USMLE Step 1 Question of the Week #2

A 65-year-old male patient is brought to the emergency department by his relatives for sudden onset of shortness of breath. He was recently diagnosed with bronchogenic carcinoma of the small cell variety. He had come in with a history of coughing up blood on several occasions with a persistent cough. He had been smoking two packs of cigarettes a day for the last 20 years. Today he also complains of occasional headaches and a difficulty in seeing. He complains that these symptoms are more prominent in the morning when he wakes up from sleep. It subsides as the day progresses. Which of the following are the further physical findings the physician is expected to find in this patient?

A. Lower extremity edema along with distention of the superficial veins of the abdomen.

B. Edema and a purplish hue in the upper extremities, extending to the head.

C. Low blood pressure and a weak pulse, with extended jugular veins.

D. Breathing produces paradoxical movements in the chest.

E. Swelling of the feet with an increased shortness of breath as the patient lies down.

USMLE Step 1 Question of the week #1

Saturday challenge! Answer this  question. Here is how a typical Archer Step 1 Qbank interface looks, simulates USMLE Step 1 exam exactly. Try more at

Archer Step 1 Qbank interface


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Archer USMLE Step 3 CCS Live Webinar – January 2018

Live Workshop/ Webinar date: JANUARY 27TH 2018

Regsiter at

Interactive practice of USMLE Step3 CCS Cases.

The most time efficient strategy to pass USMLE Step 3! A component of Archer Live USMLE Reviews. Schedule ( Starts at 10 AM CDT i.e; 11 AM EST)

10 AM to 10:15 AM – Intro on the Webinar functions

10:15 AM to 12:15 PM – Recognizing Unstable vitals. – General approach to ER cases– Real time vs. Simulated time – Strategies to keep Simulated time low (ER) – Demonstration of high scoring strategies

12:15 pm to 12:30 pm – Q and A session

12:30 PM to 1:30 PM – Office case manAgement principles – General approach to office cases – Indications for admisiion – Scheduling follow up tests – Navigating the clock with ease to score more. – Demonstration of office cases

1:30 PM to 2:30 PM – Q and A session

2:30 PM to 4:00 PM – Lunch break

4:00 PM to 5:30 PM – Practice of very High Yield cases with one on one Q and A sessions

5:30 PM to 5:45 PM – Break

5:45 PM to 7:45 PM – Practice of Very Highyield CCS cases

7:45 PM to 8:00 PM – Break

8:00 PM to 9:00 PM – Case Practice, discussion and wrap-up!

Can’t make it to the Webinar ? Have exam before next live session? :   PPV recordings of most high-yield CCS workshops are readily available at  Price: $88 and you may access those 24/7.

Interpreting Mixing studies – Hematology HigYield

via Interpreting Mixing Studies – Hematology Highyield Concept I

Interpreting Mixing Studies – Hematology Highyield Concept I


Archer USMLE Blog

Approaching Prolonged PTT and understanding Mixing Studies : 


Question :  On a mixing study, the PTT corrects initially but gets prolonged again after incubation for 2 hours. What is this condition?

This description of mixing studies is consistent with presence of a temperature- and time-dependent anti-VIII inhibitor. It just means that the inhibitor is a warm reacting IgG antibody that requires one or two hour’s incubation at 37°C to be detected. If the PTT corrects initially but prolongs again after incubation (meaning if thePTT is at least 15% longer than the normal reagent plasma’s incubated PTT ) –> anti-VIII should be suspected. This can be confirmed by obtaining a Factor VIII level which will be low in case of presence of inhibitor. Further coinfirmation of Factor VIII inhibitor can be obtained by Bethesda Titer. In such cases, you should also carefully review patient’s prior bleeding history –…

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Question of the Week #490

490. An 18-year-old male presents to the Emergency Department for evaluation of chest pressure for an hour. The pain is radiating to his jaw. On examination, he is diaphoretic, and he complains of nausea. Past medical history is unremarkable. Urine reveals positive benzolegonine. Below is his ECG. What is the most likely cause of the patient’s symptoms?


A. Early repolarization

B. Ischemia

C. Cocaine induced myocardial infarction

D. Atrial fibrillation

E. Wolf-Parkinson-White Syndrome

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