 What is going on everybody? Welcome back to my channel. Today I'm going to be embarrassing myself yet again by taking the USMLE step one examination. I'm not really taking the entire examination because I don't really want to take a six-hour exam again, but luckily board vitals has given me exclusive access to their question bank and they're also the sponsor of today's video. So let's go ahead and answer some USMLE questions and show how little I actually know on that topic. Let's go. So again board vitals was nice enough to sponsor this video today. If you've never heard of board vitals, well you're missing out because they make some of the best cubings on the planet. I have used them for USMLE studying, my radiology board exam studying, Comlex studying. I mean I've used their cubings for pretty much every single milestone within my medical training and look at me now. So like I said in the intro they gave me exclusive access to their USMLE question bank here. So I'm going to do like a 10 question quiz. You saw my previous video where I took MCAT questions and I got so many commenters saying how these questions aren't like the MCAT and where to get these questions and all that stuff. So today we're doing this officially and we're going to be using the board vitals USMLE step one question make. Use my code drchelene to get 20% if you need to. I'm going to do a 10 question custom quiz here and see how well I do. And just a little disclaimer here. You take your USMLE step one board exam. It's the first board exam you take in medical school and you take it after your second year of pre-clinical training. So it's halfway through medical school which was eight years ago for me. Just kind of go ahead and throw that out there. So there are a lot of nuance questions on these cubings stuff I haven't even thought of or basic science questions. I haven't even considered remembering in eight plus years. There's little tiny facts you have to know for this examination and at the time I didn't know a lot of them because I did pretty well in the exam. But I'm kind of nervous to see how much I have forgotten in the interim because after all interventional radiology is a pretty subspecialized field because that's the way medicine has gone these days. So a lot of this stuff I haven't thought of in forever. And before we get into this video make sure you smash that like button and hit the subscribe button as well while you're at it. Hitting that like button really helps out the YouTube algorithm and helps the channel and helps me keep creating content like this. So smash the like button and also subscribe because there are a ton of you all that watch my videos lurking around in the background and don't actually subscribe. So please subscribe. Both of those really help out the channel. So thank you in advance. The third disclaimer is that this video is sponsored by Bored Vitals which I've said like five times now. So let's go ahead and create a quiz and embarrass myself. Alright 10 question quiz starts now. Question number one a 14 year old boy is evaluated for malaise and abdominal pain. He reports passing dark urine this morning. His past medical history is significant for strep pharyngeitis 10 days ago which was true year with amoxicillin. Today his vinyl signs were under normal limits. Albinoma, blah blah blah, blood pressure, Xambril's facial edema with pronounced orbital swelling, 1 plus fetal edema, diffuse tinnitus, reboundary and blah blah. Unremarkable serum except for serum creatinine of 2.0 which is elevated. What is the common finding associated with this patient's condition? So I think he has post streptococcal glomerulonephritis. I don't know how I just remember that to be honest with you. That's like reaching back deeply here. Polyuria is I think this is like a nephritic syndrome. There's nephritic and nephritic syndrome. I think this is a nephritic syndrome. So let's strike these two out. I don't think it's hypovolemia. I don't think it's hypokalemia. Don't think it's polyuria because it's not nephritic syndrome. I'm pretty sure it's nephritic syndrome and they have they can get microscopic hematuria in which they'll have red blood cells in their urine. So let's go with this. I still got it. I just don't do anymore. So next question. During an infertility evaluation, a 38 year old woman undergoes a blood test on day 19 of her menstrual cycle. If ovulation has occurred, relatively high levels of what hormone will be detected in her serum? So day 19 of a normal 28 day menstrual cycle. This will be the second half of the menstrual cycle, which I think it's dominated by not follicle stimulated hormone because that's what stimulates the follicle. And I think it would be progesterone because I think that's the I can't remember. I just remember progesterone is the second half of the menstrual cycle. Let's go. So progesterone is produced in the corpus luteum of the ovary after ovulation. Progesterone is a dominant hormone during the luteal phase. That's what I was looking for. Luteal phase is the second half of the menstrual cycle. Inhibits, blah, blah, blah. I'll let you guys read that because we have to get on to the second question. Our third question. Let's go. Question three. A 42 year old woman presents with a dry cough that worsens at night. After workup, you diagnose her with a dirt and prescribed pantoprosal. Pantoprosal inhibits the product of which of the following cells. So pantoprosal inhibits acid in the stomach. So they're asking which cells produce acid in the stomach. And that is of course the parietal cells because everybody knows that. Correct. I haven't seen these questions. And for those of you who are going to say, oh, you've seen these questions. I haven't seen these questions. I literally just set up a 10 question quiz random here. I'm just that good. Just kidding. I'm surely going to be a question here that's going to completely stop me, but we'll see. Next question for a 30 year old man is performing squats, resting a heavy bar on his shoulders. When he hears a pop immediately, experiences focal right back pain over the next 24 hours. Pain dramatically increases in intensity and he is unable to walk. He undergoes MRI of his lumbar spine, which shows a cutely herniated disc at L5S1 protruding into the right paracentral canal, which nerve root is likely to be compressed. Well, this is in my area of expertise, radiology, because we read MRI of the spine all the time. Well, not so much anymore, but I did during residency, which was six months ago. So the descending nerve root is always what's affected by a paracentral disc bulge or herniation. If it were a lateral or subarticular disc herniation, it would affect the nerve root at that level. So since this is L5S1, paracentral canal is going to be compressing the descending S1 nerve root. Let's go. Oh, 80% of people got that right. This is a hard question. This actually is a hard question. This stumps a lot of people. And I remember taking this examination. I had a question similar to this, or maybe it was during studying or whatever, but I can never remember which one. And then finally in residency, actually, I committed that to memory. It's just anatomy. If you know your anatomy, you can answer any of these questions like this. That's easier said than done. It took me like 10 years to get to where I am today. So there you go. Next. A 40-year-old female presents an emergency crime with chest pain that began while laying in the bed this evening and resolved 20 minutes later. Medical history is remarkable for hypertension, dyslabidemia, obesity. On arrival, the pulse is 80 minutes normal, blood pressure normal, ECG, so normal sinus rhythm without SC elevation. It means there is no sign of ischemia on EKG. Laboratory testing is negative for troponin, which is negative for a heart attack or a myocardial infarction. She's admitted to the hospital to rule out myocardial infarction, even though she has a negative EKG and a negative troponin. So not sure what those providers were doing at this fate hospital. Overnight, the patient is, has several episodes of chest pain lasted 15-20 minutes and review of telemetry shows transient ST elevations during episodes of chest pain. Oh, maybe they were on to something. The appropriate diagnosis is made, which of the following interventions would most likely improve this patient's symptoms? Oh, I don't know this one. So let's see, let's, let's break it down. So coronary artery stenting, I feel like she's having angina. So coronary artery stenting, I don't know. The other question, so this is a calcium chamber blocker, a beta blocker and verapamil. These are basically in similar classes here. I think I want to say verapamil, because she's normal and she's not having a heart attack or evidence of ischemia, but then she has these transient angina episodes. I think I'd probably pick, so calcium chamber blocker and beta blocker isn't necessarily fast acting. So it's either verapamil, which I think it would probably be verapamil, or you could take her to stenting afterwards. Oh, which would improve these patient's symptoms? So if it was symptoms, not long term, I think verapamil. No. What's the highest answer? Nephetapine? See, and this is the stuff I don't know. Chest pain is accompanied by transient ST elevation. Yes, I got the diagnosis right. I just don't know the treatment. Varian angina, first secondary tooth coronary base with spasm dip. So I guess treatment includes calcium channel blockers and nitrates. That's what I was looking for. I was looking for nitrate. I normally would just give them nitroducerin, but that wasn't an option, and I don't know the other options to treat this besides nitro, because I don't do this. So this is a little shot to my ego here. I should have got that right. Next. A 23 year old woman underdosed thyroid surgery. During recovery she has hoarseness and tries to speak. She's found to have an injury in the recurrent laryngeal nerve. The nerve innervates all intrinsic laryngeal muscles except for one. Why I remember this? I have no idea. I just do. It's the tritothyroid muscle. It's like somewhere in my brain. I'll show you. I hope they have the anatomy. I can't relate. It's just this is just pure anatomy. I'll show you. Maybe they have a diagram. Let's see. Yeah, they do. I just remember memorizing this, and for some reason it's still in my head. Next. Oh, we got an x-ray on this one. The 51 year old Mexican immigrant is evaluated for low-grade beavers, productive cough, and blood-tinged sputum, and chest pain. 30-pack your history of tobacco smoothing. On exam, he has supraclavicular adenopathy during the momentous lesions of his arms. That's a hint. And subcutaneous abscess. So he's got abscess, adenopathy, which means he has an infection. An oscillation of his lawn fields of real bilateral brachnia. We're using it on the right side. His chest x-ray is pictured below. And on his chest x-ray, he has a pretty nice opacity, kind of rounded opacity here in the left lower lung. Obviously, it's hard to tell what that is with just one view, because one view is no view in terms of radiology speak. That's like the lingo. We always say one view is no view. You have to get two views, especially out of chest x-ray. So I think the answer here, they're trying to allude us to a granulomus infection here, which affects the lungs and the skin. Klebsiella can look like this on x-ray, but it doesn't give you all the other stuff. Pneumocystis gervechi. This occurs in immunocompromised patients. They didn't tell us it was immunocompromised. Mycoplasma pneumonia. That's like a community-acquired pneumonia. Caxidoids, imidus. That is the one we're looking at here. And Legionella is not this. It doesn't give you the same thing, so it's caxidoids, caxidoids, caxidoids, imidus. Boom. All right, let's go to the next question. I'm crushing it so far. I've got one wrong. I say that, and now I'm watching me get the rest of them wrong. 13-year-old boy with past mental history of Crohn's disease is in the recovery room following an upper endoscopy. He could blame the nurse that he is feeling dizzy headache. Fullsox is 85 percent on Rumeria, which is really low. Fizzler disease is marked before sinosis and lethargy. He is cyanotic and having trouble breathing, obviously, because it's 85 percent. Fullsox, and as ABG reveals, brown discoloration in the patient is placed on supplemental oxygen. PO2 and arterial blood gas analysis is shown to what the following. I don't know. So 85 percent, why is his, why are his O2 sets down? What is the brown discoloration? That, that's something to do with like some hemidelobinemia or something. I don't remember any of this stuff. I'm going to go with his PO2 is probably low given how cyanotic he is. So let's go with 30. The patient has sinosis and brown blood. Yeah, met hemidelobinemia. I get the diagnosis, but I don't know these like third order questions. Next. All right, two more. 30-year-old woman who's G3P3, gynecologist, three-day post-farm with painful breasts. The fist Rosanne with breast swollen heart, firm, shiny, warm, laryl, large lumbar nodule, nipples are flattened and she has lowered fever and large tender lymph nodes in her armpits, gynecologist, fries medication efficient natural hormones that produce his lactation in endometrial muscle, crashing during birth. Medication activates G protein-dependent phospholipase C, which intracellular substance increases after the exposure to this drug. No clue. I think she has mastitis. That's what I do know, but she promotes lactation. What medication did I give? Is it Potosin or oxytocin? I'm going to go with, so it's either, I think it stimulates muscle contraction. So I'm going to go with potassium. I think it's sodium that'll increase. Potassium goes extra cellular. Clearly. I was a little wrong on that one. So here we have a nice diagram of basic medical science stuff we learned at Med School and I have clearly forgotten in the last eight years. So all these enzymes are activated amongst all this crazy cellular stuff that I don't know and honestly don't really care about anymore. But the main thing is we got the diagnosis right which is mastitis and we got the drug right which is oxytocin or Potosin, which you've all heard if you know anybody who's given birth. Next. A 74 year old female presents with nausea, worsening cramping, abdominal pain, particularly after meals. Hint. For the past week, she currently with striage pain 7 out of 10. She designs fever, urinary emergency, dysuria. Her past medical history is significant for asthma stride, coronary disease, and atrial fibrillation. These are enzymes that are irregular pulse and weak femoral and dorsalis pedis on the left side. Adrenaline dimension demonstrates hypoactive bowel sounds and slightly distended abdomen. She has mild defuse of dolomitembers, no rebound or darting. Stool syndrome is kind of positive for blood. Conostrious failure. Which of the following characterizes the likely cause of this patient's symptoms? So let's first, let's break this down because this is a lot. So what's going on here? The 74 year old female has cramping abdominal pain after she eats. Her past medical history is significant for atherosclerotic disease and AFib, which basically means she is a vascular path that has vascular disease and also has AFib, which can throw emboli or clots distally into blood vessels. And this is likely because of an embolic event. So she's actually having mesoteric ischemia here. So what following findings characterize our likely cause of this patient's symptoms? It's not neoplastic. It's not from cancer. This is from Crohn's disease right here, the cobblestone appearance. So I think you have to go with mucosal hemorrhage here and necrosis because this is, so basically she's having ischemic bowel secondary to mesoteric ischemia. So I'm gonna go with this because that's the best option. Still got it. So yeah, she's diagnosed with non-inclusive mesoteric ischemia, which is, which can cause ischemic colitis, especially someone who has AFib. So let's go ahead and grade this here. I ended up scoring a 70% on this examination, which honestly I'm pretty happy with because I haven't even thought about some of the stuff in the longest time, eight years plus probably. So this is an official examination. You cannot say it's not because it is sponsored and given to me by Board Vitals, which is the best QBank of all time. I've used them for USMLE and also my radiology boards. When I say USMLE, I use them for step one, step two, and my radiology boards. So I've used them for everything. And if you are taking any medical examination in the future, I highly recommend you try out Board Vitals. And if you are taking that exam and you want to use Board Vitals, use my code DRChalini, DrChalini, to get 20% off your purchase. I promise you you won't regret it because in my opinion, this is the best QBank on the market today, hands down, which is the exact reason I'm partnering with them. And I partner with them so often because their product is second and none. Also, for a future video, I may have Adriana take some of these board examination questions, and then I may take some of her PA board examination. So if you want to see that video, let me know if you want us to do a little switcheroo. And we may do that on an upcoming video. So as always, make sure you smash that subscribe button, thumb in and subscribe if you don't already. Make sure you go check out Board Vitals, use my code DRChalini to get 20% off. Otherwise, I'll see you all on the next video.