Question Digestion: A Guide to Breaking Down Step Questions

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By Tim Durso

Question DigestionAs someone who recently took Step 1, I can officially say that there is no way to properly emphasize how important it is to have a strategy in place for attacking questions with consistency. I DON’T EVEN THINK WRITING IN ALL CAPS IS ENOUGH!

In all seriousness, trust me when I say that developing a question taking strategy is a key component to success on test day. Now, I know what you might be thinking, “Tim, I’m in medical school. I can read. Questions have words. Mad reading skillz + words + medical knowledge = 280+ no problem.” My first reaction is… do you always read blog posts with this much internal monologue sass? My second reaction is to point out that, if that were true, then the Step 1 average would be higher than the 230 it currently is. What will follow is my general outline for approaching each and every question I come across, Step or otherwise. (more…)

Napkin Drawings Episode 3: Flow Volume Loops

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By Mark Ard

“Napkin drawing” is a term that describes diagrams that literally look like they were drawn on a napkin, devoid of proper axis labeling and/or not entirely reflective of real observations. They serve to highlight a few key concepts without getting bogged down in the details.

Loops tend to make for good napkin drawings (see episode 1). Now technically these images have axes, but the key here is that the actual contours are basically freehanded, poorly. Their shape, however, tells a story about what’s going on in the lungs.

Let’s work our way counter-clockwise around a normal lung first. A patient begins at maximal exhalation, the rightward most point on the loop (Residual Volume, if you’re trying to memorize all the different lung volumes). They inhale to their Total Lung Capacity, the far left point. As they switch from inhalation to exhalation, they cross the zero flow line and start exhaling. To start, the patient is in the “effort dependent stage” as their expiratory rate increases to 8L/s. Then the force becomes “effort independent” as their flow rate decreases until they finally poop out. (more…)

USMLE-Rx Step 2 Qmax Challenge #21514

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21514An 18-year-old college student presents to the student health clinic with a complaint of copious yellow vaginal discharge. She has been sexually active with a new partner for the past month, but she is unsure if her partner is monogamous. A speculum examination reveals petechiae in the upper vagina and malodorous, yellow-green discharge. A potassium hydroxide preparation reveals no organisms, and results of phase contrast wet mount microscopy are shown in the image.

Which of the following is the most appropriate treatment?

A. Treat her and her partner with oral fluconazole and test for other sexually transmitted diseases
B. Treat her and her partner with oral metronidazole and test for other sexually transmitted diseases
C. Treat her with oral fluconazole and test for other sexually transmitted diseases
D. Treat her with oral metronidazole and test for other sexually transmitted diseases
E. Treat her with vaginal fluconazole and test for other sexually transmitted diseases
F. Treat her with vaginal metronidazole and test for other sexually transmitted diseases

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Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 2 CK test bank. Get more Step 2 CK study help at USMLE-Rx.com.

USMLE-Rx Step 1 Qmax Challenge #3508

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 1 Qmax Challenge #3508Several days after a bioterrorist attack with an unidentified pathogen, patients begin presenting to emergency departments with shortness of breath, fever, and acidosis. Chest films are obtained, an example of which is shown in the image. Biopsy of this area shows necrosis.

The mechanism of action of this pathogen’s toxin is similar to that of which of the following organisms?

A. Mycobacterium avium-intracellulare
B. Mycobacterium tuberculosis
C. Strongyloides stercoralis
D. Vibrio cholerae

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Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 1 test bank. For more USMLE Step 1 prep, subscribe to our Flash Facts and Step 1 Express video series. Score the best deal on all three products with a Step 1 Triple Play Bundle.

The Dreaded Prolonged QT Interval

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By Joe Savarese

Recently, on my psychiatry rotation, I was looking over an elderly patient’s chart. The patient had been prescribed twenty plus medications for multiple medical conditions including bipolar type I. While a patient with this many medications is not the typical USMLE Step 1 patient, they are all too frequent in third-year clerkships (and Step 2) and future practice. The physician I was working with wanted to order a baseline EKG due to a concern about adding another medication to the regimen. He tried to gauge my own knowledge base by inquiring (pimping) me on why he would order the EKG. Of course, I stumbled for a little bit, and if I had not been on my psychiatry rotation the question would have easily been missed. I thought to myself: 2nd Generation Antipsychotics may cause prolonged QT interval.

It was a feel-good moment for a medical student who celebrates each small victory with a quick smile and concealed excitement. Concurrently, I realized something else; I forgot the rest of the medications that cause prolonged the QT interval. I fumbled around with the mnemonic in my head: Few Risky Drugs Can Prolong QT? Nah, that’s not right. Later on that night with First Aid readily in hand, I developed a more concise mnemonic to remember important drugs that may prolong QT. (more…)

USMLE-Rx Step 2 Qmax Challenge #21507

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21507A 23-year-old G1P0 woman at 37 weeks’ gestation is seen in the antepartum care unit. She is having regular contractions and the cervix is two fingerbreadths dilated on sterile pelvic examination. Results of electronic fetal heart monitoring are shown in the image.

What mechanism best explains the findings seen on this tracing?

A. Artifact from strong uterine contractions
B. Compression of the umbilical cord by uterine contractions
C. Fetal arrhythmia
D. Pressure on the fetal head coincident with uterine contractions
E. Reflex response to fetal hypoxia from fetal anemia

———————–

Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 2 CK test bank. Get more Step 2 CK study help at USMLE-Rx.com.

 

“‘Twas the Shift Before Christmas”: A Holiday Ode to Med Students

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Happy Holidays

By the First Aid Team

‘Twas the shift before Christmas, when all through the wards
Not a creature was stirring, they were studying for boards;
The stethoscopes were hung by the front desk with care,
In hopes that the First Aid Team soon would be there;

The med students were waiting all snug in their scrubs,
As they took a few minutes to inhale some bad grub;
And doctor in her ‘kerchief, and I in my mask,
Had just settled in for a long surgical task,

When out in the parking lot there arose such a clatter,
I sprang from the OR to see what was the matter.
Away to the pit I flew like a flash,
And ran into a big guy with a skid and a crash.

His eyes — how they twinkled! He breathed a deep sigh!
His face was so red, his BP clearly too high!
Still, behind him soon did appear,
An ambulance-sized sleigh loaded with Step study gear.

He spoke not a word, but went straight to the ED,
And asked the head nurse to refill his ARB,
Then, laying his finger aside of his nose,
And giving a nod, up the elevator he rose;

He strode through the wards, passing out Qmax and Flash Facts galore,
While gunners ran beside, shouting wishes for perfect Step exam scores.
The rest of us gaped and grinned as we grasped,
A free, three-month subscription to Step 1 Ultimate and Express.

This guy was laughing and happy, a right jolly old elf,
And I knew when I saw him, I’d pass my next shelf;
With First Aid for the USMLE books, I’d have knowledge in my head,
And with such great study guides, I had nothing to dread;

He passed out his last batch of study tools, and sprang to his sleigh
Turned on the siren and fired up the bay;
I heard him exclaim, ere he drove out of sight,
HAPPY HOLIDAYS TO ALL, AND TO ALL A GOOD NIGHT!

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