Kim! Hi! It’s your dad!👋 ▪ Khalilah, I’m proud of you for taking a risk for your dream. Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!firzah!! you got this girl!Hey Pink Dino Team! WE GOT THISSSSS!                       want to add a fly-by? email us! 😊
share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
search for anything NEW!score predictor (“predict me!”) NEW!
the site will be undergoing maintenance later tonight!🤖 just a heads-up! --webmaster, 8:16pm EST
That other exam …
=> Step 2 CK Free 120
=> Step 2 CK Form 6
=> Step 2 CK Form 7
=> Step 2 CK Form 8

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

Recent comments (see more)

... jacobg456 made a comment (nbme23)
 +0  submitted by jacobg456(1)

This question was messed up for me and I couldnt even understand what it was saying lol.

... drdoom made a comment (free120)
 +0  submitted by drdoom(1027)

This is a corrected version of the post from @abhishek021196 below (https://nbmeanswers.com/exam/free120/1426#3919).


Fragile X syndrome X-linked dominant inheritance. Trinucleotide repeat in FMR1 gene = hypermethylation = decreased expression.

Most common inherited cause of intellectual disability (Down syndrome is the most common genetic cause, but most cases occur sporadically).

Findings: post-pubertal macroorchidism (enlarged testes), long face with a large jaw, large everted ears, autism, mitral valve prolapse, hypermobile joints.

Trinucleotide repeat expansion [(CGG) n ] occurs during oogenesis.

... kcyanide101 made a comment (nbme18)
 +0  submitted by kcyanide101(2)

This seemed very much like schizoid, as the patient in this case appears to like to be on his own. However, his prediliction for the occult, after life and science fiction gave it away as schizotypal. Remmeber, they manifest with wishful thinking.

drdoom  magical* thinking +1
kcyanide101  @drdoom Yes! Magical thinking +
... weirdmed51 made a comment (nbme23)
 +0  submitted by weirdmed51(10)

Increased conc. Of so many lipids easily points to fam.hyperlipidemias Now to DX-

  • Incr. TG+chylomicrons
  • incr amylase-pancreatitis

Can only happen in Type I, which is due to either lipoprotein lipase defc or Apo C2 receptor defect.

[in type 2: incr cholesterol but causes MI, NOT pancreatitis].

... weirdmed51 made a comment (nbme23)
 +0  submitted by weirdmed51(10)

Increased conc. Of so many lipids easily points to fam.hyperlipidemias Now to DX-

  • Incr. TG+chylomicrons
  • incr amylase-pancreatitis

Can only happen in Type I, which is due to either lipoprotein lipase defc or Apo C2 receptor defect.

[in type 2: incr cholesterol but causes MI, NOT pancreatitis].

... weirdmed51 made a comment (nbme23)
 +0  submitted by weirdmed51(10)

Homocystinuria can be due to cystathionine synthase or methionine synthase defc.

  • cystathionine synthase defc: (more comm.) increased methionine and decreased cystathionine and cysteine...Cysteine becomes essential.
... doida made a comment (nbme19)
 +0  submitted by doida(1)

it is so sad that they do that. the whole proccess is already too expensive and they receive money w all those ads. it sucks

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

If its intrinsic defect HTF urinalysis is normal with no casts?

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

Its not Fire ant. because if it was he would notice instantly. Intense pain followed by intense pruritus.

Hypereosinophilic syndrome is a disease characterized by a persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood for at least six months without any recognizable cause, with involvement of either the heart, nervous system, or bone marrow.[2]

HES is a diagnosis of exclusion

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

Adrenal Insuff - No. Normal K & HCO3. Also normal BP.

Adverser effect of FQ - It doesn't cause anything like this. SIADH causing drugs are SSRI, Cabamazepam, Cyclophosphamide

DI - Would cause mild hypernatremia

SIADH - (the one I chose,,,dk what kind of drug I was on) is also ruled out for one there's no indication of that duh. second the Uosm < Sosm here. 200 vs (2x122 i.e 244+ )

... weirdmed51 made a comment (nbme23)
 +0  submitted by weirdmed51(10)

Phenotype- male; genotype- female

I could think 2 causes 1. Placental aromatase defc 2. CAH (21 OH defc)

1 isn’t an option.

... ali_hassan made a comment (nbme21)
 +0  submitted by ali_hassan(2)

How does 500 men with various urological conditions result in a precise estimate? Wouldn't the variety of values due to various degrees of illness reduce precision and cause a wider variety?

Maybe I overthought it

... weirdmed51 made a comment (nbme23)
 +0  submitted by weirdmed51(10)

HCV : lymphocytic aggregation + macrovesicular steatosis FA 2019- p.172

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

Ascites & adnexal mass >> Follow adnexal mass workup Even if you follow ascites protocol - ans is diagnostic paracentesis, not therapeutic.

So here you do USG + CA 125 There can be 4 combination -

High Risk USG + Elevated CA125. Worst scene >>Imaging with CT/MRI Exploratory LAP

High Risk USG + Normal CA125. intermediate scene. Also do same as prev. We trust USG more.

Low Risk USG + Elevated CA125. Intermediate scene. But here do only imaging. CA 125 is less trustable.

Low Risk USG feature + Normal CA 125. Best scene. U do further imaging and CA 125 serially to monitor.

... ali_hassan made a comment (nbme21)
 +1  submitted by ali_hassan(2)

furosemide is the DOC for fluid over flow (i.e. HF) but i cucked myself by overthinking

CKD = hypocalcemia. furosemide = more hypocalcemia. hydrochlorothiazide = get to keep the Ca2+ babies. chose thiazide with a smile on my face, but didnt last long

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

MCC of CAP in adult 40-65

Strep Pneumo H. Flu Anerobes Viruses Mycoplasma

F Step 1 content

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

why cant we obtain a psych assessment

... charcot_bouchard made a comment (step2ck_form7)
 +0  submitted by charcot_bouchard(496)

I feel the discussion is missing the key points here. Any one after step 1 will know this is ureter damage board has a hard on for following any ovarian/uterine procedure.

Ques is which test - Urine culture, renal biopsy is easy to rule out. nothing for ureter. Renal arteriography is also same. Nothing say about ureter.

I picked IVU which seem reasonable to me because it is the one most specific for ureter and overall help assess the kidneys, ureters, bladder, and urethra for any extravasation of contrast dye

And that's the key. U cant give contrast to a patient who has creatinine of 5. Its contraindicated. So and is USG.

Some notes
❧ Comments submitted this year are scramble–resistant (Scramble–resistant Staphylocomment aureus)
leaderboard does not pay membership fee

2020 MVPs

The results are in.
Here are your undisputed, heavyweight champions of the world:

Help your fellow humans! (see more)

charcot_bouchard asks (step2ck_form7):
If its intrinsic defect HTF urinalysis is normal with no casts? help answer!
ali_hassan asks (nbme21):
How does 500 men with various urological conditions result in a precise estimate? Wouldn't the variety of values due to various degrees of illness reduce precision and cause a wider variety? Maybe I overthought it help answer!
weirdmed51 asks (nbme22):
Any other conditions where pulsation in the liver can be found ? help answer!
agraham416 asks (nbme18):
I eliminated this answer because the mother already stated her concerns, which was that he's shorter than the father's height and about him not having a growth spurt. Is that not a concern? help answer!
failingnbme asks (nbme24):
can nephritic syndrome be without HTN? help answer!
athenathefirst asks (nbme20):
How do you know the answer is not E? I chose E because I thought of ATN :( Someone help please help answer!
osler_weber_rendu asks (step2ck_free120):
Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway help answer!
len49  Pick the best answer of the choices, not necessarily what you would do in real life. +1
drdoom  @len49 Sure, but in that case you’re not saying much about /why/ “Skeletal survey” is the best answer choice from the NBME-frame-of-mind. Can you elaborate? +1
drdoom  @osler My guess is that a skeletal survey is what “clinches” evidence of ongoing abuse, since skeletal surveys can reveal bone and tissue injury at /varying (time) stages of healing/, which is the kind of evidence CPS is going to need to establish a PATTERN of abuse and discredit claims like “this was just a one-time ‘accident’.” +1
stunna216 asks (free120):
why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion? help answer!
csalib2  heads up, i think you’re in the wrong question thread +1
arthur_albuquerque asks (nbme20):
What helped me to answer this one quite easily was the following rationale: Hypercalcemia + high PTH -> "primary hyperparathyroidism" How do high PTH lead to hypercalcemia? Increasing osteoclast activity! help answer!
shaz464 asks (step2ck_free120):
Still confused.. Can anyone rule out all other options please? help answer!
len49  A. Conducting a nursing in-service won't help because they do not have the ordering power, that should rest on the person writing prophylaxis prescriptions/orders. C. Not feasible for every patient (not every patient is well enough to be ambulatory. Moreover ambulation only helps so much; patients at high risk for thrombus (for instance like this patient who is hypercoagulable due to malignancy, recent surgery) need bigger guns. D. LMWH is not appropriate for all post-op patients. For instance, inappropriate for people who may be actively bleeding, patient with previous diagnosis of HIT, patients with ESRD as it is renally cleared E. It is not an isolated case, as you know DVT provoked from long hospitalizations and post-op patients is pretty high and taken pretty seriously. +1
sizario asks (step2ck_form6):
how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH? help answer!
embeemee asks (step2ck_form7):
what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately help answer!
embeemee asks (step2ck_form7):
i get the answer, but would a VB even be possible given her GBS+ status? help answer!
usmile1  Yes, being GBS+ is very common and is not a contrainidcation for vaginal delivery. just give intrapartum IV PCN to prevent infection in the newborn +1
embeemee asks (step2ck_form7):
the change from green liquid to yellow liquid threw me off. i was thinking gastric outlet obstruction that initially let out bile until it progressed further until letting out only stomach acid? help answer!
justanotherimg asks (nbme18):
This doesn't make sense to me at all. What will change by the time of the next appoinment ???? Or are they trying to say that his behaviour is normal ??? Isn't it excessive ?? help answer!
skonys asks (nbme23):
So are we supposed to just yolo this one? wtf help answer!
osler_weber_rendu asks (step2ck_form6):
Why is this not absence seizure? help answer!
yb_26  automatisms (lip-smacking, picking at his shirt collar) are seen in complex partial seizures. Also absence seizure lasts 10-20sec, not 1-2 minutes. +1
osler_weber_rendu asks (step2ck_form6):
Why not paracentesis? Sharp chest pain, JVD, enlarged globular cardiac silhouette, and nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade. help answer!
aneurysmclip  Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +1
encarnme  Do you mean pericardiocentesis? Paracentesis would be used for ascitic fluid. +1
charcot_bouchard asks (step2ck_form6):
I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue? help answer!
skonys asks (nbme23):
Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients) help answer!
weirdmed51  Let him breathe first and think of imaginary cough later ( isn’t even mentioned )! +
weirdmed51  Her* +
brandoctor asks (familymed2):
I think this is pretty clearly HSV-2 genital herpes. Just to confirm though, the blister fluid culture was negative... so that just means the test isn't very sensitive I guess, yeah? help answer!
brandoctor asks (familymed2):
Okay, but why aren't we concerned about the Benzo (and it's anticholonergic properties) in the 67yo F? help answer!
brandoctor asks (familymed2):
Why not low NPV? Since you can't say that you DON'T have strep throat if the test is negative... Does this have to do this prevalence altering NPV? help answer!
jlbae asks (step2ck_form8):
Y'aLL dOn'T KeEp BlEaCH uNdEr YoUr SiNkS??!? help answer!
lindasmith462  i would but I don't have room with my lamp oil down there +3
jlbae asks (step2ck_form8):
What would make normal lochia the correct answer? Please help I suck at ob/gyn. Am I at the character limit yet? help answer!

Tag directory (see more)
vitamins visual_field_defect visualfielddefect vascular TSH transfusion_reactions transfusion syphilis surgery stroke skin SIADH schizotypal Saline rituximab restriction_enzymes Respiratory respiratory reproductive Repro repro renal RAAS pulmonary psych protein_folding process_of_elimination prevalence pressure pregnancy post_partum postop porphyria Poorly_written_question physio physics phototherapy pharyngeal_arch pharmacology pharm

Some shelves are here, too!
=> Medicine 4
=> Family Medicine 2
=> Family Medicine 1

Leaderboard (see more)
  1. seagull
  2. sympathetikey
  3. cassdawg
  4. hungrybox
  5. hayayah
  6. yotsubato
  7. drdoom
Mercury Rising


search for anything NEW!