This month’s toughest USMLE Step 2 question to master

Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical. Once you’ve got this question under your belt, be sure to test your knowledge with other posts in this series. Ready. Set. Go. This month’s question that stumped most students: A 70-year-old woman presents to her primary care physician with diarrhea. She describes watery stools associated with abdominal cramping for the last week. There has been no fever, nausea, or vomiting. She was hospitalized 1 month ago for community-acquired pneumonia, which was treated with ceftriaxone and azithromycin. She also has a history of watery diarrhea with abdominal cramps when she consumes milk products. Physical examination reveals lower abdominal tenderness. The initial laboratory evaluation of stool is significant for the presence of fecal leukocytes. Which of the following is the most useful step in diagnosing this patient? A.  Avoiding milk products B.  Colonoscopy with biopsy C.  Stool C. difficile cytotoxic assay D.  Trial of loperamide E.  Trial of metronidazole       The corr...
Source: AMA Wire - Category: Journals (General) Authors: Source Type: news

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Discussion Transplantation is not a common problem for primary care physicians but when a child’s disease has progressed to end-stage organ failure, transplantation can be the only treatment available. While the primary care provider usually is not involved in the daily management of patients before, during and after transplantation, they can be involved in many areas. These can include providing appropriate primary and acute care, ordering and obtaining necessary medical tests, medications and equipment, assisting with medical insurance, providing medical history and records to consultants, translating medical infor...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Popularity of the stomach- and intestine-protecting drugs has skyrocketed, but related adverse events, like osteoporotic fractures, C difficile infection, and pneumonia, are problematic.Medscape Medical News
Source: Medscape Medical News Headlines - Category: Consumer Health News Tags: Gastroenterology News Source Type: news
CONCLUSION: Children admitted for status asthmaticus with and without SUP had no observed incidence of CIB. In this specific population, we propose a prerequisite assessment for the presence of known stress ulcer related gastrointestinal bleeding risk factors prior to the blanket administration of SUP. PMID: 31046509 [PubMed - as supplied by publisher]
Source: Journal of Asthma - Category: Respiratory Medicine Tags: J Asthma Source Type: research
Conclusion The impact of sepsis on the gut is manifold, e.g., sepsis mediated alteration of the gut-blood barrier and increase in the intestinal permeability, which may correlate with the phenomena of bacterial translocation and lymphatic activation (“toxic-lymph”). Systemic consequences of sepsis are widespread and concern to the coagulative system, the microbiome as well as enzymes, such as pancreatic proteases, MMPs and IAPs. Nevertheless, the therapeutic approaches for modulating the mucosal immune system are still rarely effective in daily routine. Recent published studies showing that treatment with FMT,...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Today, we received two 3rd year medical students starting their IM rotation. I told them I would give them a list of podcasts that should help them get oriented to internal medicine. This is my podcast v1.0 list: From the Curbsiders: 142 Cirrhosis TIPS for Acute Complications 104: Renal tubular acidosis with Kidney Boy, Joel Topf MD 92: Pulmonary Embolism for the Internist 86: COPD: Diagnosis, treatment, PFTs, and nihilism 76: Pneumonia Pearls with Dr Robert Centor 61: Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement 52: Anemia: Tips, and tools for diagnosis and treatment ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs
Conclusion: Some Lactobacillus strains exhibit anti-CRE activity, which suggests potential applications for controlling or preventing CRE colonization or infection. Introduction Although Enterobacteriaceae are normal flora of the human intestinal system, they are also common pathogens causing human infections in the setting of both community-acquired and healthcare-associated infections (Hsueh et al., 2010; Toh et al., 2012; Lai et al., 2014; Jean et al., 2016). In this era of widespread antibiotic resistance, Enterobacteriaceae are no exception. Recently, the emergence of carbapenem-resistant Enterobacteriaceae (C...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
In conclusion, we demonstrated that the selective boosting of lung innate immunity is a conceptually advantageous approach for improving the effectiveness of antibiotic treatment and fighting antibiotic-resistant bacteria. Introduction Pneumonia constitutes a major cause of death, morbidity and health resource use worldwide. The main causative agents identified in adult patients hospitalized for community-acquired pneumonia (CAP) are viruses (in 27–30% of cases, the most common being rhinovirus, influenza and coronavirus) and bacteria (14–23% of cases, with a marked predominance of Streptococcus pneumonia...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Publication date: Available online 6 March 2019Source: American Journal of Infection ControlAuthor(s): Michelle T. Hecker, Andrea H. Son, Nina Naeger Murphy, Ajay K. Sethi, Brigid M. Wilson, Richard R. Watkins, Curtis J. DonskeyBackgroundFluoroquinolones are often prescribed unnecessarily and are an important risk factor for infection with fluoroquinolone-resistant gram-negative bacilli and Clostridioides difficile.MethodsWe conducted a quasi-experimental study to determine the impact of sequential syndrome-specific stewardship interventions on use of and resistance to fluoroquinolones in a tertiary care hospital. An initi...
Source: American Journal of Infection Control - Category: Infectious Diseases Source Type: research
There were reductions in urinary and surgical infections, but not in pneumonia or C. diff infections.
Source: NYT Health - Category: Consumer Health News Authors: Tags: Hospitals Infections Clostridium Difficile (Bacterium) Antibiotics Source Type: news
Conclusion:As abatacept replaces the missing CTLA4 protein, it should be part of the treatment regimen in patients with CTLA4 haploinsufficiency presenting with cytopenias. Both long term treatment outcomes and schedule of administration are yet to be determined in a larger cohort in the setting of a clinical trial.DisclosuresUzel: Novartis: Research Funding. Rao: novartis: Research Funding.
Source: Blood - Category: Hematology Authors: Tags: 203. Lymphocytes, Lymphocyte Activation, and Immunodeficiency, including HIV and Other Infections: Poster II Source Type: research
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