m**********3
发帖数: 706 | 1 UPDATE--Got my score today, 22X, not a high score but I am satisfied!
这是本人的智商暴露贴：）， 主要是给后来人分享失败的经验。
考分》240的大牛请绕道。智商》120的请绕行。
本人昨天考的CK。从头到尾，就是最后一个BLOCK做出了平时的感觉，其他全是梦游状
态。
为什么？题目太“非典”了。
本人背景：国内临床三年，去年6月起和两个小组分别过了MTB2,3。UW过了两遍。
KAPLAN CD， NBME OFFLINE 模拟能答对80%.UW平均70%，最后能上90%-95%
考试：1.罕见的病太多太多，而且鉴别诊断及其复杂。A病和B病，各有各的可能性，1
分钟之内很难下结论。大多数情况下我就只好闭眼选一个。比如VIPOMA 和GLUCAGNOMA
和类癌。
2.时间很紧。每个题目没有时间细细考虑。就这样，每个BLOCK就剩1-2分钟。也没法检
查。
3.常见病也不好好给你出题。一个题干很长，另外一个选项很不明朗。很明显出题的故
意浪费你的时间。
4.学好杂科很重要。内科大概60-70%，杂科占了30-40%吧。杂科的题目基本全是考处理
，陷阱无数。一定要把鉴别诊断，手术指证，抗生素应用活学活用，否则完蛋
5.感觉MTB2+3+UW不够，可能要上KAPLAN VIDEO/NOTE, FIRST AID.有时间的人看看这两
个东西会有帮助.因为这个考试要求你把每个病人的情况摸透，所谓个体化治疗方案。
6.感染的题目有大概40%。包括内外妇儿传。所以这个绝对是重点。最可能的诊断，最
可能的病原体。记住我说的都是最可能。所以排除法有时候真的很重要!!!
7.内科心血管多，神经少。可惜我把神经内科搞得清清楚楚，最后只考了几个很罕见的
周围神经病。
想到再说。反正提醒大家重视。 | d******d
发帖数: 192 | 2 Thanks for sharing! Scared... Though.
1
GLUCAGNOMA
【在 m**********3 的大作中提到】
: UPDATE--Got my score today, 22X, not a high score but I am satisfied!
: 这是本人的智商暴露贴：）， 主要是给后来人分享失败的经验。
: 考分》240的大牛请绕道。智商》120的请绕行。
: 本人昨天考的CK。从头到尾，就是最后一个BLOCK做出了平时的感觉，其他全是梦游状
: 态。
: 为什么？题目太“非典”了。
: 本人背景：国内临床三年，去年6月起和两个小组分别过了MTB2,3。UW过了两遍。
: KAPLAN CD， NBME OFFLINE 模拟能答对80%.UW平均70%，最后能上90%-95%
: 考试：1.罕见的病太多太多，而且鉴别诊断及其复杂。A病和B病，各有各的可能性，1
: 分钟之内很难下结论。大多数情况下我就只好闭眼选一个。比如VIPOMA 和GLUCAGNOMA
| d********e
发帖数: 30 | 3 3x 4 sharing and agree with u! | J*********4
发帖数: 1274 | 4 完全同意！
我考试的感觉完全一样。事实上我的成绩比摸考低好多。
所以，要重视。 | t******a
发帖数: 408 | 5 Thank you very much!
Saved in my collection.
Good luck!!
1
GLUCAGNOMA
【在 m**********3 的大作中提到】
: UPDATE--Got my score today, 22X, not a high score but I am satisfied!
: 这是本人的智商暴露贴：）， 主要是给后来人分享失败的经验。
: 考分》240的大牛请绕道。智商》120的请绕行。
: 本人昨天考的CK。从头到尾，就是最后一个BLOCK做出了平时的感觉，其他全是梦游状
: 态。
: 为什么？题目太“非典”了。
: 本人背景：国内临床三年，去年6月起和两个小组分别过了MTB2,3。UW过了两遍。
: KAPLAN CD， NBME OFFLINE 模拟能答对80%.UW平均70%，最后能上90%-95%
: 考试：1.罕见的病太多太多，而且鉴别诊断及其复杂。A病和B病，各有各的可能性，1
: 分钟之内很难下结论。大多数情况下我就只好闭眼选一个。比如VIPOMA 和GLUCAGNOMA
| u*******8
发帖数: 497 | | D********3
发帖数: 786 | | h*******y
发帖数: 1220 | 8 谢谢。可能是题库换了。
VIPOMA 和 GLUCAGNOMA 差别在 GI，血糖，皮肤症状？后个有migratory necrotizing
skin lesion？
Bless 考高分。 | h*******y
发帖数: 1220 | 9 Sorry for hacking your thread. Those who have not taken CK may learn a point
or two:
From wiki
VIPoma：A VIPoma (also known as Verner Morrison syndrome, after the
physicians who first described it)[1] is a rare (1 per 10,000,000 per year)
endocrine tumor,[2] usually (about 90%) originating from non-β islet cell
of the pancreas, that produce vasoactive intestinal peptide (VIP). It may be
associated with multiple endocrine neoplasia type 1.
The massive amounts of VIP in turn cause profound and chronic watery
diarrhea and resultant dehydration, hypokalemia, achlorhydria (hence WDHA-
syndrome, or pancreatic cholera syndrome), acidosis, vasodilation (flushing
and hypotension), hypercalcemia and hyperglycemia.[3]
The major clinical features are prolonged watery diarrhea (fasting stool
volume > 750 to 1000 mL/day) and symptoms of hypokalemia and dehydration.
Half of the patients have relatively constant diarrhea while the rest have
alternating periods of severe and moderate diarrhea. One third have diarrhea
< 1yr before diagnosis, but in 25%, diarrhea is present for 5 yr or more
before diagnosis. Lethargy, muscle weakness, nausea, vomiting and crampy
abdominal pain are frequent symptoms. Hypokalemia and impaired glucose
tolerance occur in < 50% of patients. Achlorhydria is also a feature. During
attacks of diarrhea, flushing similar to the carcinoid syndrome occur
rarely.
Besides the clinical picture, fasting VIP plasma dosage may confirm the
diagnosis, and CT scan and somatostatin receptor scintigraphy are used to
localise the tumor, which is usually metastatic at presentation.
Tests include:
Blood chemistry tests (basic or comprehensive metabolic panel)
CT scan of the abdomen
MRI of the abdomen
Stool examination for cause of diarrhea and electrolyte levels
Vasoactive intestinal peptide (VIP) level in the blood
The first goal of treatment is to correct dehydration. Fluids are often
given through a vein (intravenous fluids) to replace fluids lost in diarrhea.
The next goal is to slow the diarrhea. Some medications can help control
diarrhea. Sandostatin, which is a human-made form of the natural hormone
somatostatin, blocks the action of VIP.
The best chance for a cure is surgery to remove the tumor. If the tumor has
not spread to other organs, surgery can often cure the condition.
Some People seem to respond to a combination chemo called Capecitabine and
Temozolomide but there is no report that it totally cured people from vipoma
. | h*******y
发帖数: 1220 | 10 A glucagonoma is a rare tumor of the alpha cells of the pancreas that
results in up to a 1000-fold overproduction of the hormone glucagon. Alpha
cell tumors are commonly associated with glucagonoma syndrome, though
similar symptoms are present in cases of pseudoglucagonoma syndrome in the
absence of a glucagon-secreting tumor.
he primary physiological effect of glucagonoma is an overproduction of the
peptide hormone glucagon, which enhances blood glucose levels through the
activation of anabolic and catabolic processes including gluconeogenesis and
lipolysis respectively. Gluconeogenesis produces glucose from protein and
amino acid materials. It also increases lipolysis, which is the breakdown of
fat. The net result is hyperglucagonemia, decreased blood levels of amino
acids (hypoaminoacidemia), anemia, diarrhea, and weight loss of 5–15 kg.
Necrolytic migratory erythema (NME) is a classical symptom observed in
patients with glucagonoma and is the presenting problem in 70% of cases.[1]
Associated NME is characterized by the spread of erythematous blisters and
swelling across areas subject to greater friction and pressure, including
the lower abdomen, buttocks, perineum, and groin.
Diabetes mellitus also frequently results from the insulin and glucagon
imbalance that occurs in glucagonoma.[2] Diabetes mellitus is present in 80
–90% of cases of glucagonoma, and is exacerbated by preexisting insulin
resistance. | | | t*********8
发帖数: 106 | 11 Thanks a lot for detailed information. Wish LZ best luck!
the
and
of
【在 h*******y 的大作中提到】
: A glucagonoma is a rare tumor of the alpha cells of the pancreas that
: results in up to a 1000-fold overproduction of the hormone glucagon. Alpha
: cell tumors are commonly associated with glucagonoma syndrome, though
: similar symptoms are present in cases of pseudoglucagonoma syndrome in the
: absence of a glucagon-secreting tumor.
: he primary physiological effect of glucagonoma is an overproduction of the
: peptide hormone glucagon, which enhances blood glucose levels through the
: activation of anabolic and catabolic processes including gluconeogenesis and
: lipolysis respectively. Gluconeogenesis produces glucose from protein and
: amino acid materials. It also increases lipolysis, which is the breakdown of
| m**********3
发帖数: 706 | 12 Yes, I know. But if the pt had both diarrhea and hyperglycemia without rash,
what is the diagnosis.
Most Qs are like this. You know the typical symptoms of both diseases, but
the pt. may present symptoms that represent both diseases. I agree I can
finish it if I have more time. But in 60min for 45Q, you don't have enough
time to think.
necrotizing
【在 h*******y 的大作中提到】
: 谢谢。可能是题库换了。
: VIPOMA 和 GLUCAGNOMA 差别在 GI，血糖，皮肤症状？后个有migratory necrotizing
: skin lesion？
: Bless 考高分。
| m**********3
发帖数: 706 | 13 Again, I think in the real exam you have to pick the most possible diagnosis
. For example, a pt. with headache and his csf is full of WBC, is it p.
strep or N. meningitis. ? I think if the pt. has no rash, p. Strep is a
better choice,although both are very likely, and N. Meningitis will not
necessarily show rashes.
Hope you guys can understand what I mean in the real test. The above Q if
the pt. has no rash, maybe VIPoma, because it is MORE LIKELY that
glucagonoma will have rash. (some may not but the likelyhood is low!)
So pls remember the words "the BEST choice", "the most Likely" "the most
possible Dx" if you are very uncertain between 2 diseases. | t*********8
发帖数: 106 | 14 Thanks again for your suggestions!
diagnosis
【在 m**********3 的大作中提到】
: Again, I think in the real exam you have to pick the most possible diagnosis
: . For example, a pt. with headache and his csf is full of WBC, is it p.
: strep or N. meningitis. ? I think if the pt. has no rash, p. Strep is a
: better choice,although both are very likely, and N. Meningitis will not
: necessarily show rashes.
: Hope you guys can understand what I mean in the real test. The above Q if
: the pt. has no rash, maybe VIPoma, because it is MORE LIKELY that
: glucagonoma will have rash. (some may not but the likelyhood is low!)
: So pls remember the words "the BEST choice", "the most Likely" "the most
: possible Dx" if you are very uncertain between 2 diseases.
| m**********r
发帖数: 183 | | h*******y
发帖数: 1220 | 16 So it is about patient populations: neonates: group B Strep, children and
old people: Pneumococci, young adults, people in jail, dorm, barrack: N.
Meningitis... | f*****y
发帖数: 464 | 17 刚刚开始做CK的UW题库，感觉就跟楼主一样了，太难了，连大概知道是啥病的还是选不
对呀。 | f*******l
发帖数: 606 | 18 This is depend on patients age. If the patient is new born, grop B strep is
most likely. children, teens and young aldult, N. meningitis; rest of the
adult, S. pneomonia. Exteremly high protein always rule in TB.
diagnosis
【在 m**********3 的大作中提到】
: Again, I think in the real exam you have to pick the most possible diagnosis
: . For example, a pt. with headache and his csf is full of WBC, is it p.
: strep or N. meningitis. ? I think if the pt. has no rash, p. Strep is a
: better choice,although both are very likely, and N. Meningitis will not
: necessarily show rashes.
: Hope you guys can understand what I mean in the real test. The above Q if
: the pt. has no rash, maybe VIPoma, because it is MORE LIKELY that
: glucagonoma will have rash. (some may not but the likelyhood is low!)
: So pls remember the words "the BEST choice", "the most Likely" "the most
: possible Dx" if you are very uncertain between 2 diseases.
| f*******l
发帖数: 606 | 19 This is depend on patients age. If the patient is new born, grop B strep is
most likely. children, teens and young aldult, N. meningitis; rest of the
adult, S. pneomonia. Exteremly high protein always rule in TB.
diagnosis
【在 m**********3 的大作中提到】
: Again, I think in the real exam you have to pick the most possible diagnosis
: . For example, a pt. with headache and his csf is full of WBC, is it p.
: strep or N. meningitis. ? I think if the pt. has no rash, p. Strep is a
: better choice,although both are very likely, and N. Meningitis will not
: necessarily show rashes.
: Hope you guys can understand what I mean in the real test. The above Q if
: the pt. has no rash, maybe VIPoma, because it is MORE LIKELY that
: glucagonoma will have rash. (some may not but the likelyhood is low!)
: So pls remember the words "the BEST choice", "the most Likely" "the most
: possible Dx" if you are very uncertain between 2 diseases.
| m**********3
发帖数: 706 | 20 good point!
is
【在 f*******l 的大作中提到】
: This is depend on patients age. If the patient is new born, grop B strep is
: most likely. children, teens and young aldult, N. meningitis; rest of the
: adult, S. pneomonia. Exteremly high protein always rule in TB.
:
: diagnosis
| | | m**********3
发帖数: 706 | 21 我现在准备放下包袱，正在准备STEP３。 粗略看了下STEP３ FIRST AID， 才发现
这本书居然对考CK很有用。强烈推荐大家有时间的话可以过一遍。对于疾病的处理很有
帮助。比如THYROID NODULE的处理原则，就非常简洁明了。 | s********n
发帖数: 2071 | 22 祝贺miaomiao2003顺利完成STEP2 CK考试。谢谢你的宝贵经验。不知道能否将你的
STEP2 CK的NBME下载版本给我一份。我的电子邮箱是s********[email protected]．提前谢
谢您。 | m*********s
发帖数: 56 | 23 谢谢！能否也把STEP2 CK的NBME下载版本发给我一份？或者告诉我哪里可以下载？
l******[email protected]. 谢谢。 | p****r
发帖数: 117 | 24 着实被楼主的帖子吓了一把，都不敢报名考试了。感谢楼主提供的经验，但还是想详细
问一下楼主复习情况：您从去年6月份就开始准备CK，到今年四月初考试用了近十个月
时间，期间就只看了MTB2/3,NBME 和2遍UW 吗？没看其他资料吗？难道楼主每天只用一
小部分时间学习？你感觉考试内容非典与你没花足够多的时间看书有关， 还是用了10
个月看了很多书但仍不够有关？绝不怀疑楼主的智商，只是觉得你的NBME 和UW 分都不
错，为什么实战的感觉差距那么大？难道精华区的考经已经不再适合现在的CK 考试准
备了吗？真心希望你的这种感觉是错觉，预祝你考高分！ | a*****n
发帖数: 154 | 25 同求,谢谢。 a*****[email protected]
【在 s********n 的大作中提到】
: 祝贺miaomiao2003顺利完成STEP2 CK考试。谢谢你的宝贵经验。不知道能否将你的
: STEP2 CK的NBME下载版本给我一份。我的电子邮箱是s********[email protected]．提前谢
: 谢您。
| m**********3
发帖数: 706 | 26 这几天我也在反思为什么花了时间却考不好。我觉得第一是我的鉴别诊断没有真正过关
。基本上要达到看完题目，不看答案就能给出诊断的本事（参考EMMA的复习经验）。第
二个也是我说的UW+MTB+NBME没有包括所有考点，也许大家看看KAPLAN NOTE,CD, FIRST
AID会扩展自己的知识面。总之，CK是比以前难了,对点（深度）和面（广度）的要求
更高。大家要重视。
NBME OFFLINE版的我可能没有时间给大家发了，因为要准备CS了。大家可以自己GOOGLE.
10
【在 p****r 的大作中提到】
: 着实被楼主的帖子吓了一把，都不敢报名考试了。感谢楼主提供的经验，但还是想详细
: 问一下楼主复习情况：您从去年6月份就开始准备CK，到今年四月初考试用了近十个月
: 时间，期间就只看了MTB2/3,NBME 和2遍UW 吗？没看其他资料吗？难道楼主每天只用一
: 小部分时间学习？你感觉考试内容非典与你没花足够多的时间看书有关， 还是用了10
: 个月看了很多书但仍不够有关？绝不怀疑楼主的智商，只是觉得你的NBME 和UW 分都不
: 错，为什么实战的感觉差距那么大？难道精华区的考经已经不再适合现在的CK 考试准
: 备了吗？真心希望你的这种感觉是错觉，预祝你考高分！
| h**s
发帖数: 1757 | 27 放松吧，应该成绩不错的！ 考了就是大胜利！
不过，给还没考的同学说一下，如果在诊断和鉴别诊断上纠结的，FA CK真的是本好书
。拿来每章的目录打开，看看相似的病能不能迅速的找出不同，这样考试使此类题不会
太慌。
FIRST
GOOGLE.
【在 m**********3 的大作中提到】
: 这几天我也在反思为什么花了时间却考不好。我觉得第一是我的鉴别诊断没有真正过关
: 。基本上要达到看完题目，不看答案就能给出诊断的本事（参考EMMA的复习经验）。第
: 二个也是我说的UW+MTB+NBME没有包括所有考点，也许大家看看KAPLAN NOTE,CD, FIRST
: AID会扩展自己的知识面。总之，CK是比以前难了,对点（深度）和面（广度）的要求
: 更高。大家要重视。
: NBME OFFLINE版的我可能没有时间给大家发了，因为要准备CS了。大家可以自己GOOGLE.
:
: 10
| D******D
发帖数: 1159 | |
|
