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USMLE Step 2 CK
High yield questions for CK. Content from First Aid for CK, Secrets for CK, and USMLE World.
Terms in this set (743)
inhibit IL-1 production
folic acid antagonist, inhibits DHF reductase, S-phase specific, inhibits DNA synthesis
calcineurin inhibitor; inhibits IL-2 production; nephrotoxic, gum hypertrophy, hursutism
calcineurin inhibitor; inhibits signaling thru T cell receptor
prevents T cell activation
antineoplastic; cleaved to mercaptopurine; inhibits DNA/RNA synthesis; BM suppression
antithymocyte globulin (OKT3)
antibody against CD3 on T cells; causes pulmonary edema
monoclonal antibody to IL-2 receptor
fetal heart tones begin at
fetal quickening (movement) occurs at
4 measurements that can be taken from fetal US
crown-rump length, biparietal diameter, femur length, abdominal circumference
most reliable parameter for set. fetal weight in cases of fetal growth restriction
Gestational sac is visible by what gestational age?
b-hCG peaks when?
10 weeks GA
average increase in weight during pregnancy
25 lb (11 kg)
additional kcal needed during pregnancy
when should supplemental iron be started in a pregnant woman?
first prenatal visit
What 2 supplement to pregnant vegans need?
Vit D, Vit B12
What cardiovascular parameters DECREASE during pregnancy?
blood pressure and peripheral vascular resistance
What happens to electrolytes during pregnancy?
NOTHING! Remain unchanged.
What causes herpangina?
coxsackievirus (an enterovirus)
How do you screen for Hep C on the first prenatal visit? What about Hep B?
Hep C - history. Hep B - HBsAg
When is gestational diabetes screened for in pregnancy?
How are AFP results reported?
multiples of the median (MoM)
Quad screen shows "pan-low".
trisomy 18 (low AFP, low estriol, low b-hCG, low inhibin A)
Quad screen shows low AFP, low estriol, high b-hCG, high inhibin A.
Risk of fetal loss during chorionic villus sampling
Third trimester test used to detect presence of phosphatidylglycerol
tetratogen that can cause lack of cranial ossification
tetratogenic defects of streptomycin or kanamycin
hearing loss; CN VIII damage
2 tetratogens causing anotia or microtia
thalidomide, Vit A
can cause neonatal nasal hypoplasia an stippled bone epiphyses
tetratogen assoc. w/ neonatal bowel atresia
Woman with hyperhomocysteinemia loses a 19 week pregnancy. What enzyme is deficient?
methylene tetrahydrofolate reductase
Amount of caffeine required to cause spontaneous abortion
Deficiency of what hormone increases risk for spontaneous abortion? (estrogen, progesterone, growth hormone, testosterone, or FSH)
Prophylactic med for toxo during pregnancy
Cardiac defect assoc. w/ congenital rubella
treatment for congenital CMV
Pregnant HIV+ women should receive what prenatal meds?
AZT or nevirapine
When does an HIV+ women get a C-sec?
viral load >1000
eye disease in late congenital syphilis
Tx for threatened AB
pelvic rest for 24-48 hrs, then follow up US
How can misoprostol be administered?
oral, vaginal, sublingual, buccal
2 meds used for first-trimester therapeutic abortions
How does oxytocin work to induce or augment labor?
binds receptors on myometrium, increases Ca influx to stimulate contractions
Components of a Bishop score
dilation, effacement, station, cervical position, cervical consistency
Prolonged active stage of labor due to
things that can decreases fetal heart rate variability
hypoxia, opioids, magnesium, sleep cycle
drug assoc. w/ a "pseudosinusoidal" variability pattern on fetal heart rate tracings
complication of a supine nonstress test
What is "15-15-2-20"?
Normal "reactive" nonstress test: 2 FHR accelerations ≥ 15 bpm above baseline lasting ≥ 15 sec over a 20 min period
Next step if nonstress test is nonreactive?
How can you induce contractions in a contraction stress test?
nipple stimulation or oxytocin
Next step if contraction stress test is positive
components of a biophysical profile
fetal tone, fetal breathing, fetal movement, amniotic fluid volume, nonstress test
what is a modified biophysical profile?
NST + amniotic fluid index
reversal of umbilical artery diastolic flow indicates what?
nerve responsible for perineal pain during delivery
lab values seen in hyperemesis gravidarum
high b-hCG, high estradiol, large ketonuria (get a UA)
First step in dx of hyperemesis gravidarum?
rule out molar pregnancy w/ ultrasound +/- b-hCG
Tx for hyperemesis gravidarum
Vit B6, antihistamines (doxylamine, promethazine, dimenhydinate). If severe, metoclopramide, ondansetron, prochlorperazine. If dehydrated, IVFs, NPO, parental nutrition, IV dimenhydrinate.
First step in management of gestational diabetes
ADA diet, exercise, glucose monitoring. Insulin only if all this fails
Management of pregestational diabetic during labor
IV insulin drip and hourly glucose measurements
antihypertensive meds in pregnancy
methyldopa (#1), metoprolol, nifedipine, hyralazine
Most likely cause of hemolytic anemia, elevated liver enzymes, and thrombocytopenia in pregnancy
(HELLP syndrome) Vasospasm leading to hemorrhage and organ necrosis
Tx for preeclampsia if far from term?
modified bed rest and expectant management
How to administer magnesium for seizure prophylaxis in preeclampsia
continuous MgSO4- IV drip
Dx: Pregnant woman present w/ vaginal bleeding & abdominal pain. US shows a retroperitoneal clot.
Next step in management for mild placental abruption with premature fetus
Management of placenta previa
No vaginal exam. Tocolytics. Betamethasone for lung maturity. C-sec delivery.
Next step in assessing a reproductive age woman w/ acute onset abdominal pain, + pregnancy test and empty uterus on US
serial hCG to confirm ectopic pregnancy
medical management for small, unruptured ectopic pregnancy
What should be given to an IUGR fetus near due date?
steroids (betamethasone) ≥ 48 hrs prior to delivery to accelerate fetal lung maturity
fetal anomalies assoc. w/ polyhydramnios
duodenal atresia, TE fistula, anencephaly
What can be done for Rh isoimmunization hemolysis prior to delivery?
intrauterine blood transfusion
Woman has gestational trophoblastic disease. What dietary modifications could have prevented this?
Increase dietary folate and/or beta-carotene
chemo tx for malignant gestational trophoblastic tumors
MTX or dactinomycin
Uterus is evacuated of a "mass of grapes." Next step?
recoil of the perineum during second stage of labor indicates impending...
shoulder dystocia (this is called "turtle sign")
When is cervical ripening indicated?
failure to progress in latent stage; failure to have progressive cervical change
What medicine is used for cervical ripening?
misoprostol (a prostaglandin)
Next step if pregnant woman presents w/ "gush of blood"?
nitrazine paper test, fern test, or indigo carmine dye test
what is contraindicated on pts w/ PROM?
digital vaginal exam (increases risk for infection)
What effect does ABx have during tx of PROM, other than preventing infection?
they prolong the latency period
ABx given in cases of rupture of membrane
ampicillin and gentamicin
What is tachysystole?
> 5 uterine contractions in 10 min
ABx given for GBS ppx if preterm delivery is likely
penicillin or ampicillin
murmur likely heard in a premie
continuous machine-like murmur of PDA
fetal head position at risk for failure to progress
#1 risk factor for fetal malpresentation
Most common form of breech presentation?
frank breech: thighs flexed, knees extended
What should be given to decrease gastric acidity during c-sec?
fistula assoc. w/ episiotomy
First step in managing uterine atony
bimanual uterine massage
Difference btw placenta accreta/increta/percreta
accreta: partial invasion of myometrium
increta: further/full invasion
percreta: penetrates uterine serosa
Next step once Sheehan syndrome is diagnosed by MRI
When will lactose intolerance be evident?
Within 1 week postpartum. (Mature milk does not have lactose until 1 week)
ABx for mastitis
thelarche begins when?
8-11 years old
menarche begins when?
10-16 years old
What is the lipid profile during menopause?
high cholesterol, low HDL
What malignancy/malignancies are postmenopausal pts on HRT at risk for?
What malignancy/malignancies are postmenopausal pts on HRT protected from?
endometrial cancer, ovarian cancer
Name IUDs effective for 3, 5, and 10 years, respectively.
Implanon (progestin-only IUD) - 3 years
Mirena (IUD w/ progestin) - 5 years
ParaGard (copper IUD) - 10 years
When must the "morning after pill" be taken to be effective?
within 120 hours (5 days) of unprotected sex
16 yo w/ amenorrhea has normal smell, negative pregnancy test, normal 46 XX karyotype and normal breasts. Next step?
bone age x-ray (PA left hand)
How do you treat premature ovarian failure?
combined estrogen/progestin HRT
Excess levels of what mediator are present in primary dysmenorrhea?
MCC of infertility in menstruating women >30 years old
First line treatment for endometriosis. First line for adenomyosis.
Combined OCPs (endometriosis). NSAIDs (adenomyosis).
Major complication of adenomyosis
can progress into endometrial carcinoma (rare)
Postmenopausal woman w/ abnormal uterine bleeding has a 5 mm endometrium on US. Next step?
Tx for CAH?
What are the 17-ketosteroids?
DHEA and androstenedione
First enzyme in glucocorticoid synthetic pathway
CAH when 11-DOC is elevated
Woman with skin rash and US that shows subcapsular follicles in a "pearl necklace" pattern
PCOS (rash is acanthosis nigricans)
first line tx for ovulatory stimulation in PCOS
clomiphene +/- metformin
PCOS incr risk of what cancer(s)?
breast, endometrial (not ovarian)
Tx for asymptomatic Bartholin gland cyst
no treatment +/- warm soaks
Tx for trichomoniasis
single-dose PO metronidazole or TINIDAZOLE for pt and partner(s)
grayish-white vaginal discharge vs. yellow-green, frothy vaginal discharge
grayish-white = bacterial vaginosis
yellow-green, frothy = trichomoniasis
If not managed appropriately, TSS can lead to death by what mechanism?
ARDS (most common), or severe hypotension or hemorrhage 2º to DIC.
Dx: 23 yo F present w/ vomiting, watery diarrhea, T 103F, and and desquamating rash. Blood cx negative.
toxic shock syndrome
What should women w/ fibroids be told re: pregnancy and menopause?
Fibroids may grow during pregnancy and shrink during menopause, as they are estrogen and progesterone sensitive.
Dx: 40 yo F present w/ urinary frequency, pelvic pressure and a "cobblestone uterus" on exam.
uterine leiomyoma (fibroids)
Medical management of BLEEDING assoc. w/ uterine fibroids
medroxyprogesterone acetate or danazol
poor prognostic factors for endometrial cancer
p53 gene mutation, serous or clear cell histology
When can cervical cancer screening stop
women ≥70 yo w/ 3 normal Paps, or total hysterectomy
T or F: Women who have had Gardasil no longer need to be screened for cervical cancer.
A 30 yo F has had 3 consecutively normal Paps. Next step?
Pap once every 3 years
Next step if cervical cytology (Pap) shows ASCUS.
HPV DNA testing
Next step if cervical cytology (Pap) shows ASCUS and HPV DNA test is negative? Is positive?
If negative: repeat Pap in 1 year
If positive: colposcopy
Only time a pregnant woman should get colposcopy
Pap shows HSIL (high-grade squamous intraepithelial lesion)
HPV subtypes assoc. w/ vulvar cancer
16, 18, 31
Which is a risk factor for vulvar cancer: lichen planus or lichen sclerosus?
Diagnosis of vulvar cancer
vulvar punch biopsy
female organ prolapse increases risk for what cancer?
Other than colon cancer, Lynch II syndrome (or HNPCC) is assoc w/ what other cancer(s)?
ovarian, endometrial, breast
benign or malignant: 5 cm calcified cystic Right adnexal mass with unilocular septations
increased CA-125 is assoc. w/ what benign condition?
Tx for ovarian mass w/ LDH+ genetics
surgery + postop chemo + RADIATION (dysgerminoma)
what is "procidentia"?
marked uterine prolapse
MCC of infectious vulvovaginitis in kids
Group A strep
Dx: little girl has a "bunch of grapes" within the vagina
sarcoma botryoides (rhabdomyosarcoma)
Dx: 6 yo F w/ precocious puberty and dark skin spots that stop at the midline
McCune-Albright syndrome (precocious puberty, polyostotic fibrous dysplasia [bone disorder], unilateral cafe-au-lait spots)
mechanism of fibrocystic breast change
exaggerated stromal tissue response to hormones & growth factors
What dietary modification can be suggested to help w/ fibrocystic change?
reduce caffeine intake (methylxanthine abstention)
phylloides tumor is a subtype of what?
Tx for fibroadenoma & phylloides tumors
dietary risk factors for breast cancer
high fat, low fiber
supraclavicular LAD indicates breast cancer stage ___
comedocarcinoma is a subtype of what?
DCIS (ductal carcinoma in situ)
tumor markers for
CEA, CA 15-3, CA 27-29
Breast cancer receptor status w/ poor prognosis
Triple negative: ER-, PR-, EGFR- (HER2/neu is an EGF receptor)
lumpectomy + axillary dissection + postop radiation has equal efficacy as what?
modified radical mastectomy (total mastectomy + axillary dissection)
MCC of infertility in menstruating women < 30 years old
nodularities on the broad ligament and a retroverted uterus suggest
"strawberry cervix" or cervical petechiae
Tx for chlamydia
doxycycline x 7 days OR azithromycin once. If pregnant, erythromycin or azithromycin
T or F: Automatically give gonorrhea treatment to pts w/ chlamydial infection.
False. Give pts w/ gonorrhea infection treatment for suspected chlamydia.
Dx: normal looking 16 yo girl w/ breasts but no axillary or pubic hair and amenorrhea
Tx for mastitis due to MRSA
Bactrim (TMP-SMX) or clindamycin
30 yo F who uses an IUD for contraception develops PID. Most likely organism?
A 20 yo F on OCPs requires elective surgery. What should you tell her about her OCP use?
Stop 1 month before surgery, and do not restart until 1 month after surgery.
Guy w/ skin fifth metacarpal fracture gets hand infection.
Boxer's fracture w/ human oral pathogens (Eikenella). Give ABx.
+ Thompson test
squeezing gastrocnemius elicits no foot plantar flexion; indicates Achilles rupture. (+ test may be a normal finding in elderly pts.)
Tx for carpal tunnel syndrome
splint wrist + NSAIDs. Surgery for intolerable symptoms.
subacromial bursa lies between acromion and
trochanteric bursitis located at insersion of what muscle?
21 yo college student w/ painful, swollen elbow. No history of gout or trauma.
most common site for lumbar disc herniation
L5-S1 (L4-L5 is second most common)
50 yo man w/ low back pain. X ray shows facet hypertrophy and degenerative changes. Next step?
(Spinal stenosis) NSAIDs and abdominal muscle strengthening
Dx: 65 yo M w/ knee pain and crepitus, X-ray shows subchondral bone cysts, aspiration of joint fluid is straw-colored.
Dx: During a Super Bowl party, a 40 yo M goes on a drinking binge and develops severe acute foot pain.
anti-cyclic citrullinated peptide antibodies
rheumatoid arthritis (anti-CCP antibodies)
First line therapy for ACUTE gout attacks
NSAIDs (e.g., indomethacin)...NOT acetaminophen, which has no anti-inflammatory properties
Tx for gout: overproducers vs. undersecretors
60 yo F w/ HTN on lasix gets acute foot pain
gout (remember, POSTmenopausal women!)
Tx of choice for acute gout in pts w/ renal disease
steroids (oral prednisone)
+ Schober test
decr spinal flexion seen in ankylosing spondylitis
What are two extra-articular manifestations of ankylosing spondylitis?
anterior uveitis (or iridocyclitis), heart block
20 yo M w/ skin rash, dactylitis and abnormal hand x-ray
psoriatic arthritis ("pencil in cup" deformity)
Pts w/ dermatomyositis are at risk for what malignancies?
lung & breast cancer
Which of the following is assoc. w/ polymyositis and dermatomyositis?
antibody assoc. w/ polymyositis & dermatomyositis
anti-smooth muscle antibody
mixed connective tissue disease
anti-topoisomerase 1 antibody
Wegener's (granulomatosis w/ polyangiitis)
type of anemia assoc. w/ rheumatoid arthritis
anemia of chronic disease
Dx: 40 yo F w/ ulnar deviated hands, LUQ mass, and low WBC count
Felty's syndrome (RA, splenomegaly and neutropenia)
best initial disease-modifying antirheumatic drug (DMARD) for RA
Dx: inflammatory myopathy affecting M>F, distal muscles, loss of deep tendon reflexes and no autoantibodies
inclusion body myositis
another name for anti-Jo-1 antibodies assoc. w/ polymyositis/dermatomyositis
anti-signal recognition antibodies
cardiac conduction manifestations assoc. w/ polymyositis/dermatomyositis
features of CREST syndrome
calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, telangiectasias
drug used for cutaneous scleroderma
Tx for Raynaud's
Pt w/ calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly and telangiectasias develops acute renal failure. What could have prevented this?
ACEIs (scleroderma renal crisis)
anti-leucine aminopeptidase antibody
lupus often affects which heart valve?
mitral valve (Libman-Sacks endocarditis)
what tests should be ordered for neonates w/ lupus?
EKG and echo (for congenital heart block and transposition of great vessels, respectively)
involvement of which organ system(s) excludes drug-induced lupus?
CNS and/or renal (these are spared in drug-induced lupus)
temporal artery biopsy in giant cell arteritis will show what?
thrombosis, necrosis of media, presence of lymphocytes and/or plasma cells
<11 tender points in a 50 yo F w/ depression and anxiety
myofascial pain syndrome
cause of death in Duchenne muscular dystrophy
cardiac fibrosis -> high-output heart failure -> pulmonary congestion
What immunostain is used to diagnose Duchenne muscular dystrophy?
endocrinopathy assoc. w/ slipped capital femoral epiphysis
hypothyroidism. Rule out w/ TSH
Tx for scoliosis based on degree of involvement
<20 degrees: observation
20-49 degrees: brace
>50 degrees: surgery
Dx: boy w/ arthritis, daily high/spiking fevers and an evanescent, salmon-colored rash
Still's disease (acute febrile/systemic juvenile idiopathic arthritis)
Tx for juvenile idiopathic arthritis
Which organisms causing pneumonia can be diagnosed with a urine antigen test?
Legionella and Strep pneumo
Pneumonia diagnosed w/ serum cold agglutinin test
Dx: Pt w/ fever, productive cough, and sputum Gm stain shows lancet-shaped Gm+ diplococci
Pt being treated for TB complains of new vision problems. Cause?
side effect of ethambutol is optic neuritis
Pt being treated for TB now has elevated liver enzymes. Cause?
side effect of INH is hepatitis
Who should be notified of new TB diagnosis
ALL cases of TB (both latent & active) must be reported to local and state health departments.
MCC of bacterial diarrhea? Tx?
Choroidal tubercles on eye exam in a pt w/ a cough suggests what?
Next step in TB pt treated w/ 2 months of RIPE.
4 months of INH + rifampin
What is an alternative to ethambutol in RIPE tx of TB?
Tx for strep throat
penicillin x 10 days
Dx: Pt w/ strep throat develops thrombophlebitis of the jugular vein
Lemierre's syndrome, due to oral anaerobe Fusobacterium
First-line tx for acute bacterial sinusitis
amoxicillin/clavulanicate 500 mg PO TID x 10 days
What are hemagglutinin and neuraminidase?
glycoproteins assoc. w/ influenza A
Antigenic drift is specific for which influenza virus(es)?
only influenza A
What phenomenon allows individuals to be affected w/ influenza more than once?
How old do you have to be to get a flu shot?
≥ 6 months old
When is LP contraindicated in meningitis?
papilledema or focal neurologic deficits
Close contacts of pts w/ meningococcal meningitis should receive what for ppx?
Tx for seizures due to meningitis
benzos and phenytoin
What is the only live vaccine you can give an HIV+ patient?
Dx: HIV pt w/ cough and sputum stain shows folded cysts containing comma-shaped spores
Pneumocystis jiroveci pneumonia
T of F: Mycobacterium avium complex (MAC) is only a disease of immunocompromised individuals.
False. 1º pulmonary MAC occurs in apparently healthy non-smokers (Lady Windermere syndrome)
What is the most common serious medical complication of pregnancy?
First-line med for uncomplicated pyelonephritis