THE OFFICIAL... USMLE World WTF are you talking about Post!!!

[IzzyMD09]

---

Members don't see this ad.

Ok, so I have heard and seen a couple of good ones out there already, feel free to continue this post as a means to vent your UWorld frustrations....

UWorld I hate you but I love you more 😎



LASS = lactic acidosis + steatosis syndrome with NRTI's ......wtf

imatinib mesylate as first line treatment for CLL.....ok

 

[EternalMD]

For CLL? I thought imitinab was for CML? Btw imitinab aka gleevac

 

[ranmyaku]

It's CML

 

[IzzyMD09]

right CML

 

[EternalMD]

i remember running across a question that dealt with cold water face immersion and some type of arrhythmia - does anyone remember what that was for?

oh yeah and "WTF"

 

[futrorthodr]

I hate questions that differ based on the age of the patient. I had a question about a 7 yr old kid who definitely had lyme disease and I said to give him Doxycycline but they said the treatment was amoxicillin for kids under the age of 9.😡

I mean I can understand you wouldnt give doxy to pregnant women but I never heard about having to be over the age of 9.

 

[IzzyMD09]

😀had both of them, and Im actually glad i remember
the cold water face thing was for SVT, or re-entry arrythmia and if that thing fails do adenosine, i was also like wtf because i didnt know cold water to the face was the same as carotid massage or valsalva, i cant remember the question that well either but i remember the EKG looked pretty much almost exactly like Afib which is why i got it wrong

i too got the amoxi tetracycline thing wrong, for lyme, maybe the 7 year old is pregnant and we dont want HER baby to have teeth discoloration

who kows

i guess the point is we remember......

 

[gonogo]

I hate questions that differ based on the age of the patient. I had a question about a 7 yr old kid who definitely had lyme disease and I said to give him Doxycycline but they said the treatment was amoxicillin for kids under the age of 9.😡

I mean I can understand you wouldnt give doxy to pregnant women but I never heard about having to be over the age of 9.

I think you can't give doxycycline to kids under the age of 8, except in RMSF that you can do it because the required dose is lower.

 

[EternalMD]

thanks izzy for the info. i thought it was but obviously didn't take notes nor wanted to go through the question banks to find the question.

 

[Pathinterpreter]

...I mean I can understand you wouldnt give doxy to pregnant women but I never heard about having to be over the age of 9.

Remember Tetracycline's effect on bone growth in children.

 

[ranmyaku]

Lyme -
<9 yo = Amoxicillin x21 days
>9 yo = doxycycline

(note- uptodate says it is <8yo and >8yo for the cutoff, but world says it is 9yo)

Lyme arthritis with neurologic disease, late lyme neurologic disease
IV therapy with ceftriaxone, cefotaxime, or penicillin G

RMSF -
adults and children >45kg
Doxycycline 200 mg/qday in two divided doses continued until at least 3 days after pt has become afebrile
-if less than 45kg its 2.2mg/kg

if pregnant - chloramphenicol (1 in 25,000 to 40,000 chance of fatal aplastic anemia)

 

[kreddy05]

<n/m ranmyaku just covered it>

 

[ranmyaku]

sorry i didn't know you were going to post that also. I figured it would be a good review if I went through it again myself. hah

 

[medready2005]

Four words: "Vanishing Bile Duct Syndrome"

 

[MaxMoonMD]

Four words: &quot;Vanishing Bile Duct Syndrome&quot;

Yeah, that one was hilarious.

 

[climbguy]

There are a TON of garbage questions on World.

At first I thought WorldQ's were really good, but now that I'm almost through them all I think I'm getting dumber.

 

[Krazykritter]

My favorite one's to just LMFAO at are the ones that give a giant long scenario w/ about 6-8 clues as to the dx & then the list of answers are 5-12 eponymed diseases (of which the 2-3 I have ever heard of are obviously not correct).

I have a hard time believing the the real exam is going to test to see if you can choose from a list of obscure eponyms (& if it does well then I will just click & move on).

 

[IzzyMD09]

I still have yet to have figured out why two patients in similar vehicular trauma, with similar signs and symptoms and similar stages in presentation

get different treatment, one gets laparotomy right away the other gets FAST then laparotomy,

i have read both answers and explanations like 12 times

this is crazy

WTF

 

[climbguy]

I've had the same problem. We were taught during surgery that a blunt abdominal injury with unstable vitals not responsive to fluids goes to the OR. In fact, one of our surgery attendings said he didn't trust FAST exams b/c of high interoperator variability.

 

[IzzyMD09]

tension pneumothorax and unstable patient
what do you do first

PEstana says chest tube, UWorld says need decompression

???? WTF

 

[Babycatcher2B]

tension pneumothorax and unstable patient
what do you do first

PEstana says chest tube, UWorld says need decompression

???? WTF

The first step to quickly release the air is needle decompression. However, eventually you will need a chest tube.

 

[IzzyMD09]

😉thanks babyatcher i thought so as well

😀😀

Here is a good one

Pleural effusion thats clearly an exudate,

high adenosine deaminase signifies an increase in cappilary permeability due to TB....oooooooooooooooook

 

[mjs16]

Hey I had this question on my medicine shelf and never found out the answer, anyone know??

How to treat a patient with an acute gouty attack with a creatinine of 4.5??

answer choices were pain management, indomethacin, and some antibiotics

 

[IzzyMD09]

probably pain management, as i dont see how Ab's or indo would do anything for an acute gouty attack


heres another WTF

and maybe i just never learned this somewhere else

but prostatodynia

-----------whateva!!!!!!!!!😱

 

[ranmyaku]

probably pain management, as i dont see how Ab's or indo would do anything for an acute gouty attack


heres another WTF

and maybe i just never learned this somewhere else

but prostatodynia

-----------whateva!!!!!!!!!😱

NSAIDs are first line therapy in acute gout. Indomethacin is an NSAID.

You'd want to read in the question stem though to see if there was some contraindication to the use of an NSAID.

Other agents include colchicine, intraarticular and oral glucocorticoids.

 

[IzzyMD09]

NSAIDs are anti-inflammatory's that stop inflammation, they are not necessarily treatment for pain medication, but yeah you would need to read the stem

anyways

im off to take the test

good luck all, I will let you know how it goes

😱

 

[mjs16]

what about the fact that you are giving an NSAID (indomethacin) to a person with renal disease? I was pretty sure antibiotics was wrong, but I couldn't figure out if you could give the nsaid with a creatinine of 4.5 or just give morphine (the pain management option). Colchicine is a good answer but was not a choice.

 

[ranmyaku]

NSAIDs are anti-inflammatory's that stop inflammation, they are not necessarily treatment for pain medication, but yeah you would need to read the stem

anyways

im off to take the test

good luck all, I will let you know how it goes

😱

I was just making sure you realized indo is an nsaid, and that if the pt. didn't have renal impairment, it would be first line.

Given that the pt. has a Cr of 4.5, you prob wouldn't use indo or colchicine. Though you would need to calculate the patients creatinine clearance to be sure you couldn't use them. I'd be interested to know what the other options were...the poster only listed 3 answer choices.

 

[deuist]

I took STEP 2 today. It much easier than USMLEWorld. The eponyms were not on the real thing nearly as frequently as UW.

 

[futrorthodr]

So which is best to follow AAA's. I have read that CT's are the best way if there arent any other factors ilike renal insufficiency etc, but UW says that AB ultrasound is the best way period?

 

[Babycatcher2B]

So which is best to follow AAA's. I have read that CT's are the best way if there arent any other factors ilike renal insufficiency etc, but UW says that AB ultrasound is the best way period?

Abdominal ultrasounds are used to follow progression of size.

 

[ranmyaku]

You are right that CT is a better way (read 'more accurate'), but World is probably basing their recommendation (for U/S) off of the MASS trial. There are 4 major trials for AAA screening...and the MASS trial has the best cost-effectiveness data of the studies done (which all use U/S as their screening modality).

 

[premiergator]

i have got a question that i had on a medicine q book test i took.

for controlling HTN in a diabetic pt. would you use an ACE-I first or would you go with standard HCTZ. The answer was ACE-I. I mean I can understand why that might be but in clinical practice i've seen docs usually goin with the HCTZ initially to control the BP and then will add the ACE as second line due to the diabetes.

any thoughts?

 

[Babycatcher2B]

i have got a question that i had on a medicine q book test i took.

for controlling HTN in a diabetic pt. would you use an ACE-I first or would you go with standard HCTZ. The answer was ACE-I. I mean I can understand why that might be but in clinical practice i've seen docs usually goin with the HCTZ initially to control the BP and then will add the ACE as second line due to the diabetes.

any thoughts?

ACE inhibitors protect the kidneys in diabetics, BOTTOM LINE!!! ACE inhibitors should be used even if patient doesn't have HTN. Therefore you get 2 deals out of one drug. HCTZ wouldn't protect the kidneys, so that wouldn't be good.

 

[EternalMD]

Even in practice, ALL diabetic patients should be put on an ACE-i as first line due to its renoprotective properties. Thiazides also are known to cause hyperglycemia so definitely avoid them in that population.

 

[Babycatcher2B]

I came across the question that Oral Metronidazole to treat bacterial vaginosis during pregnancy shouldn't be used. It says only to use topical agents. However, I am really not convinced. Anybody feel the same way? Supposedly it is safe to use oral or topical preps during pregnancy and there is no proof that it causes birth defects (you know that stuff they make us learn called "evidence based medicine"). Also by trying to find an answer by browsing the internet, I found out that the oral preps do not prevent PROM and Preterm labor that BV is associated with. Anybody have any thoughts??? I'm just not convinced on this question.

 

[ranmyaku]

I came across the question that Oral Metronidazole to treat bacterial vaginosis during pregnancy shouldn't be used. It says only to use topical agents. However, I am really not convinced. Anybody feel the same way? Supposedly it is safe to use oral or topical preps during pregnancy and there is no proof that it causes birth defects (you know that stuff they make us learn called "evidence based medicine"). Also by trying to find an answer by browsing the internet, I found out that the oral preps do not prevent PROM and Preterm labor that BV is associated with. Anybody have any thoughts??? I'm just not convinced on this question.

This is what uptodate says.

Symptomatic BV infection — All women with symptomatic BV should be treated to relieve bothersome symptoms. Oral treatment is effective and has not been associated with adverse fetal or obstetrical effects [88-93] . The therapeutic options include [47] :

* Metronidazole 500 mg orally twice daily for seven days
* Metronidazole 250 mg orally three times daily for seven days
* Clindamycin 300 mg orally twice daily for seven days

Some clinicians avoid use of metronidazole in the first trimester because it crosses the placenta, with a potential for teratogenicity. In addition, the drug is mutagenic in bacteria and carcinogenic in mice. However, meta-analysis has not found any relationship between metronidazole exposure during the first trimester of pregnancy and birth defects [94] . The Centers for Disease Control and Prevention no longer discourage the use of metronidazole in the first trimester.

As mentioned above, topical therapy is as effective as oral therapy in the treatment of nonpregnant women with BV. In contrast, some experts avoid topical therapy in pregnant women because they believe oral treatment is more effective against potential subclinical upper genital tract infection [95-97] .

 

[IzzyMD09]

I thought it was hard, I thought it was as hard as USMLE World, hopefully, i pray which is a rarityl, UWorld prepared me for this challenge,

I am disoriented right now and have no idea what is going on, there were definately Uworld questions on that test maybe 5

indomethecin or pain killers for gout was in my second block which i thought was funny, i also got cannabis intoxication 3 times which i thought was funny as well

i wil lwrite more later

izzy

 

[Babycatcher2B]

This is what uptodate says.

Symptomatic BV infection — All women with symptomatic BV should be treated to relieve bothersome symptoms. Oral treatment is effective and has not been associated with adverse fetal or obstetrical effects [88-93] . The therapeutic options include [47] :

* Metronidazole 500 mg orally twice daily for seven days
* Metronidazole 250 mg orally three times daily for seven days
* Clindamycin 300 mg orally twice daily for seven days

Some clinicians avoid use of metronidazole in the first trimester because it crosses the placenta, with a potential for teratogenicity. In addition, the drug is mutagenic in bacteria and carcinogenic in mice. However, meta-analysis has not found any relationship between metronidazole exposure during the first trimester of pregnancy and birth defects [94] . The Centers for Disease Control and Prevention no longer discourage the use of metronidazole in the first trimester.

As mentioned above, topical therapy is as effective as oral therapy in the treatment of nonpregnant women with BV. In contrast, some experts avoid topical therapy in pregnant women because they believe oral treatment is more effective against potential subclinical upper genital tract infection [95-97] .

Thanks, I knew that question wasn't all the way right.

 

[Gibbles]

Even in practice, ALL diabetic patients should be put on an ACE-i as first line due to its renoprotective properties. Thiazides also are known to cause hyperglycemia so definitely avoid them in that population.

I agree, this day in age you're pretty much medically negligent as a physician if your diabetics aren't on an ACE inhibitor or ARB, aspirin, a statin, and a glycemic control agent. Combination HCTZ/ACE inhibitors are actually a first-line therapy option.

Beta-blockers are still up in the air and your goal A1C will depend upon who you talk to, because the endocrinologists want it less than 6.5 while everybody else is a huge fan of the number 7. The same holds true for lipids the incredibly frustrating tug-of-war that takes place among specialists and subspecialists.

 

[MaxMoonMD]

I thought it was hard, I thought it was as hard as USMLE World, hopefully, i pray which is a rarityl, UWorld prepared me for this challenge,

I am disoriented right now and have no idea what is going on, there were definately Uworld questions on that test maybe 5

indomethecin or pain killers for gout was in my second block which i thought was funny, i also got cannabis intoxication 3 times which i thought was funny as well

i wil lwrite more later

izzy

Hi Izzy,

Congratulations for being done! 👍

Hope you can take some days now to relax before your rotation starts. I´m taking the test tomorrow, can´t wait until it´s over, guess I will be experiencing some withdrawal the following days.

 

[flumazenil]

so i just got a question about a 33 yr old female comes into the ER with a 4 day history of left sided flank pain, fever, chills, nausea, and vomitting.
Temp 102 F, BP 100/60
UA: + nitrites, many WBC, and bacteria
lab studies: WBC count 17,000/cmm with 8% bands
question asks most appropriate next step:

i selected IV antibiotics, but the correct answer is blood cultures. saying that acute pyelonephritis can potentially result in gram neg sepsis.
ughh i hate this type of question..i mean you get blood cultures great..but the person is sick- and should need IV antibiotics SOON

 

[MaxMoonMD]

so i just got a question about a 33 yr old female comes into the ER with a 4 day history of left sided flank pain, fever, chills, nausea, and vomitting.
Temp 102 F, BP 100/60
UA: + nitrites, many WBC, and bacteria
lab studies: WBC count 17,000/cmm with 8% bands
question asks most appropriate next step:

i selected IV antibiotics, but the correct answer is blood cultures. saying that acute pyelonephritis can potentially result in gram neg sepsis.
ughh i hate this type of question..i mean you get blood cultures great..but the person is sick- and should need IV antibiotics SOON

I guess the point here is that you need to do draw some blood for a blood culture BEFORE you give empiric IV antibiotics, otherwise you might falsify your blood culture results, and when the patient get&#180;s into sepsis you&#180;re in big trouble if your unable to identify the causing organism.

 

[ArcherM2]

A greenstick fracture will have crepitance? really? I was completely unaware of this. To me crepitance indicates either subcutaneous air or "real" fracture...

 

[trdc3lica]

I got a couple.

One patient had a BUN of 22 mg/dl but the answer says that thats a normal value...even though the lab sheet shows BUN max is 18 mg/dl. It doesn't really affect the answer, but its just an inconsistency I noted.

Another question asks why ABO incompatibility between an "O" mother and her fetus (father is "AB") wouldn't occur. I couldn't find a satisfying answer so I chose the least wrong (at least in my opinion), which was "These antibodies are less antigenic"... or something like that. It was the wrong answer. The explanation says that these antibodies do not cross the placenta because they are IgM only. Now if you read Levinson's Micro and Immuno... it says that an "O" mother produces both IgG and IgM, while an "A" or "B" mother produces mostly IgM. The you read Current Obs and Gyne and it says "the reason for the mild severity is unknown since both IgG and IgM are produced". Unless both of these books are wrong, then UW is completely wrong.

So .... WTF???

Also, I was just doing another set of questions, and a question came up regarding diabetes mellitus. A woman comes to you asking for diabetes screening, so you perform an overnight fasting blood glucose. This comes back with a value of 130 mg/dl. The question asks what you should do next. The two choices I narrowed it down to were either: A) Repeat overnight fasting glucose, and B) Do 75g 1 hour Glucose tolerance test. I chose B. I figured that she asked for the test, so she'd be willing to (since she was already fasting) take the OGTT and get the results in an hour. But, UW says its less expensive to perform two fasting glucose tests, so A is the right answer. I'm saying that if I was her physician I'd go ahead and do the OGTT. Wouldn't this be less time consuming, and less of a hassle for the patient?

Wow...I just keep coming across these stupid questions. There is a question regarding abortion. A girl who is 14 wants to have an abortion, who gives permission? I chose the parent... but they say that the girl choses. They then go further and say that the law varies by state, and some states require parental consent. In Kaplan rule #13 in the Ethics section they say "issues governed by laws varying across states cannot be tested....this includes elective abortions (minor and spousal rights vary by locality). So what kind of question is this? We are required to know each states law regarding abortion? I hope questions like that don't come on the real exam, otherwise I'm screwed!

 

[Femtochemistry]

I understand your concern guys--I am in the same boat. But you have to realize that with over 2300 questions, there bound to be some odd ball ones: it was the same story with UW Step 1 questions. Good thing is the majority, if not all of these oddities, will never be tested on the real thing.

 

[rayofdiana]

For what it's worth, I had a ton of questions on USMLEWorld that I thought were totally ridiculous and confounding. I thought I might be in trouble. Then I got my score yesterday, and I apparently rocked it. So, have faith that the real thing is more reasonable.