(Solved) Step 2 CK NBME 8: USMLE : Questions &
Answers: Updated Solution
Pneumococcal vaccine schedule: all ages - ANSWERAdults age < 65
- Give PPSV23 alone for smokers, diabetics, and chronic heart/lung/liver disease
- Give PCV13 followed by PPSV23 for high risk patients such those with CSF leaks,
cochlear implants, sickle cell disease, asplenia, or immunodeficiency. PPSV23 is given
8 weeks later, revaccinate 5 years later, and after age 65 (see below)
Adults age > 65
Two options, but NBME seems to prefer the first one below
- PCV13 followed by PPSV23 1 year later or
- PPSV23 alone
Kids
- PCV13 only
- 3 doses at 2, 4, 6 months of age
- 4th dose at 12-15 months
Pneumococcal vaccine schedule: children - ANSWERKids
- PCV13 only
- 3 doses at 2, 4, 6 months of age
- 4th dose at 12-15 months
Pneumococcal vaccine schedule: adults > 65 - ANSWERAdults age > 65
Two options, but NBME seems to prefer the first one below
- PCV13 followed by PPSV23 1 year later or
- PPSV23 alone
Pneumococcal vaccine schedule: adults < 65 - ANSWERAdults age < 65
- Give PPSV23 alone for smokers, diabetics, and chronic heart/lung/liver disease
- Give PCV13 followed by PPSV23 for high risk patients such those with CSF leaks,
cochlear implants, sickle cell disease, asplenia, or immunodeficiency. PPSV23 is given
8 weeks later, revaccinate 5 years later, and after age 65 (see below)
Post-transplant lymphoproliferative disorder - ANSWEREBV infection. when T cells
down due to immunosuppression, infected B lymphocytes replicate. up to half
present with extra-nodal mass. txt is reduction of immunosuppressive meds - if
severe, rituximab
s/s of multiple myeloma - ANSWERIncrease in fractures, bone pain, lytic bone
lesions, high calcium levels, kidney damage, frequent infections
lithium utility in bipolar - which parts - ANSWERall three: acute or chronic mania and
depression
, txt acute depression in bipolar pts - ANSWERlithium, lamotrigine, quietapine,
lurasidone
botulism - response on nerve stimulation - ANSWERcharacteristic low amplitude
response that improves with repeated stimulation
what does vertebral artery come off of - ANSWERsubclavian artery
occlusion of vertebral artery = what part of brain - ANSWERbrain stem, cerebellum,
occipital lobes (vestibulocerebellar signs, ipsilateral CN dysfunction, contralateral
hemiparesis, contralateral impairment in pain/temp
prevention of stroke in chronic or paroxysmal a fib - ANSWERanticoagulation
(warfarin) - CHADSVASC score
prevention recurrent strokes in patients without a fib - ANSWERaspirin or clopidogrel
inflammation of vestibular portion of CN VIII is called - ANSWERvestibular neuronitis
inflammation of auditory part of CN VIII is called - ANSWERlabrynthitis
vestibular neuronitis commonly arises as a consequence of __ - ANSWERviral
infection
vestibular neuronitis presentation - ANSWERacute vertigo, n/v, nystagmus, gait
instability. usually constant rather than episodic.
peripheral vertigo is caused by X and presents as Y nystagmus - ANSWERlesions of
the vestibulocochlear nerve
horizontal or rotary nystagmus. absence of visual input (closing eyes) worsens
peripheral vertigo
txt vestibular neuronitis - ANSWERusually self-limited. antiemetics and vertigo
medications for sx. sometimes glucocorticoid taper
yeast diaper rash txt - ANSWERtopical nystatin
yeast diaper rash presentation - ANSWERred, macerated thin plaques with satellite
papules. in skin folds
topical mupirocin is what - ANSWERantibacterial cream
coccidioides immitis - type of infection, where it is from - ANSWERendemic fungus,
southwestern US and Central Valley California
Answers: Updated Solution
Pneumococcal vaccine schedule: all ages - ANSWERAdults age < 65
- Give PPSV23 alone for smokers, diabetics, and chronic heart/lung/liver disease
- Give PCV13 followed by PPSV23 for high risk patients such those with CSF leaks,
cochlear implants, sickle cell disease, asplenia, or immunodeficiency. PPSV23 is given
8 weeks later, revaccinate 5 years later, and after age 65 (see below)
Adults age > 65
Two options, but NBME seems to prefer the first one below
- PCV13 followed by PPSV23 1 year later or
- PPSV23 alone
Kids
- PCV13 only
- 3 doses at 2, 4, 6 months of age
- 4th dose at 12-15 months
Pneumococcal vaccine schedule: children - ANSWERKids
- PCV13 only
- 3 doses at 2, 4, 6 months of age
- 4th dose at 12-15 months
Pneumococcal vaccine schedule: adults > 65 - ANSWERAdults age > 65
Two options, but NBME seems to prefer the first one below
- PCV13 followed by PPSV23 1 year later or
- PPSV23 alone
Pneumococcal vaccine schedule: adults < 65 - ANSWERAdults age < 65
- Give PPSV23 alone for smokers, diabetics, and chronic heart/lung/liver disease
- Give PCV13 followed by PPSV23 for high risk patients such those with CSF leaks,
cochlear implants, sickle cell disease, asplenia, or immunodeficiency. PPSV23 is given
8 weeks later, revaccinate 5 years later, and after age 65 (see below)
Post-transplant lymphoproliferative disorder - ANSWEREBV infection. when T cells
down due to immunosuppression, infected B lymphocytes replicate. up to half
present with extra-nodal mass. txt is reduction of immunosuppressive meds - if
severe, rituximab
s/s of multiple myeloma - ANSWERIncrease in fractures, bone pain, lytic bone
lesions, high calcium levels, kidney damage, frequent infections
lithium utility in bipolar - which parts - ANSWERall three: acute or chronic mania and
depression
, txt acute depression in bipolar pts - ANSWERlithium, lamotrigine, quietapine,
lurasidone
botulism - response on nerve stimulation - ANSWERcharacteristic low amplitude
response that improves with repeated stimulation
what does vertebral artery come off of - ANSWERsubclavian artery
occlusion of vertebral artery = what part of brain - ANSWERbrain stem, cerebellum,
occipital lobes (vestibulocerebellar signs, ipsilateral CN dysfunction, contralateral
hemiparesis, contralateral impairment in pain/temp
prevention of stroke in chronic or paroxysmal a fib - ANSWERanticoagulation
(warfarin) - CHADSVASC score
prevention recurrent strokes in patients without a fib - ANSWERaspirin or clopidogrel
inflammation of vestibular portion of CN VIII is called - ANSWERvestibular neuronitis
inflammation of auditory part of CN VIII is called - ANSWERlabrynthitis
vestibular neuronitis commonly arises as a consequence of __ - ANSWERviral
infection
vestibular neuronitis presentation - ANSWERacute vertigo, n/v, nystagmus, gait
instability. usually constant rather than episodic.
peripheral vertigo is caused by X and presents as Y nystagmus - ANSWERlesions of
the vestibulocochlear nerve
horizontal or rotary nystagmus. absence of visual input (closing eyes) worsens
peripheral vertigo
txt vestibular neuronitis - ANSWERusually self-limited. antiemetics and vertigo
medications for sx. sometimes glucocorticoid taper
yeast diaper rash txt - ANSWERtopical nystatin
yeast diaper rash presentation - ANSWERred, macerated thin plaques with satellite
papules. in skin folds
topical mupirocin is what - ANSWERantibacterial cream
coccidioides immitis - type of infection, where it is from - ANSWERendemic fungus,
southwestern US and Central Valley California
