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Uworld step 2ck account for sale Valid till July 15 No reset available No self assessment forms available Price 1500 INR

A 48-year-old man is admitted to the hospital 2 hours after the onset of severe abdominal pain, nausea, and vomiting. The pain radiates to the back but improves when he bends forward. He has no history of serious illness and takes no medications. He does not smoke cigarettes. He drinks two 12-oz beers weekly. He appears restless. He is 173 cm (5 ft 8 in) tall and weighs 90 kg (198 lb); BMI is 30 kg/m2

. Temperature is 38.0°C (100.4°F), pulse is 110/min, respirations are 20/min, and blood pressure is 110/60 mm Hg. On pulmonary examination, decreased breath sounds are heard at the lung bases; there is dullness to percussion. Abdominal examination shows distention and severe tenderness to palpation of the epigastrium and left upper quadrant. Laboratory studies show:

Hemoglobin 13.5 g/dL Serum Urea nitrogen 30 mg/dL Glucose 120 mg/dL Creatinine 1.2 mg/dL Cholesterol 300 mg/dL Triglycerides 1500 mg/dL Total bilirubin 1.1 mg/dL Amylase 300 U/L

Administration of intravenous fluids and analgesics is begun. The patient’s abdominal pain, nausea, and vomiting decrease. Which of the following is the most appropriate next step in management? (A) Apheresis (B) Ezetimibe therapy (C) Gemfibrozil therapy (D) Metformin therapy (E) Recommendation for weight loss Isn’t it supposed to be apheresis if tgl more than 1000

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A 42-year-old woman comes to the physician because of a 1-day history of severe pain, swelling, and warmth in her left knee. Her pain is moderately relieved with ibuprofen use. She notes that she awoke with the pain 1 day after she did an aerobic kickboxing workout. Her temperature is 37.2°C (99°F), pulse is 86/min, and blood pressure is 120/70 mm Hg. The upper aspect of the left knee is erythematous and warm to the touch with an effusion. Range of motion is limited by pain. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?

A. Reassurance

B. Application of a knee brace and ice and elevation

C. MRI of the knees

D. Intravenous antibiotic therapy

E. Arthrocentesis

A previously healthy 32-year-old woman comes to the physician because of mild headaches and weakness for 3 months. Her pulse is 80/min, and blood pressure is 150/105 mm Hg. Examination shows no other abnormalities. Serum studies show: Na+ 143 mEq/L Cl− 98 mEq/L K+ 2.4 mEq/L HCO3− 33 mEq/L Urea nitrogen 18 mg/dL Creatinine 0.8 mg/dL

Which of the following is the most likely diagnosis?

A. Addison disease

B. Adrenal adenoma

C. Adrenogenital syndrome

D. Cushing syndrome

E. Hyperaldosteronism

F. Pheochromocytoma Isn’t it adenoma

A 56-year-old postmenopausal woman with type 2 diabetes mellitus and hypertension comes to the clinic for a routine follow-up examination. Her parents immigrated from Libya. She says she has been feeling more tired than usual for the past 2 months; she has been sleeping well but becomes fatigued as the day progresses. She otherwise has no symptoms. Vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.5 g/dL Hematocrit 33% Mean corpuscular volume 75 μm3 Red cell distribution width 17% (N=11.5–14.5) Serum  Ferritin 45 ng/mL  Thyroid-stimulating hormone 2.7 μU/mL how isthis thalasemia of rdw is high isnt it low thalasemis

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A 71-year-old woman comes to the clinic because of a 2-month history of increasingly severe, aching pain in her shoulders, upper arms, and thighs. She says, "I can't roll over in bed any longer and my husband has to assist me in getting up from a chair." She also has had associated muscle stiffness that lasts 1 hour every morning upon awakening; the same stiffness sometimes occurs in the afternoon following periods of inactivity. She also reports awakening multiple times during the night, diffuse joint pain, and a 7.7-kg (17-lb) weight loss despite no change in appetite. Menopause occurred at age 56 years. She also has osteopenia and generalized anxiety disorder. Her medications are estradiol, escitalopram, and vitamin D and calcium supplementation. Her mother and aunt had rheumatoid arthritis, and her brother had sclerosing cholangitis. The patient appears to be in moderate discomfort. She is 174 cm (5 ft 9 in) tall and weighs 64 kg (140 lb); BMI is 21 kg/m2. Temperature is 36.3°C (97.3°F), pulse is 68/min, respirations are 18/min, and blood pressure is 124/76 mm Hg. Muscle strength and tone are normal. She is unable to actively abduct the shoulders bilaterally past 90 degrees because of stiffness. Passive range of motion of the shoulders and hips is decreased. There is no pain on palpation of the temporalis muscles. Results of laboratory studies are shown: Hemoglobin 8.9 g/dL Hematocrit 25% Leukocyte count 8200/mm3 Platelet count 572,000/mm3 Erythrocyte sedimentation rate 82 mm/h Serum  C-reactive protein 15.3 mg/L  Creatine kinase 112 U/L

Electromyography and nerve conduction studies disclose no abnormalities. Which of the following is the most appropriate next step in the management of this patient?

A. Biopsy of the temporal artery

B. Biopsy of the vastus medialis muscle

C. Dopamine transporter (DAT) scan

D. Duloxetine therapy

E. Polymerase chain reaction testing for Rickettsia rickettsii

F. Prednisone therapy

G. Transthoracic echocardiography

Isn’t ck more than 100 high