USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Abdominal pain, ascites, hepatomegaly - (ANSWER)Budd-Chiari Syndrome (posthepatic venous
thrombosis, can be related to Polycythemia vera)
Achilles tendon Xanthoma - (ANSWER)Familial Hyper cholesterolemia (low LDL receptor signaling)
AD
Adrenal hemorrhage, hypotension, DIC - (ANSWER)Waterhouse-Frieerichsen syndrome (Neisseria
meningitidis)
Arachnodactyly (spider fingers), lens dislocation, aortic dissection or aneurysm, hyperflexible joints,
pectus excavatum - (ANSWER)Marfan Syndrome (fibrillin defect)
AD
Bilateral acoustic schwannomas - (ANSWER)Neurofibromatosis type 2
occur in cerebellopontine angle, S100 marker
Bilateral hilar adenopathy, uveitis, high ACE, hypercalcemia (activated macrophages for Vit D),
interstitial fibrosis, erythema nodosum, high CD4 - (ANSWER)Sarcoidosis (non-caseating granulomas)
Black eschar on face of patient with diabetic ketoacidosis - (ANSWER)*Mucor or Rhizopus fungal
infection*
Travels through cribiform plate vessels
Blue sclera - (ANSWER)Osteogenesis Imperfecta (Type I collagen defect forming triple helix)
Blue due to exposure of choroidal veins
Bluish line on gingiva and basophilic stippling - (ANSWER)Burton line (lead poisoning)
,USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Basophilic stippling (rRNA remnants)
Constipation, anemia, CNS impairment
Bone pain, bone enlargement (hat size or hearing loss), arthritis - (ANSWER)Paget disease of bone
(Increased osteoclastic, then osteoblastic activity)
Osteosarcoma or heart failure
"Butterfly" facial rash or discoid rash and Raynaud phenomenon in a young female - (ANSWER)Systemic
lupus erythematosus
Type III Hypersensitivity (antigen-antibody complexes deposit) with glomerulonephritis
Type II hypersensitivity with autoimmune hemolysis
Cafe-au-lait spots, Lisch nodules (iris hemartoma), cutaneous neurofibromas -
(ANSWER)Neurofibromatosis Type I, pheochromocytoma, optic gliomas
Cafe-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine
abnormalities - (ANSWER)*McCune-Albright syndrome*
(mosaicism, G-protein signaling mutation)
Calf pseudohypertrophy - (ANSWER)Muscular dystrophy (Duchenne, due to X-linked frameshift >
*truncated dystrophin*)
Dilated cardiomyopathy (DCM)
High CK
,USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Cervical lymphadenopathy, desquamating rash on palms and soles, coronary aneurysms, red
conjuctivae, and strawberry tongue - (ANSWER)Kawasaki disease (treat with IVIG and aspirin which
inhibits TXA2)
"Cherry-red spots" on macula - (ANSWER)Tay-Sachs (ganglioside accumulation - NO
hepatosplenomegaly)
Niemann-Pick (sphingomyelin accumulation w/ hepatosplenomegaly)
Central retinal artery occlusion
Chest pain on exertion - (ANSWER)Angina
stable: with moderate exertion, *cellular swelling indicates reversibility*, atherosclerosis;
unstable: with minimal exertion or at rest, partial occlusion
Chest pain, pericardial effusion/friction rub, persistent fever following MI (weeks later) -
(ANSWER)*Dressler syndrome*
(autoimmune mediated post-MI *fibrinous pericarditis*, 2-12 weeks after acute episode)
Chest pain with ST depressions EKG - (ANSWER)Subendocaridal ischemia
Unstable angina (troponins -, reversible) and NSTEMI (troponins +, irreversible)
Child with fever later develops red rash on face that spreads to body - (ANSWER)"Slapped cheeks"
(Erythema infectiosum/fifth disease: parvovirus B19)
Single-stranded DNA virus
Aplastic Anemia in Sickle Cell, B-thalessemia
, USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Chorea, dementia, caudate degeneration - (ANSWER)*Huntington disease* (AD, CAG repeat expansion)
Hemiballismus caused by *subthalamic nuclei* (STN)
Loss of GABAergic neurons
Chorioretinitis, hydrocephalus (CSF acculmulation > UMN injury), intracranial calcifications -
(ANSWER)Congenital Toxoplasmosis
Chronic exercise intolerance with myalgia, painful cramps, myoglobinuria, arrythemia - (ANSWER)AR
*McArdle disease*
(skeletal muscle glycogen phosphorylase deficiency)
-defect in anaerobic glycogen metabolism
Cold intolerance, weight gain, bradycardia, facial myxedema, *hypercholesterolemia* -
(ANSWER)Hypothyroidism
Dx: Thyroxine (T4)
Conjugate horizontal gaze palsy, horizontal diplopia - (ANSWER)*Internuclear opthalmoplegia*
(damage to MLF; may be unilateral or bilateral)
Continuous "machine-like"heart murmur - (ANSWER)PDA (close with indomethacin; open or maintain
with PGE analogs)
Congenital Rubella
*Late cyanosis in lower extremity*
failure of branchial arch 6
Cutaneous/dermal edema due to connective tissue deposition - (ANSWER)*Myxedema*
Abdominal pain, ascites, hepatomegaly - (ANSWER)Budd-Chiari Syndrome (posthepatic venous
thrombosis, can be related to Polycythemia vera)
Achilles tendon Xanthoma - (ANSWER)Familial Hyper cholesterolemia (low LDL receptor signaling)
AD
Adrenal hemorrhage, hypotension, DIC - (ANSWER)Waterhouse-Frieerichsen syndrome (Neisseria
meningitidis)
Arachnodactyly (spider fingers), lens dislocation, aortic dissection or aneurysm, hyperflexible joints,
pectus excavatum - (ANSWER)Marfan Syndrome (fibrillin defect)
AD
Bilateral acoustic schwannomas - (ANSWER)Neurofibromatosis type 2
occur in cerebellopontine angle, S100 marker
Bilateral hilar adenopathy, uveitis, high ACE, hypercalcemia (activated macrophages for Vit D),
interstitial fibrosis, erythema nodosum, high CD4 - (ANSWER)Sarcoidosis (non-caseating granulomas)
Black eschar on face of patient with diabetic ketoacidosis - (ANSWER)*Mucor or Rhizopus fungal
infection*
Travels through cribiform plate vessels
Blue sclera - (ANSWER)Osteogenesis Imperfecta (Type I collagen defect forming triple helix)
Blue due to exposure of choroidal veins
Bluish line on gingiva and basophilic stippling - (ANSWER)Burton line (lead poisoning)
,USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Basophilic stippling (rRNA remnants)
Constipation, anemia, CNS impairment
Bone pain, bone enlargement (hat size or hearing loss), arthritis - (ANSWER)Paget disease of bone
(Increased osteoclastic, then osteoblastic activity)
Osteosarcoma or heart failure
"Butterfly" facial rash or discoid rash and Raynaud phenomenon in a young female - (ANSWER)Systemic
lupus erythematosus
Type III Hypersensitivity (antigen-antibody complexes deposit) with glomerulonephritis
Type II hypersensitivity with autoimmune hemolysis
Cafe-au-lait spots, Lisch nodules (iris hemartoma), cutaneous neurofibromas -
(ANSWER)Neurofibromatosis Type I, pheochromocytoma, optic gliomas
Cafe-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine
abnormalities - (ANSWER)*McCune-Albright syndrome*
(mosaicism, G-protein signaling mutation)
Calf pseudohypertrophy - (ANSWER)Muscular dystrophy (Duchenne, due to X-linked frameshift >
*truncated dystrophin*)
Dilated cardiomyopathy (DCM)
High CK
,USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Cervical lymphadenopathy, desquamating rash on palms and soles, coronary aneurysms, red
conjuctivae, and strawberry tongue - (ANSWER)Kawasaki disease (treat with IVIG and aspirin which
inhibits TXA2)
"Cherry-red spots" on macula - (ANSWER)Tay-Sachs (ganglioside accumulation - NO
hepatosplenomegaly)
Niemann-Pick (sphingomyelin accumulation w/ hepatosplenomegaly)
Central retinal artery occlusion
Chest pain on exertion - (ANSWER)Angina
stable: with moderate exertion, *cellular swelling indicates reversibility*, atherosclerosis;
unstable: with minimal exertion or at rest, partial occlusion
Chest pain, pericardial effusion/friction rub, persistent fever following MI (weeks later) -
(ANSWER)*Dressler syndrome*
(autoimmune mediated post-MI *fibrinous pericarditis*, 2-12 weeks after acute episode)
Chest pain with ST depressions EKG - (ANSWER)Subendocaridal ischemia
Unstable angina (troponins -, reversible) and NSTEMI (troponins +, irreversible)
Child with fever later develops red rash on face that spreads to body - (ANSWER)"Slapped cheeks"
(Erythema infectiosum/fifth disease: parvovirus B19)
Single-stranded DNA virus
Aplastic Anemia in Sickle Cell, B-thalessemia
, USMLE STEP 2 CK HIGH YIELD QUESTIONS AND ANSWERS
Chorea, dementia, caudate degeneration - (ANSWER)*Huntington disease* (AD, CAG repeat expansion)
Hemiballismus caused by *subthalamic nuclei* (STN)
Loss of GABAergic neurons
Chorioretinitis, hydrocephalus (CSF acculmulation > UMN injury), intracranial calcifications -
(ANSWER)Congenital Toxoplasmosis
Chronic exercise intolerance with myalgia, painful cramps, myoglobinuria, arrythemia - (ANSWER)AR
*McArdle disease*
(skeletal muscle glycogen phosphorylase deficiency)
-defect in anaerobic glycogen metabolism
Cold intolerance, weight gain, bradycardia, facial myxedema, *hypercholesterolemia* -
(ANSWER)Hypothyroidism
Dx: Thyroxine (T4)
Conjugate horizontal gaze palsy, horizontal diplopia - (ANSWER)*Internuclear opthalmoplegia*
(damage to MLF; may be unilateral or bilateral)
Continuous "machine-like"heart murmur - (ANSWER)PDA (close with indomethacin; open or maintain
with PGE analogs)
Congenital Rubella
*Late cyanosis in lower extremity*
failure of branchial arch 6
Cutaneous/dermal edema due to connective tissue deposition - (ANSWER)*Myxedema*
