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ass2017 kaplan Stop + Hom Siraegies How to answer Qbanks - USMLE Forums. kaplan Step 1 Item Strategies How to answer Qbanks [got these from A personal Email from Kaplan Site ..i hope that you enjoy it 1, A 16-year-old girl comes from a very religious family and denies any sexual activity. She has severe acne unresponsive to previous treatment of conventional therapy. Which of the following laboratory studies should be performed by prior to prescribing isotretinoin? A) Lipid profile B) Liver function studies C) Measurement of serum urea nitrogen (BUN) D) Complete blood count E) Measurement of urine b-hCG STRATEGY: Understanding what's really being asked. You are dealing with a young woman who may be sexually active, therefore, it is always necessary to check for pregnancy before prescribing a drug. Knowing this, you could correctly answer this item (E) without knowing much if anything about the specific properties of isotretinoin. 2, A 30-year-old woman with no significant past medical history presents with serosanguinous discharge from one of her breasts. She is not lactating and has no family history of breast disease. Physical exam reveals a moderate amount of serosanguinous discharge expressed from the left nipple. Cytological exam of the fluid is negative. What is the most appropriate next step in management? A) Advise the patient to return in 6 months for re-evaluation B) Obtain a mammogram C) Perform a chest x-ray D) Perform an excisional biopsy of the retroareolar area E) Perform a needle biopsy of the retroareolar area STRATEGY: This item illustrates one of the common themes in clinical items--understanding the proper sequence of lab ordering. Here, while a mammogram may not provide definitive diagnostic information about the patient's problem, it is standard procedure to order a mammogram before ordering more invasive or expensive tests. 3. A 4-year old boy is admitted with respiratory difficulty. He has had several previous admissions for pneumonia. History is significant for the failure to pass meconium at birth. Temp is 101.1 F, respiration rate is 35. Physical exam reveals a thin, malnourished boy < Sth percentile for height and weight. Rales heard over the left lower lobe and percussion over the region is dull. Sputum culture grows Pseudomonas aeruginosa. Which test would confirm the diagnosis? A) Bronchoscopy B) Chloride sweat test C) CT scan of the thorax D D-xylose absorption test E) Pulmonary function tests STRATEGY: This item illustrates the USMLE policy of portraying diseases in their most classical presentation. The boy's history and symptoms are textbook indications of CF, so the answer is B. Notice also, however, that as with many other clinical items, one doesn't receive direct credit for knowing what the boy has, but for reaching that conclusion THEN using that knowledge to answer what's actually being asked, which is what test would clinch that diagnosis, 4, An 8-year-old boy is seen for a routine check-up. His vaccinations are current and he has been healthy. The child is at the Sth percentile for height and at the 20th percentile for weight. His thumbs are disproportionately small compared to his other digits. There are several round, smooth, flat, light-brown areas ranging in size from 3 to 5 cm on his trunk and extremities. For which of the following genetic disorders is the child most likely at risk? hp dew usme-frums.comusmle-stop-1-orun/S75-kagan- stop t-tom-stratoghes-how-answer-anks Html 18 ass2017 kaplan Stop + Hom Siraegies Haw to answer Qbanks - USMLE Forums A) Down's syndrome B) Fanconi's syndrome €) Fetal alcohol syndrome D) Trisomy 18 C) Cri du chat STRATEGY: If you have even the most general knowledge of the symptoms of Down's, Fetal alcohol, ‘Trisomy 18 and Cri du chat, then it is obvious that these severe syndromes would have been evident and diagnosed long before this child reached the aac of 8. By exclusion, then, if not through knowledge of Fanconi's syndrome, this would be the best answer (B) 5, A 62-year old man is complaining of fatigue of 4 months duration. He was recently seen by another physician for nephrolithiasis. He takes no medications and is otherwise healthy, except for mild hypertension controlled with diet, CBC is normal. Which of the following lab values would suggest primary hyperparathyroidism? A) Decreased calcium, decreased phosphorus, and increased parathyroid hormone B) Decreased calcium, increased phosphorus, and increased parathyroid hormone ) Increased calcium, decreased phosphorus, and increased parathyroid hormone D) Increased calcium, increased phosphorus, and increased parathyroid hormone E) Increased calcium, decreased phosphorus, and decreased parathyroid hormone STRATEGY: This item illustrates how even on Step 2 or Step 3, you could be asked basic science information. This item also shows how a straightforward endocrine physiology question (The final sentence in the stem), can be made to "look" clinical but attaching a vignette introduction. But none of that information Is necessary to answer the question, The correct answer is C. 6. A 52-year old man with a ten year history of hypertension complains of abdominal and back pain for the past 6 months, a 10 pound weight loss and greasy, foul-smelling stools. He smokes 2 packs of cigarettes and drinks a pint of whiskey/day. On physical exam, he is afebrile with mild epigastric tenderness but no guarding, rigidity, or distension. Bowels sounds are present and rectal exam is normal. Hematocrit: 48%, sodium: 141 mEq/L, potassium: 3.9 , mEq/L, glucose: 148 mg/dl, ALT: 16, AST: 24, albumin: 4.7 g/dl, prothrombin time: 11 seconds. Chest x-ray is normal, abdominal plain film shows pancreatic calcifications, Which of the following is most likely responsible for his weight loss? A) Alcoholic hepatitis B) Duodenal ulcer C) Gastric ulcer D) Pancreatic insufficiency E) thiamin deficiency STRATEGY: People who have really struggled to do well on multiple choice exams before often carry around some emotion about having to take these kinds of tests. Sometimes they feel items are designed to trick them into choosing wrong answers. Here, such experiences would lead to avoiding answer D because the stem lists “pancreatic calcifications," so the suspicious test-taker reasons that this couldn't possibly be the correct answer and must be there to lure them. They choose another answer, and get the item wrong. Notice also how the true distractors (wrong answers) each agree with some part of the findings or history clues--the patient drinks heavily, so A and E relate to this fact. The patient has abdominal symptoms, so B and C relate to those symptoms. In a well-written test, nearly every distractor fits at least part of the stem information, but only the correct answer fits ALL the clues given in the stem. 7. A neonate has a flat, dark-pigmented area of skin over the sacral region. The area is roughly oval, has a clearly defined border, and differs from, surrounding skin only in ‘color. Which of the following is the most likely diagnosis? A) Diastematomyelia B) Mongolian spot C) Nevus flammeus D) Pilonidal cyst E) Spina bifida hp twwrw use frums.comusmle.stop-1-orun/S75-kapan- stop tom-stratoghes-how-answer-anks Html ass2017 kaplan Stop + Hom Siraegies Haw to answer Qbanks - USMLE Forums STRATEGY: Using reasoning strategies doesn't ever guarantee a correct answer. However, they allow you to extrapolate from what you recall to the specifics of a given question. Here, if you didn’t know the answer (B), you could still probably eliminate E as the findings would be more drastic for spina bifida. You might also reason that it wouldn't be a cyst as the stem states that the area differs only in color and with a cyst, you would expect there to be a palpable mass as well. Knowing some word structure might help you eliminate C because flammeus suggests either redness or heat, which aren't present in the stem clues. This would leave you with a guess between A or B and B is correct. Over a long test, using these techniques yields more correct guesses and a higher score. 8, A 55-year-old woman with no significant medical history complains of difficulty in keeping her balance. Cranial nerve, motor and mental status exam are all within normal limits. There is diminished proprioception in the joints of all 4 extremities, with a greater deficit ‘on the right side, She is able to stand with a narrow base with her arms extended and eyes open. However, when she stands in a similar manner with her eyes closed, she immediately begins to fall. Which of the following is the most likely site of the lesion? A) Cerebellum B) Cerebral cortex ) Peripheral nerve D) Posterior column E) Pons STRATEGY: I used a combination of strategies to figure out this item, even though I've never studied neuroanatomy. This is 2 problem with balance, so for that reason, it isn't likely to be C because peripheral nerves aren't CNS. It also isn't likely to be B, since the cortex functions involve higher order thought and this is a balance or coordination, not a thought disrupting problem. The correct answer is D, and I chose it because of a mnemonic I heard from a med student many years ago, that the body, like a temple, stands because of its "columns." 9. A 20-year-old football player is sent to the campus health clinic by his coach after complaining of neck pain following a hard tackle during practice. He has a normal neurological exam, but his posterior neck is tender. Which of the following would be the best initial step in management? A) Administer non-steroidal anti inflammatory agents B) Apply a hard-cervical collar and immobilize his spinal cord C) Apply a soft cervical collar and order bed rest D) Send him to the hospital for cervical spine x-ray E) Apply ice directly to the affected area STRATEGY: This item illustrates the theme of recognizing potentially serious findings and dealing with them first. The test-writer has hidden the seriousness, though, by making the situation a campus clinic rather than an emergency room. Use a systematic decision-making process by asking yourself first, What do I know? In this case, do I really know the extent of the young man's injuries here? No? Then it is wisest to act cautiously by applying a hard collar until the injuries can be further explored at a hospital (answer B). 10. A 52-year-old physician whom you know socially has taken secobarbital, 2 g daily, for 7 years despite several attempts to stop using the drug. He has been abstinent from alcohol for 10 years. The patient weighs 72 kg (158 Ib). Exam shows no abnormalities. Which of the following is the most appropriate next course of action? A) Detoxification as an outpatient and referral for group treatment B) Discontinuation of secobarbital and prescription for a benzodiazepine in equivalent doses C) Hospitalization for detoxification D) Psychotherapy E) Suggest that he gradually reduce the dosage of secobarbital hp dew usme-frums.comusmle-stop-1-orun/S75-kagan- stop t-tom-stratoghes-how-answer-anks Html

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