Study Timing: How Soon Is Too Soon?

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By Tim Durso

Study Timing - How Soon Is Too SoonThere’s one age old question that inevitably creeps into the forefront of the (admittedly neurotic) mind of many medical students during the pre-clinical years:

“When should I start studying for Step 1?”

For a question that seems so universal, the answer is far from it. I’ll give you my perspective on the issue, and granted it it’s a sample size of one (great time to review study power in your handy-dandy copy of First Aid), but it’s a strategy that put me in a position to exceed even my own expectations on test day. (more…)

USMLE-Rx Step 1 Qmax Challenge #3403

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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 #3403A 63-year-old woman presents to the emergency department complaining of a productive cough with green sputum. She smoked 1.5 packs of cigarettes per day for the past 30 years and had several hospitalizations in the past 15 years for lung infections. She reports some friends in her nursing home have been sick recently with “some sort of lung infection.” Further work-up is indicated and CT of the chest is ordered (see image).

What pathology is most likely present in this patient?

A. Bronchiectasis
B. Lung cancer
C. Pneumonia
D. Pulmonary embolism
E. Tuberculosis

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Mnemonic Monday: Argyll-Robinson Pupil

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By Haley Masterson

To remember the ocular symptoms of Argyll-Robinson Pupil, just take the first letter of each word – ARP – and read it forwards and backwards. Forwards, you have ARP – Accommodation Reflex Present. Backwards, you have PRA – Pupillary Reflex Absent.

Usually the constriction to light is stronger than constriction to a near stimulus, but the reverse is true in the case of Argyll-Robinson pupil. Remember that “accommodation” refers to the ability of the eyes to focus on a near object. This reflex is carried out in part by pupillary constriction – so the pupils will constrict as you bring a far object into the near eye field – for example, moving your finger close to the patient’s nose. However, the “pupillary reflex” refers to the ability of the eye to constrict when exposed to a bright stimulus, such as your pen light. (more…)

USMLE-Rx Step 2 Qmax Challenge #21159

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Check out today’s Step 2 CK Qmax Question Challenge.

Know the answer? Post it in the comments 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 #21159A 2100-g (4.6-lb) boy was born at 32 weeks’ gestation by spontaneous vaginal delivery after an uncomplicated pregnancy to a Group B Streptococcus-negative, 22-year-old G2P1 woman. The amniotic fluid was clear. He began crying immediately after he was born. His Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. Within 30 minutes of birth he was in respiratory distress, with tachypnea, nasal flaring, and subcostal retractions, and rhonchi throughout both lung fields. He was given supplemental oxygen but his condition deteriorated. He was intubated and given 100% oxygen. He did not receive surfactant. Despite this therapy he became increasingly cyanotic and died 2 days later. Below is a microscopic image of his lung tissue at autopsy.

Which of the following conditions most likely caused his death?

A. Bronchopulmonary dysplasia
B. Neonatal respiratory distress syndrome
C. Pneumonia
D. Pulmonary hemorrhage
E. Transient tachypnea of the newborn

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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 #3408

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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 #3408A patient undergoing lung transplantation because of pulmonary fibrosis had his pressure-volume curves monitored throughout the operation. The following events took place in the operating room: (1) his right lung was resected, (2) the new right lung was transplanted, and (3) positive end-expiratory pressure (PEEP) was added to prevent pulmonary edema.

Which pressure-volume loop most likely represents the patient’s pulmonary function when the patient was being ventilated on one lung prior to the new lung being transplanted?

A. Loop A
B. Loop B
C. Loop C
D. Loop D

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USMLE-Rx Step 1 Qmax Challenge #3401

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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 #3401A 67-year-old nurse dies and an autopsy is performed to determine the cause of death. She was the victim of a needle stick injury about 40 years ago. Prior to her death, she appeared jaundiced and had abdominal ascites. Her husband states that she abstained from alcohol but smoked 1 pack of cigarettes a day for 25 years, quitting 10 years ago. The woman’s liver at autopsy is shown in the image.

Based on the pathology seen in the image, which of the following laboratory findings would be expected?

A. ?-Fetoprotein level of 64 ng/mL
B. ?-Human chorionic gonadotropin level of 10,000 mIU/mL
C. Aspartate aminotransferase and alanine aminotransferase levels of 590 and 967 U/L, respectively
D. International Normalized Ratio of 1.0
E. Total protein level of 14 g/dL
F. WBC count of 25 × 10³/?L

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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.

An Attempt to Clean the Mess of the GI Tract Plexuses

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By Joe Savarese

Perhaps I am the only one out there with this particular problem, but for some reason, I would always confuse the gastrointestinal tract plexuses. Like most miscellaneous Step 1 topics, I remembered the concept well when as I was reviewing it, but give me a week or two during Step 1 studying and those layers became a mess.

So here is my gift to you. Since I created this mnemonic, I have never mixed up these layers. (more…)

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