dr.pumpkin
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thnk u npas, sunny2 for the explanations...yeah npas, now can i recall the atypical symptoms in `bipolar disorders`...
sunny2 u are welcome always to participate in the discussion...infact we too have a extended viewpoints n that too pretty good ones.. ..
12# C ..
13# D ..
take care all...
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| dr.pumpkin
Forum Newbie
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dear zianab...
where r u buddy ?? its been soo long widout ur posts on the forum....
hope u r doing well....
take care, n do write up buddy...
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| sunny2
Forum Elite
Topics: 51
Posts: 385
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Hello mazinger, npas, dr pumpkin, zianab
Thanks for the questions mazinger...
giving a quick real fast try, let's see what happens as each of it unfolds...may be wrong after wrong ...am prepared for the assault 
1.D;2-B;3-A;4-?D;5-C;6-D;7-B;8-D;9-C;10-A;11-?A;12-A
Have a Nice Day
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| mazinger
Forum Guru
Topics: 46
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1st opiates, heroin gives the classic narcotic triad...
2nd I always suck at this sort of questions, not to mention BS was my lowest performance in step 1.. As far as I know, you dont need the guardians permission for prenatal care, nor stds, nor prescribing contraceptive measures, nor treating drug ods... But this patient is just having non specific pelvic pain and symptoms suggestive of pregnancy.. Do we need guardians permission for asking a pregnancy test?? If we dont need permission for that I guess we should only let the patient decide.. Remember pregnancy doesnt make minors competent..
Bottom line I dont know... 
3rd. Agree A
4th. agree Granulosa cell tumors can make postmenopausal women rebleed produces lots of strogens.....
5. agree Endometrial biopsy.. First thing to rule out is malignancy..
6. agree Weight loss
7. Agree its epididymitis... I found it quite confusing.. why not torsion? why would a blood deprived organ have an increased uptake of T99? then after givin it a thought its epididymitis
8. Agree Bradykinin
9 A its increased platelet destruction, heparin produces an immunologic destruction of platelets..
10. dont know
11. A? I am also not sure
12 .... hold on I have to go..
Edited by mazinger on 11/23/06 - 12:27 PM
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| mazinger
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Now I am back, after trying to get myself a xbox 360 at amazon while it was $100... I was not succesful... there was a major sold out ten min after the sales initiated.. I guess my fantasies of having fun for less buck are gone.
Anyways back to the real world the answer for the 12th q is C...
Edited by mazinger on 11/23/06 - 12:31 PM
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| sunny2
Forum Elite
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mazinger,
For Q.3 - she can give consent, following are some rules, please go thru them, they wld help someway or the other:
• Twenty-five states and the District of Columbia have laws or policies that explicitly give minors the authority to consent to contraceptive services.
• Twenty-seven states and the District of Columbia have laws or policies that specifically authorize a pregnant minor to obtain prenatal care and delivery services without parental consent or notification.
• All 50 states and the District of Columbia specifically allow minors to consent to testing and treatment for STDs, including HIV. (With respect to HIV, three states limit this authorization to testing only.)
• Forty-four states and the District of Columbia have laws or policies that authorize a minor who abuses drugs or alcohol to consent to confidential counseling and medical care.
• Laws in 20 states and the District of Columbia give minors the explicit authority to consent to outpatient mental health services.
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| zianab
Forum Elite
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Posts: 282
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qs 3--borrelia (typical lyme lesions)
qs4--I am not sure.Can you please expalin sunny how you think of your option???
qs5--guys this qs what I am thinking is is irregular and consistent in size with a 10-week
gestation. I don't know if endometrial ca will give such a big mass.,or a fibroid ,which can bleed too.
guys please throw some light on that?????
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| zianab
Forum Elite
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6--weight loss
7--Epididymitis
8--D) Increased serum bradykinin levels
9 D) Uncontrolled activation of coagulation and
fibrinolytic cascades
10.--not sure ,please expalin sunny or anybody else who knows it???
11--may be A not sure
A) Aggregation of cholesterol in the gallbladder
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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Sunny2 thank you for the tips... I think you are right the only person we should ask for consent for a pregnancy test is the patient herself regardless of her age....
Q5 Dear zianab from my perspective fibroids or leiomyomas are estrogen dependant tumors so these lesions tend to disappear in the postmenopausal women... These may produce bleeding in women during the reproductive age.. and if my memmory doesnt betray me endomerial carcinomas may present as a intrauterine mass (you will have to confirm this last thing because Im not 100% sure)
First thing to rule out in this patient is endometrial cancer as in all postmenopausal women who rebleed..
Q9 produces platelet destruction through immunological mechanisms... you can check on that on a google search... look for antibodies to platelet factor 4 (PF4)..
Q12 sunny2 and zianab could you please explain how aggregation of cholesterol may increase Indirect bilirrubin levels please? I still think its c..
anyways nothing is absolute and things may vary.. So please any of you would please try to convince me that Im wrong and you are right..
Edited by mazinger on 11/23/06 - 04:10 PM
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| layla
Forum Senior
Topics: 18
Posts: 90
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Hi
I want to start studying for the step2 so looking around in this website to get some info about material i would need to study, then i noticed that you are using Harriosn review and pre test as extra Q resources, i would be very thankful if you share your experiment with those book, would you advice then to someone else?
thanks
Layla
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| npas
Forum Senior
Topics: 8
Posts: 198
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Hi Layla..yes we r using pre test and used to do Harrison..but my personal opinion is we should choose books after evaluating it ourselves..we all found Harrison to be time consuming..I left it mid way..will try to complete if I get time..pre test does not depict the exam question std but is good when u want to revise chapter wise on a 'just to recall' basis..and if u wish to take USMLE world qs after all ur reading for self evaluation then u ought to have some question source before that..that is why I'am using pre test..hope this helps..
all the very best
npas
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| npas
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Dear Friends..real good work going on here from the past 2 days..I missed some action ..I agree with most of ur answers..lemme try the confusion ones..
4)Zainab..u had a confusion..I agree with sunny2 and Mazinger..it is granulosa cell tumour..I was confused with why not hyperthecosis(which too should be producing estrogen..)..but hyperthecosis cannot be taken as avarian thecomas..hyperthecosis does not produce an ovarian mass as such..its just a hystological finding..and morover Granulosa cell tumour r the most common tumour in the sex cord stromal tumour category..
9)agree with u Mazinger..totally
10)Trying to make a guess with half knowledge..probability is .39...and it means it lies more towards uncertainity than certainity in the range of 0 to 1..so there is a connection between the vaccine and adverse effect..but we r uncertain about it..that is option a)..let me do more reding and confirm this one
12)Guys..the question is .".Which of the following is the most likely cause of this patient's hyperbilirubinemia? "..this can't be cholesterol stone..hasn't it to be hemolysis?...morover sc patients have calcium bilirubinate stones more commonly..
Ready for ue comments..
npas
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| layla
Forum Senior
Topics: 18
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npas
thakn you very much :-) wish you the best of luck on your exam
Layla
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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npas, zianab, sunny2, dr pumpkin how r u? hows the has prep been going?
I took the weekend off and I am having great expectations for this week that just started..
ok... I want to post new questions, but I think we should wait for dr pumpkin to answer the last qs I posted... dr pumpkin where r u?
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| sunny2
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Topics: 51
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Hello mazinger,zianab,npas ,drpumpkin
preparation is going smoothly....how abt you.
mazinger, relaxed and recharged for the new week...deadly
roll in the new set....let's face the enemy....we'll nail it down
Best wishes to all
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| npas
Forum Senior
Topics: 8
Posts: 198
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Mazinger..I'am not sure if dr Pumpkin will be able to contribute right now..There is some problem with accessing the computer for Dr P..Hope Dr Pumpkin will join us soon..
Can any one of u help me with the the 10th answer..I'am still confused..
Zainab..Have u started UW qs?hope u all r doing gr8..I have started my internal medicine revision..
God bless all of us..npas
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| npas
Forum Senior
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Let me try the qs..
1)c..lead time bias
2)E..Septal motion increases
3)D { A 35-year-old woman}..Menieres ds..
3)c {An obese 33-year-old woman has had four 12-hour}..USG
4)c topical benzoyl peroxide
Mazinger..u have marked 2 qs as no:3..
will try the others later
npas
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| mazinger
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npas wrote: Mazinger..u have marked 2 qs as no:3.. npas
My bad... 
1 agree
2 Left ventricular diastolic pressure
3 agree
3 agree
4 in the presence of nodular lesions oral isotretrinoin should be prescribed...
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| npas
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Dear mazinger...I chose increased septal motion thinking that the patient has constrictive pericarditis(due to radiation)..and in that u get to see the rapid filling and associated ventricular septal shift to the left..the ventricular septal "bounce" that is given in some books..but when I thought about it ur answer 'increased end diastolic volume' does make more sense..
4th..yes..I should have looked at the nodular one..u r correct..Isotretinoin and tetracyclines should never be used together..know why?
Good luck all..npas
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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Dear npas I dont know why you cant combine those 2... in fact that is something I was unaware of..
Could you or anyone explain why?
regards..
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| npas
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Both tetracycline and isotretinoin may cause pseudotumor cerebri (benign intracranial swelling); therefore, the two medications should never be used together....I also was unaware until today morning..npas
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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cool
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| mazinger
Forum Guru
Topics: 46
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5.B) Cervical spondylosis
6. C) Fluoxetine?? 
7. B) Serum lipid studies
8. A) Excessive sweat electrolyte level
9. C) Cholelithiasis
10 E) Left thyroid lobectomy
Comments are welcome...
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| zianab
Forum Elite
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Hello Guys,
Here are the answers.
1--LEAD TIME BIAS
2 B) Fall in systolic arterial pressure with
inspiration
{CAN U PLEASE DO LITTLE BIT MORE RESEARCH ON IT AND LET ME KNOW IF I AM CORRECT. WHAT LEAD ME TO THE ANSWER IS THE POINTS THAT THE HEART SOUNDS ARE DISTANT IN THIS QUESTION AND An x-ray film
of the chest shows an enlarged
cardiac silhouette}}
3D) Meniere's disease
3C) Ultrasonography of the upper abdomen
4A) Oral isotretinoin
5B) Cervical spondylosis ?????NPAS CAN YOU PLEASE COOMENT ON THIS QS TOO??
6C) Fluoxetine
7 B) Serum lipid studies
8A) Excessive sweat electrolyte level?NPAS CAN YOU COMMENT TOO
9B) Appendicitis ????PLEASE CHECK ON APPEDICITIS LOCATION CHANGE IN PREGNANCY.LET ME KNOW ABOUT THIS ANSWER
10 E) Left thyroid lobectomy
11F) von Willebrand's disease
11D) Vaginal foreign body
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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Dear Zianab for question 2 you picked pulsus paradoxus which I think is right... pulsus paradoxus is present in cases of cardiac tamponade.. I picked the other choice because I was thinking that end diastolic pressure is increased in all chambers equally with cardiac tamponade, BUT an isolated increase in the end diastolic pressure of the left ventricle is compatible with CHF...
you are right I was wrong...
And for Q7 cystic fibrosis there is a defect in CFTR gene which prodruces very thick secretions in many glands causing obstruction and excessive salt loss through transpiration..
Q9 I was so confused.. I was not aware that in pregnant women the classic description of appendicitis may vary.. That would explain the leucocitosis and the absent bowel movements.. Could you comment more on this question please...
Npas and zianab I have learned so much from you... thanks
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