Step 2 CK CCSSA NBME Form 7

Authors: Susan Basharkhah

Editor: Jordan Abrams

Practice exam: myNBME

Please note: The HY Medicine is in no way affiliated with the Federation of State

Medical Boards (FSMB) or the National Board of Medical Examiners® (NBME®)

BLOCK 1

1) Family therapy

• Goal of family therapy is to ↓ conflict, help family members understand each other’s needs and to help the family cope with the internally destructive forces

2) Triglycerides

• TAGs > 1,000 → acute pancreatitis

3) Splenectomy

• Spherocytes + ↑ mean corpuscular hemoglobin concentration (MCHC) = hereditary spherocytosis → sxs improve with splenectomy

4) Surgical exploration of the mediastinum

• Widened mediastinum on CXR after CABG is consistent with aortic dissection

5) Small bowel obstruction

• Severe SBO presents with:

• ↓ bowel sounds

• Distended and tympanic abdomen

• Postprandial pain

• Pain relieved with vomiting (relieves some intra-abdominal pressure)

• SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds

6) Indomethacin

• Acute gout attack (swelling, erythema, tenderness of great toe)

• Celecoxib (COX-2 inhibitor) can help with gout but a non-selective COX inhibitor (Indomethacin) would be better because COX-1 inhibitor also prevents hemostasis (no build up of uric acid at a single site)

• 2nd line for acute gout attack = colchicine

7) Thoracic aorta

• Bruising and tenderness over sternum = blunt thoracic injury

• Isthmus of thoracic aorta is most vulnerable location to deceleration injuries → thoracic aortic aneurysm (widened mediastinum)

• Dx: CT angiography

8) Bone marrow aspiration

• Pancytopenia → perform bone marrow aspiration to see if this is aplastic anemia or cancer

9) Exercise stress test

• Indigestion while walking briskly or uphill that is relieved by rest is consistent with angina (especially given that her sxs are not related to eating and aren’t relieved by antacids)

• Pretest probability of CAD is intermediate in women with typical aging age 30-50 or atypical angina ≥ age 50

10) Barium swallow

• Zenker diverticulum presents with dysphagia, regurgitation, and halitosis

• Dx: barium esophagram or esophageal manometry

11) Amniotomy and vaginal delivery

• No current genital herpes outbreak → can safely deliver vaginally

• Have to rupture the still intact membranes (amniotomy)

• Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or valacyclovir beginning at 36 weeks of pregnancy

12) Urinary stasis

• High levels of progesterone during pregnancy → relaxation of ureters and bladder → urinary stasis

13) Mupirocin ointment

• Crusted, papular, honey colored lesions with clear discharge is consistent with impetigo

14) Bipolar disorder

• Remember “DIG FASTER”

• Manic episode (marked impairment) + depressive episode = Bipolar I

15) Culture for herpes simplex

• Painful vulvar blisters (vesicles, pustules, or ulcers) + systemic symptoms (malaise, myalgia) = HSV

• Genital herpes can be diagnosed with viral culture or PCR

16) Haloperidol

• Corticosteroid psychosis

17) Intravascular volume depletion

• Vitals show orthostatic hypotension

• Glucosuria-induced osmotic diuresis

18) Central retinal vein occlusion (CRVO)

• CRVO = acute or subacute U/L vision loss that is usually noted upon waking in the morning

• Risk factors: old age and HTN

• Venous occlusion → venous dilation

• CRVO is associated with a “blood and thunder” appearance (diffuse hemorrhage) and cotton wool spots (patches of white exudate)

• The key difference between CRAO and CRVO is the presence of hemorrhages. If there is no artery (CRAO) then there is no blood flow → therefore NO hemorrhages. If there is no vein (CRVO) then there is still blood coming in via the artery but the path out is obstructed → hemorrhages

• In CRAO on fundoscopic examination you will see diffuse ischemic retinal whitening, pale optic disc, cherry red fovea, and boxcar segmentation of blood in retinal veins

19) Pilosebaceous follicles

• Blockage and/or inflammation of pilosebaceous units → Acne vulgaris

20) Child abuse

• Bilateral retinal hemorrhages and neurological abnormalities (eg, poor feeding, sleeping more than usual) suggest shaken baby syndrome

21) Repeat BP measurement in 4 weeks

• Has had normal BP before most recent measurement

• HTN diagnosis requires two separate elevated BP measurements

22) Decreased calcium

• Alcoholic with low serum magnesium will also have low serum calcium

• Hypomagnesemia → PTH resistance and ↓ PTH secretion with subsequent hypocalcemia

23) IVF therapy

• Contrast-induced nephropathy could have possibly been prevented with IVF

• Had the creatinine bump been purely from hypovolemia (volume depletion/poor intake), then it would have been apparent on admission

24) Bilateral varicoceles

• Tortuous dilation of the pampiniform plexus

• Common cause of male infertility

25) Fat embolism syndrome

• Triad: respiratory distress, neurologic dysfunction, petechial rash

• Common after fracture of a long bone (contains marrow [eg, femur]) or orthopedic surgery

• Presence of petechiae helps to differentiate fat embolism from ARDS

• In fat embolism syndrome will see respiratory alkalosis vs. metabolic acidosis in ARDS

26) Osteoporosis

• Anorexia → ↓ GnRH → ↓ LH, FSH → ↓ estrogen → amenorrhea and bone loss (→ ↑ risk of osteoporosis)

27) Ankylosing spondylitis

• ‘Bamboo spine’ = fusion of vertebral bodies with ossification of intervertebral discs

• Presents with limited spinal mobility (eg, ↓ flexion at the waist), morning stiffness that improves with activity, and tenderness