USMLE Step 2 CK
steroids - (correct Answer) - inhibit IL-1 production
methotrexate - (correct Answer) - folic acid antagonist, inhibits DHF reductase, S-phase specific, inhibits
DNA synthesis
cyclosporine - (correct Answer) - calcineurin inhibitor; inhibits IL-2 production; nephrotoxic, gum
hypertrophy, hursutism
tacrolimus (FK506) - (correct Answer) - calcineurin inhibitor; inhibits signaling thru T cell receptor
mycophenylate mofeil - (correct Answer) - prevents T cell activation
azathioprine - (correct Answer) - antineoplastic; cleaved to mercaptopurine; inhibits DNA/RNA synthesis;
BM suppression
antithymocyte globulin (OKT3) - (correct Answer) - antibody against CD3 on T cells; causes pulmonary
edema
basiliximab, daclizumab - (correct Answer) - monoclonal antibody to IL-2 receptor
fetal heart tones begin at - (correct Answer) - 10-12 weeks
fetal quickening (movement) occurs at - (correct Answer) - 17-18 weeks
4 measurements that can be taken from fetal US - (correct Answer) - crown-rump length, biparietal
diameter, femur length, abdominal circumference
abdominal circumference - (correct Answer) - most reliable parameter for set. fetal weight in cases of
fetal growth restriction
Gestational sac is visible by what gestational age? - (correct Answer) - five weeks
b-hCG peaks when? - (correct Answer) - 10 weeks GA
average increase in weight during pregnancy - (correct Answer) - 25 lb (11 kg)
additional kcal needed during pregnancy - (correct Answer) - 100-300 kcal/day
when should supplemental iron be started in a pregnant woman? - (correct Answer) - first prenatal visit
What 2 supplement to pregnant vegans need? - (correct Answer) - Vit D, Vit B12
What cardiovascular parameters DECREASE during pregnancy? - (correct Answer) - blood pressure and
peripheral vascular resistance
What happens to electrolytes during pregnancy? - (correct Answer) - NOTHING! Remain unchanged.
,What causes herpangina? - (correct Answer) - coxsackievirus (an enterovirus)
How do you screen for Hep C on the first prenatal visit? What about Hep B? - (correct Answer) - Hep C -
history. Hep B - HBsAg
When is gestational diabetes screened for in pregnancy? - (correct Answer) - weeks 24-28
How are AFP results reported? - (correct Answer) - multiples of the median (MoM)
Quad screen shows "pan-low". - (correct Answer) - trisomy 18 (low AFP, low estriol, low b-hCG, low
inhibin A)
Quad screen shows low AFP, low estriol, high b-hCG, high inhibin A. - (correct Answer) - Down syndrome
Risk of fetal loss during chorionic villus sampling - (correct Answer) - 1%
Third trimester test used to detect presence of phosphatidylglycerol - (correct Answer) - amniocentesis
tetratogen that can cause lack of cranial ossification - (correct Answer) - ACEI
tetratogenic defects of streptomycin or kanamycin - (correct Answer) - hearing loss; CN VIII damage
2 tetratogens causing anotia or microtia - (correct Answer) - thalidomide, Vit A
can cause neonatal nasal hypoplasia an stippled bone epiphyses - (correct Answer) - warfarin
tetratogen assoc. w/ neonatal bowel atresia - (correct Answer) - cocaine
Woman with hyperhomocysteinemia loses a 19 week pregnancy. What enzyme is deficient? - (correct
Answer) - methylene tetrahydrofolate reductase
Amount of caffeine required to cause spontaneous abortion - (correct Answer) - >500 mg/day
Deficiency of what hormone increases risk for spontaneous abortion? (estrogen, progesterone, growth
hormone, testosterone, or FSH) - (correct Answer) - progesterone
Prophylactic med for toxo during pregnancy - (correct Answer) - spiramycin
Cardiac defect assoc. w/ congenital rubella - (correct Answer) - PDA
treatment for congenital CMV - (correct Answer) - postpartum ganciclovir
Pregnant HIV+ women should receive what prenatal meds? - (correct Answer) - AZT or nevirapine
When does an HIV+ women get a C-sec? - (correct Answer) - viral load >1000
eye disease in late congenital syphilis - (correct Answer) - interstitial keratitis
Tx for threatened AB - (correct Answer) - pelvic rest for 24-48 hrs, then follow up US
How can misoprostol be administered? - (correct Answer) - oral, vaginal, sublingual, buccal
2 meds used for first-trimester therapeutic abortions - (correct Answer) - misoprostol, mifepristone
,How does oxytocin work to induce or augment labor? - (correct Answer) - binds receptors on
myometrium, increases Ca influx to stimulate contractions
Components of a Bishop score - (correct Answer) - dilation, effacement, station, cervical position,
cervical consistency
Prolonged active stage of labor due to - (correct Answer) - cephalopelvic disproportion
things that can decreases fetal heart rate variability - (correct Answer) - hypoxia, opioids, magnesium,
sleep cycle
drug assoc. w/ a "pseudosinusoidal" variability pattern on fetal heart rate tracings - (correct Answer) -
meperidine
complication of a supine nonstress test - (correct Answer) - maternal hypotension
What is "15-15-2-20"? - (correct Answer) - Normal "reactive" nonstress test: 2 FHR accelerations ≥ 15
bpm above baseline lasting ≥ 15 sec over a 20 min period
Next step if nonstress test is nonreactive? - (correct Answer) - biophysical profile
How can you induce contractions in a contraction stress test? - (correct Answer) - nipple stimulation or
oxytocin
Next step if contraction stress test is positive - (correct Answer) - delivery
components of a biophysical profile - (correct Answer) - fetal tone, fetal breathing, fetal movement,
amniotic fluid volume, nonstress test
what is a modified biophysical profile? - (correct Answer) - NST + amniotic fluid index
reversal of umbilical artery diastolic flow indicates what? - (correct Answer) - IUGR
nerve responsible for perineal pain during delivery - (correct Answer) - pudendal (S2-S4)
lab values seen in hyperemesis gravidarum - (correct Answer) - high b-hCG, high estradiol, large
ketonuria (get a UA)
First step in dx of hyperemesis gravidarum? - (correct Answer) - rule out molar pregnancy w/ ultrasound
+/- b-hCG
Tx for hyperemesis gravidarum - (correct Answer) - Vit B6, antihistamines (doxylamine, promethazine,
dimenhydinate). If severe, metoclopramide, ondansetron, prochlorperazine. If dehydrated, IVFs, NPO,
parental nutrition, IV dimenhydrinate.
First step in management of gestational diabetes - (correct Answer) - ADA diet, exercise, glucose
monitoring. Insulin only if all this fails
Management of pregestational diabetic during labor - (correct Answer) - IV insulin drip and hourly
glucose measurements
antihypertensive meds in pregnancy - (correct Answer) - methyldopa (#1), metoprolol, nifedipine,
, hyralazine
Most likely cause of hemolytic anemia, elevated liver enzymes, and thrombocytopenia in pregnancy -
(correct Answer) - (HELLP syndrome) Vasospasm leading to hemorrhage and organ necrosis
Tx for preeclampsia if far from term? - (correct Answer) - modified bed rest and expectant management
How to administer magnesium for seizure prophylaxis in preeclampsia - (correct Answer) - continuous
MgSO4- IV drip
Dx: Pregnant woman present w/ vaginal bleeding & abdominal pain. US shows a retroperitoneal clot. -
(correct Answer) - placental abruption
Next step in management for mild placental abruption with premature fetus - (correct Answer) - bed rest
Management of placenta previa - (correct Answer) - No vaginal exam. Tocolytics. Betamethasone for lung
maturity. C-sec delivery.
Next step in assessing a reproductive age woman w/ acute onset abdominal pain, + pregnancy test and
empty uterus on US - (correct Answer) - serial hCG to confirm ectopic pregnancy
medical management for small, unruptured ectopic pregnancy - (correct Answer) - methotrexate
What should be given to an IUGR fetus near due date? - (correct Answer) - steroids (betamethasone) ≥
48 hrs prior to delivery to accelerate fetal lung maturity
fetal anomalies assoc. w/ polyhydramnios - (correct Answer) - duodenal atresia, TE fistula, anencephaly
What can be done for Rh isoimmunization hemolysis prior to delivery? - (correct Answer) - intrauterine
blood transfusion
Woman has gestational trophoblastic disease. What dietary modifications could have prevented this? -
(correct Answer) - Increase dietary folate and/or beta-carotene
chemo tx for malignant gestational trophoblastic tumors - (correct Answer) - MTX or dactinomycin
Uterus is evacuated of a "mass of grapes." Next step? - (correct Answer) - weekly b-hCG
recoil of the perineum during second stage of labor indicates impending... - (correct Answer) - shoulder
dystocia (this is called "turtle sign")
When is cervical ripening indicated? - (correct Answer) - failure to progress in latent stage; failure to have
progressive cervical change
What medicine is used for cervical ripening? - (correct Answer) - misoprostol (a prostaglandin)
Next step if pregnant woman presents w/ "gush of blood"? - (correct Answer) - nitrazine paper test, fern
test, or indigo carmine dye test
what is contraindicated on pts w/ PROM? - (correct Answer) - digital vaginal exam (increases risk for
infection)
steroids - (correct Answer) - inhibit IL-1 production
methotrexate - (correct Answer) - folic acid antagonist, inhibits DHF reductase, S-phase specific, inhibits
DNA synthesis
cyclosporine - (correct Answer) - calcineurin inhibitor; inhibits IL-2 production; nephrotoxic, gum
hypertrophy, hursutism
tacrolimus (FK506) - (correct Answer) - calcineurin inhibitor; inhibits signaling thru T cell receptor
mycophenylate mofeil - (correct Answer) - prevents T cell activation
azathioprine - (correct Answer) - antineoplastic; cleaved to mercaptopurine; inhibits DNA/RNA synthesis;
BM suppression
antithymocyte globulin (OKT3) - (correct Answer) - antibody against CD3 on T cells; causes pulmonary
edema
basiliximab, daclizumab - (correct Answer) - monoclonal antibody to IL-2 receptor
fetal heart tones begin at - (correct Answer) - 10-12 weeks
fetal quickening (movement) occurs at - (correct Answer) - 17-18 weeks
4 measurements that can be taken from fetal US - (correct Answer) - crown-rump length, biparietal
diameter, femur length, abdominal circumference
abdominal circumference - (correct Answer) - most reliable parameter for set. fetal weight in cases of
fetal growth restriction
Gestational sac is visible by what gestational age? - (correct Answer) - five weeks
b-hCG peaks when? - (correct Answer) - 10 weeks GA
average increase in weight during pregnancy - (correct Answer) - 25 lb (11 kg)
additional kcal needed during pregnancy - (correct Answer) - 100-300 kcal/day
when should supplemental iron be started in a pregnant woman? - (correct Answer) - first prenatal visit
What 2 supplement to pregnant vegans need? - (correct Answer) - Vit D, Vit B12
What cardiovascular parameters DECREASE during pregnancy? - (correct Answer) - blood pressure and
peripheral vascular resistance
What happens to electrolytes during pregnancy? - (correct Answer) - NOTHING! Remain unchanged.
,What causes herpangina? - (correct Answer) - coxsackievirus (an enterovirus)
How do you screen for Hep C on the first prenatal visit? What about Hep B? - (correct Answer) - Hep C -
history. Hep B - HBsAg
When is gestational diabetes screened for in pregnancy? - (correct Answer) - weeks 24-28
How are AFP results reported? - (correct Answer) - multiples of the median (MoM)
Quad screen shows "pan-low". - (correct Answer) - trisomy 18 (low AFP, low estriol, low b-hCG, low
inhibin A)
Quad screen shows low AFP, low estriol, high b-hCG, high inhibin A. - (correct Answer) - Down syndrome
Risk of fetal loss during chorionic villus sampling - (correct Answer) - 1%
Third trimester test used to detect presence of phosphatidylglycerol - (correct Answer) - amniocentesis
tetratogen that can cause lack of cranial ossification - (correct Answer) - ACEI
tetratogenic defects of streptomycin or kanamycin - (correct Answer) - hearing loss; CN VIII damage
2 tetratogens causing anotia or microtia - (correct Answer) - thalidomide, Vit A
can cause neonatal nasal hypoplasia an stippled bone epiphyses - (correct Answer) - warfarin
tetratogen assoc. w/ neonatal bowel atresia - (correct Answer) - cocaine
Woman with hyperhomocysteinemia loses a 19 week pregnancy. What enzyme is deficient? - (correct
Answer) - methylene tetrahydrofolate reductase
Amount of caffeine required to cause spontaneous abortion - (correct Answer) - >500 mg/day
Deficiency of what hormone increases risk for spontaneous abortion? (estrogen, progesterone, growth
hormone, testosterone, or FSH) - (correct Answer) - progesterone
Prophylactic med for toxo during pregnancy - (correct Answer) - spiramycin
Cardiac defect assoc. w/ congenital rubella - (correct Answer) - PDA
treatment for congenital CMV - (correct Answer) - postpartum ganciclovir
Pregnant HIV+ women should receive what prenatal meds? - (correct Answer) - AZT or nevirapine
When does an HIV+ women get a C-sec? - (correct Answer) - viral load >1000
eye disease in late congenital syphilis - (correct Answer) - interstitial keratitis
Tx for threatened AB - (correct Answer) - pelvic rest for 24-48 hrs, then follow up US
How can misoprostol be administered? - (correct Answer) - oral, vaginal, sublingual, buccal
2 meds used for first-trimester therapeutic abortions - (correct Answer) - misoprostol, mifepristone
,How does oxytocin work to induce or augment labor? - (correct Answer) - binds receptors on
myometrium, increases Ca influx to stimulate contractions
Components of a Bishop score - (correct Answer) - dilation, effacement, station, cervical position,
cervical consistency
Prolonged active stage of labor due to - (correct Answer) - cephalopelvic disproportion
things that can decreases fetal heart rate variability - (correct Answer) - hypoxia, opioids, magnesium,
sleep cycle
drug assoc. w/ a "pseudosinusoidal" variability pattern on fetal heart rate tracings - (correct Answer) -
meperidine
complication of a supine nonstress test - (correct Answer) - maternal hypotension
What is "15-15-2-20"? - (correct Answer) - Normal "reactive" nonstress test: 2 FHR accelerations ≥ 15
bpm above baseline lasting ≥ 15 sec over a 20 min period
Next step if nonstress test is nonreactive? - (correct Answer) - biophysical profile
How can you induce contractions in a contraction stress test? - (correct Answer) - nipple stimulation or
oxytocin
Next step if contraction stress test is positive - (correct Answer) - delivery
components of a biophysical profile - (correct Answer) - fetal tone, fetal breathing, fetal movement,
amniotic fluid volume, nonstress test
what is a modified biophysical profile? - (correct Answer) - NST + amniotic fluid index
reversal of umbilical artery diastolic flow indicates what? - (correct Answer) - IUGR
nerve responsible for perineal pain during delivery - (correct Answer) - pudendal (S2-S4)
lab values seen in hyperemesis gravidarum - (correct Answer) - high b-hCG, high estradiol, large
ketonuria (get a UA)
First step in dx of hyperemesis gravidarum? - (correct Answer) - rule out molar pregnancy w/ ultrasound
+/- b-hCG
Tx for hyperemesis gravidarum - (correct Answer) - Vit B6, antihistamines (doxylamine, promethazine,
dimenhydinate). If severe, metoclopramide, ondansetron, prochlorperazine. If dehydrated, IVFs, NPO,
parental nutrition, IV dimenhydrinate.
First step in management of gestational diabetes - (correct Answer) - ADA diet, exercise, glucose
monitoring. Insulin only if all this fails
Management of pregestational diabetic during labor - (correct Answer) - IV insulin drip and hourly
glucose measurements
antihypertensive meds in pregnancy - (correct Answer) - methyldopa (#1), metoprolol, nifedipine,
, hyralazine
Most likely cause of hemolytic anemia, elevated liver enzymes, and thrombocytopenia in pregnancy -
(correct Answer) - (HELLP syndrome) Vasospasm leading to hemorrhage and organ necrosis
Tx for preeclampsia if far from term? - (correct Answer) - modified bed rest and expectant management
How to administer magnesium for seizure prophylaxis in preeclampsia - (correct Answer) - continuous
MgSO4- IV drip
Dx: Pregnant woman present w/ vaginal bleeding & abdominal pain. US shows a retroperitoneal clot. -
(correct Answer) - placental abruption
Next step in management for mild placental abruption with premature fetus - (correct Answer) - bed rest
Management of placenta previa - (correct Answer) - No vaginal exam. Tocolytics. Betamethasone for lung
maturity. C-sec delivery.
Next step in assessing a reproductive age woman w/ acute onset abdominal pain, + pregnancy test and
empty uterus on US - (correct Answer) - serial hCG to confirm ectopic pregnancy
medical management for small, unruptured ectopic pregnancy - (correct Answer) - methotrexate
What should be given to an IUGR fetus near due date? - (correct Answer) - steroids (betamethasone) ≥
48 hrs prior to delivery to accelerate fetal lung maturity
fetal anomalies assoc. w/ polyhydramnios - (correct Answer) - duodenal atresia, TE fistula, anencephaly
What can be done for Rh isoimmunization hemolysis prior to delivery? - (correct Answer) - intrauterine
blood transfusion
Woman has gestational trophoblastic disease. What dietary modifications could have prevented this? -
(correct Answer) - Increase dietary folate and/or beta-carotene
chemo tx for malignant gestational trophoblastic tumors - (correct Answer) - MTX or dactinomycin
Uterus is evacuated of a "mass of grapes." Next step? - (correct Answer) - weekly b-hCG
recoil of the perineum during second stage of labor indicates impending... - (correct Answer) - shoulder
dystocia (this is called "turtle sign")
When is cervical ripening indicated? - (correct Answer) - failure to progress in latent stage; failure to have
progressive cervical change
What medicine is used for cervical ripening? - (correct Answer) - misoprostol (a prostaglandin)
Next step if pregnant woman presents w/ "gush of blood"? - (correct Answer) - nitrazine paper test, fern
test, or indigo carmine dye test
what is contraindicated on pts w/ PROM? - (correct Answer) - digital vaginal exam (increases risk for
infection)
