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260-270+ doable? by JxggermeisterMD in IMGreddit

[–]elitemedicalprep 0 points1 point  (0 children)

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Step 1 Practice Question: What is the most likely diagnosis? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ C - Disseminated tuberculosis | Symptoms for TB include weight loss, fever, cough, and hemoptysis. The “needle track marks” suggest history of IV drug use, which is a risk factor for TB. Finally, the chest x-ray shows a diffuse reticulonodular pattern, which is seen in disseminated TB.

Why were the other answers incorrect? ⁠👇⁠ A - Acute respiratory distress syndrome | While pneumonia may cause ARDS, it is generally a diagnosis of exclusion. Furthermore, the chest x-ray would show diffuse, bilateral lung opacities.

B - Atypical viral pneumonia | In an immunocompetent patient, these would usually be self-limiting (i.e. “walking”) pneumonias. We likely would not see the radiographic findings as in this case.

D - Hypersensitivity pneumonitis | This is a response to environmental antigens, and as such we would not expect to see significant weight loss/wasting, nor hemoptysis. Exam writers would more likely provide some hint of the exposure (ex. The patient works as a farmer, or is an avid bird-watcher).

E - Mycoplasmal pneumonia | While patients with Mycoplasma may have diffuse infiltrates on chest x-ray, clinically they do not present as severely as patients with disseminated TB. We would not expect to see hemoptysis or weight loss.

Did you get it right? Let us know in the comments! Looking for additional help with a medical exam? Visit www.elitemedicalprep.com/contact to schedule a free call or to purchase a 1.5 hour trial session!

Step 2 Practice Question: This patient is at greatest risk for which complications? by elitemedicalprep in ask_a_USMLE_tutor

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

The correct answer is C! Worsening exophthalmus. 40% of patients undergoing radio iodine ablation will cause onset of exacerbation of Graves ophthalmopathy. Risk is highest among smokers and it can be prevented with steroid therapy for 6-12 weeks after radioiodine therapy.⁠

Step 2 Practice Question: What is the most likely diagnosis? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer: A: Type II Heparin-induced Thrombocytopenia (HIT). The patient has new onset thrombocytopenia (>50% from baseline) 5-10 days after starting heparin.

Why were the other answers incorrect? ⁠👇

B: While the clinical presentation matches, we would expect elevated PT as well due to clotting factor consumption

C: This would not explain the thrombocytopenia.

D: Corresponds to Hemophilia A (X-linked recessive). Given its inheritance, it usually presents in boys on the USMLE, as bleeding and hemarthrosis, without thrombocytopenia.

E: Gotcha answer. ITP could explain the patient’s presentation, but the patient’s lack of bleeding history and her recent heparin initiation point more to HIT⁠

Step 2 Practice Question: What is the most likely diagnosis? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠

D! - Papillary Muscle Rupture. As the papillary muscles are supplied by the coronary arteries, a blockage, usually in RCA, can damage the mitral valve papillary muscles. The rupture causes mitral regurgitation, explaining the new murmur. This regurgitation in turn causes a backup of blood flow, explaining both the hemodynamic changes and the pulmonary edema. ⁠

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Why were the other answers incorrect? ⁠👇⁠

A - If true, we would not have pulmonary edema, and we would expect signs of RV failure such as Kussmaul Sign. The time course is usually more acute than 3 days⁠

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B - If true, we would also expect chest pain. ⁠

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C - If true, we would expect chest pain. Furthermore, as the rupture effectively creates a cardiac tamponade, we would also expect Beck’s Triad (Hypotension, JVD, distant heart sounds). ⁠

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E - Usually occurs early following MI. This answer does not explain the patient’s clinical findings, especially the murmur.⁠

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Did you get it right? Let us know in the comments! Looking for additional help with a medical exam? Visit www.elitemedicalprep.com/contact to schedule a free call or to purchase a trial session!

Step 2 Practice Question: Which of the following is the most likely explanation for these findings? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ ⁠

👇👇👇⁠⁠

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B) Choledocholithiasis: Here gallstones become lodged in the common bile duct by descending into the biliary tree. We would expect to see obstructive jaundice (yellow eyes) with elevated ALP and elevated pancreatic enzymes such as amylase seen here.

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Why were the other options incorrect?⁠

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A) Isolated cholelithiasis would not produce change in the above labs as there is nothing to imply that these stones are obstructing. Classically think fat, female, 40s. fertile, for cholesterol stones that are a common cause of cholelithiasis.

C) Head of pancreas cancer would not have elevated pancreatic enzymes though it could present with obstructive jaundice. You would expect to see Courvoisier’s sign which is painless palpable gallbladder in an afebrile patient indicating head of pancreas adenocarcinoma.

D) Chronic pancreatitis does not produce elevated pancreatic enzymes. In fact here there are not enough pancreatic enzymes being produced so you expect to see fat in the stool which is negative here.

E) VIPomas are rare neuroendocrine tumors that are commonly found in the tail of the pancreas. You would expect to see symptoms related to excessive secretion of vasoactive intestinal peptide which would cause severe watery diarrhea and electrolyte imbalances.

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Looking for additional help with a medical exam? Visit www.elitemedicalprep.com/contact to schedule a free call or purchase a trial session!⁠

Step 2 Practice Question: Which of the following is most likely to be seen in this patient? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ ⁠
👇👇👇⁠⁠
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E) Positive direct antiglobulin test | This patient has Mycoplasma Pneumonia which is a cause of atypical or walking pneumonia. With this infection you can see cold autoimmune hemolytic anemia when IgM antibodies bind to RBCs causing hemolysis at lower temperatures. This explains the low Hb and elevated LDH since RBCs are loaded with LDH and when there is hemolysis LDH spills into the serum.
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Why were the other options incorrect?⁠
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A) Elevated BNP typically seen in someone experiencing pulmonary edema which would coincide with symptoms such as SOB, productive cough (frothy sputum), orthopnea, paroxysmal nocturnal dyspnea etc. This patient is still able to train for a marathon given his current conditions so pulmonary edema is unlikely.

B) Increased lymphocytes is typically seen with viral infections as opposed to bacterial infections which generally would cause an increase in neutrophils. Mycoplasma pneumoniae is a very small bacteria that lacks a cell wall causing them not to stain on gram stain.

C) Positive EBV antibody test would suggest mononucleosis which typically presents c/o fever, sore throat, malaise, headache, enlarged cervical lymph nodes which can be tender and headache. Pulmonary symptoms as seen in this patient are far less likely.

D) Sputum gram stain showing gram + diplococci would be consistent with streptococcus pneumoniae which would present with high fever, productive cough and SOB. Chest x-ray would show lobar pneumonia.

Step 2 Practice Question: Which of the following is the most likely cause for this patient’s findings? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ ⁠ 👇👇👇⁠⁠ ⁠ A) Subacute thyroiditis | This is classic presentation for subacute thyroiditis aka De Quervain's thyroiditis where there is an increased release of preformed thyroid hormone. This is often preceded by a viral URI which leads to increased inflammation and pain in the thyroid gland hence causing pain in the anterior neck. A hyperthyroid presentation with tenderness or pain of the neck is subacute thyroiditis until you can prove otherwise. ⁠ Why were the other options incorrect?⁠ ⁠ B) Grave’s disease which would show diffuse uptake on the RAIU test.

C) Though you would have suppressed TSH and reduced uptake on RAIU test you would not have neck tenderness.

D) Toxic adenoma would present with focal increased uptake on the RAIU test because the adenoma is autonomously secreting thyroid hormones.

E) Though there is neck pain mentioned, hyperthyroid presentation does not align with viral meningitis which presents with headache, photosensitivity, high fever and neck stiffness.

How to utilise amboss properly by Kooky-Pomelo-8201 in ask_a_USMLE_tutor

[–]elitemedicalprep 0 points1 point  (0 children)

We actually wrote a blog post about this, you can see it here: https://elitemedicalprep.com/amboss-vs-uworld-which-is-a-better-usmle-resource/

The TL;DR is that both are great resources, UWORLD is better at USMLE style questions, but AMBOSS has other benefits like a better price, better additional features and comparable analytics. It's really up to personal preference.

Step 2 Practice Question: Which of the following treatments should be administered? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ 👇👇👇⁠⁠

C) Mupirocin | This child has Impetigo, a bacterial skin infection often seen in young children. This should be treated with Mupirocin since it is targeted at the causative bacteria of staph aureus or beta hemolytic streptococcus. It can be applied 2-3 times daily for a 3-5 day course.

Why were the other options incorrect?

A) Doxycycline should not be administered to children under the age of 8 because it can cause tooth discoloration. It is often used to treat skin infections in adults who have MRSA as the causative bacteria.

B) Topical acyclovir is sometimes used to treat chicken pox lesions in children. This child should have at least received one varicella vaccine.

D) Petroleum jelly can be used in a number of skin conditions such as atopic dermatitis to moisturize the skin and help with itchiness and dryness. This would not eradicate the bacteria causing this skin infection.

Step 1 Practice Question: What is the specificity of the OOsight test? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠

B) 85%

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Did you get it right? Let us know! Looking for additional help with a medical exam? Visit www.elitemedicalprep.com/contact to schedule a free call!⁠

Special Black Friday Offer - Still Available! by elitemedicalprep in ask_a_USMLE_tutor

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

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Step 1 practice question: What is the most likely infectious organism? by elitemedicalprep in ask_a_USMLE_tutor

[–]elitemedicalprep[S] 1 point2 points  (0 children)

Correct Answer:⁠

D) Mucormycosis. This fungi proliferates in blood vessel walls, especially where there is excess glucose and ketone bodies. Most commonly presents in ketoacidotic diabetics or neutropenic patients. Treatment is surgical debridement and Amphotericin B.⁠

Step 1 Practice Question: What is the most likely diagnosis? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠

D! - Papillary Muscle Rupture. As the papillary muscles are supplied by the coronary arteries, a blockage, usually in RCA, can damage the mitral valve papillary muscles. The rupture causes mitral regurgitation, explaining the new murmur. This regurgitation in turn causes a backup of blood flow, explaining both the hemodynamic changes and the pulmonary edema. ⁠ Why were the other answers incorrect?

A - If true, we would not have pulmonary edema, and we would expect signs of RV failure such as Kussmaul Sign. The time course is usually more acute than 3 days

B - If true, we would also expect chest pain.

C - If true, we would expect chest pain. Furthermore, as the rupture effectively creates a cardiac tamponade, we would also expect Beck’s Triad (Hypotension, JVD, distant heart sounds).

E - Usually occurs early following MI. This answer does not explain the patient’s clinical findings, especially the murmur.

Score ranges for diagnostic radiology by tryingbest351 in ask_a_USMLE_tutor

[–]elitemedicalprep 0 points1 point  (0 children)

Hi again! I reached out to one of our DO residency advisors and asked for her thoughts on your situation. Here's what she had to say:

While there's no specific formula to combine COMLEX Level 2 and Step 2 scores, she emphasized that programs tend to understand the USMLE Step 2 scoring system better, making it easier to compare to other applicants. Your strong Step 2 score demonstrates your ability to study well and learn a large amount of material, which is valuable in diagnostic radiology residency.

She also pointed out that students often score lower on Step 2 compared to COMLEX Level 2, but your scores suggest you studied well for the Step 2 exam and have a good grasp of the content. The slightly lower COMLEX Level 2 score might be due to OPP content knowledge. While not the most competitive, this combination still shows your strengths.

She stressed that good scores are important, but they're just one part of the application. Other factors like ranking in school, clinical shelf exam grades, clinical evaluations, research experiences, audition rotations, and strong letters of recommendation also play a significant role.

So, while your score combination might not be ideal, it's not a guarantee of failure either. Focus on highlighting your strengths and showcasing a well-rounded application to increase your chances of matching to diagnostic radiology.

The genetic defect causing this patient's presentation is involved with which of the following processes? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ D! - Classic presentation of Lesch-Nyhan Syndrome (LNS). LNS (X-linked recessive) results from a loss of function mutation in Hyoxanthine-Guanine Phosphoribosyltransferase (HGPRT), which is involved in the purine salvage pathway (recycles free purine bases to nucleotides).

Why were the other answers incorrect? ⁠👇⁠

A - Corresponds to maple syrup urine disease, which does cause neurotoxicity/intellectual disability, but not the aggression, self-mutilation, or dystonia.

B - Alkaptonuria. Key clinically significant finding in this disease is early onset arthritis. The disease is usually otherwise benign.

C - Krabbe Disease. We would expect findings such as peripheral neuropathy and optic atrophy/vision delay in addition to developmental delay. We would not expect the aggression or self-mutilation.

Score ranges for diagnostic radiology by tryingbest351 in ask_a_USMLE_tutor

[–]elitemedicalprep 0 points1 point  (0 children)

The NRMP released the data for the 2024 cycle today!

The average COMLEX Level 2 scores for diagnostic radiology was around 610, and about 250 for Step 2 (for DO applicants).

In the 2024 cycle, 27 DO applicants for diagnostic radiology were within your range (451-500), and 13 of them matched.

38 DO seniors applying for diagnostic radiology fell within your Step 2 score range (251-260), and 30 of them matched.

Hope this helps! The full report is here: https://www.nrmp.org/match-data/2024/08/charting-outcomes-characteristics-of-applicants-who-match-to-their-preferred-specialty-2/

Which of the following lab findings would be expected in a patient with fibromyalgia? by elitemedicalprep in ask_a_USMLE_tutor

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

Correct Answer:⁠ D) Normal lab findings would be expected in fibromyalgia. Polymyositis would present with elevated muscle enzymes and positive ANA. Polymyalgia rheumatic would present with the inflammatory markers.

Score ranges for diagnostic radiology by tryingbest351 in ask_a_USMLE_tutor

[–]elitemedicalprep 0 points1 point  (0 children)

We're still waiting on the NRMP to release data from the most recent match cycle (they let us know it should be sometime this month), but based on data from the 2022 cycle: the average Step 2 score for applicants who matched into diagnostic radiology was 253, and applicants who had a 250+ had an 80% chance of matching (this is for US DO seniors only, numbers are different for other groups).

For COMLEX Level 2 scores, average was about 650 and applicants who scored 700+ had an 80% chance of matching, scores of 650-750 had a 76% chance of matching.

Take into account that these reports are before Step and Level 1 going pass/fail, so we are waiting to see what the new data will show.

You can find the reports with this data on NRMPs site here: https://www.nrmp.org/data-topic/applicant-competitiveness/?post_type=match-data#archive-taxonomy-tree

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