Step 2CK NBME REview{LATEST 100% CORRECT}

Step 2CK NBME Review {latest,100% CORRECT37yo F with 4-month history of numbness, burning, and tingling of the toes and soles of her feet. 3-year hx of recurrent mouth sores. Numerous oral apthous ulcers, genital ulcers, and several 2.5-cm red lesions over the left anterior tibial region. Photophobia. Ankle reflexes are absent. Proprioception and sensation to pinprick and vibration decreased in lower ext. Dx? - Behcet syndrome - autoimmune vasculititc disease - Sx: recurrent oral and genital ulcerations (usu painful), arthritis (knees, ankles), eye involvement (uveitis, optic neuritis, conjuncitivitis), CNS involvement (intracranial HTN, meningoencephalitis), fever, wt loss; erythema nodosum-like lesions, pseudofolliculitis - Dx: bx Tx: steroids *NOT polyarteritis nodosa - can be associated with hep B, HIV, drug reactions - Sx: fever, wt loss, myalgias, abdominal pain (bowel angina) - Dx: bx; elevated ESR and pANCA - Tx: corticosteroids (if severe, cyclophosphamide) 87yo F with fever for 1 day. Urinary catheter was placed 2 weeks ago. Has dementia, Alzheimer type, and is unable to communicate verbally. T 37.8 C, P 86/min, BP 120/74. Mucous membranes are moist and pink. Urinalysis shows: Color cloudy brown, Ph 8.8, Blood 2+, Glucose negative, Protein 2+, RBC numerous, wbc 20-25, Nitrites 3+, leuk esterase 3+, bacteria many. Gram stain shows gram-negative bacilli. Which would have prevented? - Use of incontinence briefs instead of the catheter (NOT changing catheter daily) 32yo M with AIDS with 1-week history of T to 40 C and cough. Current medications include trimethopim-sulfamethoxazole and three antiretroviral agents. Moist crackles over right lung base. X-ray of the chest shows an infiltrate in the right lower lobe. Causal org? - Stretococcus pneumoniae (NOT Pneumocystitis jiroveci b/c taking prophylactic oral bactrim) 77yo F with lesions on her left arm for the past 2 months. Underwent modified radical mastectomy of the left breast for breast cancer 20 years ago complicated by chronic edema of the LUE. Two r-mm, raised, hard, purple lesions just above the left elbow. Dx? - Lymphangiosarcoma - rare malignant tumor which occurs in long-standing cases of primary or secondary lymphedema. It involves either the upper or lower lymphedematous extremities but is most common in upper extremities. 57yo F with 2-week history of progressive jaundice and a 5-kg weight loss. Dark urine and pale stools. No meds. BP 120/80. Gallbladder palpated in the RUQ. Urine dipstick is positive for bilirubin. Ultrasonography shows a dilated gallbladder and dilated intrahepatic and extrahepatic biliary ducts. No calculi. Next step? - CT scan of the abdomen (Obstructive jaundice due to carcinoma head of pancreas)- Courvoisier's sign: palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. (NOT Lap Cholecystectomy) One hour after splenectomy, 42yo M has severe shortness of breath. Additional injuries include left rib and pelvic fractures. T 36.3, P 133/min, BP 80/60. Breath sounds are absent on the left. Bowel sounds are absent. Next step? - Needle thoracostomy (pneumothorax; severe) NOT CXR 67yo M with alcoholism. 15-year history of poorly controlled hypertension; takes hydrochlorothiazide, not compliant. BP 170/102. Funduscopic examination shows arteriovenous nicking and tortuosity of the arteries. Risk for? - MI - hypertensive retinopathy: AV nicking and tortuosity of the arteries NOT subarachnoid hemorrhage 32 year old woman with 1 month of diarrhea, 8lb weight loss, three to four semiliquid stools daily. No fever, abdo pain or rectal bleeding. Just returned from scuba diving in Mexico 6 weeks ago. Boyfriend is symptom free. Abdo and rectal exam are normal. What is organism? - Giardia lamblia NOT V cholerae (up to 15 stools per day) 37yo F from Guatemala with joint pain, swelling, and stiffness of her wrists and hands for 2 years. Ibupforen ineffective. No fever, cough, or weight lossl. Received all immunizations. BMI 20. Spleen tip is nontender and is palpated 4 cm below left costal margin. Grip strength is decreased. Labs: Hb 10, Leukocyte count 2.5k, Platelets 125k. Cause of the leukopenia? - Felty syndrome - disorder that involves rheumatoid arthritis, a swollen spleen, decreased white blood cell count, and repeated infections. It is rare. 37 yr old woman, sudden onset fever 7 days after splenectomy for ITP. T 102.4, mild distension and diffuse tenderness, no rebound, rigidity or guarding. No bowel sounds. Labs hg 9.8 Leuks 21,300 Platelet 105, 000, amylase 124. chest xray shows left pleural effusion. what is the most likely cause of the findings? - subphrenic abscess (Post-splenectomy subphrenic abscess, phrenic nerve impingement cause refered shoulder pain, abscess fits the Fever, Increase Leukocyte count) NOT pneumonia