Step 2 CK NBME Form 2 (Offline) Answer Key


Step 2 CK NBME Form 2


Block 1

1. B (well-fitted shoes to avoid trauma. prophylactic antibiotics not indicated.)
2. A (clue from the stem: hyperthyroidism, irregularly irregular pulse, variation in intensity of S1)
3. C
4. E (hereditary spherocytosis)
5. B
6. E (NSAID papillary necrosis doesn't happen so fast. History of trauma makes E best answer)
7. C (DT boosters indicated after every 10 years. She has all 5 doses of DTP already, so now booster is with adult DT even if she is 16 year old.)
8. C (SIADH can happen secondary to meningitis)
9. D (Hemochromatosis)
10. A (identifiable stressor)
11. J
12. H
13. D (renal artery stenosis)
14. A (HTN with hypokalemia >> Conn's syndrome)
15. D
16. B (fixed splitting of S2)
17.
18. D (refractile body at bifurcation of retinal artery >> cholesterol emboli from the internal carotid artery atherosclerotic disease >> duplex scan of carotid artery)
19. A
20. C
21. A
22. B
23. A
24. B
25. A [Pt has a crude pincer grasp- This should have been mastered by 9-14 months to be normal]
26. E
27. C
28. C (only option that goes with restrictive disease)
29. D
30. G
31. D
32. B (fat soluble vitamin)
33. E
34. A
35. C
36. A (antibiotic prophylaxis for Chronic bacterial prostatitis)
37. F
38. A (Huntington's disease)
39. G
40. A (cyclosporine-induced hypertension)
41. E
42. B
43. E (obesity >> increased estrogen)
44. C (crossed hemiplegia)
45. B
46. F

BLOCK 2

1. D (pin-point pupils >> opiates)
2. B
3. A (Lyme disease)
4. D (Granulosa cells produce excessive amounts of estrogen)
5. C
6. D
7. B (Elevating the left testicle relieves the pain >> Epidodymitis)
8. D (side effect of enalapril)
9. D (Heparin-induced thrombocytopenia. As explained by a commenter: the reason there is thrombocytopenia in HIT is because the Heparin-Platelet4 complex are attacked by IgG in the human bodies that essentially activate the platelet and thus form clots. These clots are the reason free platelets are low.)
10. C
11. B (pulsus paradoxus)
12. D
13. C (biliary colic)
14. C (Oral isotretinoin is never the first option for acne, only used when topical treatments have failed)
15. B
16. C
17. B (screening of lipid profil routinly done for every HTN patient)
18. A
19. B
20. E
21. F
22. D
23. D
24. E (white patches over the skin that become more distinct with Wood's lamp examination "ash leaf spots" >> Tuberous sclerosis)
25. D
26. I
27. B
28. E
29. B
30. D
31. E
32. B
33. B (question stem says that mother applies sunscreen 'just before she goes swimming', which is incorrect way. It should be applied at least 15-30 min before sun exposure)
34. A (Botulism)
35. A
36. D (VSD)
37. E
38. D
39. D
40. B
41. C
42. E
43. D
44. E
45. C
46. D

Block 3

1. D
2. A
3. C
4. B
5. A
6. A (aldolase-B deficiency)
7. B
8. D
9. D (risk of repeated falls)
10. B (Xanthelasma >> high cholestrol)
11. E
12. B
13. D (Prinzmetal angina)
14. A
15. C (Diabetes Inspidus)
16. E
17. C (I am confused between Conversion and Malingering, because there is possibly a motive [she doesn't want to move] but it isn't clearly stated either. So on revising the question, I am now more tilted towards Conversion.)
18. G
19. C (Patient has febrile neutropenia >> IV antibiotics)
20. B
21. E (Surgery to relieve obstruction)
22. B
23. C
24. B
25. H
26. E
27. C
28. D
29. G (Cardiac tamponade)
30. A
31. D (CMV infection)
32. D
33. C (Herpes zoster)
34. C (adrenal crisis)
35. B
36. C
37. B
38. F (Isoniazid >> B6 deficiency)
39. E
40. D (Warfarin contraindicated in pregnancy)
41. E
42. F
43. D
44. B
45. C
46. D (tension pneumothorax >> decreased venous return)

Block 4

1. A (breath holding spell >> reassurance)
2. A (RR shows a relationship but p value is statistically insignificant)
3. B
4. E (anaphylaxis)
5. E (high clinical suspicion with low-probability VQ scan >> angiography)
6. F
7. C (multiple areas of increased and decreased uptake >> MNG)
8. G
9. C (acute presentation makes aortic valve rupture more likely than congestive heart failure)
10. B (in a terminally ill patient, the priority is pain control)
11. A (erythema toxicum >> self-limiting condition)
12. C (MR, large testes >> fragile X syndrome)
13. E (Digoxin toxicity)
14. E
15. F (previous episodes of a sudden decline of cognitive functioning >> multi-infarct dementia)
16. C
17. E (delirium tremens)
18. D
19. J (proximal muscle weakness, polymyositis is one of the causes)
20. E
21. E
22. D (Mitral stenosis; most common cause RHD)
23. E (Mastitis: antibiotics, continue breast feeding)
24. A (Ephedrine is a sympathomimetic drug. For the treatment of hypotension during spinal anesthesia.)
25. B (Metoprolol improves mortality in heart disease)
26. F
27. D (Chronic Granulomatous disease)
28. D (S4 points towards MI)
29. D
30. A
31. C (thiazide diuretic >> gout)
32. B
33. D (GI obstruction >> NG tube first step)
34. D (HTN in young patient >> look for renal artery stenosis)
35. A (Malignancy related hypercalcemia fits best: Depression, Muscle weakness and fatigue, decreased tendon reflex, weight loss. Hypothyroidism wouldn't account for the weight loss.)
36. A
37. C (insulin and glucose >> fastest way to lower down serum K)
38. E (she is asymptomatic, no treatment at this point is indicated)
39. D (intussusception >> contrast enema both diagnostic and therapeutic)
40. C (ectopic pregnancy)
41. D
42. D
43. C
44. A (Hepatic artery complications are very common following liver transplant in children.)
45. A (http://pediatrics.aappublications.org/content/65/6/1125.abstract)
46. C

189 comments:

  1. block 1 q 2 is A) Atrial fib. causes variation in S1

    ReplyDelete
  2. thank you. the offline questions didn't have the accompanying ECG, leading to confusion. corrected above.

    ReplyDelete
  3. Hi awais192, just wanted to clear a confusion in block 3, no 13, as you rightly pointed out, this is Prinzmetal angina as the question clearly says that there were no atherosclerotic lesion on angiography. The DOC for this is of course CCB.

    But my confusion is as the patient has progressed to IW MI too as mentioned in the question as STEMI in leads II, III and aVF, it seems the CCB is actually going to harm this patient because of vasodilation >> reflex tachycardia >> increased cardiac workload.

    In my opinion, I think it is better to use ACEi which has a clear mortality benefit in MI first and once the patient has stabilized, then use a CCB (later) for prevention of future episodes of Prinzmetal's.

    Does this make sense or is there another explanation I'm missing?

    Thanks.

    ReplyDelete
  4. @ Taurus

    In Prinzmetal angina there are transient ST elevations due to the temporary spasm of the blood vessels, and these are usually not treated as myocardial infarction.

    http://www.nejm.org/doi/full/10.1056/NEJMra022580

    ReplyDelete
  5. @ awais192..

    Ok thanks..

    Still getting so many answers wrong even when I do know many of the right answers and only realizing after I check it with your answers here and re-reading the questions.. any advice on how to improve on that.

    Thanks again.

    ReplyDelete
  6. Hi, Block 3 q17. I disagree with 'tonic clonic seizure' as the answer, because the eeg is normal during one of the episodes. Most likely 'conversion disorder'.

    Thanks

    ReplyDelete
  7. @ above

    I didn't answer it as tonic clonic seizure. I had answered it as Malingering. I am confused between Conversion and Malingering, because there is possibly a motive (she doesn't want to move) but it isn't clearly stated either. So on revising the question, I am now more tilted towards Conversion.

    ReplyDelete
    Replies
    1. I wana add, the EEG is fine, even though if it is conversion, wont we see some in EEG in chanconversion disorder? can anyone plz reply

      Delete
    2. There aren't any EEG changes in conversion disorder.

      Delete
    3. i thin k it is malingering bec. thre may be secondary gain "she dont want to move" and also her behaviour iz normal and thre iz no isplation of effect...

      Delete
    4. i think it as malingering....she is perfectly normal b/w the episodes....i guess conversion has some additional features.

      Delete
  8. Q19, why you have B as the answer??

    ReplyDelete
  9. Block 3 Q 19, why have you chosen B as the answer??
    Could you pls explain.

    In my opinion it should be C, so as to give prophylactic antibiotics for neutropenia.

    ReplyDelete
  10. @ k s

    I'm sorry, that was a typo. The answer is C. Febrile neutropenia. Thanks for pointing out.

    ReplyDelete
  11. can some one send me offline nbme questions please...saranyaadd@gmail.com

    ReplyDelete
    Replies
    1. Can anyone email me the offline version for review? MedStar88@outlook.com. Thank you so much!

      Delete
  12. Thank you for sharing the keys with us.

    As for block3 q21, I prefer the answer as E.
    Chemotherapy should be the first modality applied to the patients with stageIV colorectal cancer.(FOLFOX and FOLFIRI) Then we consider surgical resection of primary and metastatic lesions if no surgical contraindication.

    ReplyDelete
    Replies
    1. This patient has abdominal obstruction. Even in this case you think chemotherapy would be the first option?

      Delete
    2. He 85, I think chemo would be better before surgery.

      Delete
    3. in this case palliative surgery is needed as tumor is obstructing the colon; adjuvant chemo/radio should be added for the mets though

      Delete
  13. block 4 q 35 i think is hyper Ca
    fatigue, m weakness, slow dtr, psych all fits
    wt loss = MM
    i dont c how thyroid could cover wt loss

    ReplyDelete
    Replies
    1. Yes, you are right. I didn't consider it. Malignancy-related hypercalcemia fits better. Thank you.

      Delete
    2. I was in between those two but I picked "B" TSH b/c I couldn't find any risk factors for malignancy

      Hypothyroidism--> depression(weakness, wt loss, fatigue, etc) and slow return of tendon reflex

      Although I do not if hypothyroidism will randomly present in a 76 year old

      Delete
    3. if its malignancy related hypercalcemia why is there a slow return of tendon reflex????

      Delete
  14. block 3 35
    is it malingering

    ReplyDelete
    Replies
    1. It's not malingering as such, but the fact that she is planning to file a claim for it goes against her motivation for hasty recovery. At least, that's what I think is the case.

      Delete
    2. Its conversion for sure

      Delete
    3. why cant it be E.. straight leg raise test positive means disk herniation... means prolonged pain....

      Delete
    4. its malingering her behaviour iz normal and thre iz no isolation of effect and thre iz secondary gain

      Delete
  15. Can you please explain why "D" is a wrong answer in block 3 q 45?
    many thanks

    ReplyDelete
  16. can u plz explain why Block 1 Q3 is E..in my opinion it should be C.Is there any idea that young children resist infection less?plz some1 explain..:)

    ReplyDelete
    Replies
    1. The correct answer is C. In my notes I had crossed E with C, [3. E XC] and this got overlooked when I uploaded it.

      Delete
  17. hello there could someone send me the offline nbme2? mfchery@hotmail.com.
    I would love to particiate but dont remember details. I took it yesterday.

    ReplyDelete
  18. the bloc 1 q7 answer is c not b.
    she has all 5 doses of dtp already. now booster is with adult dt even if she is 16 y o.

    ReplyDelete
    Replies
    1. thank you! you are right.

      Delete
  19. This comment has been removed by the author.

    ReplyDelete
  20. Question 8 from block 4 seems like it would be cardiac tamponade, not PE. You have Beck's Triad for tamponade, as well as clear lungs. Why is the right answer not D?

    ReplyDelete
    Replies
    1. In cardiac tamponade there are muffled heart sounds. Heart sounds are normal in this case.

      Delete
    2. that question says "discrete PMI", are we assuming that if they don't say muffled heart sounds that it is normal?

      Delete
    3. discrete PMI is normal.
      Also, there case says 'right parasternal heave', which is another hint for PE

      Delete
    4. its definitely cardiac tamponade. you cannot have elevated JVD with PE. thats a main difference between the two.

      Delete
    5. Massive PE can cause RV failure & JVD.

      Delete
    6. JVD is a nonspecific sign of right ventircular failure of almost any cause.

      as awais said- there would be no right parasternal heave in tamponade- this is a symptom of a right ventricule straining against a large afterload (due to the embolus). in Tamponade, pericardial fluid is pushing on the RV and effecting its contractility- making a parasternal heave unlikely to occur.

      Delete
  21. Please let me know where to download the offline version of nbme 2-3-4
    Thanks

    ReplyDelete
    Replies
    1. give me ur email. i'll email you.

      Delete
    2. hello, could you please email me the offline version for the 4 nbme's as well?
      htkd001@gmail.com

      Thank you!

      Delete
    3. hello
      me too please


      my email ddavp1919@live.com

      Delete
    4. Hi!! Im also preparing for step2ck, can you also send the offline forms to me? yesenia2704@gmail.com...Thx u!!

      Delete
    5. hey... could you please email me the offline version for the four nbme's as well? especially form 2 and 4?

      omar_dbz@hotmail.com

      thanks!

      Delete
    6. anyone can send me the offline of nbme 2

      Delete
  22. Hi, my exam is in a week and I'm trying to match up the ans to the nbme I just took, so if anyone can please provde the questions for the offline nbme's, it will be much appreciated!. Thank you!

    htkd001@gmail.com

    ReplyDelete
    Replies
    1. the download links have been updated.

      Delete
  23. Hey, thanks for doing this, was thinking the same thing. Got a few corrections:

    Block 3 Q2: Answer is E. If over a certain BP, you start rx regardless, there is a table on uptodate with weight/heights/ages that has the cutoffs

    Block 4: Q9: Answer is C, from the acute presentation = aortic valve rupture
    Q 35: Is definitely E, the delayed relaxation phase is is classic for hypothyroid

    Q28 block 4: not sure about this one but could be diffuse esophageal spasm (the relief with nitro was what made me think that, and no radiation of pain)

    ReplyDelete
    Replies
    1. q28 block 4, I believe the pain would be more severe and it wouldn't be associated with exertion if it was spasms

      Delete
    2. ditto to block 3 q2
      http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.pdf

      Delete
    3. Block 3 Q2, what cut-off BP would apply in this patient to start pharmacologic treatment?

      Delete
    4. Block 4, Q9. Yes, acute presentation would make aortic valve rupture more likely. Thanks.

      Delete
    5. To awls block 3 q2:

      The chart shows that it depends on the age, so for this child she was 15 and her blood pressure was above the 99th for her age which would require pharmacologic treatment. Or if she was 90-95% with symptoms that would also require treatment.

      Delete
    6. block 3 qs 2..
      why not measure urinary catecholamines in this patient?? very young age we should look for aal the secondary causes of hypertension

      Delete
  24. In block 4 ,q10
    Why not the answer C ??

    ReplyDelete
    Replies
    1. administering the centrally acting stimulant is unnecessary. the Q is a test of medical ethics. B is humane and morally permissible.

      Delete
  25. Block 2 number 9 i think should be D: Uncontrolled activation of coagulation and Fibrinolytic Cascades. The thrombocytopenia is due to heparin, like you said. But the reason there is thrombocytopenia in HIT is because the Heparin-Platelet4 complex are attacked by IgG in the human bodies that essentially activate the platelet and thus form clots. These clots are the reason free platelets are low.

    ReplyDelete
    Replies
    1. thank you for the correction!

      Delete
    2. it cant be D because the INR is normal, & the coagulation cascade(ie clotting factors) is not activated in HIT; uncontrolled activation of coagulation & fibrinolytic cascades occurs in DIC

      Delete
    3. in HIT there is antibody mediated activation 9 not destruction ) of platelets - i LL GO WITH D

      Delete
  26. block4 q40
    what were the question and answer choices?

    ReplyDelete
    Replies
    1. 40. A previously healthy 14-year-old girl is
      brought to the
      emergency department because of abdominal pain for 12
      hours. She has a 1-week
      history of brownish vaginal discharge. Menarche was
      at the age of 12
      years, and her periods have occurred at regular 28-day
      intervals over
      the past year. Her last menstrual period was 7 weeks
      ago. Her
      temperature is 37 C (98.6 F), blood pressure is 85/55
      mm Hg, pulse is 145/min,
      and respirations are 24/min. Abdominal examination
      shows generalized
      tenderness, and there is guarding with rebound in the
      right lower
      quadrant. Her hematocrit is 24%, and leukocyte count
      is 9400/mm3 (60%
      segmented neutrophils, 3% bands, 1% eosinophils, 35%
      lymphocytes, and 1%
      monocytes). Serum electrolyte levels are within
      normal limits.

      A
      ) Administration of parenteral antibiotics

      B
      ) Admission to the hospital for medical management

      C
      ) Admission to the hospital for operative
      management

      D
      ) Colon contrast studies

      E
      ) Discharge for follow-up by personal physician

      F
      ) Endoscopy

      G
      ) MRI of the abdomen

      H
      ) Observation in the emergency department

      Delete
  27. Block 4, Q 34.

    Why is sodium and potassium normal in this patient if it is secondary hypertension due to renal artery stenosis?

    ReplyDelete
    Replies
    1. Is disturbance of Na and K levels a must in Renal Artery Stensis?

      Delete
    2. it should be,bcz stenosis,leads to inc aldosterone,that causes Na and water retention so hypertension . .and at the same time it dec potassium level . .

      Delete
  28. it does not match the nbme 2ck form 2 that i just took 3 days ago!!
    from the explanations that you make the qs are different!!
    I think the qs are just mixed.

    any suggestions?

    thx guys..

    ReplyDelete
    Replies
    1. the questions in the online nbme are in a different arrangement from the ones you'll find offline. the questions and blocks are the same, only arrangement is different.

      Delete
    2. thanks awais192,

      is it possible to make hints for all the Qs as the others?

      thanks again.

      Delete
  29. hey awias192, can you plsease send me nbme 3 and 4....my exam in 1st week of august thanx... and ya i really appreciate these answers help a lot...
    neel4887@yahoo.in

    ReplyDelete
  30. Hi awais,

    Can you please send me the nbme form 2 please. My exam is in 4 days time. Thanks.. My email is koramy@gmail.com

    ReplyDelete
  31. Q 15, Blk 4.
    The answer put is lt temporal lobe infarct, assuming that you are thinking this is multi-infarct dementia..however the pt does not exhibit any focal neurological deficits such as speech or hearing problems. If the temporal lobe is infarcted, then he would have some hearing manifestations as well as memory issues. I feel this is very difficult to distinguish from Alzheimer's and that is what I marked, but I am unsure.

    ReplyDelete
    Replies
    1. "The patient has had at
      least three to four
      previous episodes of a sudden decline of cognitive
      functioning over the
      past 3 years without full recovery."

      This is characteristic of multi-infarct dementia.

      Delete
    2. I was wondering if it possible to have 3 yrs of multi-infarct without any neurological symptoms?

      Delete
  32. Anyone have any idea of score estimation if I took it offline? Like if I missed 30 for example anyone have an idea what the 3 digit score might be?

    ReplyDelete
    Replies
    1. http://step2cknbme.blogspot.com/2012/08/nbme-step-2ck-offline-correlation-table.html

      Delete
  33. q30 block 4

    He is sundowning which can be seen in dementia patients, therefore the answer is D(haloperidol)

    ReplyDelete
    Replies
    1. Haloperidol for sundowning? Can you give a reference?

      Delete
    2. http://www.clinicalgeriatrics.com/articles/Sundowning-Syndrome-Older-Patient?page=0,2

      Its not as formal as a source, but its accurate. Article talks about lighting during the day, but then wikipedia talks about lighting at night and as informal as wiki is, its never led me astray. I guess the answer could be A since we would want to use non pharmacological treatment beforehand?

      Delete
    3. hi,
      Thanks for sharing this.can you plz expalin this
      A 2-month-old boy is brought to the physician because
      of a 6-week
      history of persistent diarrhea and vomiting, most
      pronounced after formula
      feedings. He has had a 113-g (4-oz) weight loss since
      birth. He
      currently weighs 3100 g (6 lb 13 oz) and is 51 cm (20
      in) in length. He
      appears irritable. Examination shows jaundice. The
      lungs are clear to
      auscultation. No murmurs are heard. The liver is
      palpated 2 to 3 cm
      below the right costal margin, and the spleen is
      palpated 1 to 2 cm below
      the left costal margin. Laboratory studies show:


      Serum
      Glucose 35 mg/dL
      Bilirubin (total) 2.3 mg/dL
      Urine
      Glucose negative
      Reducing substances 3+

      Which of the following is the most likely mechanism of
      these findings?

      A
      ) Decreased gluconeogenesis

      B
      ) Decreased insulin secretion

      C
      ) Increased glucagon secretion

      D
      ) Increased gluconeogenesis

      E
      ) Increased insulin secretion

      F
      ) Insulin resistance

      Delete
    4. Decreased gluconeogenesis 2ndary to Aldolase B deficiency.... Form 3 Q.6

      Delete
  34. Block 2 : Q. 35 child was born premature so E. should be the right answer. i think something similar was in Uworld.

    Block 2 : Q. 45 since the pt is an IV drug abuser Echo should be the right choice because back pain is most likely due spetic emboli from the heart causing an abscess formation and next step in management would be CT scan not MRI.

    plz let me know if this sounds right and thanks for the answer keys really appreciate it.

    ReplyDelete
    Replies
    1. block 2 Q45: as you said its most likely an epidural abscess formed due to a septic emboli from the heart.. the diagnosis of an epidural abscess is by MRI not a CT scan. ( abscess in the abdomen would be diagnosed by CT)

      Delete
    2. Block2 Q25: i am confused on that one too.. A seems more appropriate.. anyone who took the form online plz answer this..

      Delete
    3. oops, typo.. E seems more appropriate..

      Delete
    4. Block 2 Q 45,correct answer is C, MRI of back. this patient is IV drug user, key is fever and back pain and tenderness over L4 on palpation, they are leading you to see osteomyelitis due to IV drug use. Most common cause is staph aureus. Key to diagnosing is MRI of the back. there is a similar question in U world.

      Delete
    5. I think it is seizures, option E. I was stuck between A (child abuse) and E (seizures), I think its seizures. I found the following:
      "Preterm birth increased the odds for epilepsy in adulthood as much as five-fold, Swedish investigators reported.

      The odds rose by 75% for a gestational age at birth of 35 to 36 weeks and increased as gestational age decreased. Adults who were born before 32 weeks had an epilepsy rate that was five times greater than that of adults delivered at full term (≥37 weeks)."
      source:
      http://www.medpagetoday.com/Neurology/Seizures/28858

      Delete
    6. it iz A bec itiz unplanned pregnancy and her family members do not know abut pregnancy...baby at birth iz normal making seizures less likely option

      Delete
  35. In block 3 q5, why is the ans C? Isn't 15y the age at which you begin investigating the reason behind amenorrhea..?

    Would someone be kind enough to explain. Thanks a lot!!

    ReplyDelete
    Replies
    1. I thought that too, but if you research, the age is actually 16. I googled it. from wiki and other sources: " It is defined as an absence of secondary sexual characteristics by age 14 with no menarche or normal secondary sexual characteristics but no menarche by 16 years of age"

      Delete
  36. how do you estimate your score with form 2? thanks

    ReplyDelete
  37. I took paid for version and based off what I put as my answers and this key I missed 31 which was a 235 if that helps anyone.

    ReplyDelete
  38. BLOCK 2 question 35. shouldnt the answer be E?? how can it be hypocalcemia. can you explain?

    ReplyDelete
    Replies
    1. I think it is seizures, option E. I was stuck between A (child abuse) and E (seizures), I think its seizures. I found the following:
      "Preterm birth increased the odds for epilepsy in adulthood as much as five-fold, Swedish investigators reported.

      The odds rose by 75% for a gestational age at birth of 35 to 36 weeks and increased as gestational age decreased. Adults who were born before 32 weeks had an epilepsy rate that was five times greater than that of adults delivered at full term (≥37 weeks)."
      source:
      http://www.medpagetoday.com/Neurology/Seizures/28858

      Delete
  39. I know this thread is old but any way I can get access to the offline questions? Just took the test today- exam next week

    ReplyDelete
    Replies
    1. the download links on top left are not working?

      Delete
  40. Hello everyone.

    Can anyone be kind enough to email me NBME -4 please. Thanks in advance :)
    Caramelboy24@gmail.com

    ReplyDelete
  41. BLOCK 4, Q 36, WHY CCANNOT SCHIZO BE THE ANSWER, COZ THE PATIENT HAS AUDITORY HALLUCINATIONS.

    HOW WILL YOU DIFFERENTIATE?

    THANKS.

    ReplyDelete
    Replies
    1. pt has history of depression. the voices have been going on for 3 days, so it cant be schizophrenia. this is a manic episode. so bipolar disorder is correct answer

      Delete
    2. Would you please email me NBME -3 and 4. Thank you in advance.
      takayoshi_shimizu1109@yahoo.co.jp

      Delete
  42. block 4 , q 9
    If it was aortic valve rupture, it would lead to aortic regurgitation, and the murmur would be heard right? And there would be a wide pulse pressure too, how will you explain this?

    ReplyDelete
  43. block 4 q 4
    if the patient had anaphylaxis, would she present after 2 hrs to the ER?
    moreover, its I.M. epinephrine which is given and not subcutaneous right?

    Could it be an exacerbation of asthma, which could be treated with inhaled bronchodilators or steroids?

    please explain, thanks.

    ReplyDelete
    Replies
    1. block 4 q4, Im with you, I don't know if its necessarily anaphylaxis. I picked the beta agonists as well. Here is why though. I reread the Q. SHE IS UNSTABLE, look at the BP:
      "Her blood pressure is 80/60 mm Hg, pulse is 120/min and regular, and respirations are 20/min"

      She needs epi, her BP is dangerously low. Epi takes care of her BP and the lungs at once. beta agonist wont do anything for her BP.

      Delete
  44. Form 1:

    http://www.filefactory.com/file/3r9ukrajouuh/n/Form_1.doc

    Form 2:

    http://www.filefactory.com/file/4r8ntngpj81x/n/Form_2.doc

    Form 3:

    http://www.filefactory.com/file/7ox0qqzgte1/n/Form3.zip

    Form 4:

    http://www.sendspace.com/file/kvzrnx

    ReplyDelete
  45. Block 2, q 9. HIT has nothing to do with coagulation cascade and fibrinolysis. HIT very simslar to ITP with overdestruction of platelets by circulating antibodies with the only difference that in the case of HIT this antibodies are specific for PF4. This supported by normal PT and PTT. So, I think correct answer is A.

    ReplyDelete
  46. can someone please send me the step2 nbme forms to this email izzykuritho@gmail.com.
    thank u in advance

    ReplyDelete
  47. B4Q9E
    How does this person rupture her aortic valve? acute endocarditis? I don't think so. severe blunt trauma? not there.
    Wouldn't she have severe aortic regurg if valve ruptured? like increased pulse pressure and diastolic murmur? she has 90/60 and an S3.
    I think it is CHF.

    B2Q9A
    I agree it is heparin-induced thrombocytopenia, therefore I marked "excessive platelet destruction"

    B1Q17D
    Heel tenderness in a runner, plantar fasciitis.

    ReplyDelete
  48. By the way, thank you for your work.

    ReplyDelete
  49. hey guys I was just wondering if someone could send me nbme form 2 questions to this email ensar.hasanovic@yahoo.com
    Thanks.

    ReplyDelete
  50. hi guys B2 Q41
    the answer is A, this is a urea cycle defect, Carbamyol phosphate synthase, or Ornithine Trans Carbomyolase, both give a profond acidosis, and symptomes of hyper ammoniemia, and they are mitochodrial enzymes, so the answer is A

    ReplyDelete
    Replies
    1. wow, good thinking, very tough question, I wonder if the test considers NH4 an organic acid? I dont think it is. I looked all over google, ammonia (NH4) is considered a weak base/ weak acid from what I have found. You are right both enzymes of the Urea cycle are in the mitochondrial matrix of the liver hepatocytes, here is a source for what carbamoyl phosphate synthase I does...

      http://www.ncbi.nlm.nih.gov/gene/1373

      Delete
    2. Hyperammonemia with acidosis results from organic acidemias; a group of disorders characterized by increased excretion of organic acids in urine. Hyperammonemia in organic acidemias results from inhibition of one of the urea cycle enzymes, most likely CPSI.
      http://www.ncbi.nlm.nih.gov/books/NBK1134/

      Urea cycle defects have hyperammonemia with nornal pH or even alkalosis.

      Delete
  51. can someone explain number 42 block 4 of form 2 please

    ReplyDelete
    Replies
    1. His PPD is positive, so he needs prophylaxis whichis with INH and vit B6 ( as inh leads to deficiency of b6)

      Delete
  52. q3B1: Can someone please explain why is B not the correct answer?

    ReplyDelete
    Replies
    1. salivary enzymes would not augment (to make greater) the infection. these bites are usually deep puncture wounds, therefore difficult to cleanse, so that is why C is right.

      Delete
  53. please email me at reedsposer22@hotmail.com if you need NMBE forms 1-4. I can email you them. I organized them into nice PDFs that can be viewed easily, each page is dedicated to 1 question! Took a while to do it, but it turned out nice. let me know! good luck studyn for STEP 2 CK. I take mine next week!!!!! May 29th 2013 is the big day for me!!

    ReplyDelete
  54. @reedsposer22...thank you SO much for providing the NBME forms...you're a lifesaver!

    ReplyDelete
  55. in block 2 , q 17, I think it would be E renal scan . cause renal artery stenosis is very common cause of hypertension

    ReplyDelete
  56. question 36 , block 2 answer would be TOF noy vsd. Cause vsd dont cause enlarged heart, the baby has right heart failure. it takes time get right heart failure untill eisenmenger syndrome occurs .

    ReplyDelete
  57. block 2 question, 42 it should be chalamydia trachomatis cause i think chalamydia should cause interstitial infiltrate not group b streptococcus

    ReplyDelete
  58. @reedsposer22...the materials will be very helpful.. thank u so much.

    ReplyDelete
  59. can anyone please mail me the nbme questions. my mial id is
    toshailaja@gmail.com

    ReplyDelete
  60. reedsposer22 I cannot thank you enough for the materials! Amazing!!! Will definitely help me on the study front. Best of luck to you!

    ReplyDelete
  61. Block 3 q40

    Thou I get the answer, but how can you have heparin as outpatient? 9 months on IV???

    ReplyDelete
  62. Any explanation on Block 4 q 26? Absolutely confused by the answer.

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  63. pls where can i get the questions? i'm struggling now as i only see these answer keys, pls somebody help!!

    ReplyDelete
  64. ck forms pls!! any help

    ReplyDelete
  65. Reedposer22 thank you so much for sending me the nbmes! You're awesome!

    ReplyDelete
  66. Hey all, I think question 34, section 4 is incorrect. Hypercalcemia does not give you a slow return of DTRs - - hypothyroid does. Plus a weight loss of 2.5 lbs per month (10 over 4 months) is consistent with depression. I checked with two of the smartest people in my class and they agree. Correct answer should be E. Thyroid Stimulating Hormone. :)

    ReplyDelete
  67. Reedposer22 - You are super legit. Thanks for sending NMBEs my way! Best of luck to everyone!

    ReplyDelete
  68. Reedposer22- you are awesome!!! Thanks again for sending the NBMEs to me.

    ReplyDelete
  69. Thanks reedsposer22 for sending me the forms.

    ReplyDelete
  70. Block 2, Qn 14 - Ans is E. Topical metronidazole cuz the diagnosis is probably Rosacea rather than Acne (frequent flushing episodes, wine)

    ReplyDelete
    Replies
    1. Ya..you are right..thanks

      Delete
  71. Thanks reedsposer22 for sending me the forms!

    ReplyDelete
  72. Did anyone else do as bad as i did.

    NBME 4 9 DAYS OUT - 221
    NBME 6 6 DAYS OUT - 210
    UWORLD ASS 4 DAYS OUT - 230
    NMBE 2 2 DAYS OUT - 198

    This is horrible...plz help!!

    ReplyDelete
  73. Reedposer22: Thanks very much for your NBME forms. You are so nice!!! Wish u good luck for your match!!!

    ReplyDelete
  74. can anyone please explain why q39b1 is normal aging? I would hv thought poor sleep hygiene or maybe melatonin def (which has an association with BPH)

    ReplyDelete
  75. q41 block4 why is the answer d PCKD and not E RCC which has the triad of flank pain,hematuria and abdominal mass while in PCKD there should be bilateral masses thank you

    ReplyDelete
    Replies
    1. ADPK is usually B/L but can be unilateral. This is a classic case of ADPKD with chronic stones, HTN, flank pain and palpable mass
      20 year hx for RCC too long, also for RCC there is usually hematuria, weight loss and fever,and its more common in men over 50. Lastly if its RCC for 20 yrs it shd have metastasized to the lungs or bones by now and also manifest with some paraneoplastic syndromes (eg ectopic EPO, ACTH, PTHrP, and prolactin)

      Delete
  76. Q9B4 It is very unlikely to be aortic valve rupture, there is no murmur heard. I believe the answer is pulmonary edema which is a severe form of CHF that can present acutely and is life threatening, so the answer is option E:CHF. additionally, from the options, only CHF/pulmonary edema will have S3. everything in the history can be seen in CHF/PE even hypotension, definitely JVD, SOB, and crackles.
    On another note, please reedposer22 can you send me your famous nbme forms I emailed you but have not gotten a response yet. My Email is amad_1980@hotmail.com OR any other person that has reedposer's nbme version please kindly send to me, thanks

    ReplyDelete
  77. hi my exam is in a week can someone send me reedposer's nbme version to me too my email is hamid_enas@hotmail.com,and plz can some one answer the q of differents btw PCKD AND RCC q41 block4 thank u

    ReplyDelete
  78. thank you sorry didnt see your reply earlier thax again

    ReplyDelete
  79. Can someone please send me this form? My exam CK exam is next week. I can't find the one that correlates to this answer key. My Email address is Jobyj7@gmail.com

    ReplyDelete
  80. Hello guys, I really need your help! I am taking my exam this Wednesday, August 21st. Can you please email me this form? My Email address is Jobyj7@gmail.com. Thank you!

    ReplyDelete
  81. Thanks to reedposer for the NMBE exams!!! He's legit y'all :)

    ReplyDelete
  82. Reedposer is the MAN!!! He is for real an his NBME forms 1, 2 and 4 are so well arranged

    ReplyDelete
  83. can someone email me the nbme forms please...sfontan17@gmail.com

    ReplyDelete
  84. I missed 40 on the online exam n I got 330 !? does it sound right ??

    ReplyDelete
  85. hey can I get the reedposer version too, my email is secretadmirer2001@live.com. Thanks in advance. Best of luck!!

    ReplyDelete
  86. Hey guys,can anyone mail me NBME form 1,3,4,6 questions??
    Pleeeaaaase,as i got only 198 in NBME2 / 3 days ago and 211 in UWSA yesterday and my exam will be on 29th october

    ayser_891010@yahoo.com

    ReplyDelete
  87. I need NBME 1,3,4,6 question
    can anyone send it to me please
    ayser_891010@yahoo.com

    ReplyDelete
  88. hi everyone. my exam is coming soon!! If anyone has Reedposer's NBME forms 1-4 ,6 could you please send it to me? i really need it! tiffany821201@hotmail.com. Thank you!!

    ReplyDelete
  89. Hey guys, my exam is next month and would like to practice with the nbme forms offline, one each weekend, i will post my feedbacks, could anyone please send the forms to my email? johnsmithchap@yahoo.com thanks in advance!

    ReplyDelete
  90. please email me at reedsposer22@hotmail.com if you need NMBE forms 1-4. I can email you them. I organized them into nice PDFs that can be viewed easily, each page is dedicated to 1 question! Took a while to do it, but it turned out nice. let me know! good luck studyn for STEP 2 CK. I took mine May 29th, 2013, I did well, I scored 249, I believe these NMBE forms helped me alot.

    ReplyDelete
  91. Hello friends,
    Does anyone has offline questions nbme form 1,2,3,and 4? I did nbme 6 and the result was bad. So If anyone that kind to share the other forms please email me at yrisela@gmail.com. Thanks a lot.

    ReplyDelete
  92. Thanks a lot reedsposer22. Thank you for your PDF. It helps.=D

    ReplyDelete
  93. thanks so much reedposer22.Your efforts will be rewarded.

    ReplyDelete
  94. highly appreciated gud work....can anyone explain blk 2 q 7....most distinguishing feature b/w epididimytis and torsion iz urine culture which iz negative....although cremastric reflex iz normal but urine culture iz negative i think torsion iz bst option.????...thnx

    ReplyDelete
  95. Posting the key with the Answer choice next to them really help! Since i don't have the actual version that these questions are pulled from.

    ReplyDelete
    Replies
    1. Can someone with a copy of the exam associated with the key go through and write the answers associated with the Letters?-- Thank you much!

      Delete
  96. Can someone PLEASE send me NBME 1-4? My exam is only 3 weeks away. I would really, really appreciate it! Please, pay it forward! My email is nata723@yahoo.com. Thanks very much!

    ReplyDelete
  97. Thanks so much to reedsposer22@hotmail.com!! I really appreciate the fact that he sent the files to me in a really organized manner. Best of luck to everyone.

    ReplyDelete
  98. Thank you very much reedsposer22@hotmail.com. This is a legit person and best of luck to you in all your future steps!

    ReplyDelete
  99. Just wanted to thank reedsposer22 also! The forms are incredibly helpful

    ReplyDelete
  100. Can someone email me the offline forms? PRBoy6@gmail.com

    ReplyDelete
  101. Can some email me the form 2 in the order its listed here please.
    Thanks in advance
    ron.paul10@aol.com

    ReplyDelete
  102. Are you looking for a diode laser hair removal delhi that is perfect for your hair type?

    ReplyDelete
  103. Thank you Reedsposer22 for your email =) Although I have seen I have already had your answer key from someone else I appreciate your help

    ReplyDelete
  104. can someone send me the offline form of nbme 2 ?

    ReplyDelete
  105. can someone send me the nbme forms- neilnf@gmail.com

    Thanks in advance.:)

    ReplyDelete
  106. thanks for the e-mail reedsposer22, really appreciate it!!

    ReplyDelete
  107. can somone please email me the forms: soccersbk@gmail.com

    Thanks you so much!!!!

    ReplyDelete
  108. thank you reedposer for your email! greatly appreciated

    ReplyDelete
  109. Can someone please email me the nbme forms ASAP? need them urgent :-/
    saira_a77@hotmail.com

    Thank you in advance!

    ReplyDelete
  110. Hi! Can you send me please the nbme forms?
    thanks a lot!

    alostseafarer@outlook.com

    Thanks again :D

    ReplyDelete
  111. I just wanted to thank ReedsPoser22 for taking the time not only to email me the NBME forms, but to offer advice and guidance as well. I found his email on here from last year and emailed, with the expectation that it probably would not be answered. It's an amazing feeling to know that there are genuine helpful people out there. Much thanks to the blog writer as well. I only stumbled upon this the other day and already have found the discussions of answers useful. Thanks so much -- catch you on the M.D. side :)

    ReplyDelete
  112. hi,
    could you plese, send me the nbme forms?
    thank you very much,
    :)

    vero_arias2@outlook.com

    ReplyDelete
  113. Can someone send me pdfs for forms 1, 2 and form 5 if it exists, thanks so much!

    skassf@yahoo.com - my test is in 2 weeks!

    ReplyDelete
  114. can any send me offline NBME 2, 4, and 6, for step 2 ck Please?


    hoor2noor@yahoo.com

    ReplyDelete