USMLE Step 2 CK: Next Step in Management with
complete solution
high-grade reflux in females that persists into adulthood with no clear secondary cause
surgical repair
multiple 2nd trimester spontaneous abortions
cervical cerclage
erythematous knee with effusion and fever
arthrocentesis [ need to tell apart gout from septic arthritis]
spontaneous pneumothorax in a tall young man
supplemental oxygen
clue cells seen in vaginal swab in a fertile woman
oral metronidazole
acute open-angle glaucoma
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
CT scan of the face (coronal section)
someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo
dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)
someone that comes in with headaches and shows papilledema in the opthalmic exam
CT scan of the head non-contrast - r/o mass
treament for scabies
permethrin
Scaphoid fracture that is negative on X-ray
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
decompression of the GI tract...requires nasogastric tube
mini-mental status exam of <24
neuropsychologic testing to rule-out alzheimer's (other causes of dementia)
cord compression confirmed with CT-spine
dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)
borderline personality disorder
dialectical behavioral therapy
Pulmonary edema in acute CHF exacerbation
100% O2 therapy
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy
IV furosemide
supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus
rhythm
Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or
adenosine
, Asymptomatic aortic stenosis
Hydrocholorothiazide to reduce preload
Hypertension with underlying diabetes type 2
ACE-inhibitor or ARB
Syncope with normal vitals and no previous episodes
Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and
arrythmia
PR interval=o.3 sinus rhythm normal
Nothing, no management needed; PR>0.2 is first degree heartblock
A-fib secondary to hypertension for >48 hours
Diltiazem; rate control + anticoagulant
A patient presents with hypertension and chest pain on exertion
IV nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD
72 hr Holter monitor
Angina symptoms
Beta-blockers - they increase the threshold of angina
Posterior anterolateral MI and Percutaneous coronary intervention
Clopidogrel
teenage patient grunting and blinking many times a day for at least 1 year
haloperidol
suspected pulmonary embolism
spiral CT scan
prinzmetal angina
calcium channel blockers or nitrates (also for esophageal spasm)
Lambert Eaton Syndrome
radiation and chemotherapy as it is the manifestation of a pre-existing small cell
carcinoma of the lung.
stroke outside the 3 hour period but within 6 hours
intra-arterial tPA administration
osteopenia in an elderly patient
calcium, vitamin D, and weight-baring exercise
tracheobronchial rupture
bronchoscopy (flexible or rigid)
abdominal pain out of proportion to clinical findings
laparatomy
Guillane Barre Syndrome
plasmapheresis or IVIG with admission to ICU
shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)
McRoberts maneuver - flexion of mother's thighs against her abdomen
central retinal artery occlusion
ocular massage with high flow oxygen
malaria protection for a trip to India spent outdoors
Mefloquine
avoiding calcium oxalate stones
complete solution
high-grade reflux in females that persists into adulthood with no clear secondary cause
surgical repair
multiple 2nd trimester spontaneous abortions
cervical cerclage
erythematous knee with effusion and fever
arthrocentesis [ need to tell apart gout from septic arthritis]
spontaneous pneumothorax in a tall young man
supplemental oxygen
clue cells seen in vaginal swab in a fertile woman
oral metronidazole
acute open-angle glaucoma
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
CT scan of the face (coronal section)
someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo
dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)
someone that comes in with headaches and shows papilledema in the opthalmic exam
CT scan of the head non-contrast - r/o mass
treament for scabies
permethrin
Scaphoid fracture that is negative on X-ray
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
decompression of the GI tract...requires nasogastric tube
mini-mental status exam of <24
neuropsychologic testing to rule-out alzheimer's (other causes of dementia)
cord compression confirmed with CT-spine
dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)
borderline personality disorder
dialectical behavioral therapy
Pulmonary edema in acute CHF exacerbation
100% O2 therapy
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy
IV furosemide
supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus
rhythm
Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or
adenosine
, Asymptomatic aortic stenosis
Hydrocholorothiazide to reduce preload
Hypertension with underlying diabetes type 2
ACE-inhibitor or ARB
Syncope with normal vitals and no previous episodes
Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and
arrythmia
PR interval=o.3 sinus rhythm normal
Nothing, no management needed; PR>0.2 is first degree heartblock
A-fib secondary to hypertension for >48 hours
Diltiazem; rate control + anticoagulant
A patient presents with hypertension and chest pain on exertion
IV nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD
72 hr Holter monitor
Angina symptoms
Beta-blockers - they increase the threshold of angina
Posterior anterolateral MI and Percutaneous coronary intervention
Clopidogrel
teenage patient grunting and blinking many times a day for at least 1 year
haloperidol
suspected pulmonary embolism
spiral CT scan
prinzmetal angina
calcium channel blockers or nitrates (also for esophageal spasm)
Lambert Eaton Syndrome
radiation and chemotherapy as it is the manifestation of a pre-existing small cell
carcinoma of the lung.
stroke outside the 3 hour period but within 6 hours
intra-arterial tPA administration
osteopenia in an elderly patient
calcium, vitamin D, and weight-baring exercise
tracheobronchial rupture
bronchoscopy (flexible or rigid)
abdominal pain out of proportion to clinical findings
laparatomy
Guillane Barre Syndrome
plasmapheresis or IVIG with admission to ICU
shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)
McRoberts maneuver - flexion of mother's thighs against her abdomen
central retinal artery occlusion
ocular massage with high flow oxygen
malaria protection for a trip to India spent outdoors
Mefloquine
avoiding calcium oxalate stones
