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Alle 15 spørsmål i oversikt

Vil du heller lese før du spiller? Alle spørsmålene i smakebiten står listet under. Svar og forklaringer er skjult til du åpner dem.

1. 1. A 72-year-old man reports two episodes of syncope while climbing stairs. Examination shows a crescendo-decrescendo systolic murmur at the right upper sternal border that radiates to both carotids, and the carotid upstroke is slow and low in volume. Which diagnosis best explains these findings?

   • A. Mitral regurgitation
   • B. Hypertrophic cardiomyopathy
   • C. Aortic regurgitation
   • D. Aortic stenosis
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   Svar: D. Aortic stenosis

   A slow, low volume carotid upstroke with a systolic ejection murmur radiating to the carotids points to a fixed obstruction at the aortic valve, and exertional syncope means the stenosis is severe enough that cardiac output cannot rise with demand. Mitral regurgitation gives a holosystolic murmur at the apex that radiates to the axilla, and aortic regurgitation is diastolic with a bounding rather than a weak pulse. Hypertrophic cardiomyopathy can sound similar, but its murmur gets louder with Valsalva while the aortic stenosis murmur softens, because less preload means less flow across a fixed valve.

2. 2. A test with a sensitivity of 95 percent and a specificity of 70 percent was validated in a referral clinic. It is now used to screen a general population where the disease is far less common. Which value falls the most in the new setting?

   • A. Sensitivity
   • B. Specificity
   • C. Positive predictive value
   • D. Negative predictive value
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   Svar: C. Positive predictive value

   Sensitivity and specificity describe how the test behaves in people who do and do not have the disease, so they do not move when prevalence changes. Predictive values do. When prevalence drops, most positives are now false positives, so positive predictive value falls while negative predictive value rises. This is why a test that looks convincing in a specialty clinic can generate mostly false alarms when it is turned into a population screen.

3. 3. Complete the sentence.

   In a trial, the event rate is 20 percent in the control group and 15 percent in the treatment group. The absolute risk reduction is 5 percent, so the number needed to treat is _____.

   Alternativer for luke 1: 4, 5, 20, 100

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   Svar: 20

   Number needed to treat is 1 divided by the absolute risk reduction, so 1 divided by 0.05 gives 20. Relative risk reduction for the same numbers is 25 percent, which sounds far more impressive from the same data, and that gap is exactly why trials are often reported in relative terms. Always convert to absolute risk reduction before you judge how much a treatment actually buys.

4. 4. Screening recommendations usually specify an age to stop as well as an age to start. What is the main reason for the upper age limit?

   • A. Older adults cannot tolerate the screening test
   • B. Disease incidence falls sharply with age
   • C. Insurance stops covering the test
   • D. The benefit of screening appears only after years, so a person with limited life expectancy takes on the harms without living long enough to gain
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   Svar: D. The benefit of screening appears only after years, so a person with limited life expectancy takes on the harms without living long enough to gain

   Screening harms are immediate: false positives, biopsies, overdiagnosis and the treatment that follows it. The benefit, fewer deaths from the disease, arrives years later. When remaining life expectancy is shorter than that lag, the arithmetic turns negative. Incidence of most screened cancers actually rises with age rather than falling, which is why the stopping rule is about life expectancy and comorbidity, not about age alone.

5. 5. Which feature best distinguishes preeclampsia from chronic hypertension in a pregnant patient?

   • A. Blood pressure elevation documented before 20 weeks of gestation
   • B. A family history of hypertension
   • C. New onset hypertension after 20 weeks of gestation
   • D. Hypertension that persists more than 12 weeks after delivery
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   Svar: C. New onset hypertension after 20 weeks of gestation

   The dividing line is timing. Hypertension present before 20 weeks, or still present more than 12 weeks after delivery, is chronic hypertension. New hypertension after 20 weeks with proteinuria or with end organ dysfunction such as thrombocytopenia, elevated transaminases, renal impairment, pulmonary edema or new neurologic symptoms is preeclampsia. The two can coexist, which is called preeclampsia superimposed on chronic hypertension, and that combination raises risk more than either alone.

6. 6. Which findings belong to the diagnostic picture of a manic episode?

   Velg alle som passer.

   • A. A decreased need for sleep with normal or high energy the next day
   • B. Flight of ideas or racing thoughts
   • C. Psychomotor retardation with hypersomnia
   • D. An increase in goal directed activity or agitation
   • E. Anhedonia present nearly every day for two weeks
   Vis svar og forklaring

   Svar: A. A decreased need for sleep with normal or high energy the next day, B. Flight of ideas or racing thoughts, D. An increase in goal directed activity or agitation

   A manic episode needs a distinct period of elevated, expansive or irritable mood together with increased activity or energy, plus symptoms such as decreased need for sleep, racing thoughts, distractibility, inflated self esteem, pressured speech or risky goal directed behavior. Decreased need for sleep is not the same as insomnia: the patient sleeps little and still feels fine. Psychomotor retardation with hypersomnia and two weeks of anhedonia describe a major depressive episode, which is the other pole and not part of mania.

7. 7. A 9-month-old has sudden episodes of crying while drawing his knees up, alternating with periods of lethargy. Examination reveals a sausage shaped mass in the right abdomen and a stool sample mixed with blood and mucus. Which is the most appropriate next diagnostic step?

   • A. Abdominal ultrasound
   • B. Upper gastrointestinal contrast series
   • C. CT of the abdomen with contrast
   • D. Colonoscopy
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   Svar: A. Abdominal ultrasound

   The picture is classic for intussusception, which peaks between about 6 and 36 months. Ultrasound is the first line study because it is fast, needs no radiation and shows the telescoped bowel as a target or donut on cross section. CT would answer the question too but costs radiation in an infant, an upper GI series looks at the wrong segment, and colonoscopy has no diagnostic role here.

8. 8. Complete the sentence.

   The Apgar score rates a newborn's color, heart rate, reflex irritability, muscle tone and respiratory effort, and it is assigned at _____ minute and again at _____ minutes after birth.

   Alternativer for luke 1: 1, 2, 5

   Alternativer for luke 2: 3, 5, 10

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   Svar: 1, 5

   Five components are each scored 0, 1 or 2, for a total of 0 to 10, at 1 and 5 minutes. If the 5 minute score stays low, scoring is repeated at intervals while the infant is assessed. The score describes the newborn's condition and how it responds over time, and it is not what triggers resuscitation, which begins on clinical assessment without waiting for a number.

9. 9. Three days after an open abdominal operation a patient has distension, nausea and no flatus. Bowel sounds are absent. An abdominal radiograph shows gas distributed evenly through the small bowel and the colon, with no transition point and no distal collapse. Which explanation fits best?

   • A. Adhesive small bowel obstruction
   • B. Postoperative ileus
   • C. Sigmoid volvulus
   • D. Perforated viscus
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   Svar: B. Postoperative ileus

   The discriminating detail is the pattern of gas. Mechanical obstruction produces dilated bowel proximally, a transition point and a collapsed segment beyond it. Ileus is a failure of coordinated motility along the whole tract, so gas sits everywhere including the colon with no transition. Volvulus gives a characteristic dilated closed loop, and a perforated viscus is suggested by free air under the diaphragm and peritoneal signs, neither of which is described here.

10. 10. Which statements describe requirements for valid informed consent?

    Velg alle som passer.

    • A. The patient is told the nature and purpose of the proposed intervention
    • B. Risks, expected benefits and the reasonable alternatives, including doing nothing, are disclosed
    • C. The patient has decision making capacity and the decision is voluntary and free of coercion
    • D. Consent is valid only if a family member countersigns the form
    • E. A relative may override the refusal of an adult who has capacity
    Vis svar og forklaring

    Svar: A. The patient is told the nature and purpose of the proposed intervention, B. Risks, expected benefits and the reasonable alternatives, including doing nothing, are disclosed, C. The patient has decision making capacity and the decision is voluntary and free of coercion

    Valid consent needs disclosure, capacity, voluntariness and comprehension, and the signed form is only evidence that the conversation happened. Alternatives, including no intervention at all, are part of the disclosure, because a patient cannot weigh an option they were never told about. A competent adult's decision does not require a relative's approval and cannot be overridden by one.

11. 11. An adult patient with full decision making capacity refuses a blood transfusion on religious grounds and states clearly that she understands she may die without it. Which response is most appropriate?

    • A. Seek a court order authorizing transfusion
    • B. Ask her adult children to consent on her behalf
    • C. Confirm that she understands the consequences and alternatives, then respect the refusal
    • D. Wait until she loses consciousness and then transfuse
    Vis svar og forklaring

    Svar: C. Confirm that she understands the consequences and alternatives, then respect the refusal

    An adult with capacity may refuse any intervention, including one that is life sustaining, and the reason for the refusal does not have to be one the clinician agrees with. The physician's job is to confirm capacity, make sure the refusal is informed and voluntary, document it, and continue offering the care the patient does accept. Surrogates and courts step in when capacity is absent, not to overrule a capacitated adult, and transfusing after she becomes unconscious would defeat a decision she made while capable.

12. 12. According to Light's criteria, which findings identify a pleural effusion as an exudate?

    Velg alle som passer.

    • A. A pleural fluid to serum protein ratio above 0.5
    • B. A pleural fluid to serum lactate dehydrogenase ratio above 0.6
    • C. A pleural fluid lactate dehydrogenase above two thirds of the upper limit of normal for serum
    • D. A pleural fluid glucose identical to the serum glucose
    • E. An effusion occurring in decompensated heart failure
    Vis svar og forklaring

    Svar: A. A pleural fluid to serum protein ratio above 0.5, B. A pleural fluid to serum lactate dehydrogenase ratio above 0.6, C. A pleural fluid lactate dehydrogenase above two thirds of the upper limit of normal for serum

    Light's criteria need only one of the three to be met for the fluid to count as an exudate, which makes them very sensitive and somewhat prone to labeling a transudate as an exudate. The distinction matters because it splits the differential: exudates come from inflammation, infection or malignancy that leaks protein across the pleura, while transudates come from pressure problems such as heart failure, cirrhosis or nephrotic syndrome. Fluid glucose equal to serum is unremarkable, and heart failure is the classic transudate.

13. 13. Complete the sentence.

    A diagnosis of schizophrenia requires continuous signs of the illness for at least _____ months, while a presentation that has lasted between one and six months is called _____.

    Alternativer for luke 1: 1, 3, 6

    Alternativer for luke 2: brief psychotic disorder, schizophreniform disorder, schizoaffective disorder

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    Svar: 6, schizophreniform disorder

    The psychotic disorders are separated mainly by duration. Under one month is brief psychotic disorder, one to six months is schizophreniform disorder, and six months or more of continuous signs, counting prodromal and residual periods, is schizophrenia, with at least one month of active symptoms inside that window. Schizoaffective disorder is defined differently: it needs a mood episode plus a period of psychosis lasting two weeks or more without prominent mood symptoms.

14. 14. Which headache history feature most strongly suggests a secondary rather than a primary headache?

    • A. A throbbing unilateral headache with photophobia that eases after sleep
    • B. Sudden onset pain that reaches maximum intensity within a minute
    • C. A bilateral band like pressure that builds through the workday
    • D. Pain that improves after caffeine
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    Svar: B. Sudden onset pain that reaches maximum intensity within a minute

    A thunderclap headache, one that peaks within about a minute, is the classic red flag for subarachnoid hemorrhage and other vascular causes, and it warrants urgent evaluation rather than symptomatic treatment. Other red flags include a first severe headache after age 50, fever with neck stiffness, focal neurologic deficits, papilledema, pain that worsens with position or Valsalva, and headache in someone who is immunosuppressed or has cancer. The other three options describe familiar primary patterns, migraine and tension type headache.

15. 15. Which set of laboratory findings best fits iron deficiency anemia?

    • A. Low mean corpuscular volume, low ferritin, high total iron binding capacity
    • B. Low mean corpuscular volume, high ferritin, low total iron binding capacity
    • C. High mean corpuscular volume, normal ferritin, normal total iron binding capacity
    • D. Normal mean corpuscular volume, low vitamin B12, high methylmalonic acid
    Vis svar og forklaring

    Svar: A. Low mean corpuscular volume, low ferritin, high total iron binding capacity

    In iron deficiency the stores empty first, so ferritin falls, and the liver makes more transferrin to scavenge what iron is left, which raises total iron binding capacity. Red cells made without enough iron end up small, so the mean corpuscular volume drops. Anemia of chronic disease is the trap: it is also microcytic or normocytic, but ferritin is normal or high because it is an acute phase reactant and total iron binding capacity is low. The high volume and the B12 patterns point to macrocytic causes instead.

Dette tester Step 2 CK, og derfor veier den tyngre nå

Step 2 CK er eksamenen i klinisk kunnskap i rekkefølgen United States Medical Licensing Examination, et samarbeidsprogram mellom Federation of State Medical Boards og National Board of Medical Examiners. I januar 2022 sluttet Step 1 å rapportere et tresifret tall og begynte å rapportere bare bestått eller ikke bestått. Step 2 CK ble ikke endret, så den ble den eneste USMLE-poengsummen med tall som de fleste residency-programmer noen gang ser. Den ene endringen er grunnen til at denne siden finnes.

Eksamenen er én dag med flervalgsblokker, flere timer lang, og den gir en tallpoengsum. Antall oppgaver, blokkstrukturen, tiden per blokk og gjeldende grense for bestått settes av USMLE-programmet og har blitt justert mer enn én gang, så les de tallene på usmle.org og i den gjeldende innholdsoversikten framfor å stole på et tall fra et foruminnlegg.

Innholdet er klinisk. Indremedisin har den største andelen, med kirurgi, pediatri, gynekologi og fødselshjelp og psykiatri som fyller det meste av resten, pluss helseoppfølging og screening, pasientsikkerhet, etikk og kommunikasjon, og anvendt biostatistikk. De fleste oppgavene er vignetter som spør om en diagnose, det neste diagnostiske steget, den mest sannsynlige mekanismen, eller hvordan et resultat bør endre det du tror.

Slik bruker du denne smakebiten, og slik leser du stoffet

Disse 15 spørsmålene er bygd rundt resonnementssteget framfor gjenkalling. De spør hvilket funn som snevrer inn differensialdiagnosen, hva den neste diagnostiske testen gir deg, hvilken egenskap ved en test som beveger seg når prevalensen beveger seg, og hvordan et varighetskriterium skiller to psykiatriske diagnoser. Det er vanen Step 2 CK belønner, fordi en vignett som regel gir deg nok data til å nå svaret hvis du vet hva hver bit er til for.

Ta alle 15 i én økt uten notater, og les så forklaringen til hvert spørsmål, også de du fikk riktig. Å gjette riktig og å kunne er forskjellig, og bare forklaringen forteller deg hvilket av dem som skjedde. Behandle et galt svar som et tema framfor et faktum. Bommet du på spørsmålet om pleuravæske og spørsmålet om anemi, er lærdommen at du leser prøvesvar én verdi om gangen i stedet for som et mønster.

En ærlig merknad. Denne siden er eksamensøving skrevet av StudyPDF-teamet ut fra den publiserte innholdsoversikten for Step 2 CK. Det er ikke medisinsk veiledning, og ingen av disse er ekte eksamensoppgaver. Der en ekte vignett ville bedt deg velge et legemiddel eller en dose, spør denne smakebiten om resonnementet i stedet.

Slik bygger StudyPDF fullengdes øvingsprøver fra ditt eget materiale

Femten spørsmål kan vise deg hvor det kliniske resonnementet er tynt. De gjør deg ikke klar til en heldagseksamen alene, og en generell spørsmålsbank treffer aldri vektleggingen i shelf-eksamenen du tar neste måned eller i notatene fra din egen praksisperiode.

StudyPDF jobber fra ditt materiale i stedet. Du laster opp Step 2-repetisjonsboka, notatene fra praksisperioden, en forelesningspresentasjon eller PDF-utdelingene fra clerkshipen, så bygger Bo, studieagenten, fullengdes øvingsprøver fra akkurat de sidene. Hvert spørsmål er forankret i ditt materiale og hver forklaring viser hvor svaret kommer fra, så du kan hoppe rett til siden når noe ser galt ut. Du kan lage nye prøver så ofte du vil, snevre dem inn til ett område som kardiologi eller fødselshjelp, og følge med på hvilke begreper du stadig bommer på fra forsøk til forsøk.

Du trenger ikke noe dokument for å komme i gang. Har du ingenting å laste opp, oppgi et tema i stedet, for eksempel syre-base-forstyrrelser, screening i svangerskapet eller etikken rundt stedfortredende beslutninger, så skriver Bo en øvingsprøve fra det. Gratis å komme i gang.