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USMLE STEP 2 CK QUESTIONS AND ANSWERS
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USMLE STEP 2 CK QUESTIONS AND ANSWERS
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USMLE STEP 2 CK QUESTIONS AND ANSWERSpregnant with active HBV - Answers-tx newborn with HBIG and HBV vaccine
Beck's triad for tamponade - Answers-hypotension, JVD, muffled heart sounds (also
pulsus paradoxus). Electrical alternans
subarachnoid hemorrhage - Answers-increased ADH and BNP --> hyponatremia. Tx -
water restriction
coccidioidomycosis - Answers-SW US, central/south America. Pulm infection - dry
cough, weight loss, pleuritic chest pain, erythema multiforme/nodosum, arthralgias
histoplasmosis - Answers-SE US, mid Atlantic, central US, caves. Acute PNA, but
usually asymptomatic. HIV disseminated infection- hilar LAD, pneumonitis,
pancytopenia, hepatosplenomegaly, palatal ulcers. tx- IV amphotericin B followed by
lifelong itraconazole.
Blastomycosis - Answers-central US (most in Wisconsin). Often asymptomatic or flu-like
Sx. Systemic disease- lytic bone lesions, pulmonary infection, skin lesions. Dx- broad-
based budding yeast. Tx- itraconazole, amphotericin B
aspergillosis - Answers-invasive in IMCD. CXR - cavitary lesions. CT - pulm nodules,
halo sign, air crescent
sporotrichosis - Answers-subcutaneous infection. Gardeners. Travel up lymphatics for
nodules on forearms
cryptococcus - Answers-pulm infection often asymptomatic. Usually
meningoencephalitis in HIV with CD4<200
hemochromatosis infections - Answers-Listeria monocytogenes, Yersinia enterocolitica,
septicemia - Vibrio vulnificus
Narcolepsy treatment - Answers-methyldphenidate, modafinil, antidepressants (for
cataplexy)
galactorrhea - Answers-test B-HCG, prolactin, TSH
septic abortion - Answers-cervical/blood cultures, antibiotics, gentle suction currettage
Lesch-Nyhan - Answers-x-linked recessive, HPRT deficiency, increased uric acid. Sx -
self mutilation, dystonia, spacticity, gout. Presents at 6 months.
minimal change disease - Answers-tx - prednisone, cyclophosphamide for resistant
cases/frequent relapse
,Sturge-Weber - Answers-seizures, retardation, trigeminal port-wine stain, hemi neuro
findings, tramline intracranial calcifications
tuberous sclerosis - Answers-seizures, retardation, intracranial calcifications (tubers),
ashleaf spots, adenoma sebaceum (red papules on face)
osteogenesis imperfecta - Answers-autosomal dominant. Type 1 collagen problem. Type
2 most severe with perinatal fractures and often intrauterine death. Blue sclera,
fractures, hypotonia, hearing loss, joint hypermobility, dentinogenesis imperfecta
polymyalgia rheumatica - Answers-neck/shoulder/hip pain/stiffness. >50 years old, high
ESR. Tx- low dose prednisone, high dose for temporal arteritis
massive blood transfusion - Answers-citrate anticoagulant --> chelates Ca and Mg -->
low Ca --> paresthesias, hyperactive reflexes
nephrotic syndrome - Answers-dyslipidemia, accelerated atherosclerosis,
hypercoagulable, risk for MI/stroke, higher infxn susceptibility. Can have renal vein
thrombosis, usually with membranous GN
aortic regurgitation - Answers-early diastolic (mild) to holodiastolic (severe) murmur.
Bounding pulses. Tx- decrease afterload with DHP Ca-channel blockers, ACEi, NOT
beta blockers.
mycoplasma PNA - Answers-erythema multiforme. No cell wall so not on gram stain
candidal vulvovaginitis - Answers-pseudohyphae. In IMCD and Abx treated people. Tx-
oral fluconazole, topical nystatin
nonseminomatous germ cell tumor - Answers-large anterior mediastinal mass, young
males. High HCG and AFP.
seminoma - Answers-high HCG but normal AFP
thymoma - Answers-associated with myasthenia gravis, pemphigus
hepatocellular carcinoma - Answers-high AFP but normal HCG
choriocarcinoma - Answers-gestational trophoblastic disease usually in molar
pregnancy. Very high HCG
C. dif diagnosis - Answers-cytotoxin assay of stool
Erb-Duchenne palsy - Answers-C5, C6. waiter's tip, absent Moro but intact grasp
,Klumpke's paralysis - Answers-C7, C8, T1. hand paralysis, Horner's (ptosis, miosis)
dermatitis herpetiformis - Answers-papulovesicular, pruritic. Associated with Celiac. Dx -
IgA anti-endomysial Ab, anti-gliadin
phenelzine - Answers-MAOi antidepressant. Avoid tyramine (aged meat/cheese) -->
HTN crisis
CMV esophagitis - Answers-in HIV. Dysphagia, odynophagia, shallow ulcers,
intranuclear/cytoplasmic inclusions. Tx- ganciclovir IV
HSV esophagitis - Answers-in HIV. Small ulcers with volcano-like appearnace.
Eosinophilic intranuclear inclusions. Tx- acyclovir
candidal esophagitis - Answers-most common HIV esophagitis. Tx - oral fluconazole
splenic rupture - Answers-ex-lap if unstable. CT if stable
pseudocyesis - Answers-pregnancy conversion disorder
prolactin - Answers-stimulated by serotonin and TRH, inhibited by dopamine.
Hypothyroid --> amenorrhea/galactorrhea
adenomyosis - Answers-endometrial glands in myometrium. Usually > 40yo,
dysmenorrhea, menorrhagia, enlarged symmetric uterus. Must curettage to r/o
endometrial carcinoma
leiomyoma/fibroids - Answers-irregular shaped uterus
endometriosis - Answers-uterus not enlarged. Dysmenorrhea, dyspareunia, dyschezia.
Dx- laparoscopy. Tx- OCPs
aminoglycosides - Answers-amikacin, gentamicin, tobramicin. ototoxic, nephrotoxic.
Gentamicin very ototoxic
hydroxychloroquine - Answers-DMARD. Treats SLE. SE - retinopathy/corneal damage
(need q6month eye exams), GI, hemolysis in G6PD
methotrexate SE - Answers-DMARD. Inhibits folate metabolism. Macrocytic anemia, GI,
hepatotoxic, ILD, alopecia, pancytopenia
premature ovarian failure - Answers-low estrogen, high FSH > LH, <40yo
hyperparathyroidism - Answers-hypercalcemia - stones, bones, groans, psyciatric
overtones, polydipsia, polyuria. pseudogout. Also sometimes HTN
, low-grade (without mets) gastric MALT lymphoma - Answers-H pylori association. Tx-
PPI, clarithromycin, amoxicillin
Jarisch-Herxheimer rxn - Answers-primary/secondary syphilis treated with penicillin -->
spirochetes die --> immune complexes --> looks like syphilis flare-up
INH SE - Answers-hepatitis, peripheral neuropathy/ataxia (give pyridoxine)
fanconi anemia - Answers-pancytopenia, congenital anomalies, presents 4-12yo.
Autosomal recessive. Skin changes
diamond-blackfan - Answers-pure red cell aplasia, congenital anomalies. Presents 3
months old. Tx - steroids, possibly transfusion
transient erythroblastopenia of childhood - Answers-RBC aplasia. Presents 6mo - 5yo
psoriatic arthritis - Answers-DIP, dactylitis. Tx- NSAID, anti-TNF, methotrexate, NOT
steroids
RA - Answers-MCP, PIP, not DIP. Tx- methotrexate, hydroxychloroquine, TNF inhibitors
(infliximab, etanercept)
OA - Answers-DIP
adjustment disorder - Answers-within 3 months of event, lasts < 6 months post-event.
Tx- cognitive/psychodynamic psychotherapy
cushing's - Answers-high corticosteroids, central obesity, DM, proximal muscle
weakness, psychosis, thin skin, purple striae, osteoporosis, hypokalemic alkalosis,
secondary HTN
APML - Answers-Tx- ATRA
CML - Answers-leukocytosis, anemia, increased granulocytic forms (PMNs, bands), leuk
alk phosh low (high in leukemoid reaction). Philadelphia chromosome, t(9:22), BCR-ABL
gene. Tx- tyrosine kinase inhibitors (imatinib). Usually > 50yo
McCune-Albright - Answers-3 P's - precocious puberty, pigmentation (café-au-lait),
polyostotic fibrous dysplasia. Associated with other endocrine d/o's - hyperthyroid,
prolactinoma, growth hormone, cushing's
von Recklinghausen/NF1 - Answers-autosomal dominant. café-au-lait, axillary/genital
freckling, Lisch nodules, neurofibromas, bony lesions, tumors.
NF2 - Answers-autosomal dominant. brain tumors, bilateral acoustic neuromas, other
tumors.
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