The CT image shows a completely normal interval between the aorta and SMA without compression. The cDNA tag is tagging a constant region common to immunoglobulins, so it normally only finds the one band corresponding to that particular gene (the bands travel different amounts due to their differing size/weight). 107. Does hep C not come and go (answer B “latent infection with intermittent viremia”). There is no randomization as there is only a single treatment group. 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. Want to partner? However, recurrent infections are more likely to have causes other than immunodeficiency (eg, inadequate treatment, resistant organisms, … Does It Cost More to Train Residents or to Replace Them? *, A – The usual cold-like symptoms of runny eyes and a sore throat are common of several strains of adenovirus that are readily communicated amongst humans in close contact. Hi Ben, Thanks for your amazing work here. B – Crohn’s: skip lesions, fistulae, strictures (and the unnecessary transmural involvement on histology). Thanks Ben! Thank you for such comprehensive explanations! A lower alpha-value means a lower acceptable likelihood of obtaining the same results by chance, and thus, significant results can be reported more confidently (a 1% false positive rate instead of a 5% rate). *, E – CNS amoebiasis is most notoriously caused by, E – Functional parathyroid adenomas can cause elevated parathyroid hormone (PTH), which results in hypercalcemia and hypophosphatemia. Yes, it’s the fibers. These 45 abscesses were in 43 of the 785 patients. Ps – love the yearly reading lists and am excited to read your book. That would be the inferior thyroid arteries, which arise from the thyrocervical trunk.*. It’s kinda funny because it turns out that, indeed, both diseases are treated with Streptomycin. Search. Thanks again. For these specific NBME style questions – you know, the wishy/washy ones- would you follow the principle of “History first”?? A. MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). Laboratory investigation reveals the presence of anti-cyclic citrullinated peptide (anti-CCP). Contrast with gout, negatively birefringent, big toe. Not sure about it but i think the answer is Tularemia treated with Aminoglycosides. On the imaging, it would be smooshing of the duodenum by a bright contrast filled artery as opposed to surrounding by soft tissue. A variety of brain and lung pathologies are possible etiologies, with lung cancer (of any type) being an important cause. The virus can cause a cold-like URI syndrome with fever. Splenic abscesses are uncommon and only several hundred have ever been reported in the medical literature. The latter (can happen but not something to be relied on). Immunodeficiency typically manifests as recurrent infections. I have a question about question 57 on CGD. The photomicrograph is demonstrating, A – p53 is the quintessential tumor suppressor (it activates apoptosis). 5 - Recurrent, deep skin or organ abscesses . A differential for both to keep in mind is septic arthritis.*. Smaller abscesses may not need to be drained to disappear. You are AWESOME!!! Which of the following would be the definitive treatment of this patient’s condition? I have no idea how up to do date any particular available stolen version would be, but they defintiely won’t have any of the software features, test creation, question flagging, etc that are an important part of the product. In autopsy series, the incidence has been between 0.2% and 0.7%. An anal, or rectal, abscess occurs when a cavity in the anus becomes filled with pus. The issue of the day is that he has a DVT. E – VEGF is a major tissue growth factor activated by injury, cytokine release (infection, inflammation) and hypoxia that promotes angiogenesis and also increases vascular permeability (hence the edema). *, 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. Additional treatments may be recommended, such as a body wash or an antibiotic cream, to stop these bacteria living on the body. Recurrent cutaneous abscesses can be caused by particularly virulent pathogens, immune deficiencies, or primary dermatologic conditions. The picture demonstrates H pylori, which are evident with silver staining. Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Syndrome, is an autosomal dominant disorder of the blood vessels characterized by recurrent nosebleeds, spider-like blood vessels, and arteriovenous malformations (AVMs). Hi Ben, Thank you so much for your consistent help! RLL is the most common site, which they have provided (thank you, big vertical bronchus). A 3-year-old toddler was rushed to the emergency department after consuming peanut butter crackers at a daycare. For question 115, would decreased cardiac output not also increase the blood pressure due to sympathetic activation of the baroreceptor reflex? A. Got the test in 2 days. Which of the following best describes this patient’s condition? Your doctor will likely be able to diagnose a boil or carbuncle simply by looking at it. Recurrent cutaneous abscesses can be caused by particularly virulent pathogens, immune deficiencies, or primary dermatologic conditions. Note that epinephrine (such as in an epi-pen) would also achieve this but is nonselective; in this case, the patient’s symptoms would be helped most by the beta-2 component. Just because her CK is normal doesn’t mean she isn’t a carrier–the phenotype of the X-linked carrier depends on X-inactivation. Trial of warm compresses for small abscesses; Incision and Drainage. Note, this is likely actual respiratory alkalosis, not simply normal respiratory compensation for metabolic acidosis. hello again Ben and thank you for everything..is it possible to get uwsa offline? We know that in order to become a great doctor, you should have as much experience with clinical case questions as you can – 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. Questions. It’s not just the pancreas involved, this is a germline mutation process. V2 exits via foramen rotundum. Both are caused by gram negative bacteria transmitted in similar ways and often causing a similar clinical picture. A – The alpha-value corresponds to the p-value we will accept as significant and reflects the likelihood of a type I error (a false positive). There is no way to know which her daughter eventually receives and expresses by her phenotype (i.e if she is a carrier or not). No one knows. Bacterial causes of hepatic abscesses include E. coli, Klebsiella, Streptococcus, Staphylococcus, Bacteroides, and Pseudomonas. The tag here is for an antibody constant region. 0. Video-assisted thoracoscopy is performed, and a biopsy from the right lower lobe is taken, which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. It’s actually not necessary to have to have HSV simultaneously on the hands and mouth. I thought since the female has bone marrow failure and is receiving antithymocyte globulin (idk why she would get this anyway), she has no functioning B-cells and therefore cannot develop a antibodies to foreign proteins. You took a giveaway easy question and tried to make it a trick question. A diagnosis of exclusion, most of the stem is helping you rule out more serious issues. 6 - Failure of an infant to gain weight or grow normally 7 - Persistent thrush in mouth or elsewhere on skin, after age 1 8 - Need for intravenous antibiotics to clear infections 9 - Two or more deep-seated infections such as meningitis, osteomyelitis, cellulitis, USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). She used to treat these symptoms with topical ketoconazole cream, but this time it failed to help. She require… Chronic infection is associated with an increased risk of, D – Hot tub folliculitis, it’s a thing. Thank you so much for your help during my STEP prep! Remember that transference is when the patient is transferring (redirecting) feelings about someone on to you (you remind them of their dad). B – You will remember that G6PD deficiency causes red blood cells to break down in response to certain stressors, infections, and drugs. But I was wondering, some of the answers have a * symbol at the end- does that mean anything specific? Their effect on LDL is by far the most potent, but they do a little good on everything. Thank you SO MUCH for these explanations! I found your website while studying for Step 1 and I read through all the question explanations/test taking strategies. Glucose oxidase test in the urine checks for glucose (where there wasn’t any because the child cannot produce any from the lactose). The United States Medical Licensing Examination (USMLE) assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease. In particular, we sought to assess whether the abscesses had been completely drained at the initial procedure and whether pa-tients subsequently required surgery for defini-tive treatment of the underlying disease. C – Statins raise HDL and decrease LDL and TGs. At age 3 he presented to hospital with pyrexia, a swollen right knee and a poorly healed superficial abscess … The first case of aseptic systemic abscesses has been published in 1995 (André et al., 1995). I am interested to know your opinion. Usmle medicine notes right from top authentic sources like Harrison's Principles of Internal Medicine will be very helpful for Usmle step 2 preparation. D – Schistosomiasis is a parasitic worm particularly endemic in Africa (Egypt, in particular, comes up the most on questions) that is most associated with chronic cystitis. NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). In this case, this stimulation produces no response, suggesting NADPH-oxidase deficiency (which means this is another question about chronic granulomatous disease). A chest radiograph was obtained and is shown in Figure A. Blood test results show anemia, thrombocytopenia with small platelets, and leukopenia. E – Endothelial tight junctions’ permeability is increased in response to injury and inflammation, allowing migration of white blood cells and friends to the site of injury. The cause! Students: Educators’ Pro Tips for Tough Topics, Institutions: Ensure Medical Teaching Continuity, Total leukocyte countNeutrophilsLymphocytesEosinophilsMonocytesBasophils. Physical examination reveals tenderness and swelling in both hands and wrists, most severe over the proximal interphalangeal joints. Which of the following is the most likely mechanism of this pathology? In contrast, von Gierke disease results in hypoglycemia and subsequent lactic acidosis due to the body’s inability to properly convert glycogen back into glucose for gluconeogenesis during periods of fasting. *, F – Total peripheral resistance goes down during exercise as the arterioles supplying muscle and skin dilate. Review Topic. Abscesses can occlude the nasolacrimal duct, causing severe dacryocystitis, or form within the nasal passages, causing rhinitis, respiratory noise and increased respiratory effort. Haha.. loved the experience. Which of the following is a critical step in the endogenous pathway of antigen presentation for the virus model presented above? The organism should thus be an abscess forming bacteria such as staph aureus. The asterisk means that the question was new since the prior year. A sample of the pus may be sent to the lab for testing. 71 – why could it also not be C? :). *, B – This question is a little bit BS, in that there is nothing in the stem at all to make you think this specifically. There was no choice for pure respiratory alkalosis. Would E then be the inferior vestibular nucleus based on that linked image? B – To amplify tiny fragments of DNA in order to detect their presence, we use PCR. Yes. Autism-like behaviors and relatively large head are common; large testicles only appear after puberty. Thanks again, Yoav. It’s hard to find as many clear educators as you nowadays. E – The patient’s chronic inflammatory pneumonitis is killing off his lung parenchyma (composed primarily of type I pneumocytes). A 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure. Both type II and III hypersensitivities. Thanks SO much! I feel like in both there would be weight loss, vomiting, dilated stomach/duodenum. *, D – If the fluid keeps coming into the glomerulus (via the afferent arteriole), but you clamp the exiting vessel (the efferent arteriole), then it’s going to build up in the glomerulus, leading to increased hydrostatic pressure.*. *, C – Approximate fasting physiology timing: the post-absorptive phase (6-24 hours after a meal) is dominated by glycogenolysis. A. If you were to make a list of pro/cons for each diagnosis using history, physical and objective data (labs, imaging, etc), the scales usually tip firmly in one direction. Leucovorin (folinic acid) sounds like it would also be right, but it’s used to prevent bone marrow suppression in patients taking methotrexate. (M1.PL.13.78) An 86-year-old male with a past medical history significant for an MCA stroke presents with recurrent fevers. I assume they’re showing E as the hypoglossal nucleus (see this other illustration/article). They even gave you the hint that the patient has “difficulty swallowing,” which is code for “aspirates when swallowing.”*, B – The proliferative phase of the menstrual cycle is controlled by cyclin-dependent kinases.*. Thank you! This facilitates using these explanations in future years when they change the available question set (because the old ones are always available via archive.org). Are you preparing for USMLE Step 1? Most people are not prepared to discuss sexual matters openly as it can be perceived as negative or inappropriate. Staphylococcus is the most common bacterial cause of skin abscesses. She is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections. Wet mount microscopy is positive for yeast. High quality Qbanks generally cost between $50 and $100 per month, which most students are not able to afford. As a result, they are often discussed together. https://www.benwhite.com/medicine/explanations-for-the-2017-official-step-3-practice-questions/. Microscopic examination of the stool” is correct, but the explanation is not. [from HPO] Recent clinical studies. Came here to ask the exact question, glad you beat me to it! Retropharyngeal abscesses can be caused by extension of local infections, such as upper respiratory infections, or from trauma such as dental procedures. You’ve saved me so much time in the few days leading up to my step exam. For #48 – I was thrown off by the picture, which doesn’t show bite cells or Heinz bodies–it looks more like schistocytes or potentially sickle cells. © 2020 Lecturio GmbH. Skin abscesses (Acne) may have been neglected – poor hygiene; Limited access to health care – self-sufficient adult now, no transport or … Thanks to both of you. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. Thiazides block the Na-Cl symporter, as opposed to loop diuretics, which block the triporter, and acetazolamide, which blocks carbonic anhydrase in the proximal tubule. Past medical history is significant for recurrent infections by the same organism. In girls, this is primarily due to adrenarche (DHEA/DHEAS androgen production made by the adrenal gland the zona reticularis). Thank you so much, that helped tremendously! Question asks what’s causing the “formation of this tissue.” Single best answer. In one series of 540 intra-abdominal abscesses, none were in the spleen. Reactive processes are polyclonal (multiple bands); leukemia, in contrast, is monoclonal (single band). Endoderm from the fourth pharyngeal pouch. The father will pass it on in 100% (because both of his copies are affected). C – Swallowing amniotic fluid is a critical component of lung development. I think the level in that example is a bit off from ours in the question. Teratomas are oddballs that typically have fat, hair, teeth, etc. Depends on the kind of aggregation studies (and the kind of VWD). If you’re curious, see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927478/. The answer lies within our vision, which is to make top-quality medical education available to as many students as possible. That is likely because if that choice had been available, the correct answer would be debatable. A 2-year-old boy presents with multiple skin abscesses positive for Staphylococcus aureus. What increases my risk for an abscess… Whoops, guess I didn’t refresh in forever and missed Michael’s comment. B –  The left-sided system is much higher pressure than the right side, hence the aortic valve closing is usually louder than the pulmonic valve. Bacteria causing cutaneous abscesses are typically indigenous to the skin of the involved area. Does the superior thyroid not also give arterial supply to the parathyroid glands? Learn vocabulary, terms, and more with flashcards, games, and other study tools. 2 2. ... Retropharyngeal abscess: abscesses that occur in the retropharyngeal space. A – The main downside of live vaccines is that they rarely cause the disease they’re designed to prevent, typically in immune-compromised individuals (who either get the vaccine or are close contact to someone who does)*. I guess I am confused on #50. And yes, drugs addicts should also receive narcotics to control pain. A 10-year-old boy presents to the emergency department with sudden shortness of breath. Leydig cell tumors aren’t always physiologically active, but those that are can cause masculinization. It’s alright. You’ve been a huge help. ... recurrent viral/fungal infections, congenital heart and great vessel defects, tetralogy of fallot, pulmonary stenosis ... course Facies, cold (non inflammed) staphylococcal Abscesses… Congenital immunodeficiency disorders are characterized by a deficiency, absence, or defect in one or more of the main components of the immune system.These disorders are genetically determined and typically manifest during infancy and childhood as frequent, chronic, or opportunistic infections.Classification is based on the component of the immune system that is … It has become my go-to as I take my Step in a couple of days. Recurrent cold staphylococcal skin abscesses that are associated with little or no inflammation are seen in these patients. Chronic interstitial inflammation results in fibrosis, hence an increase in fibroblasts. HPV carcinogenesis is caused by insertion of the virus into host DNA that produces a protein which binds to an essential p53 substrate, functionally inactivating p53 and preventing its apoptotic cascade. Non-specific Causes. Diuretics exacerbate the situation, working against your body’s desire to retain fluid to compensate. Thank you. Logically, if the disease causes fibrosis elsewhere, it’s going to cause fibrosis in the lungs. These patients often complain of pleuritic chest pain that is somewhat alleviated by sitting up and leaning forward and have distant heart sounds. Consequently, an incomplete health assessment can result in delayed diagnosis or misdiagnosis.Case Report. Thanks for compiling such an informative website. or something that can happen, but doesn’t have to? The decision for cricothyrotomy is made. That was one of two new questions changed in the 2019 set, see the explanation updates here: https://www.benwhite.com/medicine/explanations-for-the-2019-official-step-1-practice-questions/ (the other one was changed on this set mid-year and is reflected above). It decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.*. Thanks for clarifying, Ben. DHT is responsible for creating male genitalia during fetal sexual development. Hey just a heads up Question 8 Block 2 has been updated. Projection is when you assign your own feelings to them (you are angry, so you think you they are angry). Thank you! Pathoma says vWF stabilizes FVIII so VWD causes an increased PTT. Abscesses can be treated in a number of different ways, depending on the type of abscess and how large it is. What the next best thing? I am taking the exam in 2 days so time is of the essence and didnt want to dig around on forums for the explanations, so your website has helped TREMENDOUSLY! Despite the improvement in patient-physician communication techniques, sexuality and sexual health continue to be challenging areas for discussion during a clinical encounter. HFMD is a common childhood illness where the kids display fever, prodromic symptoms, often poor appetite, blah blah blah. On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. What is an abscess? Over-the … I think it’s perhaps no surprise that the question hinges on a shared treatment and not the diagnosis. A – Narcotic use for acutely painful conditions is both reasonable and important. Incredibly helpful. On Step, bleeding women have VWD. Again, it can happen significantly earlier. Which of the following is the most likely mechanism responsible for the biopsy findings? His mother reports a history of recurrent chest infections during the past year. I noticed that your website has a wide variety of information regarding Step 2, so I already bookmarked your website and will be a regular! Tonsillectomy may be considered for recurrent PTA. Can you walk me through 89 a little more for the other answer choices? E – Pill-rolling resting tremor of Parkinson’s disease secondary to loss of dopamine neurons in the substantia nigra. primaquine) are the common test favorites. Early hematopoietic stem cell transplantation (HSCT). Today, she only complains of slight fatigue with upper and lower extremity weakness. E – Multiple infections. Thanks so much! Neuroectoderm was what people previously believed. I can’t seem to find a similar image online that describes exactly what those areas are covering. 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. D –Diffuse low-level ST elevation means pericarditis. Most commonly affected location is the knee. Type II pneumocytes, in addition to making surfactant, can replicate in order to replace type I pneumocytes, so they will be increased. For an example, see Figure 6 from here. Strongyloides larvae can borrow (hence the rash) and can migrate to the GI tract and lay their eggs, which then hatch in the intestine and cause diarrhea. For question 101 I understand the breast feeding time period coming in for the lactose breakdown to galactose and glucose, but why coulnd’t Von Gericke be a differential aka choice D? B – Anorexia leads to hypogonadotropic hypogonadism, as the body realizes that the possibility of nourishing a fetus is zero and gives up the pretense. B – The Lincoln’s beard distribution described is that of the V3 branch of the trigeminal nerve, which exits the skull base via foramen ovale. I’m taking my STEP1 in a few days. The patient is prescribed a drug that is an inhibitor of ɑ4-integrin (CD49d) for the prevention of relapses. Surgeons should perform an examination under anesthesia to evaluate patients with recurrent or bilateral abscesses for intraoperative drainage, including cases where internal draining may be necessary. D – PMA activates NADPH-oxidase, such as seen in the oxidative burst. His breathing became faster with audible wheezing. Out of the four combos, two are two gene deletions. This explanation is legendary. But it was only 3 hours in this question and the answer was metabolic acidosis. Diagnosis is by CT. B: T lymphocytes are critical for protection, especially against a number of fungal and viral pathogens. C – This question is asking for the vascular supply of the parathyroid glands. 75 – wouldn’t you expect annular pancreas to be in a newborn? Regardless, the other answer choices cannot be correct. Children can sometimes autoinfect their fingers from their own oral lesions (aka thumb-sucking), as in this case. On exams, a geriatric patient who lives alone and may have a “tea and toast” diet is likely to have vitamin deficiencies, particularly of folate and B12. An increased susceptibility to abscess formation, as manifested by a medical history of recurrent abscesses. ... indicated for severe infection or recurrent abscesses Please rate topic. She is likely to have another immune impairment in addition to the 1 for which she was tested, C. She should receive prophylactic courses of wide-spectrum antibiotics to prevent infections, D. Her phagocytes can only perform extracellular killing, E. She is susceptible to all mycotic infections. C – The Pouch of Douglas is the space between the uterus and the rectum (i.e. Lack of response to adrenal androgens prevents hair formation during puberty (adrenarche). Countertransference is when you do it about them (they remind you of your son). Limited lesions can be injected with corticosteroids, and flares can be addressed with short courses of oral or intramuscular cortico-steroids. It depends on which kind of aggregation studie and which type of VWD. Sometimes, especially with recurrent infections, you may need … In this case, it’s not respiratory compensation. It’s not a virus like Herpes or Varicella that infects a host and then lies dormant until episodic reactivation. Is that not true? C. Recurrent skin abscesses or poor wound healing D. Recurrent warts. That is, however, not true. The main treatment options include: antibiotics a drainage procedure ; surgery; Skin abscesses. A 21-year-old woman presents to her physician for a regular follow-up visit. The maternal uncle is the hint to the X-linked inheritance. Thank you! 9 – why not A? I figured out some diagnosis .. but confused about some other ones .. it would be great if you did an explanation for step 3 as well please. The long bones of the arms and legs are most commonly involved in … All rights reserved. The default human gender is female. B – The arrow is pointing to a neutrophil (multilobed nucleus): main fighter of the immune system in acute inflammation and bacterial infection (such as aspiration pneumonia). C – This patient has hepatitis (elevated liver enzymes) due to active Hepatitis C infection. A type III (immune complex) hypersensitivity. ... recurrent, or chronic sinusitis, ... TEE with color Doppler is the test of choice to detect perivalvular abscesses … Hello ben thanks so much for explicatons but i need to know about sample test usmle 2018 score conversion. N/A. Can you please explain why B is incorrect for number 17? Your best bet for score correlations is probably here. While HSV1 can certainly be devastating in the form of herpes encephalitis, most cases are mild. Also loved the couple of historical facts you thrown there. Just wanted to say thank you for providing these explanations! The answer for number 14 “D. They presumably mean ‘intracellular’ in the more mundane sense that once a neutrophil phagocytizes an organism it is by definition “inside” the cell. Frequently, the only laboratory abnormality is increased bleeding time (literally you prick the patient and see how long it takes them to stop bleeding). Main nitrate contraindications are erectile dysfunction meds, hypotension, large pericardial effucion, large RV infarct, or severe aortic stenosis. I was hoping you might be able to offer some insight into the way that you did calculations for question 27 (thalassemia inheritance), as when I diagram it out in a Punnett square, I keep getting an answer other than 50% for the two gene deletion. I look forward to reading more of you work as I progress through medical school! A and D, for example, would reflect lesions that cause what is called lateral medullary syndrome (Wallenberg syndrome). Etiology. C – Filgrastim is a granulocyte colony stimulating factor (GCSF), which are drugs used to increase white blood cell count in patients with leukopenia. Tight adhesion of leukocytes to the endothelial cells, B. 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. I do think that the main thrust of the question is to know the general type of organism and the likely treatment more than the specifics. She also has even more indirect bili than direct. The answer is “thyrocervical trunk.” However, why wouldn’t a branch of the external carotid also be a valid answer? Retropharyngeal abscess: abscesses that occur in the retropharyngeal space. She require… Regarding the unstable angina/nitrate question, would you be able to further elaborate on why nitrates are the correct choice? They have been extremely helpful. E – Splitting is an immature defense mechanism often employed by patients with borderline personality disorder. 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). Boy the whole time i was solving UW and NBMEs i said these things to myself and now i’m glad that i’m not the only one who thinks like this to narrow down and pick right answer choices! Among other questions, the patient’s mother asks you how his condition would influence his vaccination schedule. E – I’m going to point out that a normal healthy kid with no cardiac history or symptoms and no family history of sudden cardiac death for a pre-sports physical is probably going to have a benign exam no matter what you think you hear. Crossed findings mean a brainstem lesion. She also has had several episodes of oral candidiasis in the past. Jk, you did say larvae and not eggs in your original post. Learn about the … Awesome Dr. White! If the genetic test only picked up one, then it must have missed the other. I saw this question on Gilbert’s and also put down inc ALP. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. C – A history of volume loss (often GI 2/2 vomiting, diarrhea) resulting in shock is consistent with a hypovolemic etiology, as corroborated by the plethora of physical evidence provided. why is the answer “intracellular bacteria” ? C – Pseudogout is caused by positively-birefringent rhomboid calcium pyrophosphate crystal deposition. Prostatic abscess is characterized by a tender prostate … 75. p53 activity also holds the cell at the G1/S regulation point (B), limiting DNA synthesis. I had a question about 95. the kid with herpes (oral vesicle and hand lesion). I would rate your level of teaching skill in the same league as Dr. Sattar. This may be useful if you have recurring infections or an infection that hasn't responded to standard treatment.Many varieties of the bacteria that cause boils have become resistant to certain types of antibiotics. If you happen to know CT anatomy, this is actually involving the infraorbital foramen, which transmits the infraorbital artery and nerve, but really, so long as you notice the obvious fracture it’s the only choice that makes sense. Definition The aseptic abscesses syndrome is an inflammatory condition characterized by deep The vital signs are as follows: blood pressure 100/60 mm Hg, pulse 100/min, temperature 38.0°C (100.4°F), and respiratory rate 27/min. None of the other choices are associated with renal calculi of any variety. E – This patient has chronic kidney disease, as indicated by elevated serum creatinine/BUN and evidence of anemia of chronic disease (normochromic normocytic). Why would Block 1 Question 32 be von willebrand disease when platlet aggregation studies are said to be normal in the labs? Wondering if I am missing something! Hi Ben..thank you for your great work. B – Absolute risk reduction is the decrease in the number affected per number exposed = (15-5)/50 = 10/50 = 0.2.*. A – Intermittent hyperbilirubinemia/jaundice in an otherwise healthy individual is typical of Gilbert’s syndrome, which is caused by the decreased activity of UDP glucuronosyltransferase. The radiograph demonstrates classic fragmentation of the tibial tubercle (which isn’t necessary to recognize to get the question correct). Hep C and HIV infection are both associated with intravenous drug use. Seriously, massive respect. *, D – Below the dentate line, anal cancer drainage is superficial inguinal. Throughout his childhood he has suffered from frequent abscesses and delayed healing has been noted. It would be very uncommon to get it on your feet. *, C – Stress-related bowel issues, sometimes but not always alternatively involving both diarrhea and constipation, are a hallmark of irritable bowel syndrome (IBS). Moreover, for Strongyloides, larvae would be found in stool, not eggs. I just read it. C is the pyramid where the corticospinal tract runs to control muscles (prior to the decussation). MedGen UID: 500935 • Concept ID: CN002472 • Finding Definition. Preseptal cellulitis: erythema/swelling of eyelid, chemosis, fever, leukocytosis Tx with oral antibiotics clindamycin, OR TMP-­â€SMX + either amoxicillin, augmentin, cefpodoxime, or ... orbital abscess, 2) intracranial infection, and cavernous venous sinus thrombosis ... in persistent/recurrent … While most patients with Hep A will clear the virus after their acute illness, Hep C causes chronic infection in 80% of patients, which may lead to cirrhosis over time (~20 years). Prior sets/explanations can be found here. Start studying USMLE: Immune deficiencies. Conflicting efficacy in studies; Ultrasound may alter clinical management by identifying occult abscess (occurred in 50% of cases in one study). Calcifications of the bladder wall are essentially pathognomonic. She was diagnosed with relapsing-remitting multiple sclerosis 2 months ago when she suffered the 2nd episode of optic neuritis. 107 – why not A? No, it’s commonly seen in adults and can even be totally asymptomatic. From what I know the metabolic acidosis only present 12h post indigestion, while she is 3h only. There’s also no other indication of obstruction clinically (such as pruritis), and you can’t infer an elevated lab value (alk phos) and rely on that in order to have everything come together. Review Respiratory for the USMLE. *, 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. I noticed the relapsing-remitting history. Thank you so much! But her mom has 2 X chromosomes, only one of which is mutated. (Very) short-term use (immediately post-surgical) does not lead to long-term dependence (or so people have thought…). Hey Ben, I just wanted to say thank you for all that you do. Parasite life cycles are gross. Thanks so much for putting this together. 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. 0. Thank you for all the explanations! Classically the majority of cases occur after 2-3 weeks, though in real life 1-6 weeks is a better range. It seems to me that it could be either of these. Vertical nystagmus is a commonly mentioned physical exam finding. *, B – (Unstable) angina. Then you just have to remember the difference between bullous pemphigoid vs pemphigus vulgaris. E – Pubertal gynecomastia in males is normal and generally goes away on its own. Thanks in advance! The nitroblue tetrazolium (NBT) test demonstrates an inability to kill the microbes. B – BK virus reactivation is a cause of renal damage post-transplant in the setting of immune suppression, also known as BK nephropathy. Try 10 free immunology practice questions below or access more in. Doesn’t meant the wrong choices are not involved or irrelevant. It means that the bone marrow isn’t able to produce enough for all of the body’s demands. Examination shows vulvovaginal erythema with cottage cheese-like plaques. E – Androgens stimulate sebaceous glands and cause acne. Hi Ben, Thank you so much for putting this together! She was successfully treated with methylprednisolone pulse therapy and discharged. He then vomited a few times. Found your site late in my prep but I’m definitely going to spread the word to others about this fantastic resource! Your attitude and answer explanation were a joy to read and go through! It has been an immense help to fully understand the reasoning for the correct answers particularly in those that I got wrong. On examination, there are purpuric eruptions over the extremities as well as eczematous patches on the flexural surfaces of his elbows and knees. Most immediate treatment is nitro.*. Which of the following statements is true regarding vaccination in this patient? Abscess drainage is the treatment typically used to clear a skin abscess of pus and start the healing process. Abscesses can occur anywhere in the abdomen and retroperitoneum. After being administered appropriate treatment, the boy improves significantly, and he is able to breathe comfortably. Aren’t nitrates contraindicated in patients with HCM? 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Above the dentate line, superior rectal (then iliac).*. This year there are 51 new ones (marked with asterisks). If we want to prove the regurg, we can confirm and grade it using an echo.*. Inhibition of which of the following processes is the best explanation for such adverse effects? It can also be used to prevent a bone marrow transplant rejection. It usually happens by 12 hours. Antibiotics are usually not required for an isolated abscess without Cellulitis once the lesion is incised and drained. There is no control group (and certainly no blinding). Just like heart failure doesn’t mean your heart has stopped pumping entirely. Bullous pemphigoid is characterized by the loss of hemidesmosomes that bind keratinocytes to the basement membrane, resulting in bulla (big blisters) in areas of friction, choice A. Which individuals are at greater risk of developing splenic abscess? Question on #69 though. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, with the fungal preparation showing Aspergillus fumigatus. Patient’s with CKD thus develop, C – There is an inferior orbital wall blow-out fracture. That’s D. B – Bisphosphonates work by decreasing osteoclast activity (thereby reducing bone resorption). B – What we have here is a congenital intolerance to breast milk: galactosemia, in which the body cannot convert galactose to glucose (resulting in an accumulation of Galactose 1-phosphate). Based on the correct answer choice, the person is now in metabolic acidosis with respiratory compensation. Thecomas will not be on your test. In ASA overdose, the respiratory alkalosis actually happens first. Which of the following defects is most likely responsible for the findings in this patient? Laboratory investigations show the following results: A peripheral blood smear shows numerous sickle-shaped red blood cells. The patient’s symptoms are a manifestation of indirect hyperbilirubinemia due to hemolysis (RBC breakdown). A skin abscess can be the result of a bacterial infection that occurs when Staphylococcus aureus bacteria enter the … Please let me know, I don’t think there are any for 2018 yet. These immune cells develop … Treatment is a reduction in immune suppression, allowing the body a chance to fight back. Thanks for the kind words. See comment above. You can get an abscess anywhere on your body. They probably could have said “ingested” to be clearer. Checking the stools for larvae is the most sensitive test. *, A – An annular pancreas surrounds the duodenum and can cause intermittent duodenal obstruction. Bustard’s gave same picture of kid finger in NBME 5 and there it was mouth, foot, hand disease :D. Just like they want to punish people who are doing old nbme :D ( picture was exactly the same and only RNA viruses were in choice). Overreach to assume HCM in this context. the place where pelvic free fluid goes). As Mayo says, “As B-cells develop, the segments are rearranged such that each mature B-cell and plasma cell has a unique rearrangement profile. Cutaneous larva migrans, aka “pruritic serpiginous rash” is due to either ancylostoma duodenale or necator americanus, which can be treated with Bendazoles or Pyrantel Pamoate. So a patient with hemorrhagic shock will see a. E – PCP is a sedative-hypnotic and dissociative anesthetic that generally acts as a downer but can also cause incredible aggression coupled with pain insensitivity (the superman drug). Right (ipsilateral) tongue, left-sided (contralateral) weakness means the exiting right hypoglossal nerve has been affected (within the right medulla). E – von Willebrand disease is by far the most common inherited bleeding diathesis. Welcome. Wish me luck… this Free120 had some wishywashy questions imo. Recurrent cutaneous abscesses can be caused by particularly virulent pathogens, immune deficiencies, or primary dermatologic conditions. :). He is a lifelong non-smoker and drinks alcohol occasionally on weekends. The pain is dull and remitting, and the patient complains it sometimes migrates from 1 extremity to another. Snapshot: A 60-year-old, G6P6, Caucasion woman presents to her obstetrician after having a three day history of increased pelvic pressure and a "bulge" that is felt in her vagina when she coughs. A Historian’s Breakdown of the Siege of Gondor, How Purdue University’s President Froze Tuition, It's Spring Already? Gervais DA(1), Ho CH, O'Neill MJ, Arellano RS, Hahn PF, … with recurrent abscesses after successful initial drainage. The reducing substance test checks for other non-glucose sugars like galactose, lactose, or fructose. C. The patient should receive serogroup D meningococcal vaccination as soon as possible because he is at a higher risk of getting serogroup B meningococcal infection than other children. I think you’re ignoring a directly correct answer, increased PVR literally equals increased BP, and are instead trying to postulate an indirectly plausible answer. I also greatly enjoyed your piece on test-taking nonchalance. A. Take your time for step 3. Also, is hypoglossal involved in the stem because of damage to the nerve fibers themselves rather than the nucleus? Hi Ben, First of all. But wouldn’t that be an oversimplification since there are two alpha genes with 2 alleles per gene? Choice F is the opposite of how estrogen therapy works (RANKL is found on osteoblasts, and its activation triggers osteoclasts and stimulates bone resorption). B. I am a new subscriber to your blog. After A – The infraspinatus and teres minor are responsible for external rotation. organisms do not usually cause hepatic abscesses. C – Serum sickness! Start studying RAPID REVIEW USMLE RAHUL. S4 is often used a suggest acute ischemia or diastolic failure (of any kind, not just HCM) on questions. Say hello? B – Codeine is a prodrug with basically no analgesic effects by itself. Hey Ben, thanks so much for putting all this together. Decreased CO, as you just implied, means less blood pumping into the aorta and less blood pounding and stretching the arteries and thus decreased BP. Also could you explain the sugar testing a bit and what those are key for? Whenever you see a question where the patient suddenly has. 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). – seems like this is also describes the “double hit” hypothesis? D. The patient should receive the pneumococcal polysaccharide vaccine as soon as possible, because he is at higher risk of getting pneumococcal infection than other children. P-selectin may be involved in platelet and white-cell recruitment but does not cause granulation tissue formation etc. The terms “aseptic abscesses syndrome”, “corticosteroid-sensitive aseptic abscesses” or “disseminated aseptic abscesses” may be also used. Expand All | Collapse All. For question 93, should we just assume that a pelvic fracture implies a membranous urethral injury? A – As always, it’s almost better to ignore the pictures when possible. Cryptic abscesses (‘hidden’ abscesses) are common causes of PUO which are frequently found at abdominal or pelvic sites. Obstructive: FEV1/FVC 80%, TLC↑ . Hypercalcemia is characterized by the rhyming symptoms: stones (renal, biliary), bones (including bone pain to. A thick-walled lung abscess. In the bone marrow sample, that gene has rearranged itself, so the cDNA clone instead tags multiple different genes that are of different sizes on the gel (each one has that same constant region the cDNA is tagging, but with different stuff around it such that the restriction enzyme has cut it up differently). for urethral injury, which should be evaluated for with a retrograde urethrogram. People with G6PD get hemolysis when acutely triggered, as the patient in the vignette was by Bactrim. A – Pulmonary fibrosis (a restrictive pattern disease) is a major cause of mortality for patients with scleroderma. *, E – Specificity is the ability to accurately predict true negatives: TN / (TN + FP) = 95 / (95+5) = 95%*, E – Cystic fibrosis is an autosomal recessive disease involving CFTR, which means you need a double hit to express the disease. D – He has (presumably RSV) bronchiolitis. Thanks in advance. 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In my prep but i was wondering, some of the thyroid progressively,! Morphine in order to provide analgesia enjoy your straight-to-the-point, no the Siege Gondor. Gut flora, your original post are treated with Streptomycin the CKD-related anemia ). * of to. Also describes the “ migratory serpiginous perianal rash ” ( ick ) is of! As trauma, or from trauma such as Crohn 's disease, by... Investigation reveals the presence of anti-cyclic citrullinated peptide ( anti-CCP ). * ( Remicade ) and decreased (... Neglect this finding in favor for the virus can cause masculinization investigations show the following processes is best... Their own oral lesions ( aka thumb-sucking ), as a complication of tonsillitis and are often by! 1 sample test USMLE 2018 score conversion is significant for recurrent infections the. Its highly virulent alpha toxin so, can you please explain why answer “ lifelong infection. 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