylilron  When could the answer be "increased infusion of IV glucose"? He is receiving 5% dextrose. +
etherbunny  You'd have to give a boatload of 5% dextrose to get someone with functioning glucose metabolism to become hyperglycemic. They'd probably get fluid overloaded first. +
jcrll  The labs pattern made me think of HHS +
... benwhite_dotcom made a comment on step2ck_free120/block3/q#91 (A 72-year-old woman is evaluated in the acute...)
 +1 
submitted by benwhite_dotcom(573)

Don’t be a dick. Don’t be a dick. Don’t be a dick. Don’t be a dick. Don’t be a dick. Don’t be a dick. Don’t be a dick.

... benwhite_dotcom made a comment on step2ck_free120/block3/q#100 (An 18-year-old man is being prepared to undergo left...)
 +1 
submitted by benwhite_dotcom(573)

Stop. Wrong sided surgery is a big no no. Everyone on the team should feel empowered to stop a surgery or procedure if something in the preprocedural checklist is amiss.

... yobo13 made a comment on step2ck_free120/block3/q#106 (A 27-year-old man comes to the physician because of...)
 +1 
submitted by yobo13(3)

Bernard Soulier Syndrome has thrombocytopenia, otherwise looks similar to vWD

... benwhite_dotcom made a comment on step2ck_free120/block1/q#8 (A 37-year-old man with type 1 diabetes mellitus is...)
 +1 
submitted by benwhite_dotcom(573)

Autonomy matters. If a patient has the capacity to make medical decisions (i.e. understands the risks) and is not an imminent harm to self or others (i.e. suicidal or homicidal), then he cannot be held against his will. We don’t institutionalize people just for noncompliance with medical treatment.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#19 (A cohort study is conducted to compare the incidence...)
 +1 
submitted by benwhite_dotcom(573)

A cohort study (as opposed to a randomized controlled trial) is ripe for selection bias, which occurs when the treatment and control groups are not truly comparable. Matching for some factors (age, gender) doesn’t mean you’ve controlled for all possible confounders. That’s what randomization does!

tinylilron  This one tripped me up and I selected Type I error but I guess the p value= 0.01 so Type 1 is less likely... Am I thinking about this correctly? +
... benwhite_dotcom made a comment on step2ck_free120/block1/q#21 (A 17-year-old girl comes to the physician for an...)
 +1 
submitted by benwhite_dotcom(573)

Repetitive vomiting (be it due to viral gastroenteritis or bulimia) leads to hypokalemic hypochloremic metabolic alkalosis. Alkalosis means elevated bicarbonate, which in this case is created as the byproduct of increased stomach acid production.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#29 (A 47-year-old man is brought to the emergency...)
 +1 
submitted by benwhite_dotcom(573)

Two things make this aortic dissection instead of a heart attack or pulmonary embolism. First, the diastolic murmur is that of aortic insufficiency/regurgitation, which is happening because the dissection is involving the aortic root. Second, the presence of diminished femoral pulses implies that the dissection also involves the descending thoracic aorta distal to the takeoff of the brachiocephalic and left subclavian arteries (which supply the arms). Only an issue in the aorta can cause that constellation of symptoms.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#37 (A 32-year-old man comes to the physician because he...)
 +1 
submitted by benwhite_dotcom(573)

Bipolar disorder is the only reasonable answer, as evidenced by the increased energy, elevated mood, labile affect, and poor judgment and focus. You don’t develop ADHD at 32.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#41 (A hospitalized 57-year-old man has had severe...)
 +1 
submitted by benwhite_dotcom(573)

Pseudogout (calcium pyrophosphate deposition disease) is an inflammatory arthritis with a predilection for the knee that causes synovial calcifications.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#46 (A 64-year-old woman comes to the physician because...)
 +1 
submitted by benwhite_dotcom(573)

Weight loss and worsening lung symptoms in a smoker mean lung cancer. Non-small cell is by far the most common variety. The small cell variety on tests will usually have fun paraneoplastic syndromes.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#58 (A previously healthy 17-year-old girl comes to the...)
 +1 
submitted by benwhite_dotcom(573)

Cough is often the only sign of asthma. Exercise-induced asthma is exercise-induced asthma.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#62 (A 62-year-old woman comes to the physician for a...)
 +1 
submitted by benwhite_dotcom(573)

Weight gain, fatigue, and constipation go with hypothyroidism. High LDL cholesterol actually does too, but the question is doable even when ignoring the lab values.

tinylilron  I almost picked estrogen deficiency, but she is on estrogen replacement therapy... I wonder if estrogen deficiency can also cause these symptoms +
tomatoeandspinach  constipation/wg = hypothyroid slam dunk +
... benwhite_dotcom made a comment on step2ck_free120/block2/q#67 (A 15-year-old boy is brought to the physician...)
 +1 
submitted by benwhite_dotcom(573)

It’s not clear that the glucose is a fasting value or not, but it’s clear that the patient has symptoms of diabetes in the context insulin resistance (obese kid with acanthosis nigricans). Diet and exercise are always necessary in DM2 and can reverse many early cases. With a 10% weight loss, for example, the patient may not require pharmacotherapy.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#70 (A previously healthy 15-year-old boy is brought to...)
 +1 
submitted by benwhite_dotcom(573)

Follow your ABCs. Tachycardia and hypotension mean severe volume loss necessitating aggressive intravenous fluid resuscitation.