USMLE Step 2 CK Internal Medicine
Exam Questions with Complete
Solutions
Leukemoid reaction - Answer-Patient has leukocyte count >50k, high LAP score, more
metamyelocytes than myelocytes
Chronic myeloid leukemia - Answer-Patient has leukocyte count often >100k, low LAP
score, fewer metamyelocytes than myelocytes, absolute basophilia
Cyclosporine - Answer-Drug that inhibits transcription of IL-2, causes nephrotoxicity,
htn, neurotoxicity, glucose intolerance, infection, malignancy, gingival hypertrophy and
hirsutism
Tacrolimus - Answer-Drug that inhibits transcription of IL-2 but does not cause hirsutism
or gum hypertrophy
Mycophenolate - Answer-Drug that is a reversible inhibitor of inosine monophosphate
dehydrogenase (rate-limiting enzyme in de novo purine synthesis), causes bone
marrow suppression
Vertebral osteomyelitis - Answer-IV drug user presents with tenderness to gentle
percussion over spinous process, labs show thrombocytosis
Acute pericarditis - Answer-Patient presents with sharp, pleuritic chest pain that is
relieved by leaning forward
Diabetic ketoacidosis - Answer-Patient with DM presents with hyperventilation, glucose
250-500, bicarb <18, elevated anion gap, serum osmolality <320
Hyperosmolar hyperglycemic state - Answer-Patient with DM presents with altered
mentation, glucose >600, bicarb >18, normal anion gap, serum osmolality >320
Hyperglycemia, ketonemia and anion gap metabolic acidosis - Answer-DKA Triad
Protein C deficiency - Answer-Underlying hereditary cause of transient hypercoagulable
state in first few days of warfarin therapy, leading to warfarin-induced skin necrosis
Autoantibodies to platelet factor 4 - Answer-Genetic susceptibility to heparin-induced
thrombocytopenia
, Cholesterol embolism - Answer-Patient with history of comorbid conditions presents
with livedo reticularis, Hollenhorst plaques (eyes), eosinophilia, renal injury after cardiac
catheterization
Statin - Answer-Drug used in therapy for patient with estimated 10-year ASCVD risk
>=7.5%
Triglycerides - Answer-Lipid level reduced by use of fish oil
Niacin - Answer-Drug that is effective in raising HDL and has a modest effect of
lowering VLDL and LDL
Aortic regurgitation - Answer-Murmur in which patient presents with mild exertional SOB
and "pounding" of heart, aware of heartbeat while lying on L side, widened pulse
pressure (inc. systolic and dec. diastolic BP), water hammer pulse
Aortic stenosis - Answer-Murmur in which patient has pulsus parvus et tardus (small
amplitude and delayed upstroke)
Pyramidal tract disease - Answer-Condition detected by pronator drift test (patient has
outstretched arms with palms up and eyes closed, affected arm drifts downward and
pronates)
Romberg test - Answer-Test for proprioception in which patients are observed for
unsteadiness as they stand with feet together, arms to sides and eyes closed
Leser-Trelat sign (indicates occult internal malignancy) - Answer-Sudden onset of
multiple seborrhetic keratoses
CNS lymphoma - Answer-HIV+ patient presents with EBV DNA in CSF, MRI shows a
weakly ring-enhancing mass that is solitary and periventricular
Toxoplasmosis - Answer-MRI of HIV+ patient shows multiple, ring-enhancing, spherical
lesions in the basal ganglia
Squamous cell carcinoma - Answer-Former smoker presents with anorexia,
constipation, inc. thirst, easy fatigability, hypercalcemia d/t PTHrP , hilar mass on CXR
Acute respiratory distress syndrome - Answer-Paitent presents with dec. lung
compliance, pulmonary htn, hypoxemia with PaO2/FiO2 ratio =<300 mmHg
Central retinal artery occlusion - Answer-Patien presents with loss of monocular vision,
treated with ocular massage and high flow oxygen
Subacute thyroiditis (de Quervain) - Answer-Patient has prominent fever, hyperthyroid
symptoms, painful/tender goiter
Exam Questions with Complete
Solutions
Leukemoid reaction - Answer-Patient has leukocyte count >50k, high LAP score, more
metamyelocytes than myelocytes
Chronic myeloid leukemia - Answer-Patient has leukocyte count often >100k, low LAP
score, fewer metamyelocytes than myelocytes, absolute basophilia
Cyclosporine - Answer-Drug that inhibits transcription of IL-2, causes nephrotoxicity,
htn, neurotoxicity, glucose intolerance, infection, malignancy, gingival hypertrophy and
hirsutism
Tacrolimus - Answer-Drug that inhibits transcription of IL-2 but does not cause hirsutism
or gum hypertrophy
Mycophenolate - Answer-Drug that is a reversible inhibitor of inosine monophosphate
dehydrogenase (rate-limiting enzyme in de novo purine synthesis), causes bone
marrow suppression
Vertebral osteomyelitis - Answer-IV drug user presents with tenderness to gentle
percussion over spinous process, labs show thrombocytosis
Acute pericarditis - Answer-Patient presents with sharp, pleuritic chest pain that is
relieved by leaning forward
Diabetic ketoacidosis - Answer-Patient with DM presents with hyperventilation, glucose
250-500, bicarb <18, elevated anion gap, serum osmolality <320
Hyperosmolar hyperglycemic state - Answer-Patient with DM presents with altered
mentation, glucose >600, bicarb >18, normal anion gap, serum osmolality >320
Hyperglycemia, ketonemia and anion gap metabolic acidosis - Answer-DKA Triad
Protein C deficiency - Answer-Underlying hereditary cause of transient hypercoagulable
state in first few days of warfarin therapy, leading to warfarin-induced skin necrosis
Autoantibodies to platelet factor 4 - Answer-Genetic susceptibility to heparin-induced
thrombocytopenia
, Cholesterol embolism - Answer-Patient with history of comorbid conditions presents
with livedo reticularis, Hollenhorst plaques (eyes), eosinophilia, renal injury after cardiac
catheterization
Statin - Answer-Drug used in therapy for patient with estimated 10-year ASCVD risk
>=7.5%
Triglycerides - Answer-Lipid level reduced by use of fish oil
Niacin - Answer-Drug that is effective in raising HDL and has a modest effect of
lowering VLDL and LDL
Aortic regurgitation - Answer-Murmur in which patient presents with mild exertional SOB
and "pounding" of heart, aware of heartbeat while lying on L side, widened pulse
pressure (inc. systolic and dec. diastolic BP), water hammer pulse
Aortic stenosis - Answer-Murmur in which patient has pulsus parvus et tardus (small
amplitude and delayed upstroke)
Pyramidal tract disease - Answer-Condition detected by pronator drift test (patient has
outstretched arms with palms up and eyes closed, affected arm drifts downward and
pronates)
Romberg test - Answer-Test for proprioception in which patients are observed for
unsteadiness as they stand with feet together, arms to sides and eyes closed
Leser-Trelat sign (indicates occult internal malignancy) - Answer-Sudden onset of
multiple seborrhetic keratoses
CNS lymphoma - Answer-HIV+ patient presents with EBV DNA in CSF, MRI shows a
weakly ring-enhancing mass that is solitary and periventricular
Toxoplasmosis - Answer-MRI of HIV+ patient shows multiple, ring-enhancing, spherical
lesions in the basal ganglia
Squamous cell carcinoma - Answer-Former smoker presents with anorexia,
constipation, inc. thirst, easy fatigability, hypercalcemia d/t PTHrP , hilar mass on CXR
Acute respiratory distress syndrome - Answer-Paitent presents with dec. lung
compliance, pulmonary htn, hypoxemia with PaO2/FiO2 ratio =<300 mmHg
Central retinal artery occlusion - Answer-Patien presents with loss of monocular vision,
treated with ocular massage and high flow oxygen
Subacute thyroiditis (de Quervain) - Answer-Patient has prominent fever, hyperthyroid
symptoms, painful/tender goiter
