Step 2 CK CCSSA NBME Form 7 30/10/21, 12:23 AM
Jordan Abrams Oct 4, 2019 20 min read
Step 2 CK CCSSA NBME Form 7
Updated: Aug 29, 2020
Authors: Susan Basharkhah
Editor: Jordan Abrams
Practice exam: myNBME
Please note: The HY Medicine is in no way affiliated with the Federation of State
Medical Boards (FSMB) or the National Board of Medical Examiners® (NBME®)
BLOCK 1
1) Family therapy
• Goal of family therapy is to ↓ conflict, help family members understand each other’s needs and to help
the family cope with the internally destructive forces
2) Triglycerides
• TAGs > 1,000 → acute pancreatitis
3) Splenectomy
• Spherocytes + ↑ mean corpuscular hemoglobin concentration (MCHC) = hereditary spherocytosis →
sxs improve with splenectomy
4) Surgical exploration of the mediastinum
• Widened mediastinum on CXR after CABG is consistent with aortic dissection
5) Small bowel obstruction
• Severe SBO presents with:
• ↓ bowel sounds
• Distended and tympanic abdomen
• Postprandial pain
• Pain relieved with vomiting (relieves some intra-abdominal pressure)
• SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds
6) Indomethacin
• Acute gout attack (swelling, erythema, tenderness of great toe)
• Celecoxib (COX-2 inhibitor) can help with gout but a non-selective COX inhibitor (Indomethacin) would
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 1 of 26
,Step 2 CK CCSSA NBME Form 7 30/10/21, 12:23 AM
be better because COX-1 inhibitor also prevents hemostasis (no build up of uric acid at a single site)
• 2nd line for acute gout attack = colchicine
7) Thoracic aorta
• Bruising and tenderness over sternum = blunt thoracic injury
• Isthmus of thoracic aorta is most vulnerable location to deceleration injuries → thoracic aortic
aneurysm (widened mediastinum)
• Dx: CT angiography
8) Bone marrow aspiration
• Pancytopenia → perform bone marrow aspiration to see if this is aplastic anemia or cancer
9) Exercise stress test
• Indigestion while walking briskly or uphill that is relieved by rest is consistent with angina (especially
given that her sxs are not related to eating and aren’t relieved by antacids)
• Pretest probability of CAD is intermediate in women with typical aging age 30-50 or atypical angina ≥
age 50
10) Barium swallow
• Zenker diverticulum presents with dysphagia, regurgitation, and halitosis
• Dx: barium esophagram or esophageal manometry
11) Amniotomy and vaginal delivery
• No current genital herpes outbreak → can safely deliver vaginally
• Have to rupture the still intact membranes (amniotomy)
• Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or
valacyclovir beginning at 36 weeks of pregnancy
12) Urinary stasis
• High levels of progesterone during pregnancy → relaxation of ureters and bladder → urinary stasis
13) Mupirocin ointment
• Crusted, papular, honey colored lesions with clear discharge is consistent with impetigo
14) Bipolar disorder
• Remember “DIG FASTER”
• Manic episode (marked impairment) + depressive episode = Bipolar I
15) Culture for herpes simplex
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 2 of 26
, Step 2 CK CCSSA NBME Form 7 30/10/21, 12:23 AM
• Painful vulvar blisters (vesicles, pustules, or ulcers) + systemic symptoms (malaise, myalgia) = HSV
• Genital herpes can be diagnosed with viral culture or PCR
16) Haloperidol
• Corticosteroid psychosis
17) Intravascular volume depletion
• Vitals show orthostatic hypotension
• Glucosuria-induced osmotic diuresis
18) Central retinal vein occlusion (CRVO)
• CRVO = acute or subacute U/L vision loss that is usually noted upon waking in the morning
• Risk factors: old age and HTN
• Venous occlusion → venous dilation
• CRVO is associated with a “blood and thunder” appearance (diffuse hemorrhage) and cotton wool
spots (patches of white exudate)
• The key difference between CRAO and CRVO is the presence of hemorrhages. If there is no artery
(CRAO) then there is no blood flow → therefore NO hemorrhages. If there is no vein (CRVO) then there is
still blood coming in via the artery but the path out is obstructed → hemorrhages
• In CRAO on fundoscopic examination you will see diffuse ischemic retinal whitening, pale optic disc,
cherry red fovea, and boxcar segmentation of blood in retinal veins
19) Pilosebaceous follicles
• Blockage and/or inflammation of pilosebaceous units → Acne vulgaris
20) Child abuse
• Bilateral retinal hemorrhages and neurological abnormalities (eg, poor feeding, sleeping more than
usual) suggest shaken baby syndrome
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 3 of 26
Jordan Abrams Oct 4, 2019 20 min read
Step 2 CK CCSSA NBME Form 7
Updated: Aug 29, 2020
Authors: Susan Basharkhah
Editor: Jordan Abrams
Practice exam: myNBME
Please note: The HY Medicine is in no way affiliated with the Federation of State
Medical Boards (FSMB) or the National Board of Medical Examiners® (NBME®)
BLOCK 1
1) Family therapy
• Goal of family therapy is to ↓ conflict, help family members understand each other’s needs and to help
the family cope with the internally destructive forces
2) Triglycerides
• TAGs > 1,000 → acute pancreatitis
3) Splenectomy
• Spherocytes + ↑ mean corpuscular hemoglobin concentration (MCHC) = hereditary spherocytosis →
sxs improve with splenectomy
4) Surgical exploration of the mediastinum
• Widened mediastinum on CXR after CABG is consistent with aortic dissection
5) Small bowel obstruction
• Severe SBO presents with:
• ↓ bowel sounds
• Distended and tympanic abdomen
• Postprandial pain
• Pain relieved with vomiting (relieves some intra-abdominal pressure)
• SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds
6) Indomethacin
• Acute gout attack (swelling, erythema, tenderness of great toe)
• Celecoxib (COX-2 inhibitor) can help with gout but a non-selective COX inhibitor (Indomethacin) would
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 1 of 26
,Step 2 CK CCSSA NBME Form 7 30/10/21, 12:23 AM
be better because COX-1 inhibitor also prevents hemostasis (no build up of uric acid at a single site)
• 2nd line for acute gout attack = colchicine
7) Thoracic aorta
• Bruising and tenderness over sternum = blunt thoracic injury
• Isthmus of thoracic aorta is most vulnerable location to deceleration injuries → thoracic aortic
aneurysm (widened mediastinum)
• Dx: CT angiography
8) Bone marrow aspiration
• Pancytopenia → perform bone marrow aspiration to see if this is aplastic anemia or cancer
9) Exercise stress test
• Indigestion while walking briskly or uphill that is relieved by rest is consistent with angina (especially
given that her sxs are not related to eating and aren’t relieved by antacids)
• Pretest probability of CAD is intermediate in women with typical aging age 30-50 or atypical angina ≥
age 50
10) Barium swallow
• Zenker diverticulum presents with dysphagia, regurgitation, and halitosis
• Dx: barium esophagram or esophageal manometry
11) Amniotomy and vaginal delivery
• No current genital herpes outbreak → can safely deliver vaginally
• Have to rupture the still intact membranes (amniotomy)
• Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or
valacyclovir beginning at 36 weeks of pregnancy
12) Urinary stasis
• High levels of progesterone during pregnancy → relaxation of ureters and bladder → urinary stasis
13) Mupirocin ointment
• Crusted, papular, honey colored lesions with clear discharge is consistent with impetigo
14) Bipolar disorder
• Remember “DIG FASTER”
• Manic episode (marked impairment) + depressive episode = Bipolar I
15) Culture for herpes simplex
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 2 of 26
, Step 2 CK CCSSA NBME Form 7 30/10/21, 12:23 AM
• Painful vulvar blisters (vesicles, pustules, or ulcers) + systemic symptoms (malaise, myalgia) = HSV
• Genital herpes can be diagnosed with viral culture or PCR
16) Haloperidol
• Corticosteroid psychosis
17) Intravascular volume depletion
• Vitals show orthostatic hypotension
• Glucosuria-induced osmotic diuresis
18) Central retinal vein occlusion (CRVO)
• CRVO = acute or subacute U/L vision loss that is usually noted upon waking in the morning
• Risk factors: old age and HTN
• Venous occlusion → venous dilation
• CRVO is associated with a “blood and thunder” appearance (diffuse hemorrhage) and cotton wool
spots (patches of white exudate)
• The key difference between CRAO and CRVO is the presence of hemorrhages. If there is no artery
(CRAO) then there is no blood flow → therefore NO hemorrhages. If there is no vein (CRVO) then there is
still blood coming in via the artery but the path out is obstructed → hemorrhages
• In CRAO on fundoscopic examination you will see diffuse ischemic retinal whitening, pale optic disc,
cherry red fovea, and boxcar segmentation of blood in retinal veins
19) Pilosebaceous follicles
• Blockage and/or inflammation of pilosebaceous units → Acne vulgaris
20) Child abuse
• Bilateral retinal hemorrhages and neurological abnormalities (eg, poor feeding, sleeping more than
usual) suggest shaken baby syndrome
https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7 Page 3 of 26
