Step 2 CK CCSSA NBME Form 7

Updated: Aug 28, 2020

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®)


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