USMLE STEP 2 CK EXAM REVIEW
QUESTIONS AND ANSWERS, EXAMS OF
NURSING
lead poisoning Correct Answer Mild (5-44): no med, repeat
levels & relocation
Moderate (45-69): DMSA
Severe (>70): Dimercaprol + EDTA if encephalopathy
Sideroblastic anemia Correct Answer Basophilic stippling in
peripheral smear
Ringed sideroblasts only in bone marrow
B12 deficiency Correct Answer MMA and homocysteine
Folate deficiency Correct Answer Normal MMA and increased
homocysteine
Warm AIHA Correct Answer SLE, CLL, drugs
Cold AIHA Correct Answer Mycoplasma, mononucleosis,
walderstrom macroglobulinemia
Polycythemia vera Correct Answer Hydroxyurea IFN
Ruxolitinib (JAK inh.)
acute leukemia Correct Answer >20% blast cells
Pleural fluid in TB Correct Answer Increased protein level
(>4g/dL)
Increased lymphocytic leukocytosis
Decreased glucose levels
,Decreased ph
Increased LDH levels (>500)
Uncomplicated pleural effusion Correct Answer Negative culture
and gram stain (no bacteria)
ph > 7.2
Glucose >60
WBC < 50.000
Management: ATB only
Complicated Pleural Effusion or Empyema Correct Answer ph <
7.2
Glucose <60
WBC > 50.000
Negative gram stain and culture ( FN due to low concentration of
bacteria)
Management: chest tube + ATB
Severe PCP Correct Answer Prednisone if: PaO2 <70 mmHg or
an A-a gradient > 35
hyperlipidemia screening Correct Answer Men > 35 and older
Women > 45
All at Higher risk for CAD >20 years
Fasting samples
Repeat every 5 years
Dyslipidemia Correct Answer Total cholesterol >200 mg/dl
LDL >130 mg/dl
HDL <40 mg/dl
triglicerides >150 mg/dl
Hypertension screening Correct Answer Age >18 at every visit
Patients >60 years: >150/90 mmHg
,Patients <60 years: >140/90 mmHg
Patients >18 years + CKD or diabetes: >140/90 mmHg
Hypertensive Emergency Correct Answer >180/120 mmHg +
end-organ damage
- Malignant HTN: severe HTN + retinal hemorrhages, papilledema
or exudates
- Hypertensive encephalopathy: severe HTN + cerebral edema or
non-localizing neurologic signs and symptoms
Osteoporosis Screening Correct Answer Women >65
Start at 60 if decreased body weight or increased risk for fractures
PPSV23 Alone for age 19-64 Correct Answer Chronic heart,
lung or liver disease, diabetes, smoker, alcoholics
Sequential PCV13 + PPSV23 for age 19-64 Correct Answer
CSF leaks, choclear implants, sickle cell disease, asplenia, CKD,
Inmunocompromised
Sequential PCV13 + PPSV23 for age >65 Correct Answer 1
dose of PCV13 followed by PPSV23 at a later time
Marfan Syndrome Correct Answer AD, Upward lens dislocation,
normal intellect
Homocystinuria Correct Answer AR, downward lens dislocation,
intellectual disability
Criteria for Parathyroidectomy Correct Answer Symptomatic
hypercalcemia
Ca >11.5 mg/dL
Renal Insufficiency
Age <50
, Nephrolithiasis
Osteoporosis
Pregnant
Drugs that cause SIADH Correct Answer Carbamazepine,
Cyclophosphamide, SSRIs, antipsychotics, NSAIDs
Herpagina Correct Answer 3-10 yrs
Seasonal (summer/fall)
Ulcers and vesicles in posterior oropharynx
Tx: supportive
Herpetic gingivostomatitis Correct Answer 6mo-5yrs
No seasonality
Clusters of small ulcers on anterior oropharynx
Tx: oral acyclovir
Initial HIV screening Correct Answer Age 15-65
Treatment of TB
another STD present
Pregnant
Occupational exposure to blood/fluids
Annual Screening for HIV Correct Answer IV drug user + sex
partner
Men who have sex with men
Sex for money
Partner of a HIV positive person
>1 partner since last HIV test
Homeless
Correctional facility incarceration
S4 heart sound Correct Answer Atrial gallop sound (before S1)
Heard immediately after atrial contraction phase as blood is
forced into a stiff ventricle
QUESTIONS AND ANSWERS, EXAMS OF
NURSING
lead poisoning Correct Answer Mild (5-44): no med, repeat
levels & relocation
Moderate (45-69): DMSA
Severe (>70): Dimercaprol + EDTA if encephalopathy
Sideroblastic anemia Correct Answer Basophilic stippling in
peripheral smear
Ringed sideroblasts only in bone marrow
B12 deficiency Correct Answer MMA and homocysteine
Folate deficiency Correct Answer Normal MMA and increased
homocysteine
Warm AIHA Correct Answer SLE, CLL, drugs
Cold AIHA Correct Answer Mycoplasma, mononucleosis,
walderstrom macroglobulinemia
Polycythemia vera Correct Answer Hydroxyurea IFN
Ruxolitinib (JAK inh.)
acute leukemia Correct Answer >20% blast cells
Pleural fluid in TB Correct Answer Increased protein level
(>4g/dL)
Increased lymphocytic leukocytosis
Decreased glucose levels
,Decreased ph
Increased LDH levels (>500)
Uncomplicated pleural effusion Correct Answer Negative culture
and gram stain (no bacteria)
ph > 7.2
Glucose >60
WBC < 50.000
Management: ATB only
Complicated Pleural Effusion or Empyema Correct Answer ph <
7.2
Glucose <60
WBC > 50.000
Negative gram stain and culture ( FN due to low concentration of
bacteria)
Management: chest tube + ATB
Severe PCP Correct Answer Prednisone if: PaO2 <70 mmHg or
an A-a gradient > 35
hyperlipidemia screening Correct Answer Men > 35 and older
Women > 45
All at Higher risk for CAD >20 years
Fasting samples
Repeat every 5 years
Dyslipidemia Correct Answer Total cholesterol >200 mg/dl
LDL >130 mg/dl
HDL <40 mg/dl
triglicerides >150 mg/dl
Hypertension screening Correct Answer Age >18 at every visit
Patients >60 years: >150/90 mmHg
,Patients <60 years: >140/90 mmHg
Patients >18 years + CKD or diabetes: >140/90 mmHg
Hypertensive Emergency Correct Answer >180/120 mmHg +
end-organ damage
- Malignant HTN: severe HTN + retinal hemorrhages, papilledema
or exudates
- Hypertensive encephalopathy: severe HTN + cerebral edema or
non-localizing neurologic signs and symptoms
Osteoporosis Screening Correct Answer Women >65
Start at 60 if decreased body weight or increased risk for fractures
PPSV23 Alone for age 19-64 Correct Answer Chronic heart,
lung or liver disease, diabetes, smoker, alcoholics
Sequential PCV13 + PPSV23 for age 19-64 Correct Answer
CSF leaks, choclear implants, sickle cell disease, asplenia, CKD,
Inmunocompromised
Sequential PCV13 + PPSV23 for age >65 Correct Answer 1
dose of PCV13 followed by PPSV23 at a later time
Marfan Syndrome Correct Answer AD, Upward lens dislocation,
normal intellect
Homocystinuria Correct Answer AR, downward lens dislocation,
intellectual disability
Criteria for Parathyroidectomy Correct Answer Symptomatic
hypercalcemia
Ca >11.5 mg/dL
Renal Insufficiency
Age <50
, Nephrolithiasis
Osteoporosis
Pregnant
Drugs that cause SIADH Correct Answer Carbamazepine,
Cyclophosphamide, SSRIs, antipsychotics, NSAIDs
Herpagina Correct Answer 3-10 yrs
Seasonal (summer/fall)
Ulcers and vesicles in posterior oropharynx
Tx: supportive
Herpetic gingivostomatitis Correct Answer 6mo-5yrs
No seasonality
Clusters of small ulcers on anterior oropharynx
Tx: oral acyclovir
Initial HIV screening Correct Answer Age 15-65
Treatment of TB
another STD present
Pregnant
Occupational exposure to blood/fluids
Annual Screening for HIV Correct Answer IV drug user + sex
partner
Men who have sex with men
Sex for money
Partner of a HIV positive person
>1 partner since last HIV test
Homeless
Correctional facility incarceration
S4 heart sound Correct Answer Atrial gallop sound (before S1)
Heard immediately after atrial contraction phase as blood is
forced into a stiff ventricle
