USMLE STEP 2 CK: NEXT STEP IN MANAGEMENT
High-grade reflux in females that persists into adulthood with no clear secondary cause
- Answers-surgical repair
Multiple 2nd trimester spontaneous abortions - Answers-cervical cerclage
Erythematous knee with effusion and fever - Answers-arthrocentesis [ need to tell apart
gout from septic arthritis]
Spontaneous pneumothorax in a tall young man - Answers-supplemental oxygen
Clue cells seen in vaginal swab in a fertile woman - Answers-oral metronidazole
Mini-mental status exam of <24 - Answers-neuropsychologic testing to rule-out
alzheimer's (other causes of dementia)
Cord compression confirmed with CT-spine - Answers-dexamethasone ( before MRI of
the spine to gold-standard confirm cord compression)
Borderline personality disorder - Answers-dialectical behavioral therapy
Pulmonary edema in acute CHF exacerbation - Answers-100% O2 therapy
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy - Answers-IV
furosemide
Supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus
rhythm - Answers-Vagal manuevers first -carotid massage, then valsalva , then
pharmacological-ccbs or adenosine
Asymptomatic aortic stenosis - Answers-Hydrocholorothiazide to reduce preload
Hypertension with underlying diabetes type 2 - Answers-ACE-inhibitor or ARB
Syncope with normal vitals and no previous episodes - Answers-Check the electrolytes
and medications - thiazide diuretics can cause hypokalemia and arrythmia
PR interval=o.3 sinus rhythm normal - Answers-Nothing, no management needed;
PR>0.2 is first degree heartblock
A-fib secondary to hypertension for >48 hours - Answers-Diltiazem; rate control +
anticoagulant
, Acute open-angle glaucoma - Answers-1)beta-2-antagonist eye drops i.e. Timolol,
betaxolol
2) carbonic anhydrase inhibitors
3) if medication fails, then a trabeculoplasty or trabeculectomy can improve aqueous
drainage
Chronic sinusitis - Answers-CT scan of the face (coronal section)
Someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo -
Answers-dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's
disease)
Someone that comes in with headaches and shows papilledema in the opthalmic exam
- Answers-CT scan of the head non-contrast - r/o mass
Treament for scabies - Answers-permethrin
Scaphoid fracture that is negative on X-ray - Answers-spica cast and re-evaluate in 2~3
weeks
3-hour old infant with poor feeding who vomits green material and has a double-bubble
on KUB - Answers-decompression of the GI tract...requires nasogastric tube
A patient presents with hypertension and chest pain on exertion - Answers-IV
nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD - Answers-72 hr Holter monitor
Angina symptoms - Answers-Beta-blockers - they increase the threshold of angina
Posterior anterolateral MI and Percutaneous coronary intervention - Answers-
Clopidogrel
Teenage patient grunting and blinking many times a day for at least 1 year - Answers-
haloperidol
Suspected pulmonary embolism - Answers-spiral CT scan
Prinzmetal angina - Answers-calcium channel blockers or nitrates (also for esophageal
spasm)
Lambert Eaton Syndrome - Answers-radiation and chemotherapy as it is the
manifestation of a pre-existing small cell carcinoma of the lung.
Stroke outside the 3 hour period but within 6 hours - Answers-intra-arterial tpa
administration
High-grade reflux in females that persists into adulthood with no clear secondary cause
- Answers-surgical repair
Multiple 2nd trimester spontaneous abortions - Answers-cervical cerclage
Erythematous knee with effusion and fever - Answers-arthrocentesis [ need to tell apart
gout from septic arthritis]
Spontaneous pneumothorax in a tall young man - Answers-supplemental oxygen
Clue cells seen in vaginal swab in a fertile woman - Answers-oral metronidazole
Mini-mental status exam of <24 - Answers-neuropsychologic testing to rule-out
alzheimer's (other causes of dementia)
Cord compression confirmed with CT-spine - Answers-dexamethasone ( before MRI of
the spine to gold-standard confirm cord compression)
Borderline personality disorder - Answers-dialectical behavioral therapy
Pulmonary edema in acute CHF exacerbation - Answers-100% O2 therapy
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy - Answers-IV
furosemide
Supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus
rhythm - Answers-Vagal manuevers first -carotid massage, then valsalva , then
pharmacological-ccbs or adenosine
Asymptomatic aortic stenosis - Answers-Hydrocholorothiazide to reduce preload
Hypertension with underlying diabetes type 2 - Answers-ACE-inhibitor or ARB
Syncope with normal vitals and no previous episodes - Answers-Check the electrolytes
and medications - thiazide diuretics can cause hypokalemia and arrythmia
PR interval=o.3 sinus rhythm normal - Answers-Nothing, no management needed;
PR>0.2 is first degree heartblock
A-fib secondary to hypertension for >48 hours - Answers-Diltiazem; rate control +
anticoagulant
, Acute open-angle glaucoma - Answers-1)beta-2-antagonist eye drops i.e. Timolol,
betaxolol
2) carbonic anhydrase inhibitors
3) if medication fails, then a trabeculoplasty or trabeculectomy can improve aqueous
drainage
Chronic sinusitis - Answers-CT scan of the face (coronal section)
Someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo -
Answers-dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's
disease)
Someone that comes in with headaches and shows papilledema in the opthalmic exam
- Answers-CT scan of the head non-contrast - r/o mass
Treament for scabies - Answers-permethrin
Scaphoid fracture that is negative on X-ray - Answers-spica cast and re-evaluate in 2~3
weeks
3-hour old infant with poor feeding who vomits green material and has a double-bubble
on KUB - Answers-decompression of the GI tract...requires nasogastric tube
A patient presents with hypertension and chest pain on exertion - Answers-IV
nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD - Answers-72 hr Holter monitor
Angina symptoms - Answers-Beta-blockers - they increase the threshold of angina
Posterior anterolateral MI and Percutaneous coronary intervention - Answers-
Clopidogrel
Teenage patient grunting and blinking many times a day for at least 1 year - Answers-
haloperidol
Suspected pulmonary embolism - Answers-spiral CT scan
Prinzmetal angina - Answers-calcium channel blockers or nitrates (also for esophageal
spasm)
Lambert Eaton Syndrome - Answers-radiation and chemotherapy as it is the
manifestation of a pre-existing small cell carcinoma of the lung.
Stroke outside the 3 hour period but within 6 hours - Answers-intra-arterial tpa
administration
