USMLE Step 2CK facts

Pediatrics (< 21yo):

1. Non-blanching purple lesion in the lower extremities with recent viral infection 3 days ago
1.  Henoch Scholein Purpura (Hen/noch Scho/len)
2. ddd

OBGYN:

1. ID and tx
1. Routine clean-catch urine culture in healthy, asymptomatic primigrivid woman grows greater than 100,00 colonies/mL of E. coli. Tx
1. Amoxicillin (or nitrofurantoin, or oral cephalosporin)
2. Guideline is to tx asymptomatic bacteriuria in pregnant women with antibiotics, esp betw 12-16 wks gestation
3. Complications of untx'd bacturia
1. invasive UTI
2. preterm deliveries
3. low birth-wt
2. first-line agent in the tx of pyelonephritis and uncomplicated cystitis in non-pregnant adults??
1. Ciprofloxacin??
3. Fluoroquinolones, potential complication to unborn fetus
1. arthropathy
4. Trimethroprim-sulfamethoxazole, when can be used during preg
1. 2nd trimester
2. 1st trimester interferes with folic acid metabolism
3. 3rd trimester can cause kernicterus
5. tx of gonorrhea decreases risk of
1. premature rupture of membrane and preterm labor
2. chorioamnionitis
2. Meds
1. SE of aspirin and NSAIDs during pregnancy
1. increases risk for miscarriage
2. promotes premature closure of fetal ductus arteriosus
3. Preventive medicine
1. All pregnant women without contraindications should receive
1. Flu shot
2. Test for every pregnant patient
1. STDs
1. pap smear if due
2. syphilis testing (Rapid plasma reagin test) (RPR) or venereal disease research laboratory (VDRL) test
1. if positive, confirm with
1. fluorescent treponemal antibody absorption (FTA-ABS) test
2. Tx
1. penicillin
3. Chlamydia testing (Chlamydia PCR)--test only in all women <=24yo and high risk
4. HIV test
2. Other inf^
1. Hep B anigen
3. electrolytes and markers
1. Rhesus type and antibody screen
2. Hematocrit, hemoglobin, MCV
4. Immunity
1. Rubella
2. Varicella
5. Urine
1. cx
6. Offer
1. genetic cystic fibrosis screening
2. Down syndrome testing
3. Not routinely tested. Test only for high risk pts
1. Thyroid fn
2. TB
3. Toxoplasmosis
4. Hemoglobin electrophoresis
5. Lead
4. Breasts
1. when mammography would be indicated
1. blood or guaiac+ fluid in nipple d/c or breast lump in > 30
2. when ultrasonogram is indicated
1. to distinguish fluid-filled mass from solid mass
2. to guide biopsies
3. Possible causes of glactorrhea?, wrk up?
1. Prolactinoma
2. hypothyroidism
3. overstimulation of the nipple
4. OCP
5. medications which lower dopamine levels
6. wrk up: 
1. R/o pregnancy
2. serum prolactin and TSH levels
3. Possible MRI of brain if prolactin is elevated

Neurology

1. Numbness (paresthesia) and burning in the right palm--compressed n.?
1. median n.neuropathy
2. most likely cause
1. carpal tunel syndrome, and its cause, initial tx, next steps
1. repetitive wrist flexion and extension
2. initial tx: neutral pn wrist splint
3. Nxt steps: analgesics (NSAIDs but not indomethacin?), direct injection of corticosteroids into the carpal tunnel
4. if hand weakness or m. atrophy progresses, open or endoscopic surgical decompression

ENT

1. Normal or positive bilateral Rinne test
1. if Weber lateralizes to the left
1. right sensorineural loss
2. If negative Rinne test on left (bone conduction > air conduction)
1. if Weber is normal or lat to the left
1. left conductive loss
2. if Weber lat to right
1. left mixed hearing loss
3. Common causes of conductive hearing loss
1. cerumen impaction
2. middle ear fluid or infection (chronic otitis media)
3. decreased movement of small bones of the ear
4. bony tumors of the middle ear
5. otosclerosis in adults, esp in the 20's and 30's--due to abnl remodeling of otic capule, possibly an autoimmune process--the stapes become fixed
1. Tx: hearing amplification or surgical stapedectomy
4. Possible causes of sensorineural hearing loss
1. Aminoglycosides
2. Meniere's disease (other sx's: aural fullness+ tinnitus)
3. Acoustic neuroma, aka vestibular schwannoma
4. Presbycusis--hearing loss with advanced age