USMLE STEP 2 CK INTERNAL MEDICINE UPDATED STUDY
GUIDE QUESTIONS AND CORRECT ANSWERS
Leukemoid reaction Patient has leukocyte count >50k, high LAP score, more metamyelocytes than
myelocytes
Chronic myeloid leukemia Patient has leukocyte count often >100k, low LAP score, fewer metamyelocytes
than myelocytes, absolute basophilia
Cyclosporine Drug that inhibits transcription of IL-2, causes nephrotoxicity, htn, neurotoxicity,
glucose intolerance, infection, malignancy, gingival hypertrophy and hirsutism
Tacrolimus Drug that inhibits transcription of IL-2 but does not cause hirsutism or gum
hypertrophy
Mycophenolate Drug that is a reversible inhibitor of inosine monophosphate dehydrogenase
(rate-limiting enzyme in de novo purine synthesis), causes bone marrow
suppression
Vertebral osteomyelitis IV drug user presents with tenderness to gentle percussion over spinous
process, labs show thrombocytosis
Acute pericarditis Patient presents with sharp, pleuritic chest pain that is relieved by leaning
forward
Diabetic ketoacidosis Patient with DM presents with hyperventilation, glucose 250-500, bicarb <18,
elevated anion gap, serum osmolality <320
Hyperosmolar hyperglycemic state Patient with DM presents with altered mentation, glucose >600, bicarb >18,
normal anion gap, serum osmolality >320
Hyperglycemia, ketonemia and anion gap metabolic DKA Triad
acidosis
Protein C deficiency 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 Genetic susceptibility to heparin-induced thrombocytopenia
Cholesterol embolism Patient with history of comorbid conditions presents with livedo reticularis,
Hollenhorst plaques (eyes), eosinophilia, renal injury after cardiac
catheterization
Statin Drug used in therapy for patient with estimated 10-year ASCVD risk >=7.5%
Triglycerides Lipid level reduced by use of fish oil
Niacin Drug that is effective in raising HDL and has a modest effect of lowering VLDL
and LDL
, Aortic regurgitation 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 Murmur in which patient has pulsus parvus et tardus (small amplitude and
delayed upstroke)
Pyramidal tract disease Condition detected by pronator drift test (patient has outstretched arms with
palms up and eyes closed, affected arm drifts downward and pronates)
Romberg test 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) Sudden onset of multiple seborrhetic keratoses
CNS lymphoma HIV+ patient presents with EBV DNA in CSF, MRI shows a weakly ring-
enhancing mass that is solitary and periventricular
Toxoplasmosis MRI of HIV+ patient shows multiple, ring-enhancing, spherical lesions in the
basal ganglia
Squamous cell carcinoma Former smoker presents with anorexia, constipation, inc. thirst, easy fatigability,
hypercalcemia d/t PTHrP , hilar mass on CXR
Acute respiratory distress syndrome Paitent presents with dec. lung compliance, pulmonary htn, hypoxemia with
PaO2/FiO2 ratio =<300 mmHg
Central retinal artery occlusion Patien presents with loss of monocular vision, treated with ocular massage and
high flow oxygen
Subacute thyroiditis (de Quervain) Patient has prominent fever, hyperthyroid symptoms, painful/tender goiter
Disseminated histoplasmosis HIV+ patient presents with weight loss, pulmonary symptoms (cough, dyspnea),
mucocutaneous lesions, HSM, pancytopenia, transaminitis, inc. LDH and ferritin
Relative risk Measure of association used in cohort studies
Aortic regurgitation Diastolic decrescendo murmur, best heart while pt is sitting up, leaning forward
and holding breath in full expiration
Hypertrophic cardiomyopathy Presents with a harsh crescendo-decreascendo systolic murmur best hear tat
the apex and LLSB, murmur inc. with valsalva or abrupt standing
Congenital bicuspid aortic valve MC cause of isolated AR in young adults in developed countries
Rheumatic heart disease MC cause of AR in the developing world
Parapneumonic effusion Patient has SOB, low-grade fever, pleural effusion with fluid with pH >7.2,
normal glucose, WBC <50k
Pleural fluid protein/serum ratio >0.5, pleural fluid Light criteria for exudative pleural effusions
LDH/serum ratio >0.6, pleural fluid LDH >2/3 ULN
GUIDE QUESTIONS AND CORRECT ANSWERS
Leukemoid reaction Patient has leukocyte count >50k, high LAP score, more metamyelocytes than
myelocytes
Chronic myeloid leukemia Patient has leukocyte count often >100k, low LAP score, fewer metamyelocytes
than myelocytes, absolute basophilia
Cyclosporine Drug that inhibits transcription of IL-2, causes nephrotoxicity, htn, neurotoxicity,
glucose intolerance, infection, malignancy, gingival hypertrophy and hirsutism
Tacrolimus Drug that inhibits transcription of IL-2 but does not cause hirsutism or gum
hypertrophy
Mycophenolate Drug that is a reversible inhibitor of inosine monophosphate dehydrogenase
(rate-limiting enzyme in de novo purine synthesis), causes bone marrow
suppression
Vertebral osteomyelitis IV drug user presents with tenderness to gentle percussion over spinous
process, labs show thrombocytosis
Acute pericarditis Patient presents with sharp, pleuritic chest pain that is relieved by leaning
forward
Diabetic ketoacidosis Patient with DM presents with hyperventilation, glucose 250-500, bicarb <18,
elevated anion gap, serum osmolality <320
Hyperosmolar hyperglycemic state Patient with DM presents with altered mentation, glucose >600, bicarb >18,
normal anion gap, serum osmolality >320
Hyperglycemia, ketonemia and anion gap metabolic DKA Triad
acidosis
Protein C deficiency 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 Genetic susceptibility to heparin-induced thrombocytopenia
Cholesterol embolism Patient with history of comorbid conditions presents with livedo reticularis,
Hollenhorst plaques (eyes), eosinophilia, renal injury after cardiac
catheterization
Statin Drug used in therapy for patient with estimated 10-year ASCVD risk >=7.5%
Triglycerides Lipid level reduced by use of fish oil
Niacin Drug that is effective in raising HDL and has a modest effect of lowering VLDL
and LDL
, Aortic regurgitation 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 Murmur in which patient has pulsus parvus et tardus (small amplitude and
delayed upstroke)
Pyramidal tract disease Condition detected by pronator drift test (patient has outstretched arms with
palms up and eyes closed, affected arm drifts downward and pronates)
Romberg test 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) Sudden onset of multiple seborrhetic keratoses
CNS lymphoma HIV+ patient presents with EBV DNA in CSF, MRI shows a weakly ring-
enhancing mass that is solitary and periventricular
Toxoplasmosis MRI of HIV+ patient shows multiple, ring-enhancing, spherical lesions in the
basal ganglia
Squamous cell carcinoma Former smoker presents with anorexia, constipation, inc. thirst, easy fatigability,
hypercalcemia d/t PTHrP , hilar mass on CXR
Acute respiratory distress syndrome Paitent presents with dec. lung compliance, pulmonary htn, hypoxemia with
PaO2/FiO2 ratio =<300 mmHg
Central retinal artery occlusion Patien presents with loss of monocular vision, treated with ocular massage and
high flow oxygen
Subacute thyroiditis (de Quervain) Patient has prominent fever, hyperthyroid symptoms, painful/tender goiter
Disseminated histoplasmosis HIV+ patient presents with weight loss, pulmonary symptoms (cough, dyspnea),
mucocutaneous lesions, HSM, pancytopenia, transaminitis, inc. LDH and ferritin
Relative risk Measure of association used in cohort studies
Aortic regurgitation Diastolic decrescendo murmur, best heart while pt is sitting up, leaning forward
and holding breath in full expiration
Hypertrophic cardiomyopathy Presents with a harsh crescendo-decreascendo systolic murmur best hear tat
the apex and LLSB, murmur inc. with valsalva or abrupt standing
Congenital bicuspid aortic valve MC cause of isolated AR in young adults in developed countries
Rheumatic heart disease MC cause of AR in the developing world
Parapneumonic effusion Patient has SOB, low-grade fever, pleural effusion with fluid with pH >7.2,
normal glucose, WBC <50k
Pleural fluid protein/serum ratio >0.5, pleural fluid Light criteria for exudative pleural effusions
LDH/serum ratio >0.6, pleural fluid LDH >2/3 ULN
