step 1 soru bankası oluşturalım mı?

umc wrote: Artık yüklenebilir..

Ben bu soru bankası konusunda kollaboratif bir çalışma yapılabilmesi için yaratıcı bir çözüm düşünüyorum, ekşi sözlük benzeri bir çok kullanıcılı ortamda herkesin girip ekleyebileceği bir ortam gibi. Ben düşünürken Geliştirme sorumlumuz Onur ne düşünür bu konuda onu da merak ediyorum. Böyle bir şey yapabilirsek çok uzun soluklu bir proje olur, ve seneler boyu büyür büyüyebildiği kadar... Siz Word de toplamaya devam ededurun bir yeni projeyle geliyoruz...

Ulaş Abi kusura bakma biraz geç okudum bu başlığı. Bu konuyla ilgili olarak, dediğin gibi blog tarzı ya da ekşi sözlük tarzı bir sistem kurulabilir fakat bence ortada bu kadar çok kaynak varken bence böyle bir işe kalkışmak hem çok fazla zaman alır hem de Kaan Abi'nin söylediği gibi sitede çok fazla yer kaplayabilir.

Hem bu tarzda çalışma sistemi olan bir usmle soru bankası zaten internette mevcut. www.Usmlexchange.com

Aynen bahsettiğiniz mantıkla işliyor, kişiler buldukları soruları ekliyor oradaki kişiler de onları düzenleyip fazla olanları çıkartıp sitede yayınlıyorlar.

Bu sitedeki sorulara sahip olmamızı sağlayacak bir proje önermiştim hatta bir süre önce, öyle bir şey yapmak en baştan soru toparlamaya çalışmaya göre bir nebze daha kolay olabilir gibime geliyor. Merak eden arkadaşlar aşağıdaki başlıktan o konuyu okuyabilirler.

www.usmle.ulascamsari.com/index.php?opti...2009&Itemid=105#2010

bencede iyi bir fikir her gelen elindeki soruları açıklamalı olarak ekler ve bir soru bankası elde edebiliriz

kaan wrote: Arkadaslar bu sekilde soru yuklemek sayfalarca gereksiz yer isgal eder,ayrica internetten buldugunuz sorulara ne gerek var,Step 1 den en yuksek puani bile bu kaynaklardaki sorulari cozerek rahatlikla alabilrsiniz,fazla dagilmayin bu kitaplari ya alin yada internetten indirin,yada olanlari gondereyim,vereyim.
Kaplan Qbook
First Aid Step 1 Q&A
First Aid Cases Step 1

Mümkünse First Aid Q&A ve Cases kitaplarını indirebileceğimiz bir link verebilir misiniz?

Arkadaslar bu sekilde soru yuklemek sayfalarca gereksiz yer isgal eder,ayrica internetten buldugunuz sorulara ne gerek var,Step 1 den en yuksek puani bile bu kaynaklardaki sorulari cozerek rahatlikla alabilrsiniz,fazla dagilmayin bu kitaplari ya alin yada internetten indirin,yada olanlari gondereyim,vereyim.
Kaplan Qbook
First Aid Step 1 Q&A
First Aid Cases Step 1

Aslinda istege bagli olarak hazirlanan sorular ana sayfada anket sorularinin yerine gosterilebilir. Teknik olarak mumkun olur mu, emin dgilim:(

Evet sanal dünya böyle büyüyor artık

Çok fazla emek ve zaman isteyecektir bu iş.
Bedeli olmalı bence.

Açıkcası sitenin ulaşamadığım kaynak kitaplar bölümünde bu şekilde yüklenmiş e-kitaplar olduğunu düşünüyordum. O nedenle böyle bir fikirde bulunmak aklıma gelmemişti.

Şöyle bir sorun oluştu . Bendeki word 2007 sürümü olduğu için docx dosyası formatında . Ve siteye docx dosyası yüklenmiyor.

C:\fakepath\Step 1.docx
www.testprepreview.com/usmle_practice.htm

Bu sitedeki soruları word dosyası şeklinde düzenledim. Bunun üzerinden fikir yürütebilir miyiz?

Yuzlerce sorunun oldugu word veya pdf dosyasi guzel olur, ama muhtemelen cogumuz tek seferde 5-10 soru ekleriz.Sorular birikince toplayabiliriz o sekilde

Bu çok iyi bir fikir. Aynı fikir step 2 ler için de düşünülebilir. Ancak ben soruların bu şekilde yazılmasının çok kullanışlı olacağını düşünmüyorum. Word ya da pdf formatında sorular düzenlenerek siteye sunulursa daha uygun olur diye düşünüyorum.Böylece ciddi ve düzenli bir soru bankası oluşabilir.

Arkadaşlar, internette bulduğumuz soruları bu başlıkta toplayabiliriz. Ama link vererek değil, açık olarak soru-cevap şeklinde.
mesela www.aippg.com (hintlilerin sınavlara hazırlanırken kullandıkları bir site) da step 1 başlığında çok fazla soru var.(bu sorular çıkmış sorular mı,nerden buluyorlar bunları bilmiyorum)Bunların bir kısmını kopyalıyorum


A 28-yaer-old pregnat woman develops a flulike illness with fever, hedeache, myalgia, and back pain. As the comlpication of the illness she has a spontaneous abortion.Examination of the abortus demonstrates severe amnionitis. Which of the following is the most likely means by which this infection was acquired?

A. Eating soft cheese
B. Handling cats
C. Rat bite
D. Sexual transmition
E. Tick bite

A.

spontaneous abortions are associates with Listeria monocytogenes common in unpasteurized dairy product and deli foods



A 22-year-old, married woman presents with pain in her lower right abdomen. Her abdomen is tender to palpation and there is rebound tenderness. The patient reports nausea, and has a temperature of 38.3 C (101 F). A diagnosis of acute appendicitis is made, and the patient consents to, and is scheduled for immediate surgery. Prior to the surgery, the woman tells the surgeon that she is a practicing Catholic, and says that she will pray for the successful completion of the surgery. Surgical examination of the appendix reveals that it is normal and without inflammation. Examination of the abdominal cavity reveals that the true underlying cause of the patient’s pain is an ectopic pregnancy on the right side. At this point, what action should the surgeon take next?

A. Close the incision, wait until the patient recovers from anesthesia, and seek full
informed consent before proceeding
B. Consult the chief of surgery
C. Consult with the local Catholic chaplain about how to proceed based on the woman’s expressed religious beliefs.
D. Seek permission to operate on the ectopic pregnancy from the woman’s spouse
E. Surgical intervention to deal with the cause of the pain

The answer is E.
Unless the patient gives explicit permission, treatment of any kind is not permitted. There are four exceptions to this rule: emergency, waiver by the patient, patient is incompetent, and therapeutic privilege. In this case, the woman did not consent to treatment of the ectopic pregnancy. But, this is a life-threatening condition. If not treated at once, this could result in serious harm or even death. Because the patient is under anesthesia, we cannot ask her wishes. Waking her up and asking her permission puts her at even more risk. Therefore, the physician should deal with the ectopic pregnancy, which is the cause of the pain, under the emergency exception to informed consent.

Choice A is incorrect. This is a life-threatening condition. Delay might be fatal. Without some evidence of the patient's explicit refusal, the physician must act

Choice B simply passes the buck. Enough information is given in the case to allow a decision. Act to deal with this emergency.

Not only does choice C take time, it also makes the unwarranted assumption that the beliefs of this woman are those of espoused by the Catholic Church. Although she may be a practicing Catholic, she may disagree with some, or even many of the directives of the Church. Never assume what someone's beliefs are just because they are a member of a particular religion or cultural group. When in doubt, ask the person himself or herself.

Each person has control over, and decision making, over his or her own body. A husband (choice D) cannot tell you what you should do with a wife and vice versa. Even if the husband could be contacted quickly, there is no opportunity to decide if what he says truly represents the wishes of the patient.



A 25-year old man presents to a physician because of multiple small nodules on his lips. The clinician notes that the patient has a tall and thin build with long fingers. In addition he hes hyperextensible joints. Which of the following screening tests is indicated??

A. Pentagastrin stimulated calcitonin
B. Serum gastrin
C. Serum insulin
D. Serum parathyroid hormone
E. Serum vasoactive intestinal peptide

The correct answer is A

The presence of mucosal neuromas , particularly when multiple and when the patient has a marfanoid syndrome is a marker for MEN IIb. MEN IIb predisposes for medullary carcinoma of the thyroid and pheochromocytoma. Pentagastrin stimulated calcitonin studies may suggest the presence of thyroid C cell hyperplasia, which may precede frank medullary carcinoma



A 67-year-old man presents at his physician complaining of discomfort in his lower abdomen and difficulty with urination. The man is 5 feet 11 inches tall and weighs 220 pounds. Although he used to smoke cigarettes, he was able to quit when he retired at age 65. Physical examination reveals an enlarged prostate. Suspecting the possibility of cancer, the physician orders a PSA test and tells the patient he will be contacted when the results are available. The patient is visibly upset at hearing the word "cancer" and in spite of the physician's reassurances of the low probability of malignancy, is physically shaking when he leaves the office. Several days latter the results of the test are received. The patient has a PSA of 3.5, elevated, but below the commonly used screening test cutoff. At this point the physician's best course of action would be to do which of the following?

A. Arrange an appointment to talk with the patient in the next several days and review the results in person.
B. Call the patient at once to deliver the news and offer guidance.
C. Call the patient to deliver the news and congratulate him on his overall health.
D. Call the patient to deliver the news and schedule the patient for a follow-up appointment to review what he can do to improve his overall health.
E. Have the nurse employed by the practice call the patient to deliver the news and take time to answer any questions he may have.
F. Schedule an appointment to talk to the patient about the results and offer him a referral for counseling
G. Send the patient a letter detailing the test results and suggesting the next course of action.

The answer is D. All communication with a patient is best handled face to face. When this is not possible because of the need to deliver news in a timely manner, as in the present case, the phone conversation should be followed up by a visit. The follow-up visit is also needed to discuss some of the patient's other health issues, including his weight. This patient's body mass index (weight/height2) is too high.

The patient is likely to have high anxiety over the next several days as he waits to hear the results (choice A). Alleviate the anxiety by telling him as soon as possible.

The phone call gets the good news to the patient quickly, but does nothing to either further the building of a good long-term relationship with the physician or address the patient's other health concerns (choice .

Choice C, while getting the patient the news quickly, and in a cheery manner, does not address the patient's other health condition.

A 36-year-old married woman complains to her physician that she is having trouble sleeping. A detailed history shows that her insomnia is sporadic and seems to be connected to cyclical stressors related to her working environment. The physician prescribes alprazolam to be taken “as needed.” The next day, the physician receives a distressed call from the patient. With anger in her voice, she tells the physician that the “pharmacist said that taking this medication might cancel out the effects of my birth control pills.” At this point the physician’s next response should be which of the following?

A. “I’m sorry. This is my fault. The problem is not very likely given the dose level I
prescribed and your only occasional use, but I should have discussed this issue with you
before.”
B. “It’s not the pharmacist’s job to be tinkering with your medications. I suggest you
have the prescription filled somewhere else.”
C. “Its really such a small chance that it is not worth worrying about.”
D. “Really, its nothing to worry about. I’ll call the pharmacist and work it out.”
E. “Really, there is no problem here. Pharmacists just like to show what they know.”
F. “The pharmacist is being overly cautious. As long as you take both medications as I prescribed them for you, you will have no problem.”
G. “Well, if you don’t like the drug I prescribed, what would you rather have?”
H. “You seem angry about this. Tell me more about what you are feeling right now

The answer is A.

Always admit a mistake. In this case the physician erred in not discussing the interaction of the new prescription with other drugs the patient was taking. The right answer starts by admitting the mistake, moves on to provide the necessary information to the patient, and closes by admitting the mistake again. Physicians are only human. Mistakes do, unfortunately happen. Within the context of a good relationship with the patient, most mistakes can be openly discussed and corrected. By this discussion, the physician-patient relationship is strengthened.

Choices B, E, and F are defensive. Worse, they do not even acknowledge the mistake, and miss the opportunity to educate the patient. Denigrating the pharmacist, who is correctly doing his job, seeks to hide the mistake rather than correcting it.

Choice C provides an explanation without admitting any mistake was made. If the physician wants honesty from the patient, he must provide it in turn. Admit the error and then correct it.
Choice D suggests both that there is no problem, and that the physician will talk with the pharmacist and solve it. It is deceitful. No mistake is admitted, and the chance to educate the patient is lost.

In choice G, again, no mistake is admitted. Rather than educating the patient, the physician asks the patient to prescribe for herself. The physician is the one with the expertise, and must lay out options from which the patient can choose. Ideally, this should have been done before the alprazolam was prescribed.

Discussing the patient's feelings (choice H) is off the point, and avoids dealing with the mistake. The error, not the patient's feelings about it, should be the first focus of the discussion.



A 72 year-old man is brought to the emergency department and diagnosed with atrial fibrillation. Shortly after receiving a medication to treat his dysrhythmia, the patient develops ventricular fibrillation. It is discovered that the patient was initially misdiagnosed and should have been diagnosed with Wolff-Parkinson-White syndrome and atrial fibrillation. Inappropriate administration of which of the following drugs most likely resulted in the development of ventricular fibrillation?
A. Adenosine
B. Amiodarone
C. Digoxin
D. Disopyramide
E. Quinidine

The answer is C. Accessory pathways between the atria and ventricle that avoid the conduction delay of the atrioventricular node may predispose the myocardium to the development of reentrant tachycardias. Examples of these dysrhythmias include atrial fibrillation, atrioventricular reentry tachycardia (AVRT), and atrial flutter. Most commonly, these specific reentry tachycardias make direct connections between the atria and ventricle though the Kent bundles [Wolff-Parkinson-White syndrome (WPWS)]. This produces a short PR interval but an early delta wave at the onset of a wide, slurred QRS complex owing to early ventricular depolarization of the region adjacent to the pathway. In patients with WPWS and atrial fibrillation, digoxin can enhance transmission of impulses through accessory pathways. This may result in an extremely rapid ventricular rate, and even ventricular fibrillation. Digoxin is an antiarrhythmic used primarily for the treatment of atrial fibrillation and flutter. All the other agents can be used to treat supraventricular tachycardias.

Adenosine (choice A) is primarily used for conversion of paroxysmal supraventricular tachycardia (including that associated with accessory bypass tracts of WPWS) to normal sinus rhythm.

Amiodarone (choice is a class III/IA antiarrhythmic used in the treatment of refractory ventricular tachycardia and supraventricular tachycardia and in the prevention of ventricular tachycardia and ventricular fibrillation.

Disopyramide (choice D) and quinidine (choice E) are class IA antiarrhythmics used in the treatment of ventricular tachycardia and supraventricular tachycardia and in the prevention of ventricular fibrillation and symptomatic ventricular premature beats.