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  5. USMLE Step 2CK experience by Ashok Chaudhary, Test Date April 11,2017) Hello , I may be new to many of you.I am a government officer working under Ministry Of Health,Government of Nepal.I got my Step 2CK score report a few days back.I am sorry for the delay in writing this.I am writing this with a hope of making you all believe that “If I can do good,you can do it even better” and vice versa.I have named this file “surviving step 2CK” because during the course of its preparation,I think,my life was like that of in a survival mode,roughly speaking. If you have read my step 1 experience,I want to assure you that this is gonna be shorter than that.Partly because the study materials for step 2CK are less diverse than that of step 1 and partly because I don’t want to hypnotise anymore. I started my preparation for CK with the book named ”step-up to medicine”.Many people I talked to and many experiences I had read suggested MTB2 for medicine and MTB3 for other subjects like pediatrics,surgery,OB&Gyn.I bought those books as well.Actually I began with MTB2 for medicine and instantly realized that it was not my type of book.I didn’t have that bullet proof jacket to bear all those bullet styled points of MTB2.I think I was able to read only initial few pages of that book and was soon searching for its alternative.”step up” was a nice alternative I think.Its written in more of explanatory way and reading it was a smoother process.Took almost 1 month to finish it.Plz don’t get scared with the time I took for it.I was working at government hospital and it was so for the most of my preparation.So some days I could study well and some days weren’t that good.Combining job with study wasn’t very easy,I think. After stepup,I subscribed to uworld for 6 months.There were 4 or 5 days remaining in the subscription when I took the exam.If ,for step 1,First aid and uworld were the holy sources;for step 2,uworld is both.Many of you in the beginning phase of your preparation may find it difficult to accept this fact and I also didn’t realize that initially.Is it true?Are you kidding me?Only uworld and no books?Yes it is true.I am not kidding and books have very minor role.I think I didn’t remember a thing from step up but the greatest help was it made my transition to the uworld easier and smoother.Understand uworld very well.Dont just read it for the sake of reading.The tables/charts in uworld are like the pages of first aid for Step1.I mean each and every word there is for the purpose.Simply cramming up only wont help you.You need to understand those and then if needed mug them.But yes,there are few topics which you have to just mug it up.There is not much point in wasting your time understanding the developmental milestones of a child and screening/vaccination guidelines age and evaluation of pap smear of the female of age 23 and 26.But yes there is some logic behind it. Whatever you don’t understand from uworld,consult uptodate for that.Both the google and Wikipedia for the step 2 is uptodate.I think most of the things given in uworld are derivatives of the things that are already available in uptodate.You cant go through all of uptodate.It is very very detailed.So consult Uptodate for topics which are difficult to comprehend from uworld and you can also consult it for topics which are not given in uworld.Would you believe it if I said many sentences given in uworld seem to be exact copies of uptodate? And yes prepare the notes from uworld from the beginning.I had made brief notes of volatile things and things that were added from was brief because I did revision from uworld online on my laptop itself.Some people find reading from the notes/notebooks easier,so if you have time you can make detailed notes as well.I took photos of all the uworld tables/algorithms/charts and I used to go thru them whenever I got time like while going to my gym and while travelling.It helped me consolidate the things given there.I cant overemphasize the importance of those tables/charts.Very important and they are many. I also did CMS forms(all offline) for most of medicine,OBG,Psychiatry and few of surgery.If you have time go through all of them.If you don’t have time,go through psychiatry and OBG at least.I also did some topics from uw-3 like portions of cardiology,psychiatry and biostat.For biostat,also do Biostat review from step 1 and those portions from first aid for step 1.Actually,first aid for step 1 helps a lot for step 2.Many topics are related and while doing 1st round of uworld,I got many many qsns right because of knowledge of step 1.So I think,having read for step 1 before step 2 helps very significantly.I don’t know how much is the impact of taking step 2ck first has on step 1 exam,but I am very sure that taking step 1 before step 2 has big impact on step 2.There were many topics which I studied from “first aid for step 1 “ for my ck exam.I read mtb3 rapidly for peds,obg and surgery.I think I completed those within 1 week.I don’t know how useful it was but I did it because everybody else was doing it. I had read uworld total of 2 times from laptop and my short uworld notes once. During thelast month before my exam,I took nbme 4,6,7(all offline).4 and 6 were good,7 was demoralizing .If you are drooling for your friend’s girlfriend and you want your friend to break up with her,ask him to take nbme 7.Dont get demoralized with nbme 7 my friends.It is very ..hmm…what should I say…idiotic or you can call it stupid.Yes it is hard but it more weird than it is hard.Exam qsns were not in any way like that.Instead exam was closer to uwsa2 for me. I did uwsa1 online around 8 days prior and got 288.Yes…I also didn’t believe it thatswhy I had to shell out another 35$ to take uwsa2.It was 273 or 4.Exam was close to uwsa2 . Friends,practice time management very well.The resources for step 2 ck may be less than step 1,but the exam was harder,that is what I felt.Time was very tight.On a good block,I finished 3 minutes earlier and within that I had to review 8 or 9 qsns which I had marked.It was not a good feeling.I remember making some very silly errors and I think time pressure contributed significantly to it.Believe me,in every block you will get 7 or 8 or 9 very confusing qsns and that’s what that makes them difficult.The topics of the qsns are not new,even the options are not new(most of them).What makes them difficult is the very twisted way of asking qsns and the confusion between two options.If you think that you have understood the qsn and you are confused among two options in that qsn,just pick one option,mark it and move to another qsn,review it at last.Dont lose much time on it.In the exam,it may be very tempting that reading the qsn once again may help you clear your confusion among two options.Do so only if you have not understood the qsn properly or the options properly.If you think you have understood the qsns and options but you are still confused,pick one and move on. Many times during preparation,I used to feel so blank.I used to think I don’t know anything and some days were frustrating and depressing.Avoid those things/fb posts/persons who make you feel yourself inadequate,no matter whoever they are. Friends,the preparation time was not easy and I think it wont be very easy for many of you.It is very difficult to focus on your studies when many of your friends are busy talking about messi and ronaldo,when they are busy measuring how much cranberry juice to add to the whiskey,when they are busy making plans for a trekking, when there are so many responsibilities towards your family.But I believe,”if you want to have what other don’t have,you need to do what others cant do.” All the best
  6. The sister of Eman Abd El Aty, an Egyptian woman thought to have been the world's heaviest, has accused doctors of lying about her weight loss after surgery in India. She underwent surgery in Mumbai's Saifee hospital, and last week doctors said she had lost 250kg (550lbs). But her sister said this was untrue, adding that her sister was in delicate health as she may have had a stroke. The hospital has angrily rejected the allegations. The row began on Monday when Ms Abd El Aty's sister, Shaimaa Selim, released a short video on social media, alleging that her sister was still unable to speak or move, and had not lost as much weight as the hospital was claiming. On Tuesday, she told the BBC that the hospital was lying about her weight loss. "He [Dr Muffazal Lakdawala, who led the operation] didn't weigh her before and after. If he has any proof of her weight loss, show us the video of her weight before and after." Describing her sister's health as delicate, she said: "Oxygen is not normal in her body. She has to wear an oxygen mask almost all the time. There is a tube from her nose to her stomach because she can't eat or drink well from her mouth. But a spokeswoman for the hospital told the BBC that Ms Abd El Aty was weighed again on Monday and she now weighed 172kg. Dr Lakdawala also strongly denied the allegations in a tweet. Image copyright TWITTER Eman Abd El Aty suffered a stroke at the age of 11 and her weight meant she was unable to leave her home for 25 years. She was flown in a special aircraft in January to Mumbai's Saifee hospital where she underwent bariatric surgery in March by a team of doctors, led by Dr Lakdawala. The hospital says she can now fit into a wheelchair and sit up for longer periods of time. It released new pictures of Ms Abd El Aty following weight reduction surgery. Reports say Ms Selim is unhappy because the hospital authorities believe that Ms Abd El Aty's treatment is almost over and that she can be sent home to Alexandria soon. "There are cases like this in other parts of the world. In America and in other countries, there are heavyweight people. They have been in the hospital for one or two years to lose weight and become normal. "But just after a month or two here, the doctors say that I can take my sister back. I asked them how, as she is still very big and if anything happens to her in Egypt, how can I go to a hospital there? "It would be impossible and nobody would help me in Egypt. I said, 'Please please keep her for a long time to help her lose weight'," her sister said. Bariatric surgery, also known as weight loss surgery, is used as a last resort to treat people who are dangerously obese (having a body mass index of 40 or above, or 35 with other obesity-related health conditions).
  7. I am dental student ...and really this artical was of grt importance .well i always try some of above points and it works....specially connecting text with images.... One more point i would like to add....on first go ,one should avoid covering a new chapter in deep...first...brush up all the topics and then continue reading Go in deep in your second revision..on 2nd time you must go as deep as possible....its necessary to know all topic's present in a chapter,in advance it helps..{just a personal opinion}.☺
  8. Anaphylaxis
  9. Epinephrine Auto Injector helps self injecting Epinephrine in an Anaphylaxis Patient at the required doses. It is used as a shot intramuscular injection. These are used as intermediate measures while definitive treatment must be followed by a trained physician in an emergency setup. This means Epinephrine auto injector is not complete treatment for a patient with anaphylaxis. What is Epinephrine Auto Injector: Just like any other auto injector (Morphine Auto Injector, Insulin Auto injector), Epinephrine auto Injector is also a dose calibrated injector.
  10. Anaphylaxis Kit should be a standard component of any Emergency Medical Services. A patient in anaphylaxis deteriorates very fast and anaphylaxis kit is handy to save life. So, what are the anaphylaxis kit contents? How can it be prepared? An ideal Anaphylaxis Kit should contain the following: A portable bag with space for injections, syringes and vials An instruction booklet or Anaphylaxis Management Plan 02x Epinephrine Auto Injector 02× Hydrocortisone sodium succinate 100mg 01 × 1ml Chlorphenamine Injection 10mg in 1ml 01 x IV Cannula 18g Green 02 x Needle 23G x 1¼ 02 × 1ml syringe 01 x Guedel Airway Size 0, 1, 2, 3 and 4 one each 01 x Resuscitation Face Shield 01x Normal Saline 500 ml Anaphylactic Kit is not for routine use and only be used by trained medical practitioner or under supervision. Epinehrine auto injector can be used by a patient when prescribed by a doctor as self injector.
  11. Anaphylaxis management Plan helps health professionals quickly assess and treat a patient on anaphylaxis. In a true anaphylactoid reaction one seldom gets time to do investigations to establish a diagnosis. Patient sinks fast and early treatment saves life. Anaphylaxis management plan has the following components: Assesment: A quick assessment to know the status of the patient includes vitals pulse, BP, Respiratory Rate, SPO2 Life Suport: Get IV aceess, Start O2, Give ventilatory support Diagnosis: Diagnosis should be clinical and based on history. Ask following questions to patient or his Next of Kin : “Have you been exposure to a known allergy/trigger?" “When did symptoms start, and what are you current medications?" “Has this happened before?” “Are you asthmatic?” Treatment: IM ADRENALINE (1:1000) 0.5 ml (500mcg); repeat at 5 minute intervals if no improvement. This route is not recommended after cardiac arrest Or, IV (1:10,000) 0.5 ml (50mcg) if severely ill, peri-arrest or pulseless; ie the dose is different NEB SALBUTAMOL 5mg (if wheezy) IV HYDROCORTISONE 200mg IV CHLORPHENIRAMINE 10mg Procedures High flow oxygen: >10 l/min IVI + IV fluid challenge: 500 – 1000 mL. Repeat if necessary Lie patient flat, elevate legs Monitor cardiac and respiratory function
  12. Which of the following medications blocks the release of histamines? A - Hydrocortisone B - Diphenhydramine C - Pheniramine Maleate D - Epinephrine
  13. 12 Lead ECG Placement Mnemonics helps to remember placement of chest and limb ECG leads. Often the respective leads indicators are marked on chest leads. Limb leads are color coded and marked too. There are three types of ECG leads available: Banana Type Snap Type Pinch/Clip/Grabber Type Banana Type leads are common with old pattern of ECG machines. Chest leads are marked with C1, C2 or like V1, V2. Todays leads also carries a color coding. Snap Type is used very frequently and attached to the connector with a snap or button. Easy to use with disposal type of connectors and these are frequently used in ICU, NICU and Emergency deptts. Apart from color coding, often chest lead numbers are marked as V1, V2.. and Limb leads as RA, RL, LL, LA. The other type is Pinch type ECG lead and it has a clip type mouth to connect to the connector. In most cases, the leads are numbered, so that you dont have to remember them. It is true for both chest leads as well limb leads. The problem arises when the numbers fall off due wear and tear or when not numbered at all. In this case the color coding helps. The 12 ECG chest lead standard color coding are like this: With the help of numbering and color coding any lay man can place ECG leads without a mnemonic. But when only color coding is there it is really difficult. With the help of this mnemonic one can remember the color corresponding the lead. Real Yummy Glass of Bear Brings Peace Red> V1, Yellow> V2, Green> V3, Brown> V4, Black> V5, Purple> V6 For limb leads starting anticlockwise from right hand> Wrong Gemstones Return Badluck: White for Right Hand, Green for Right Leg, Red for Left Leg and Black for Left hand
  14. Dr Husam Jamil thank You so much for sharing this information for the benefit of fellow Doctors. I really appreciate it. Thank You
  15. mcq

    Which one of the following antiplatelet agents acts by inhibiting the phosphodiesterase enzyme and increasing the cellular concentration of cyclic adenosine monophosphate (cAMP)? A - Abciximab B - Ticlopidine C - Aspirin D - Clopidogrel E - Dipyridamole Show Answer Answer: E Explaination
  16. mcq

    37 year old male comes to physician for routine maintainace examination...his father was diagnosed with colon cancer at age of 50 and treated with colectomy ..he has 30 pack year smoking history which of the fallowing is initial screning test for this pt ? A - colonoscopy at age of 60 B - colonoscopy at age of 50 C - colonoscopy at age of 40 D - colonoscopy at age of 30 Show Answer Answer: C Explaination
  17. mcq

    Most accurate tool for diagnosis of Appendicitis? A - Ultrasound B - CT scan C - Diagnostic Laparoscopy D - A detailed history Show Answer Answer: B Explaination A random study on Pulmonary embolism shows (A)100 patients out of 1000 died who didnot get the treatment (B) 5 patients out of 100 died who got the proper treatment Choose the single most likely absolute risk for each of the above mentioned ? A - Absolute risk 5% B - Absolute risk 10% C - Absolute risk 2% D - Absolute risk 15% Show Answer Answer: B Explaination
  18. mcq

    Pregnant woman with UTI which is the best antibiotics to be given if she has no allergy? A - Nitrofurantoin B - Ampicillin C - Sulfatrimethoprim D - Tetracyclin E - Aminoglycoside Show Answer Answer: A Explaination Gram negative diplococcic is classical for? A - Gonorrhea B - Chlymedia C - Syphilis D - Chencroid Show Answer Answer: A Explaination Infant of HBV positive mother should receive immunoglobulin within? A - 24 hrs B - 72 hrs C - 12 hrs D - 48 hrs Show Answer Answer: A Explaination
  19. mcq

    thank you
  20. Lots of these are being used for blackmailing their boyfriends, parents, families and also for extracting gifts
  21. mcq

    Atypical pneumonia can be caused by the following microbial agents except? A - Klebsiella pneumoniae B - Human Corona virus C - Legionella pneumophila D - Mycoplasma pneumoniae Show Answer Answer: A Explaination
  22. mcq

    four dose regimen is administered in post exposure prophylaxis of rabies is? A - Day 0,3,7,14 B - Day 0,3,7,21 C - Day 0-two doses .day 7 and day 21 D - Day 0,7,14,21,28 Show Answer Answer: A Explaination Four doses at Day 0,3,7 & 14...but if patient is immunocompromised, then add d 5th dose at Day 28. if received 01 dose of rabies vaccine in the past, give only 2 doses at Day 0 & 3
  23. mcq

    A 55-year-old woman presents to the OB/Gyn clinic complaining of pain during intercourse, after which she experiences vaginal bleeding and foul discharge. She reports that she had multiple sexual partners in her youth, but has been monogamous for twenty years and has since had three children. She admits that has not seen a gynecologist in several years. On physical exam, she is pale and her cervix is nodular, with what grossly appears to be some dysplasia. Which of the following organisms is the most likely cause of her condition? A - Epstein Barr virus (EBV) B - Human immunodeficiency virus (HIV) C - Human papilloma virus (HPV) D - Human T lymphotrophic virus, type 1 (HTLV-1) E - Schistosoma hematobium Show Answer Answer: C
  24. mcq

    Which of the following ligaments prevent hyperextension of hip A - Illiofemoral Ligament B - Pubo Femoral Ligament C - Ischiofemoral Ligament D - Ligamentum Teres Femoralis Show Answer Answer: A Explaination
  25. mcq

    Angle formed by the shaft and the neck of the femur is degrees A - 115 B - 125 C - 135 D - 145 Show Answer Answer: B Explaination 125 The femoral neck and the femoral diaphysis form the femoral neck angle that normally is about 125 degrees. True about upper end of tibia is all except A - Ossification centre at the upper end fuses by 20 years B - It gives attachment to medial collateral ligament C - It gives attachment to semi-membranous D - Posterior aspect of patella articulates with upper end of tibia laterally Show Answer Answer: D Explaination Posterior aspect of patella articulates with upper end of tibia laterally Patella has no articulation with tibia; it is articulated to femur only
  26. mcq

    A 73-year-old man has his third syncopal episode in the last 6 months. An EKG done in the field shows ventricular tachycardia. His stress test is normal. What is the most appropriate next step in the management of this patient? A - Metoprolol B - Diltiazem C - Angiography D - Implantable defibrillator E - EP(Electro Physiological) studies Show Answer Answer: D Explaination As no ischemia and syncopal attack from VT best option to keep this elderly patient from risk of sudden death is D. Implantable defibrillator.
  27. mcq

    Anterior wall of the third ventricle is formed by? A - Lamina terminalis B - Pineal body C - Tuber cinereum D - Mamillary body Hide Answer Answer: A Explaination Anterior wall of third ventricle is formed by lamina terminalis, anterior commissure and anterior column of fornix.
  28. mcq

    This anatomy MCQ collection thread contains Anatomy multiple choice questions with single best answer. I will try to post MCQ explanations as well. You can click on any answer to see if youre correct. Click on Show answer button to see the explanation. You can also contribute to this topic by just pressing the button to add an MCQ All are true regarding axillary artery except? A - It is a continuation of subclavian artery B - It is crossed by pectoralis minor muscle C - It extends from outer border of second rib to the lower border of teres minor. D - The second part of part of axillary artery is posterior to pectoralis minor muscle Show Answer Answer: C Explaination Axillary artery extends from outer border of first rib to the lower border of teres major
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