
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®)
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