mazinger
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zianab wrote:
7m???mazinger can you please expalin why you choose thid option in no 7??
Well the question is quite confusing, I just made it on the basis of potassium wasting... But, I am not 100% sure in fact I have big doubts here.. These patient shows dehydration and potassium wasting which is compatible with none of the options  ...
Is the potassium wasting a consequence of the dehydration?
Could it be hashimotos thyroiditis? or pheocromocytoma (note that many patients with pheo have chronic hypertension)?
Since I am not a 100% sure I picked the one that definetly produces potassium wasting which is adrenal cortex adenomas..
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original mazinger z
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| mazinger
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anne06 wrote:
8e 9b 10d
No explanations anne06?
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original mazinger z
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| mazinger
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new set... please give explanations to your answers, no matter how brief... The point of answering questions is actively participating in discussions in order to get the most out of this...
Edited by mazinger on 12/07/06 - 06:14 PM
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original mazinger z
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| ap001
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hi folks,
i'm new to the forum. just started studying for step 2 today. i took step 1 6 yrears ago, and got a great score. but, i've been doing research for my phd and returned to the clinics like a year ago. everything has been uphill. difficult.
i don't have much time to study for step 2. i'm planning to do the usmle world q-bank and first aid for the medicine clerkship and first aid for step 2. i'm getting ~70% on usmle world right now. what is a score to pass comfortably? to do well?
thanks,
ap
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| mazinger
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with 70s youll do fine.. 6 years from step 1, you have to hurry up! your step 1 is only valid for 7 years...
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original mazinger z
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| zianab
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Q NO 9 B) Atrial septal defect
MAZINGER I AM NOT SURE ABOUT THIS OPTION,CAN U PLEASE EXPLAIN IT
IT looks like TIA ,SO D) Duplex scan of the carotid arteries .
mazinger do u know what is the correct option
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| mazinger
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Agree on both of them... About question 9 I do not remember all of the physicall findings asociated to ASD but one classic is wide fixed split S2...
U are right the first place to look for in this case, is a carotid artery dzs, not much scientific my explanations though, but this is what comes from my memmory... hahaha... I can revise later and try to post a state of the art explanation (I like this phrase, used by usmleworld staff so Im just copying it)..
Will give my best shot..
Zianab what do you think of the new set of questions, those related to psych I find them quite hard though..
Edited by mazinger on 12/06/06 - 08:15 PM
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original mazinger z
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| zianab
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thankyou mazinger for your answers .looks like it is just me and u answering qs as of right now
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| zianab
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ANSWER FOR NEW QS:
1--A) Inquiry about an egg allergy
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| zianab
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INFLUENAZA vaccine :we always ask about egg allergy
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| zianab
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3A) Cardiogenic shock
criteria for cardiogenic shock are sustained hypotension (systolic blood pressure <90 mm Hg for at least 30 min) and a reduced cardiac index (<2.2 L/min/m2) in the presence of elevated pulmonary capillary occlusion pressure (>15 mm Hg).
The diagnosis is due to hypotension and clinical signs of poor tissue perfusion, which include oliguria, cyanosis, cool extremities, and altered mentation. These signs usually persist after attempts have been made to correct hypovolemia, arrhythmia, hypoxia, and acidosis.
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| zianab
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4B) Esophageal rupture
air in mediastinum ,mazinger can u comment on this
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| zianab
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9B) Offer to change the medication
NOT SURE
10C) Add oral methotrexate
DMARD DRUGS.SECOND LINE.METHOTREXATE HAS LESS SIDE EFFECTS THEN OTHERS
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| zianab
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15B) Vitamin A
FAT SOLUBle vitamin ,stored in liver .
The rest of qs I will answer later
mazinger ,npas and dr pumkin can u p;lease start commenting on answers
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| mazinger
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1 Agree egg allergy
2 I was thinking more of a strep throat than a corynebacterium, most of the clinical manifestations of both dzs are shared but they differ on key points.. Strep can produce exudate and adenopathies, but corynebacterium produces a thick exudate resembling a pseudomembrane.. Its toxin may also have effects at the brain and the heart...
3rd agree cardiogenic shock nice explanation zianab..
4th Esophageal rupture key points, CXR widening of the mediastinum, high amylase content in the pleural fluid, hemodynamic instability... All point towards it..
5th Chylotorax milky pleural fluid is pathonogmonic..
6th I dont know I suck at this type of questions.. But if I have to choose one its admit the patient and prescribe oral imipramine.. Patient looks pretty depressed and he's having psychotic features, eventhough he's not planning to hurt himself at this moment, perhaps after he is treated he will have enough will to commit suicide, anyways I think I am fantasizing again on this case... anyways I dont know but I pick this..
8 I go for A, kids to that age should be able to scribble and also should be able to have fully functional grasp (princer grasp is achieved at 6 months of age)..
9 B agree on this, but I think I will never be a 100% sure on this type of questions..
10 Agree its C
11 C in restrictive dzs all lung volumes are decreased
12 D, why? this is a tough one, what is it that we do to lyse a clot lodged at the pulmonary vessels, we give only anticoagulant meds.. We wait for the patients own plasmin system lyse the clot.. But this doesnt always happen, many patients may develope chronic pulmonary hypertension as a consequence of a "stable clot" in the pulmonary vessels.. This patient may have chronic pulmo hypertension and will eventually have right sided heart failure..
Comments are accepted on this one, its just one of my theories though...
13 MS why MS and not ALS? or something else? this patient has a history of right eye optic neuritis, that's what made me pick this choice over anything else (optic nerve is myelinized by oligodendrocytes)...
14 Hypercholesterlomia? Highest risk factor for peripheral vascular dzs...
15 Vitamin A, its the only lipid soluble vitamin of all.. Lipids are emulsified by bile salts in order to be absorbed by the gut.. Its the only one I can think of.. Comments are also accepted here...
Well I answered all of them, Ill be waiting for the rest to answer this new set be4 I post a new one...
Regards...
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| anne06
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well i disagree on just 2 ans..
q9 i think shud b c and q14d,i think ht is d most common 4 pvd..
mazinger very nice explanation 4 q12
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| mazinger
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anne06 wrote:
well i disagree on just 2 ans..
q9 i think shud b c and q14d,i think ht is d most common 4 pvd..
mazinger very nice explanation 4 q12
Anne06 you are right about question 14, I hate doing google searches and paste ons, but I found this two little paragraphs quite useful..
Potentially Modifiable Risk Factors for Ischemic Stroke
Hypertension
Hypertension is the single most important modifiable risk factor for ischemic stroke. Most estimates for hypertension indicate a relative risk of stroke of approximately 4 when hypertension is defined as systolic blood pressure >=160 mm Hg and/or diastolic blood pressure >=95 mm Hg. A summary of seven studies assigning a relative risk of 1 for borderline or mild hypertension determined the relative risk to be about 0.5 at a blood pressure of 136/84 mm Hg and about 0.35 at a blood pressure of 123/76 mm Hg.20 From the lowest to the highest level of blood pressure in this summary, risk is increased about 10-fold. Although clearly important even in the elderly, the impact of hypertension may decrease with age: the odds ratio is 4 at age 50, decreasing to 1 by age 90.21 From population surveys the prevalence of hypertension is about 20% at age 50, about 30% at age 60, 40% at age 70, 55% at age 80, and 60% at age 90.22 When the Joint National Committee V definition is used (>=140/90 mm Hg or on antihypertensive medication), prevalence increases to about 45% at age 50, >60% at age 60, and >70% at age 70.22 The prevalence of hypertension is greater in blacks than in whites.
The efficacy of antihypertensive treatment has been well established in clinical trials. In a summary of 17 treatment trials of hypertension throughout the world involving nearly 50 000 patients, there was a 38% reduction in all stroke and a 40% reduction in fatal stroke favoring systematic treatment of hypertension.20 This effect was true in whites and blacks and at all ages. Treatment was also highly effective in preventing stroke in elderly persons with isolated systolic hypertension (Systolic Hypertension in the Elderly Program [SHEP]), the most prevalent form of hypertension in persons older than 65. Importantly, there was no less impact on stroke prevention above age 80, with incidence reduced by 40%.
So the final answer is hypertension... coool anne06.. could U explain q9 please?
regards
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original mazinger z
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| selina
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hi guys u r all doing a gr8 job and helping all of us
where can i find the questions u r discussing.
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| mazinger
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Topics: 46
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Dear selina you can go to usmleforum and check the posts because many of these mcqs were formerly posted in that forum..
BTW Gundam fight get set.... Ready? GO!!!!!!!
Sorry cant stop being an otaku..
Edited by mazinger on 12/10/06 - 06:30 PM
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| zianab
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here are answers
1E) Thiazide diuretic
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| zianab
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2A) X-ray films of the abdomen while supine and
standing
looks duodenal ulcer to me.so plain xray will be done to look for air under diaphragm
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| zianab
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3C) Scabies
The itching is due to an allergic reaction to the tiny mites, and is associated with a rash of red, raised spots e.g develops around wrists .Herpes is painful not itchy.
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| zianab
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4A) Trimethoprim-sulfamethoxazole prophylaxis
5F) Intraductal adenoma
common cause in young female
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