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Exam (elaborations)

USMLE STEP 2 CK NEXT STEP IN MANAGEMENT

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USMLE STEP 2 CK NEXT STEP IN MANAGEMENT

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  • October 23, 2024
  • 12
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • USMLE STEP 2 CK
  • USMLE STEP 2 CK
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GEEKA
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

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