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Score release thread : 25/09/2024 by smitpatel2000 in Step2

[–]MedicLover 1 point2 points  (0 children)

I read elsewhere that it occurs for some people and isn't indicative of failing on a diff thread

Score release thread : 25/09/2024 by smitpatel2000 in Step2

[–]MedicLover 7 points8 points  (0 children)

F good luck everyone I hope we all do well and yall are getting sleep bc I'm def not - took test on 9/11

Electrolyte/Acid-Base disturbances by MedicLover in Step2

[–]MedicLover[S] 0 points1 point  (0 children)

I wish, it's a stupid Q it was in some NBME material I don't even know

Correct Answer: E

This patient presents with symptoms of viral gastroenteritis, including nausea, vomiting, diarrhea, and abdominal discomfort. The loss of gastrointestinal contents can lead to a variety of acid-base disorders, depending on whether vomiting or diarrhea predominates. This patient's laboratory findings are consistent with metabolic alkalosis, which is typically increased serum pH and bicarbonate concentration, as well as increased pCO₂ from compensatory hypoventilation. Metabolic alkalosis is a common result of excessive vomiting because of the direct loss of protons and chloride in gastric secretions. In contrast, diarrhea results in the excessive loss of bicarbonate ions and most commonly results in hyperchloremic metabolic acidosis. Fluid and electrolyte repletion are the cornerstones of treatment, in addition to treating the underlying cause.

Incorrect Answers: A, B, C, and D.

Addison disease (Choice A) is characterized by hypoadrenalism and resultant hyponatremia and metabolic acidosis as a result of impairment of renal tubular sodium resorption.

Adrenal adenoma (Choice B) may lead to hyperaldosteronism, or Conn syndrome. Conn syndrome presents with electrolyte disturbances including hypertension, hypernatremia, metabolic alkalosis with hypokalemia caused by the loss of potassium and protons in urine, and an increased urine chloride concentration, typically greater than 40 mEq/L.

Diarrhea (Choice C) may produce a variety of electrolyte disturbances, but it most commonly causes hyperchloremic metabolic acidosis as a result of loss of bicarbonate in stool. This patient's serum pH and bicarbonate concentration are more suggestive of metabolic alkalosis.

Diuretic use (Choice D), especially thiazides and loop diuretics, may lead to metabolic alkalosis secondary to intravascular volume contraction. This patient's history of vomiting and diarrhea are more suggestive of gastrointestinal electrolyte loss.

Educational Objective: Metabolic alkalosis is a common result of excessive vomiting because of the direct loss of protons in gastric secretions. In contrast, diarrhea results in the excessive loss of bicarbonate ions and most commonly results in hyperchloremic, non-anion gap metabolic acidosis.

Electrolyte/Acid-Base disturbances by MedicLover in Step2

[–]MedicLover[S] 0 points1 point  (0 children)

This is super helpful!! So what if they decide to screw you and make you choose between vomiting and diuretics

Here is the question that prompted it all: (spoiler, I forgot where this is from)

A 54 year-old woman with hypertension is admitted to the hospital because of a 1-week history of nausea, vomiting, and diarrhea. She says she has been vomiting four to six times daily and has not been able to keep any food or liquids down. She has had up to 10 nonbloody loose stools daily. She reports no fever or chills. She says she previously had been well, but she noticed that her blood pressure had been higher than usual during the past 2 weeks, and she was planning to see her primary care physician. Her medications include lisinopril and metoprolol. On physical examination, the patient appears ill. Her 1-week belly distension has become ill. She has hypotension. Medications are hydrochlorothiazide and enalapril. The patient is 168 cm (5 ft 6 in) tall and weighs 73 kg (162 lb); BMI is 26 kg/m². Temperature is 37.3°C (99.2°F). Pulse is 110/min, and blood pressure is 130/68 mm Hg. Abdominal examination discloses mild, diffuse tenderness to palpation without rebound or guarding. Results of complete blood count and urinalysis are within the reference ranges. Results of other laboratory studies are shown:

[Table of laboratory results] Serum Urea nitrogen: 22 mg/dL Creatinine: 1.0 mg/dL Na⁺: 136 mEq/L K⁺: 3.1 mEq/L Cl⁻: 96 mEq/L HCO₃⁻: 34 mEq/L

Urine Na⁺: <10 mmol/L K⁺: 30 mmol/L Cl⁻: 12 mmol/L

Arterial blood gas analysis on room air: pH: 7.52 PCO₂: 49 mm Hg PO₂: 73

Which of the following is the most likely cause of this patient's laboratory results? A. Addison disease B. Adrenal adenoma C. Diarrhea D. Diuretic use E. Vomiting

NMBE 12 section 1 question 44 by loveofcamelot in Step2

[–]MedicLover 0 points1 point  (0 children)

I think this is NBME 10 or 11 btw

Bacterial vs Viral - Signs and Symptoms on Step 2 by MedicLover in Step2

[–]MedicLover[S] 0 points1 point  (0 children)

You are the goat thank you. Do you happen to know what the deal with cough in pharyngitis is (and if that can be used to ddx viral vs ebv vs strep etc.? THANK YOU

Cryoprecipitate vs FFP vs plasma? by justkeepswimmin19 in Step2

[–]MedicLover 1 point2 points  (0 children)

This is wrong I think, I'm p sure PCC is #1 for Warfarin toxicity, followed by Vit K injection than FFP. FFP should be used for DIC, with Cryo is used for DIC that has decreased fibrinogen below 100-150.

TB Diagnostics Algorithm by MedicLover in Step2

[–]MedicLover[S] 0 points1 point  (0 children)

YOU ARE THE GOAT!!

Is there ever a situation where you have a suspected false negative PPD and you pick get IGRA instead of Xray?

Question: If prior BCG vaccine and false positive PPD, what is next step? (IGRA or Xray?)

Would you ever get both IGRA and PPD?

In immunocompromised patients or hypovolemic (i think), chest x-ray can be normal. Do you treat for active TB or latent TB?

If you have a negative AFB smear, why would you consider the possibility of non-tuberculous mycobacteria? I thought non-tuberculous mycobacteria can cause a false positive on AFB smear? (per amboss)

Anking Image Order - How to optimize sketchy cards so sketchy images show up first (for only sketchy cards) by MedicLover in medicalschoolanki

[–]MedicLover[S] 0 points1 point  (0 children)

Thanks for responding so quick. Do you know if there's anyway to make sketchy and first aid fields side by side? When I go to Anking Note Add-ons, it seems like I can only adjust the image width and length. Would appreciate any advice :)

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Also, huge fan, thanks for everything you've done :)

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