The Questions about USMLEWorld questions thread

[hopefulmed]

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There are a lot of UW questions and explanations that makes me go 😕 --> 😡 --> , then -->🙄 or 🙁

Anyway, there's one case with a pretty typical presentation of appendicitis in a young man... and the next step they say is to take the guy to the OR for appendectomy... well I picked CT first, thinking that an abscess should be r/o before going to OR, or conservative mgmt. Is there a clinical way to tell if some has an abscess? How else would decide b/w OR and conservative mgmt, just based on the fact that it's so "typical"?

 

[HamOnWholeWheat]

Timing and symptoms.

1) Less than a day or so of classic symptoms -> likely Appendicitis -> clinical diagnosis -> surgery.
2) >~4 days of symptoms -> more likely complicated, consider CT -> trial of medical mgmt. -> eval for surgery
3) extended symptoms (7-10 days) with high fever (usually after surgery) -> abscess likely -> CT -> drain it
4) Non-classic ambiguous presentation -> CT to figure out exactly what it is (psoas abscess or whatever) -> treat accordingly

I think the key concept here is to recognize that the classic picture is a clinical diagnosis within a couple days. Anything that deviates from that picture is either going to get a trial of medical mgmt or a CT if you have a reason to suspect something. That's what I've pieced together from the insane ramblings of USMLEWorld. Could be way off.

My pet peeve with USMLEWorld is when they say things like "even though your answer fits the clinical picture, the other answer is more likely". That's when the forehead meets the wall.

HamOn

 

[hopefulmed]

Timing and symptoms.

1) Less than a day or so of classic symptoms -> likely Appendicitis -> clinical diagnosis -> surgery.
2) >~4 days of symptoms -> more likely complicated, consider CT -> trial of medical mgmt. -> eval for surgery
3) extended symptoms (7-10 days) with high fever (usually after surgery) -> abscess likely -> CT -> drain it
4) Non-classic ambiguous presentation -> CT to figure out exactly what it is (psoas abscess or whatever) -> treat accordingly

I think the key concept here is to recognize that the classic picture is a clinical diagnosis within a couple days. Anything that deviates from that picture is either going to get a trial of medical mgmt or a CT if you have a reason to suspect something. That's what I've pieced together from the insane ramblings of USMLEWorld. Could be way off.

My pet peeve with USMLEWorld is when they say things like "even though your answer fits the clinical picture, the other answer is more likely". That's when the forehead meets the wall.

HamOn

thanks, that was helpful 🙂

anyone run across the 24-YO female that never orgasm question? I've never asked a pt if they ever orgasm, or ever suggest self-stimulation before.. maybe I should start, apparently 73% of UW test takers are already doing that. 😀

 

[internalmed09]

thanks, that was helpful 🙂

anyone run across the 24-YO female that never orgasm question? I've never asked a pt if they ever orgasm, or ever suggest self-stimulation before.. maybe I should start, apparently 73% of UW test takers are already doing that. 😀

Haha, I got that question right.....doesn't mean I'm asking pts these ?s in real life 🙂

 

[UCLAstudent]

thanks, that was helpful 🙂

anyone run across the 24-YO female that never orgasm question? I've never asked a pt if they ever orgasm, or ever suggest self-stimulation before.. maybe I should start, apparently 73% of UW test takers are already doing that. 😀

Lol, definitely one of the stranger questions I've seen so far.

 

[G0S2]

Does anyone remember that UW Q that had a woman with amenorrhea and hirsuitism that had elevated cortisol and a LH:FSH greater than 2 and the answer was PCOS despite the elevated cortisol (the other choices were Cushings)? I had a Step 2CK Q just like that and the LH:FSH was almost 10 but cortisol was 50 ug. I chose PCOS again. This Q for some reason is killing me and I am trying to find evidence of increased cortisol in PCOS or elevated LH>FSH ratio in Cushings.

 

[Femtochemistry]

Does anyone remember that UW Q that had a woman with amenorrhea and hirsuitism that had elevated cortisol and a LH:FSH greater than 2 and the answer was PCOS despite the elevated cortisol (the other choices were Cushings)? I had a Step 2CK Q just like that and the LH:FSH was almost 10 but cortisol was 50 ug. I chose PCOS again. This Q for some reason is killing me and I am trying to find evidence of increased cortisol in PCOS or elevated LH>FSH ratio in Cushings.

I looked into this. Still can't find a clear cut answer

 

[oldManDO2009]

I finished all of the UW questions and a few marked questions. The majority of the questions are well written. Then there are the grammatic errors, bad stems and flat out wrong answers. If you recognize these questions then your ahead of the game (at least you know it is wrong). This little gem was given to me as I went through the questions and found much frustration.

Don't dwell on the bad question - just confirm your thinking via another source and move on. I found that maybe 2-5% (huge guess) were bad questions....


Just my 2 cents....


OldManDO2009

 

[hopefulmed]

What causes holosystolic murmur in newborn on the left sternal border? right sternal border? I can separate the different types in kids, adults I can understand.. is there any clue to differentiate the different type of systolic murmurs in kids? thanks