USMLE step 2 CK with complete solution(Latest 2021
update)
pregnant with active HBV
tx newborn with HBIG and HBV vaccine
Beck's triad for tamponade
hypotension, JVD, muffled heart sounds (also pulsus paradoxus). Electrical alternans
subarachnoid hemorrhage
increased ADH and BNP --> hyponatremia. Tx - water restriction
coccidioidomycosis
SW US, central/south America. Pulm infection - dry cough, weight loss, pleuritic chest
pain, erythema multiforme/nodosum, arthralgias
histoplasmosis
SE US, mid Atlantic, central US, caves. Acute PNA, but usually asymptomatic. HIV
disseminated infection- hilar LAD, pneumonitis, pancytopenia, hepatosplenomegaly,
palatal ulcers. tx- IV amphotericin B followed by lifelong itraconazole.
Blastomycosis
central US (most in Wisconsin). Often asymptomatic or flu-like Sx. Systemic disease-
lytic bone lesions, pulmonary infection, skin lesions. Dx- broad-based budding yeast.
Tx- itraconazole, amphotericin B
aspergillosis
invasive in IMCD. CXR - cavitary lesions. CT - pulm nodules, halo sign, air crescent
sporotrichosis
subcutaneous infection. Gardeners. Travel up lymphatics for nodules on forearms
cryptococcus
pulm infection often asymptomatic. Usually meningoencephalitis in HIV with CD4<200
hemochromatosis infections
Listeria monocytogenes, Yersinia enterocolitica, septicemia - Vibrio vulnificus
Narcolepsy treatment
methyldphenidate, modafinil, antidepressants (for cataplexy)
galactorrhea
test B-HCG, prolactin, TSH
septic abortion
cervical/blood cultures, antibiotics, gentle suction currettage
Lesch-Nyhan
x-linked recessive, HPRT deficiency, increased uric acid. Sx - self mutilation, dystonia,
spacticity, gout. Presents at 6 months.
minimal change disease
tx - prednisone, cyclophosphamide for resistant cases/frequent relapse
Sturge-Weber
seizures, retardation, trigeminal port-wine stain, hemi neuro findings, tramline
intracranial calcifications
tuberous sclerosis
seizures, retardation, intracranial calcifications (tubers), ashleaf spots, adenoma
sebaceum (red papules on face)
,osteogenesis imperfecta
autosomal dominant. Type 1 collagen problem. Type 2 most severe with perinatal
fractures and often intrauterine death. Blue sclera, fractures, hypotonia, hearing loss,
joint hypermobility, dentinogenesis imperfecta
polymyalgia rheumatica
neck/shoulder/hip pain/stiffness. >50 years old, high ESR. Tx- low dose prednisone,
high dose for temporal arteritis
massive blood transfusion
citrate anticoagulant --> chelates Ca and Mg --> low Ca --> paresthesias, hyperactive
reflexes
nephrotic syndrome
dyslipidemia, accelerated atherosclerosis, hypercoagulable, risk for MI/stroke, higher
infxn susceptibility. Can have renal vein thrombosis, usually with membranous GN
aortic regurgitation
early diastolic (mild) to holodiastolic (severe) murmur. Bounding pulses. Tx- decrease
afterload with DHP Ca-channel blockers, ACEi, NOT beta blockers.
mycoplasma PNA
erythema multiforme. No cell wall so not on gram stain
candidal vulvovaginitis
pseudohyphae. In IMCD and Abx treated people. Tx- oral fluconazole, topical nystatin
nonseminomatous germ cell tumor
large anterior mediastinal mass, young males. High HCG and AFP.
seminoma
high HCG but normal AFP
thymoma
associated with myasthenia gravis, pemphigus
hepatocellular carcinoma
high AFP but normal HCG
choriocarcinoma
gestational trophoblastic disease usually in molar pregnancy. Very high HCG
C. dif diagnosis
cytotoxin assay of stool
Erb-Duchenne palsy
C5, C6. waiter's tip, absent Moro but intact grasp
Klumpke's paralysis
C7, C8, T1. hand paralysis, Horner's (ptosis, miosis)
dermatitis herpetiformis
papulovesicular, pruritic. Associated with Celiac. Dx - IgA anti-endomysial Ab, anti-
gliadin
phenelzine
MAOi antidepressant. Avoid tyramine (aged meat/cheese) --> HTN crisis
CMV esophagitis
in HIV. Dysphagia, odynophagia, shallow ulcers, intranuclear/cytoplasmic inclusions.
Tx- ganciclovir IV
HSV esophagitis
, in HIV. Small ulcers with volcano-like appearnace. Eosinophilic intranuclear inclusions.
Tx- acyclovir
candidal esophagitis
most common HIV esophagitis. Tx - oral fluconazole
splenic rupture
ex-lap if unstable. CT if stable
pseudocyesis
pregnancy conversion disorder
prolactin
stimulated by serotonin and TRH, inhibited by dopamine. Hypothyroid -->
amenorrhea/galactorrhea
adenomyosis
endometrial glands in myometrium. Usually > 40yo, dysmenorrhea, menorrhagia,
enlarged symmetric uterus. Must curettage to r/o endometrial carcinoma
leiomyoma/fibroids
irregular shaped uterus
endometriosis
uterus not enlarged. Dysmenorrhea, dyspareunia, dyschezia. Dx- laparoscopy. Tx-
OCPs
aminoglycosides
amikacin, gentamicin, tobramicin. ototoxic, nephrotoxic. Gentamicin very ototoxic
hydroxychloroquine
DMARD. Treats SLE. SE - retinopathy/corneal damage (need q6month eye exams), GI,
hemolysis in G6PD
methotrexate SE
DMARD. Inhibits folate metabolism. Macrocytic anemia, GI, hepatotoxic, ILD, alopecia,
pancytopenia
premature ovarian failure
low estrogen, high FSH > LH, <40yo
hyperparathyroidism
hypercalcemia - stones, bones, groans, psyciatric overtones, polydipsia, polyuria.
pseudogout. Also sometimes HTN
low-grade (without mets) gastric MALT lymphoma
H pylori association. Tx- PPI, clarithromycin, amoxicillin
Jarisch-Herxheimer rxn
primary/secondary syphilis treated with penicillin --> spirochetes die --> immune
complexes --> looks like syphilis flare-up
INH SE
hepatitis, peripheral neuropathy/ataxia (give pyridoxine)
fanconi anemia
pancytopenia, congenital anomalies, presents 4-12yo. Autosomal recessive. Skin
changes
diamond-blackfan
pure red cell aplasia, congenital anomalies. Presents 3 months old. Tx - steroids,
possibly transfusion
transient erythroblastopenia of childhood
update)
pregnant with active HBV
tx newborn with HBIG and HBV vaccine
Beck's triad for tamponade
hypotension, JVD, muffled heart sounds (also pulsus paradoxus). Electrical alternans
subarachnoid hemorrhage
increased ADH and BNP --> hyponatremia. Tx - water restriction
coccidioidomycosis
SW US, central/south America. Pulm infection - dry cough, weight loss, pleuritic chest
pain, erythema multiforme/nodosum, arthralgias
histoplasmosis
SE US, mid Atlantic, central US, caves. Acute PNA, but usually asymptomatic. HIV
disseminated infection- hilar LAD, pneumonitis, pancytopenia, hepatosplenomegaly,
palatal ulcers. tx- IV amphotericin B followed by lifelong itraconazole.
Blastomycosis
central US (most in Wisconsin). Often asymptomatic or flu-like Sx. Systemic disease-
lytic bone lesions, pulmonary infection, skin lesions. Dx- broad-based budding yeast.
Tx- itraconazole, amphotericin B
aspergillosis
invasive in IMCD. CXR - cavitary lesions. CT - pulm nodules, halo sign, air crescent
sporotrichosis
subcutaneous infection. Gardeners. Travel up lymphatics for nodules on forearms
cryptococcus
pulm infection often asymptomatic. Usually meningoencephalitis in HIV with CD4<200
hemochromatosis infections
Listeria monocytogenes, Yersinia enterocolitica, septicemia - Vibrio vulnificus
Narcolepsy treatment
methyldphenidate, modafinil, antidepressants (for cataplexy)
galactorrhea
test B-HCG, prolactin, TSH
septic abortion
cervical/blood cultures, antibiotics, gentle suction currettage
Lesch-Nyhan
x-linked recessive, HPRT deficiency, increased uric acid. Sx - self mutilation, dystonia,
spacticity, gout. Presents at 6 months.
minimal change disease
tx - prednisone, cyclophosphamide for resistant cases/frequent relapse
Sturge-Weber
seizures, retardation, trigeminal port-wine stain, hemi neuro findings, tramline
intracranial calcifications
tuberous sclerosis
seizures, retardation, intracranial calcifications (tubers), ashleaf spots, adenoma
sebaceum (red papules on face)
,osteogenesis imperfecta
autosomal dominant. Type 1 collagen problem. Type 2 most severe with perinatal
fractures and often intrauterine death. Blue sclera, fractures, hypotonia, hearing loss,
joint hypermobility, dentinogenesis imperfecta
polymyalgia rheumatica
neck/shoulder/hip pain/stiffness. >50 years old, high ESR. Tx- low dose prednisone,
high dose for temporal arteritis
massive blood transfusion
citrate anticoagulant --> chelates Ca and Mg --> low Ca --> paresthesias, hyperactive
reflexes
nephrotic syndrome
dyslipidemia, accelerated atherosclerosis, hypercoagulable, risk for MI/stroke, higher
infxn susceptibility. Can have renal vein thrombosis, usually with membranous GN
aortic regurgitation
early diastolic (mild) to holodiastolic (severe) murmur. Bounding pulses. Tx- decrease
afterload with DHP Ca-channel blockers, ACEi, NOT beta blockers.
mycoplasma PNA
erythema multiforme. No cell wall so not on gram stain
candidal vulvovaginitis
pseudohyphae. In IMCD and Abx treated people. Tx- oral fluconazole, topical nystatin
nonseminomatous germ cell tumor
large anterior mediastinal mass, young males. High HCG and AFP.
seminoma
high HCG but normal AFP
thymoma
associated with myasthenia gravis, pemphigus
hepatocellular carcinoma
high AFP but normal HCG
choriocarcinoma
gestational trophoblastic disease usually in molar pregnancy. Very high HCG
C. dif diagnosis
cytotoxin assay of stool
Erb-Duchenne palsy
C5, C6. waiter's tip, absent Moro but intact grasp
Klumpke's paralysis
C7, C8, T1. hand paralysis, Horner's (ptosis, miosis)
dermatitis herpetiformis
papulovesicular, pruritic. Associated with Celiac. Dx - IgA anti-endomysial Ab, anti-
gliadin
phenelzine
MAOi antidepressant. Avoid tyramine (aged meat/cheese) --> HTN crisis
CMV esophagitis
in HIV. Dysphagia, odynophagia, shallow ulcers, intranuclear/cytoplasmic inclusions.
Tx- ganciclovir IV
HSV esophagitis
, in HIV. Small ulcers with volcano-like appearnace. Eosinophilic intranuclear inclusions.
Tx- acyclovir
candidal esophagitis
most common HIV esophagitis. Tx - oral fluconazole
splenic rupture
ex-lap if unstable. CT if stable
pseudocyesis
pregnancy conversion disorder
prolactin
stimulated by serotonin and TRH, inhibited by dopamine. Hypothyroid -->
amenorrhea/galactorrhea
adenomyosis
endometrial glands in myometrium. Usually > 40yo, dysmenorrhea, menorrhagia,
enlarged symmetric uterus. Must curettage to r/o endometrial carcinoma
leiomyoma/fibroids
irregular shaped uterus
endometriosis
uterus not enlarged. Dysmenorrhea, dyspareunia, dyschezia. Dx- laparoscopy. Tx-
OCPs
aminoglycosides
amikacin, gentamicin, tobramicin. ototoxic, nephrotoxic. Gentamicin very ototoxic
hydroxychloroquine
DMARD. Treats SLE. SE - retinopathy/corneal damage (need q6month eye exams), GI,
hemolysis in G6PD
methotrexate SE
DMARD. Inhibits folate metabolism. Macrocytic anemia, GI, hepatotoxic, ILD, alopecia,
pancytopenia
premature ovarian failure
low estrogen, high FSH > LH, <40yo
hyperparathyroidism
hypercalcemia - stones, bones, groans, psyciatric overtones, polydipsia, polyuria.
pseudogout. Also sometimes HTN
low-grade (without mets) gastric MALT lymphoma
H pylori association. Tx- PPI, clarithromycin, amoxicillin
Jarisch-Herxheimer rxn
primary/secondary syphilis treated with penicillin --> spirochetes die --> immune
complexes --> looks like syphilis flare-up
INH SE
hepatitis, peripheral neuropathy/ataxia (give pyridoxine)
fanconi anemia
pancytopenia, congenital anomalies, presents 4-12yo. Autosomal recessive. Skin
changes
diamond-blackfan
pure red cell aplasia, congenital anomalies. Presents 3 months old. Tx - steroids,
possibly transfusion
transient erythroblastopenia of childhood
