Plethora of evidence first. A – Ah, countertransference. RLL is the most common site, which they have provided (thank you, big vertical bronchus). https://www.benwhite.com/medicine/explanations-for-the-2017-official-step-3-practice-questions/. Which of the following is the most likely mechanism responsible for the biopsy findings? Based on last year’s set, you’d be hoping for low 80s+. For these specific NBME style questions – you know, the wishy/washy ones- would you follow the principle of “History first”?? The question states left hemiparesis and right-sided tongue deviation which would mean a right-sided lesion (answer C). An increased susceptibility to abscess formation, as manifested by a medical history of recurrent abscesses. Thank you so much for this wonderful source of information and explanation regarding the free 120 this year (and all previous years for that matter). 75 – wouldn’t you expect annular pancreas to be in a newborn? Past medical history is significant for recurrent infections by the same organism. Recurrent infection â The approach to management of recurrent purulent cellulitis is the same as the approach to management of the initial episode. S4 is not even something to jump to HCM for in a random 50-year-old man who is presenting for the very first time with classic signs of coronary ischemia. Old frail people (and alcoholics) love to get aspiration pneumonia. Perianal abscess is a simple type of anorectal abscess characterized by collection of purulent material on the skin surface surrounding the anus. super helpful and convenient! Can you or anyone please explain! Why, you might ask, would we do this? *, F – Many autoimmune/autoinflammatory conditions, including ankylosing spondylitis, are treated with DMARDs like anti-TNF-alpha medications when milder stuff doesn’t do the trick. His blood pressure is 60/40 mm Hg, respiratory rate is 27/min, and heart rate is 110/min. Oh, cool. Thanks again. I am interested to know your opinion. Hello ben thanks so much for explicatons but i need to know about sample test usmle 2018 score conversion. Projection is when you assign your own feelings to them (you are angry, so you think you they are angry). An hour later in the hospital, he slowly developed a rash on his chest, arms, and legs. Regardless, the other answer choices cannot be correct. I posted a score correlation link at the bottom of the page that you can check out which has estimates from both 2016 and 2017. Granulosa cell tumors, on the other hand, sometimes produce estrogen (which can lead to precocious puberty in young girls but otherwise may be occult). On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. Aren’t nitrates contraindicated in patients with HCM? He also has a history of chronic bloody diarrhea and pronounced bleeding after his circumcision. Dont they both have lesions in the mouth and hand/fingers? Thank you so much for these explanations they really really helped me out alot. Thank you. It is associated with morning stiffness that lasts for almost an hour. The question asks what lab finding would be consistent with decreased immune activity (and thus the only choice that matches “decreased” with an immune cell is the best answer). Microscopic examination of the stool” is correct, but the explanation is not. Thanks again. E – Gram-positive rods in a diabetic foot wound (or a World War I soldier fighting in a trench) means Clostridium perfringens (the causative organism of gas gangrene). There’s a lot of supporting data, but one should guess this answer once you read the word “gymnast” (or “dancer”). C – Osgood-Schlatter is also known as apophysitis of the tibial tubercle. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. C – Filgrastim is a granulocyte colony stimulating factor (GCSF), which are drugs used to increase white blood cell count in patients with leukopenia. I have a question about question 57 on CGD. This type of organism is, by definition, resistant to treatment with many of the standard Just because there is a treatment or potential cure for a disease doesn’t change its natural history. A 2-year-old boy presents with multiple skin abscesses positive for Staphylococcus aureus. So I was stuck between choosing hand foot mouth disease with no foot or uncharacteristically mild primary HSV-1 infection that affected both the hands and the mouth, not just one. The answer lies within our vision, which is to make top-quality medical education available to as many students as possible. She require… NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). I was between membranous and spongy and I ended up choosing spongy because of the perineal bruising and fact that the patient was riding a motorcycle (and therefore susceptible to straddle injury). Way overthinking it, I’d say. Let me know please. Usmle medicine notes right from top authentic sources like Harrison's Principles of Internal Medicine will be very helpful for Usmle step 2 preparation. Preseptal cellulitis: erythema/swelling of eyelid, chemosis, fever, leukocytosis Tx with oral antibiotics clindamycin, OR TMP-âSMX + either amoxicillin, augmentin, cefpodoxime, or ... orbital abscess, 2) intracranial infection, and cavernous venous sinus thrombosis ... in persistent/recurrent ⦠Thanks SO much! N/A. I guess I am confused on #50. Some small skin abscesses may drain naturally and … Bacteria can get into your skin and cause an abscess if you have a minor skin wound, such as a small cut or graze, or if a sebaceous gland (oil gland) or sweat gland in your skin becomes blocked. Questions. Hi Ben, Thank you so much for your consistent help! Case of recurrent infections - investigation, diagnosis and treatment of Chronic Granulomatous Disease (CGD) and study of immunology of the immunodeficiency. Wet mount microscopy is positive for yeast. Want to partner? Skin abscesses (Acne) may have been neglected – poor hygiene; Limited access to health care – self-sufficient adult now, no transport or … They have to give it to you. *, B – This question is a little bit BS, in that there is nothing in the stem at all to make you think this specifically. Learn more about ⦠No sorry, I’ve never done any of the Step 3 sample question sets. Take your time for step 3. I am a new subscriber to your blog. In one series of 540 intra-abdominal abscesses, none were in the spleen. Bleeding boys have hemophilia. *, D – A b2 agonist like the bronchodilator albuterol would sure help that wheezing. The inferior thyroid is the primary supply and thus the “single best answer.” Remember, the other answers don’t have to be wrong to not be the best. The similarity is not a coincidence. Thank you for all the explanations! B is the false positive rate, the number of people with a positive test but no disease. Which of the following statements is true regarding vaccination in this patient? Expression of selectins on the surface of endothelial cells, C. Formation of tight bounds between leukocytes and endothelial selectins, E. Inhibition of the interaction between platelet endothelial cell adhesion molecules (PECAMs) on the surfaces of leukocytes and endothelial cells. However, my thoughts were that a direct bilirubinemia is a false finding in Gilberts (since it is due to lower UDP enzyme activity), and would more likely indicate obstruction. Checking the stools for larvae is the most sensitive test. Other cell types usually retain the nonrearranged gene structures.”. Are you preparing for USMLE Step 1? Retropharyngeal abscesses can be caused by extension of local infections, such as upper respiratory infections, or from trauma such as dental procedures. E – Subacute combined degeneration (progressive peripheral sensory and motor loss) is a late sign of B12 deficiency, which is common in old people. *, C – The purpose of Rhogam is to bind to and remove the RhD antigens so that the mother does not form an immune response against the antigen in fetus’ blood. DHT is responsible for creating male genitalia during fetal sexual development. A previously healthy 11-year-old girl develops a gastrointestinal infection with cramping and watery stools. Strongyloides, unlike CLM, explains the diarrhea, weight loss, and not just the eosinophilia. Average 5.0 of 3 Ratings. First I want to say thank you so much for taking the time to do this!! Lack of response to adrenal androgens prevents hair formation during puberty (adrenarche). :). Also, is hypoglossal involved in the stem because of damage to the nerve fibers themselves rather than the nucleus? V2 exits via foramen rotundum. Most immediate treatment is nitro.*. There is more than a single monolithic VWD, and so while platelet aggregation time (or on tests the somewhat unreliable low-tech “bleeding time”) is the best test, in reality, the idea is that you don’t need a diagnostic lab abnormality to have the disease. These 45 abscesses were in 43 of the 785 patients. Trial of warm compresses for small abscesses; Incision and Drainage. C – While E coli is normal gut flora, your body would prefer it stay intraluminal.*. P-selectin may be involved in platelet and white-cell recruitment but does not cause granulation tissue formation etc. Seriously, massive respect. p53 activity also holds the cell at the G1/S regulation point (B), limiting DNA synthesis. At the time of presentation, his vital signs are as follows: the blood pressure is 80/50 mm Hg, the heart rate is 87/min, the respiratory rate is 17/min, and the temperature is 36.5°C (97.7°F). Oh wait, that’s what the question described anyway (two-year-old with recurrent abscesses), meaning that the PMA nonsense was basically superfluous. Are you sure it’s not simple A2/P2 splitting–especially given that it increases with inspiration? Lyme carditis typically manifests as AV block. He works as a sales executive and visited Hawaii a month ago. Among other questions, the patientâs mother asks you how his condition would influence his vaccination schedule. She reports that these episodes have occurred 6â7 times a year since the age of 5. A – Air and fluid = hydropneumothorax. B – p53 is an important tumor suppressor gene, particularly in its ability to cause a cell to undergo apoptosis in the event of damage. secondly all the catalse positive bacteria are not even facultivate intra-cellular… what’s your opinion on that? A. We know that in order to become a great doctor, you should have as much experience with clinical case questions as you can â not only do such questions deepen your understanding of important medical topics, but you will also learn from the beginning with the type of questions you will face during your Step 1 and Step 2 exams. Past medical history is significant for recurrent infections by the same organism. A larger abscess may require placement of a drain for up to 3 weeks. Poorly functioning kidneys do not hydroxylate 25-Dihydroxycholecalciferol to 1,25-Dihydroxycholecalciferol well nor produce adequate erythropoietin (hence the CKD-related anemia). Then you hear decreased oxidative burst and immediately think NADPH oxidase deficiency aka Chronic granulomatous disease, which causes recurrent abscess-forming infections due to the inability to kill ingested organisms because of the inability to generate superoxide radicals. You can get an abscess anywhere on your body. In autopsy series, the incidence has been between 0.2% and 0.7%. The answer you have matches up correctly. Main nitrate contraindications are erectile dysfunction meds, hypotension, large pericardial effucion, large RV infarct, or severe aortic stenosis. A group of mice are inoculated with the virus, and blood is subsequently drawn from these animals at various intervals to check immunoglobulin levels. Try 10 free immunology practice questions below or access more in. B: T lymphocytes are critical for protection, especially against a number of fungal and viral pathogens. But it was only 3 hours in this question and the answer was metabolic acidosis. 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