USMLE Step 2 CK: Diagnosis and Treatment of Common Medical Conditions, Exams of Nursing

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Management

high-grade reflux in females that persists into adulthood with no clear secondary cause correct answer- surgical repair multiple 2nd trimester spontaneous abortions correct answer- cervical cerclage erythematous knee with effusion and fever correct answer- arthrocentesis [ need to tell apart gout from septic arthritis] spontaneous pneumothorax in a tall young man correct answer- supplemental oxygen clue cells seen in vaginal swab in a fertile woman correct answer- oral metronidazole acute open-angle glaucoma correct answer- 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 correct answer- CT scan of the face (coronal section) someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo correct answer- dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease) someone that comes in with headaches and shows papilledema in the opthalmic exam correct answer- CT scan of the head non-contrast - r/o mass treament for scabies correct answer- permethrin Scaphoid fracture that is negative on X-ray correct answer- 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 correct answer- decompression of the GI tract...requires nasogastric tube mini-mental status exam of <24 correct answer- neuropsychologic testing to rule-out alzheimer's (other causes of dementia)

cord compression confirmed with CT-spine correct answer- dexamethasone ( before MRI of the spine to gold-standard confirm cord compression) borderline personality disorder correct answer- dialectical behavioral therapy Pulmonary edema in acute CHF exacerbation correct answer- 100% O2 therapy Pulmonary edema in acute CHF exacerbation after 100% O2 therapy correct answer- IV furosemide supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm correct answer- Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine Asymptomatic aortic stenosis correct answer- Hydrocholorothiazide to reduce preload Hypertension with underlying diabetes type 2 correct answer- ACE-inhibitor or ARB Syncope with normal vitals and no previous episodes correct answer- Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia PR interval=o.3 sinus rhythm normal correct answer- Nothing, no management needed; PR>0.2 is first degree heartblock A-fib secondary to hypertension for >48 hours correct answer- Diltiazem; rate control + anticoagulant A patient presents with hypertension and chest pain on exertion correct answer- IV nitroglycerin for lowering the blood pressure Palpitations with underlying lung disease i.e. COPD correct answer- 72 hr Holter monitor Angina symptoms correct answer- Beta-blockers - they increase the threshold of angina Posterior anterolateral MI and Percutaneous coronary intervention correct answer- Clopidogrel teenage patient grunting and blinking many times a day for at least 1 year correct answer- haloperidol suspected pulmonary embolism correct answer- spiral CT scan prinzmetal angina correct answer- calcium channel blockers or nitrates (also for esophageal spasm)

acute febrile non-hemolytic transfusion reaction correct answer- discontinue transfusion, give IV acetaminophen acute cholecystitis correct answer- IV fluids, pain medication, and cholecystectomy within 72 hours abscess size >3cm correct answer- CT-guided percutaneous drainage single 2cm nodule on Chest X-ray in a 25 yo male correct answer- check old Chest-X- ray to compare size or presence of the nodule. ulcer that is not infected and does not involve the bone correct answer- debridement how to diagnose hepatorenal syndrome correct answer- IV colloid challenge , if no improvement then positive for hepatorenal syndrome Primary light chain amyloidosis correct answer- mephalan and prednisone local baldness correct answer- minoxidil severe acute pancreatitis >30% necrosis on MRI correct answer- imipenem followed by percutaneous needle biopsy pseudocyst on CT-abdomen correct answer- if expanding or pain symptoms, then drain it. otherwise leave it alone. elderly patient with intermediate to high risk factors for coronary artery disease correct answer- stress test needle-stick and unvaccinated for HepB correct answer- give HepB IV-IgG and HepB vaccine MRI contraindicated in suspicious looking equivocal X-ray correct answer- Technetium bone scan man comes in with a painless chancre on the penis correct answer- swab the exudate and perform dark-field microscopy vesicles on skin and mucous membranes which erode into ulcers with inguinal lymphadenopathy Tzanck positive correct answer- acyclovir famciclovir valacyclovir

methods of treating genital warts correct answer- cryotherapy , lasers, trichloroacetic acid or podophyllin imiquimod(originally for basal cell , acktinic akeratosis) , no side effects acute viral pericarditis recurrence prevention correct answer- colchicine pericardial effusion correct answer- pericardial window placement or pericardiocentesis pneumonia, dyspnea, dry cough fever chest pain in HIV patient correct answer- Bronchoscopy with alveolar lavage dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI correct answer- CT-scan of the abdomen and pelvis the first test to determine beta-thalassemia anemia in genetic counseling correct answer- complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner) no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus correct answer- measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it) dog bite with suspicion of rabies correct answer- quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis) pinpoint calcifications in a newborn whose mother owns a cat correct answer- pyramethamine and sulfadiazine (Treats toxoplasmosis) peripartum cardiomyopathy - biventricular cardiac failure correct answer- supportive care eisenmenger's syndrome in a pregnant woman correct answer- avoid hypotension give pressors Rheumatic mitral stenosis in a pregnant woman correct answer- decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL correct answer- do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus. Estimated fetal weight is >4.5kg by sonogram correct answer- C-section perinatal management of gestational diabetes correct answer- IV D5w with insulin drip maintain glucose within 80-100mg/dL

Lichen sclerosus correct answer- corticosteroids admission to inpatient ward with febrile neutropenia correct answer- piperacillin- tazobactam cafe au lait spots with sensorineural hearing loss correct answer- MRI with gadolinium (suspect acoustic neuroma) MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a- fib. correct answer- drainage, surgical debridement and antibiotics ( acute mediastinitis) DVT identified on ultrasound correct answer- CT scan of abdomen, chest, and pelvis - search for any embolism Rhabdomyolysis correct answer- IV fluids, mannitol and bicarbonate Baseline EKG changes on patient with SSx of stable angina correct answer- Stress echocardiography instead of exercise treadmill stress test -- (echo you need to have a normal EKG reading at rest) presence of bilateral popliteal artery aneurysms correct answer- CT Abdomen -> 25% chance of abdominal aortic aneurysm present. Asystole correct answer- CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole hepatorenal syndrome correct answer- midodrine and octreotide Needlestick from an HIV infected person correct answer- Triple HAART therapy for 28 days pancreatic cancer with elevated direct bilirubin correct answer- endoscopic stent to relieve jaundice from extrahepatic cholestasis positive whiff test correct answer- amine production with KOH prep = bacterial vaginosis -- Tx --> clindamycin or metronidazole symptoms of malabsorption returning from a foreign country correct answer- Tx empirically with metronidazole. i.e. giardiasis, amoebiasis. skin rash in a person with gluten-intolerance correct answer- dapsone for dermatitis herpetiformis patient with hypothermia at 32-35C, 28-32C, and 27C degrees correct answer- general - IV hot crystalloid for hypotension with endotracheal intubation in comatose patients.

32-35 degrees - dry and cover with blankets 28-32 degrees - warm bath, heating pad, blankets <28 degrees - pleural, peritonealwarm irrigation -internal rewarming recurrent coughs with mucopurulent sputum correct answer- CT scan - bronchiectasis - dialated bronchiolar airways microcytic, hypochromic anemia in an otherwise healthy adult correct answer- test for stool occult blood - because the most common cause of iron-deficiency anemia is GI blood loss. Otherwise, colonoscopy is indicated because it has a higher sensitivity and specificity meningitis in people age 2-50 correct answer- vancoymcin + 3rd generation cephalosporin meningitis in people older than 50 correct answer- vancomycin + ampicillin + 3rd generation cephalosporin infection post-neurosurgery shunt correct answer- vancomycin + 4th generation cephalosporin (cefepime) meningitis in an immunocompromised state correct answer- vancomycin + ampicillin + 4th generation cephalosporin(cefepime) infection after penetrating trauma to the skull correct answer- vancomycin + 4th generation cephalosporin (cefepime) Tx of carcinoid syndrome correct answer- octreotide for symptomatic patients before surgery patient has blood cultures that grow Streptococcus bovis and has vegetations on mitral valve correct answer- perform colonoscopy NOT FOBT- colonoscopy is more sensitive and specific patient had a Hx of flu ten days earlier but now has increased tactile fremitus in LLL of the lung and a fever correct answer- Tx: anti-staph penicillin i.e. methicillin, oxacillin, dicloxacillin, naficillin - most common organism is Staph aurues post-influenza pneumonia. patient with a PMH of drug addiction and addiction comes in with severe pain from a motor vehicle accident. What analgesic do you give him? correct answer- Give him IV morphine. It doesn't matter what his drug abuse history is. Physicians never undertreat pain even with a risk of abuse. lupus nephritis correct answer- 1. mycophenolate mofetil

(3)1x dose of IM tetanus immunoglobulin (4) active immunization with Td(tetanus/diptheria toxoid) empiric osteomyelitis Tx correct answer- cephalosoprins, fluoroquinolones, vancomycin, linezolid, daptomycin, and clindamycin rifampin for biofilm penetration If gram negative suspected add aminoglycoside +/- beta lactam septic arthritis in an immunocompetent adult correct answer- IV beta lactamase resistant penicillin --> oxacillin OR 1st generation cephalosporin ; MRSA coverage -> vancomycin septic arthritis in a immunocompromised adult correct answer- broad spectrum antibiotic

• 3rd generation cephalosporin OR aminoglycoside ; consider pseudomonal coverage with aminoglycoside + extended spectrum pencillin warts correct answer- (1) freezing lesions with liquid nitrogen (2) salicylic acid daily topically applied for several weeks (3) 5-FU cream - retinoic acid cream for flat warts (4) surgical excision OR laser therapy (5) podophyllin for genital warts molluscum contagiosum correct answer- (1) curettage (2) podophyllin drops (3) cantharidin (4) cryosurgery silvery scales on knees and elbows correct answer- corticosteroids are first line calcipotriene and calcitriol - 1st/ 2nd line tars tazarotene ( vit A derivative) anthralin (anthracene derivative - smoke carcinogen) young woman with tender breast mass on the upper outer quadrant. LMP was three weeks ago. She has no family history of breast cancer. correct answer- Ask her to come back after the menstrual period and ask her to take note if the size of the mass has decreased after the menstrual period. Otherwise ultrasound, FNA, and excision biopsy would be the option. acute exacerbation of COPD correct answer- IV methylprednisolone 1-2x doses followed by oral therapy for 5 days. allergic conjunctivitis correct answer- olopatadine, azelastine non-herpes viral conjunctivitis correct answer- supportive therapy, warm compresses

collapsed gestational sac with no fetal heart tone on transvaginal ultrasound in a hemodynamically stable female at 8 wks gestation correct answer- follow-up outpatient ; no suction and curretage. meningitis in a 55 year-old man correct answer- 3rd gen. cephalosporin + vancomycin + ampicillin + dexamethasone bruit left periumbilical region on auscultation in middle-aged man with hypertension correct answer- captopril renal scan eye pain with Hx of occupational trauma correct answer- tetracaine for pre-op anesthesia prior to Fluorescein slit lamp examination elderly male comes in with 1 episode of syncope with no smoking history BP equal on both arms and widened mediastinum and pericardial effusion on chest X-ray correct answer- transesophageal echocardiogram --> it could be a type A retrograde aortic dissection , so the BP could be normal. frostbite injuries correct answer- rapid rewarming with warm water high blood pressure in an otherwise healthy woman of child-bearing age correct answer- 1st step: discontinue oral contraceptive pills 2nd step: diet and exercise 3rd step: introduce thiazide diuretic 5mm radiolucent stone in the ureter correct answer- potassium citrate --> uric acid is soluble at high pH elderly male with history of recurrent aspiration presents with neck mass and RLL consolidation correct answer- barium esophagram to rule out Zenker's diverticulum, CT scan of neck is indicated for airway obstruction by foreign object; bronchoscopy is 2nd line. postpartum fever with leukocytosis and non-foul smelling bloody vaginal discharge correct answer- reassurance. You don't even need empirical antibiotics. Endometritis requires the presence of foul smelling lochia acute exacerbation of COPD correct answer- non-invasive positive end expiratory pressure for 2hours acute exacerbation of COPD with failed NPPV trial correct answer- mechanical intubation malignant hypertension correct answer- lower BP 10-20% in the first hour , then 5-15% across the next 23 hours.