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

Step 2 score estimator

http://www.medfriends.org/cgi-bin/step2_estimator.cgi

How I prepared for USMLE Step I

Resources used:

1. BRS Behavioral Science
2. BRS Physiology
3. BRS Path
4. Katzung Pharm
5. First Aide Step 1
6. USMLE Worldbank
7. Kaplan Online videos-pharm only
8. High Yield Anatomy
9. High Yield Neuroanatomy
10. WebPath
11. Goljan Rapid Review Path
12. NBME practice exams 1-4, 6
13. Prometic center practice exam 150Q

My experience with Step I, the 7-block, 8-hour exam:

1. I installed the Fred v.2 two days before the exam to read over the instructions and be familiar with the application interface.
2. On the day of the exam, I just tested the headphone and the media playing buttons in the tutorial, which took 2-4mins.
3. I took a 5-min break between each block (would have a sip of coffee and use the restroom)
4. Had 17 mins remaining for the last block--used the extra time to do a quick review from my cheat sheet of list of lists (include the CP450 inducers and inhibitors, autosomal dominant dz's, x-linked dz's, oncogenes with gene locations, tumor suppressors with gene locations...)
5. Took 3 mins longer than expected on my last break--but was able to finish the block, review all the marked questions, and unmarked questions without a problem.

How I would have done differently

1. Forget Kaplan videos!!!! It's too detail
2. I spent way too much time on studying the pharm. Should had just study the pharm from First Aide.
3. Like what StudentDoctor.net forum said, just do the USMLE World questions and read the explanations!!!!

Decompressing

Decompressing

Last Tuesday, June 15th, I took the first US medical licensing exam. With only six weeks to prepare for it, I used my time meticulously.

Basically,
1) Sat 15hrs straight studying
2) Spent 30 mins stretching and running on the treadmill
3) Used 1.5 hrs cooking and preparing meal
4) Took 1 hr of break and shower
5) Got 6 hours of sleep.
6) Gave myself 4 hrs off on Friday to go grocery shopping
7) No human contact whatsoever, except listening to the Pharm guy from Kaplan Medical 

It's been over a week now, really need to go over what I learned so that I can be ready for rotations.
Therefore, in the incoming entries, the topics may be more medical relevant to you readers.