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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#41 (reveal difficulty score)
A previously healthy 57-year-old woman with ...
Botulism ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: infectious_disease

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submitted by โˆ—step_prep5(246)
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  • Previously healthy middle-aged woman who had home-canned foods who presents with GI symptoms, ocular symptoms, and autonomic symptoms with normal deep tendon reflexes, most consistent with Botulism
  • Key idea: Adult-onset botulism associated with consumption of canned foods, whereas infant-onset botulism (floppy baby syndrome) associated with consumption of honey and exposure to dust (construction site, etc.)
  • Guillain-Barre syndrome โ€“> Ascending weakness over course of weeks associated with sensory symptoms and loss of deep tendon reflexes
  • Myasthenia gravis โ€“> Often does not present acutely, would not present with autonomic symptoms and history often includes weakness that worsens with continued use, associated with thymoma
  • Lambert-Eaton syndrome โ€“> Often does not present acutely, presents with autonomic dysfunction and diminished/absent deep tendon reflexes, and improves with continued use, associated with small cell lung cancer

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 +1  upvote downvote
submitted by โˆ—endochondral1(24)
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why not myastehnia for this one? They put some LE weakness in the stem as well so that before respiratory depression made me skeptical of it being a pure descending paralysis and I went with MG instead .

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study_dude_guy  I think the history just points more towards Botulism or GBS. Tbh I'm not even entirely sure why this was Botulism and not GBS +2
seagull  The nausea, vomiting, and diarrhea are also good cues that this is a foodborne illness. Then the DTR are mildly dulled which won't happen in myasthenia gravis +
derpymd  The confusion for me is the timeline. She consumed the food 32 hours prior and symptoms started at around 24 hours. I figured with preformed toxins, the timeline would be more similar to Staph aureus (i.e. just a few hours). The learning point for me here was that it can take 12-72 hours for symptoms to occur depending on dose. +



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