Exam (elaborations)
USMLE STEP 2 CK INTERNAL MEDICINE
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USMLE STEP 2 CK INTERNAL MEDICINE
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USMLE STEP 2 CK INTERNAL MEDICINELeukemoid reaction - Answers-Patient has leukocyte count >50k, high LAP score, more
metamyelocytes than myelocytes
Chronic myeloid leukemia - Answers-Patient has leukocyte count often >100k, low LAP
score, fewer metamyelocytes than myelocytes, absolute basophilia
Cyclosporine - Answers-Drug that inhibits transcription of IL-2, causes nephrotoxicity,
htn, neurotoxicity, glucose intolerance, infection, malignancy, gingival hypertrophy and
hirsutism
Tacrolimus - Answers-Drug that inhibits transcription of IL-2 but does not cause
hirsutism or gum hypertrophy
Mycophenolate - Answers-Drug that is a reversible inhibitor of inosine monophosphate
dehydrogenase (rate-limiting enzyme in de novo purine synthesis), causes bone
marrow suppression
Vertebral osteomyelitis - Answers-IV drug user presents with tenderness to gentle
percussion over spinous process, labs show thrombocytosis
Acute pericarditis - Answers-Patient presents with sharp, pleuritic chest pain that is
relieved by leaning forward
Diabetic ketoacidosis - Answers-Patient with DM presents with hyperventilation, glucose
250-500, bicarb <18, elevated anion gap, serum osmolality <320
Hyperosmolar hyperglycemic state - Answers-Patient with DM presents with altered
mentation, glucose >600, bicarb >18, normal anion gap, serum osmolality >320
Hyperglycemia, ketonemia and anion gap metabolic acidosis - Answers-DKA Triad
Protein C deficiency - Answers-Underlying hereditary cause of transient
hypercoagulable state in first few days of warfarin therapy, leading to warfarin-induced
skin necrosis
Autoantibodies to platelet factor 4 - Answers-Genetic susceptibility to heparin-induced
thrombocytopenia
Cholesterol embolism - Answers-Patient with history of comorbid conditions presents
with livedo reticularis, Hollenhorst plaques (eyes), eosinophilia, renal injury after cardiac
catheterization
Statin - Answers-Drug used in therapy for patient with estimated 10-year ASCVD risk
>=7.5%
, Triglycerides - Answers-Lipid level reduced by use of fish oil
Niacin - Answers-Drug that is effective in raising HDL and has a modest effect of
lowering VLDL and LDL
Aortic regurgitation - Answers-Murmur in which patient presents with mild exertional
SOB and "pounding" of heart, aware of heartbeat while lying on L side, widened pulse
pressure (inc. systolic and dec. diastolic BP), water hammer pulse
Aortic stenosis - Answers-Murmur in which patient has pulsus parvus et tardus (small
amplitude and delayed upstroke)
Pyramidal tract disease - Answers-Condition detected by pronator drift test (patient has
outstretched arms with palms up and eyes closed, affected arm drifts downward and
pronates)
Romberg test - Answers-Test for proprioception in which patients are observed for
unsteadiness as they stand with feet together, arms to sides and eyes closed
Leser-Trelat sign (indicates occult internal malignancy) - Answers-Sudden onset of
multiple seborrhetic keratoses
CNS lymphoma - Answers-HIV+ patient presents with EBV DNA in CSF, MRI shows a
weakly ring-enhancing mass that is solitary and periventricular
Toxoplasmosis - Answers-MRI of HIV+ patient shows multiple, ring-enhancing, spherical
lesions in the basal ganglia
Squamous cell carcinoma - Answers-Former smoker presents with anorexia,
constipation, inc. thirst, easy fatigability, hypercalcemia d/t PTHrP , hilar mass on CXR
Acute respiratory distress syndrome - Answers-Paitent presents with dec. lung
compliance, pulmonary htn, hypoxemia with PaO2/FiO2 ratio =<300 mmHg
Central retinal artery occlusion - Answers-Patien presents with loss of monocular vision,
treated with ocular massage and high flow oxygen
Subacute thyroiditis (de Quervain) - Answers-Patient has prominent fever, hyperthyroid
symptoms, painful/tender goiter
Disseminated histoplasmosis - Answers-HIV+ patient presents with weight loss,
pulmonary symptoms (cough, dyspnea), mucocutaneous lesions, HSM, pancytopenia,
transaminitis, inc. LDH and ferritin
Relative risk - Answers-Measure of association used in cohort studies
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