Freaking Step 2 Qbank

[Etomidate]

Only done 100 questions and 2 questons I have serious issues with.

1st is a bleeding kid with elevated PTT and normal PT. Answer choices include Hemophilia A and VWD. Answer was Hemophilia A because "WVD is primarly a platelet disorder." Bullshyt. According to Goljan and Harrison's VWD also has an elevated PTT. The question should have included a bleeding time.

2nd is a kid with Hirshprung's disease. Stool is seen and evacuated during a digital rectal exam. In Hirshprung's, the rectal vault is supposed to be EMPTY with proximal dilatation.

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[14022]

Only done 100 questions and 2 questons I have serious issues with.

1st is a bleeding kid with elevated PTT and normal PT. Answer choices include Hemophilia A and VWD. Answer was Hemophilia A because "WVD is primarly a platelet disorder." Bullshyt. According to Goljan and Harrison's VWD also has an elevated PTT. The question should have included a bleeding time.

2nd is a kid with Hirshprung's disease. Stool is seen and evacuated during a digital rectal exam. In Hirshprung's, the rectal vault is supposed to be EMPTY with proximal dilatation.

Oh quit your whining. Both of those questions were simple. All of the other choices were far from correct.

First of all, the kid in the hemophilia question was like a 2 year old boy (always the classic epidemiology for hemophilia). Second, it said he had hemarthrosis, which is classic for a factor deficiency. vWD is primarily a platelet disorder, meaning that most of the bleeding is superficial, such as mucous membrance bleeding. True that aPTT is elevated (contrary to Boards and Wards), but factor VIII is present (NOT deficient) but it is less stable in the blood. It is because vWF stabilizes factor VIII in the blood so when there is no vWF, factor VIII is broken down much easier. Still there are no signs of hemarthrosis or other typical signs of factor deciciency with vWD. If the question gave you the bleeding time, it would have been ridiculously simple. They just decided to make it kind of easy by not giving it to you.

And the Hirschsprung's question. It was a young child with chronic constipation since birth. I think it even said he did not pass meconium right away after birth (dead give away for Hirschsprung's or Cystic Fibrosis).

 

[bigfrank]

I hope Step II CK is this easy.

 

[Pox in a box]

I hope Step II CK is this easy.

I'm ready if so.

 

[bigfrank]

I'm ready if so.

OK.

 

[Pox in a box]

OK.

I was just joking. Step 2 is not going to be easy.