USMLE Step 2 CK | Forum profile

The answer is D. The patient, in this case, clearly has depression and anxiety, which most likely relates to a difficult family situation. Because the patient does not express suicidal ideation, admission to the hospital is not necessary at this point (choice A). The most important next step in management is to arrange followup psychiatric care in the next couple of days. The patient will most likely benefit from a combination of...

d. Spontaneous pneumothorax

E. Prednisone

The answer is D. This patient has bacterial vaginosis, a common finding in women and the cause of approximately 50% of women's vaginitis. The presence of a more basic pH than the normal 4.5, as well as clue cells on a wet mount, are diagnostic of bacterial vaginosis. It is not a sexually transmitted disease, and can be effectively treated with metronidazole tablets or metronidazole vaginal gel. It is incorrect to tell her that this is...

C Causes of extreme elevations in serum transaminases generally fall into a few major categories, including viral infections, toxic ingestions, and vascular/hemodynamic causes. Both acute hepatitis A and hepatitis B infections may be characterized by high transaminases. Fulminant hepatic failure may occur, particularly in situations in which acute hepatitis A occurs on top of chronic hepatitis C infection or if hepatitis B and hepatitis D are...

B Fibrinogen is a 340-kDa dimeric molecule made up of two sets of three covalently linked polypeptide chains. Thrombin cleaves multiple peptides to produce fibrin monomer that factor XIII stabilizes by cross-linking. Although fibrinogen is needed for platelet aggregation and fibrin formation, even severe fibrinogen deficiency such as afibrinogenemia produces mild, rare bleeding episodes, most often after surgery. Dysfibrinogenemia refers to a...

The answer is D. Lorazepam is a short acting benzodiazepine with no active metabolites. Lorazepam is metabolized to the glucuronide form and excreted by the kidneys. The drug is tapered over 4-6 days for detoxification purposes. It is safe in patients with severe liver damage, and it won’t compromise respiration in severe COPD. Carbamazepine (choice A) is an anticonvulsant that, according to several studies, is as effective as...

c) Injury to a major bronchus

The answer should be A. In an acute ischaemic CVA, aspirin can increase risk of haemorrhagic conversion, so it shouldn't be D.

CASE STUDY Subject is a 45-year-old farmer. Eight months ago he had a renal transplant for end stage renal disease from rapidly progressive glomerulonephritis. He has been on immunosuppressive drugs, including prednisone. He presents to the hospital with a four-day history of progressive shortness of breath, productive cough, and fevers. On examination, he is tired, anxious, and in moderate respiratory distress. He can only speak in 2- to...