USMLE Step 2 CK

USMLE Step 2 CK :: RE: A 52-year-old man comes to your office for a new-patient vis

clark — Fri, 20 Nov 2009 08:49:20 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:19 pm (GMT 5.5)

E. Prednisone

USMLE Step 2 CK :: A 52-year-old man comes to your office for a new-patient vis

clark — Fri, 20 Nov 2009 08:48:42 GMT

Author: clark
Subject: A 52-year-old man comes to your office for a new-patient vis
Posted: Fri Nov 20, 2009 2:18 pm (GMT 5.5)

A 52-year-old man comes to your office for a new-patient visit. He has recently moved to the area and needs continuous medical care for pemphigus vulgaris, a chronic blistering autoimmune disease of 10 years� duration. With him, he brings extensive medical records from his previous physician. They include multiple hospitalizations and complicated treatment regimens used in the attempt to keep his skin disorder under control. Review of the records reveals multiple long courses of prednisone, mycophenolate mofetil, azathioprine, and cyclophosphamide. He has also undergone four courses of plasmapheresis in the past 2 years. Despite all that, the disease keeps recurring as soon as his medication is tapered. His medical history includes hypertension and adult onset diabetes mellitus. The family history is positive for hypertension and heart disease. On physical examination, the patient is in no acute distress. He weighs 198 lb and is 5 ft 8 in tall. His blood pressure is 140/85 mm Hg, pulse is 75/min, and respiratory rate is 16/min. You note that he has disproportionate body fat distribution and musculoskeletal changes (see photograph). There are multiple purple striae on his abdomen and proximal extremities.

Which of the following treatments is the most likely culprit for these changes?

A. Azathioprine
B. Cyclophosphamide
C. Mycophenolate mofetil
D. Plasmapheresis
E. Prednisone

USMLE Step 2 CK :: RE: A 68-year-old male with a history of coronary artery disease

clark — Fri, 20 Nov 2009 08:46:16 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:16 pm (GMT 5.5)

B.

Therapy with the antiplatelet agents ticlopidine and clopidogrel has been demonstrated to have superior effects compared with aspirin in preventing thromboembolic cerebrovascular disease. Ticlopidine and clopidogrel are structurally similar compounds that selectively inhibit ADP-induced platelet aggregation. The CAPRIE trial showed a small absolute risk reduction from 8 to 7% in cerebrovascular events in patients taking clopidogrel compared with aspirin. Ticlopidine is rarely used currently because of the risk of hematologic toxicities, including thrombotic thrombocytopenic purpura. Clopidogrel is associated with occasional thrombocytopenia but only rarely causes severe hematologic toxicity. There is no proven benefit in increasing aspirin doses to more than 325 mg daily, and increased gastrointestinal intolerance is likely at this dose. Dipyridamole inhibits platelet activation by inhibiting phosphodiesterase. The use of dipyridamole alone has increased the risk of recurrent events although there may additional benefit in terms of decreasing cerebrovascular events when it is used in combination with aspirin. Warfarin would be appropriate if the patient had atrial fibrillation.

USMLE Step 2 CK :: A 68-year-old male with a history of coronary artery disease

clark — Fri, 20 Nov 2009 08:45:15 GMT

Author: clark
Subject: A 68-year-old male with a history of coronary artery disease
Posted: Fri Nov 20, 2009 2:15 pm (GMT 5.5)

A 68-year-old male with a history of coronary artery disease presents with symptoms of slurred speech and weakness and clumsiness of the left arm that lasted less than 2 h. At the time of presentation to the emergency department, his symptoms had resolved entirely and the neurologic examination was normal. Current medications include aspirin 325 mg daily, atenolol 50 mg daily, and enalapril 20 mg twice daily. The workup does not show any significant carotid stenosis or atrial fibrillation. You diagnose a transient ischemic attack. What treatment do you advise?

A. Increase the aspirin dose to twice daily.
B. Initiate therapy with clopidogrel.
C. Initiate therapy with warfarin.
D. Discontinue aspirin and initiate therapy with dipyridamole.
E. Make no changes in the patient's current regimen.

USMLE Step 2 CK :: RE: A 52-year-old woman who is unhappy with her previous medical

clark — Fri, 20 Nov 2009 08:44:32 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:14 pm (GMT 5.5)

The answer is E. The patient has evidence of chronic hepatitis C infection and is a candidate for monotherapy with interferon or combination therapy with interferon plus ribavirin. Most authorities recommend that prior to the initiation of therapy a liver biopsy be performed to assess the severity of the disease and to obtain prognostic information.

While it is prudent to follow LFTs (choice A) in patients with chronic hepatitis C infection, in this patient with known long standing abnormalities it is more important to evaluate her for possible treatment with a biopsy.

Some authorities recommend that patients with chronic hepatitis be screened with ultrasounds (choice B) every 6�12 months for the development of liver cancer. But as discussed previously in this patient, it is imperative that she be evaluated now for possible treatment.

Alpha-fetoprotein levels (choice C) are elevated in some patients with liver cancer. In the past it has been used to screen patients with chronic hepatitis for cancer but there has been some recent controversy about the utility of this approach. In this patient with a normal ultrasound, a liver biopsy is a more pressing test than a AFP level

In the evaluation and management of this patient an MRI (choice D) is not necessary. If there was concern for a malignancy an MRI of the liver can provide useful information.

USMLE Step 2 CK :: A 52-year-old woman who is unhappy with her previous medical

clark — Fri, 20 Nov 2009 08:43:59 GMT

Author: clark
Subject: A 52-year-old woman who is unhappy with her previous medical
Posted: Fri Nov 20, 2009 2:13 pm (GMT 5.5)

A 52-year-old woman who is unhappy with her previous medical care comes to you for evaluation of a long-standing history of abnormal "liver tests." She is in generally good health and is on no medications. She has had only one sexual partner, her husband of 28 years, and denies any injection drug use. She has no family history of liver disease but did have multiple transfusions many years ago after an automobile accident. She has no current symptoms of liver disease and her physical examination is normal. An ultrasound of the liver is unremarkable. Laboratory studies show:

SGOT 146 U/L
SGPT 127 U/L
Hepatitis C antibody Positive

The next most appropriate step in the management of this patient is to

A. observe and repeat liver function tests in 3 months
B. observe and repeat ultrasound in 3 months
C. order an alpha-fetoprotein level
D. order an MRI of the abdomen
E. refer the patient for a liver biopsy

USMLE Step 2 CK :: RE: A 6-month-old male infant is seen in your office for failure

clark — Fri, 20 Nov 2009 08:43:29 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:13 pm (GMT 5.5)

B.
sandifer syndrome.... GER + opisthotonus

USMLE Step 2 CK :: A 6-month-old male infant is seen in your office for failure

clark — Fri, 20 Nov 2009 08:42:59 GMT

Author: clark
Subject: A 6-month-old male infant is seen in your office for failure
Posted: Fri Nov 20, 2009 2:12 pm (GMT 5.5)

A 6-month-old male infant is seen in your office for failure to thrive. The mother of the child says that he always regurgitates shortly after feedings, and that he had few episodes of blood stained projectile vomiting. She also reports that during the vomiting episodes, the child assumes a position with his head tilted to the left side and his back arched. On examination the child is afebrile and his abdomen is soft and non-tender to palpation. Laboratory evaluation shows hypochromic microcytic anemia. Which of the following is the most appropriate test to confirm the most likely diagnosis in this child?

A. X-ray chest (anteroposterior view)
B. Esophageal pH monitoring study
C. Esophageal manometry study
D. Barium swallow study
E. Technetium (Tc) sulfur colloid gastroesophageal scan

USMLE Step 2 CK :: RE: A 62-year-old man comes to the clinic concerned that he migh

clark — Fri, 20 Nov 2009 08:41:46 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:11 pm (GMT 5.5)

This is actinitic keratosis...so answer is A. A small number of these lesions develop into squamous cell skin cancer

USMLE Step 2 CK :: A 62-year-old man comes to the clinic concerned that he migh

clark — Fri, 20 Nov 2009 08:41:04 GMT

Author: clark
Subject: A 62-year-old man comes to the clinic concerned that he migh
Posted: Fri Nov 20, 2009 2:11 pm (GMT 5.5)

A 62-year-old man comes to the clinic concerned that he might have skin cancer. He is worried about two �bumps� on the back of his neck. The bumps have been present for at least 6 months and may be growing slowly, though he is not certain. He points out that he is a commercial fisherman and is often in the sun, having had countless sunburns over the years. Aside from his anxiety over the bumps on his neck, he reports feeling healthy. He denies any other lesions, and a review of symptoms is unremarkable. Physical examination reveals two firm, well marginated, reddish, 1.5-cm papules that have a rough feel and some surrounding erythema. A biopsy is performed that reveals a clonal proliferation of atypical but well differentiated keratinocytes. This patient should be told which of the following?

A. A small number of these lesions develop into squamous cell skin cancer
B. No further treatment is necessary, though suntan lotion should be used regularly
C. Prolonged sun exposure on this type of skin lesion increases the risk for melanoma
D. The biopsy and physical findings are consistent with the most common skin cancer
E. This lesion likely represents skin cancer; an operation

USMLE Step 2 CK :: RE: A 26-year-old woman with widespread psoriasis comes to the o

clark — Fri, 20 Nov 2009 08:39:28 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:09 pm (GMT 5.5)

The answer is A. An increased understanding of the immunologic basis of psoriasis, combined with major advances in various scientific disciplines, is enabling the development of new biologic therapies that selectively target the underlying cause of the disease. Biologic therapies are drugs that target the activity of T lymphocytes and cytokines responsible for the inflammatory nature of psoriasis. Alefacept is a dimeric fusion protein that binds to CD2 on memory-effector T cells, resulting in the inhibition of T cell activation and a reduced number of memory-effector T lymphocytes. Because it invariably causes apoptosis of T cells, a weekly CD4+ T cell count is mandatory to ensure patient safety. If the CD4+ count is 250 cells/mL or less, a dose of alefacept is deferred. If a week later the count remains at 250 cells/mL or less, the drug is discontinued altogether.

A complete blood count (choice B) is required at baseline and then initially weekly for monitoring of patients on methotrexate. Anemia and thrombocytopenia may develop soon after the drug is initiated and may require lowering the dose or complete discontinuation of the medication.

Fasting lipids (choice C) are mandatory at baseline and then on a monthly basis in all patients treated with systemic retinoids (acitretin or isotretinoin). Reversible elevation of the triglycerides may occur and treatment with lipid-lowering agents or discontinuation of the medication may be required.

Liver function tests (choice D) are performed on a monthly basis in patients with psoriasis treated with methotrexate and retinoids, as they may develop elevated transaminases. These changes are usually reversible on discontinuation of the medication.

A platelet count (choice E) is mandatory at baseline and then weekly for patients with psoriasis on methotrexate until the dose is stable. Subsequently, monitoring frequency can be reduced to biweekly or monthly for as

USMLE Step 2 CK :: A 26-year-old woman with widespread psoriasis comes to the o

clark — Fri, 20 Nov 2009 08:38:56 GMT

Author: clark
Subject: A 26-year-old woman with widespread psoriasis comes to the o
Posted: Fri Nov 20, 2009 2:08 pm (GMT 5.5)

A 26-year-old woman with widespread psoriasis comes to the office for a followup visit. She is concerned that the topical medications prescribed 1 month earlier are not working. She has dealt with the disease since she was 18 years of age and is quite frustrated with the efficacy of available treatments. Over the years she has been on methotrexate, ultraviolet light therapy, and cyclosporine, with variable results. During the visit she inquires if any new treatment alternatives have become available. Otherwise she is in good health and has no complaints. Her current medications include topical clobetasol dipropionate and topical calcipotriol. The family history is unremarkable. On physical examination, she is in no acute distress and her vital signs are within normal limits. A recent complete blood count, liver function test, and fasting lipid profile were all within the normal range. Inspection of the skin reveals generalized discrete and confluent erythematous plaques with silvery scale involving greater than 30% body surface area. There is prominent nail pitting and onycholysis. You tell her that there is a new class of biologic drugs that have become available recently for the treatment of moderate to severe psoriasis. You prescribe alefacept and explain that she will need to have weekly blood tests to monitor which of the following?

A. CD4+ T cell count
B. Complete blood count
C. Fasting lipids
D. Liver function tests
E. Platelet count

USMLE Step 2 CK :: RE: A 43-year-old man comes to your office for a periodic health

clark — Fri, 20 Nov 2009 08:38:26 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:08 pm (GMT 5.5)

The answer is D. The sad truth about the addictive nature of nicotine is that patients often require five or more attempts at quitting over the course of a few years prior to being successful. This fact makes it especially difficult to assist patients in quitting since the time to success is so long and so many attempts and failures often lead to patient frustration.

After six months of abstinence, relapse rates in fact decrease (choice A), not increase.

The average patient after they quit gains 7-12 pounds, not minimal (choice B) by most standards and less than 25% gain more than 25 pounds (choice C) if successful.

Because most patients require multiple attempts over years, he is not likely to quit after the second attempt (choice E).

USMLE Step 2 CK :: A 43-year-old man comes to your office for a periodic health

clark — Fri, 20 Nov 2009 08:37:54 GMT

Author: clark
Subject: A 43-year-old man comes to your office for a periodic health
Posted: Fri Nov 20, 2009 2:07 pm (GMT 5.5)

A 43-year-old man comes to your office for a periodic health maintenance examination. He is a manager at a local pet store and considers his life high stress. He has no current medical issues and takes only a multivitamin daily. He smokes one pack of cigarettes per day for the previous 21 years, drinking social ethanol, but denies any illicit substance abuse. His last fasting cholesterol level is 219 mg/dL. The patient admits to having attempted to quit smoking in the past and is frustrated at his failure. However, he does not want to talk about �all those risks� associated with smoking right now. The most accurate statement concerning his likely success at quitting is:

A. After 6 months of abstinence, relapse rates increase dramatically
B. He is likely to gain minimal weight if successful
C. He is likely to gain 25-30 pounds if successful
D. He is likely to quit after 5 or 6 attempts
E. He is likely to quit after the second attempt

USMLE Step 2 CK :: RE: You are called to the leukemia service to evaluate a 32-year

clark — Fri, 20 Nov 2009 08:35:38 GMT

Author: clark
Posted: Fri Nov 20, 2009 2:05 pm (GMT 5.5)

A.

Infections in patients who are undergoing chemotherapy are extremely common, particularly in neutropenic patients (neutrophils <500/mL3). Typhlitis, also referred to as necrotizing enterocolitis, is a poorly understood phenomenon that occurs primarily in immunocompromised patients. It probably involves a combination of mucosal injury to the bowel wall from cytotoxic chemotherapy, neutropenia, and impaired host defense against microorganisms. The cecum is almost always involved, but other parts of the ascending colon and terminal ileum also may be involved. Blood, stool, and C. difficile cultures should always be performed. A surgical consult is mandatory, and patients with evidence of bowel perforation or infarction should receive an exploratory laparotomy. Others may be treated conservatively with broad-spectrum antibiotics, serial examinations, and periodic CT scans.

USMLE Step 2 CK :: You are called to the leukemia service to evaluate a 32-year

clark — Fri, 20 Nov 2009 08:34:47 GMT

Author: clark
Subject: You are called to the leukemia service to evaluate a 32-year
Posted: Fri Nov 20, 2009 2:04 pm (GMT 5.5)

You are called to the leukemia service to evaluate a 32-year-old female with right lower quadrant pain. She has noted fevers and sweats for 1 day and diarrhea that is streaked with blood. She has acute myeloid leukemia (AML) and completed induction chemotherapy with cytarabine and daunorubicin 10 days ago. The examination is notable for stable vital signs, petechiae throughout the skin, and right lower quadrant tenderness. There is no rebound. Bowel sounds are present, and her stool is heme-positive. Laboratory values are notable for a white blood cell count of 100 cells/m3. Lactate is normal. Clostridium difficile toxin of the stool is negative. A CT scan is performed, which shows a thickened cecal wall with some fat stranding. There is no abscess or free intraabdominal air. You draw blood cultures, start broad-spectrum antibiotics, and call for a surgical consult. What is the diagnosis?

A. Typhlitis
B. Bowel infarction
C. Diverticulitis
D. Leukemic infiltration of the colon
E. Cytarabine toxicity

USMLE Step 2 CK :: RE: A 28-year-old man complaining of a severe outbreak of pimple

meenaxi — Fri, 20 Nov 2009 08:32:44 GMT

Author: meenaxi
Posted: Fri Nov 20, 2009 2:02 pm (GMT 5.5)

The answer is B. This patient has developed gram-negative folliculitis, an infectious complication that develops in patients with acne vulgaris or rosacea treated with` systemic antibiotics for a prolonged time. Gram-negative folliculitis should be considered in patients with acne who have a flare of pustular or cystic lesions or if the acne is resistant to treatment. Systemic antibiotics alter the nasal flora with resultant overgrowth of gram-negative bacteria leading to folliculitis. The gram-negative microorganisms responsible include Escherichia coli, Klebsiella species, Serratia species, Proteus species, and, rarely, Pseudomonas aeruginosa. Treatment of choice is with isotretinoin and systemic antibiotics chosen according to results of culture and sensitivity studies.

Demodex folliculorum (choice A) is a mite normally found to inhabit the follicular infundibula of adults. It has been implicated in the pathogenesis of rosacea in the past, but no studies have been able to prove a causal relationship.

Pityrosporum ovale (choice C) is a yeast that is normally present in the scalp of adults. Overgrowth causes the clinical picture of tinea versicolor, where slightly pink, scaly macules and patches appear on the neck, shoulders and back of young adults who sweat profusely.

Propionibacterium acnes (choice D) is a bacterium normally found to inhabit the pilosebaceous follicle of adults. It is important in the pathogenesis of acne because it hydrolyses lipids to free fatty acids, which cause inflammation and rupture of the hair follicle, leading to development of inflammatory lesions.

Staphylococcus aureus (choice E) is a bacterium that commonly causes impetigo of the skin, especially in children. Erythematous, ill-defined patches covered with honey-colored, sticky crusts develop at sites of infection. Autoinoculation with adjacent spread is very common. Diagnosis is based on clinical examination and skin cultures. Treatment is with topical and oral antibiotics

USMLE Step 2 CK :: A 28-year-old man complaining of a severe outbreak of pimple

meenaxi — Fri, 20 Nov 2009 08:32:08 GMT

Author: meenaxi
Subject: A 28-year-old man complaining of a severe outbreak of pimple
Posted: Fri Nov 20, 2009 2:02 pm (GMT 5.5)

A 28-year-old man comes to your office complaining of a severe outbreak of pimples that started a week earlier. You have been treating him for acne for the past several months with a combination of oral doxycycline, topical clindamycin, and a salicylic acid cleanser. He was doing well, with a reduction in inflammatory lesions at his most recent visit three weeks earlier. The patient tells you that he had stopped taking the doxycycline because he was doing so well, and within days, developed hundreds of new lesions. He has no other complaints and is in good health. His current medications are topical clindamycin and a multivitamin. On physical examination, the patient is in no acute distress, and his vital signs are normal. Inspection of the skin reveals hundreds of uniform, follicle-centered erythematous papules with central pustules on the face, neck, chest, back, and shoulders. Which of the following pathogens is most likely responsible for this patient's skin lesions?

A. Demodex folliculorum
B. Escherichia coli
C. Pityrosporum ovale
D. Propionibacterium acnes
E. Staphylococcus aureus

USMLE Step 2 CK :: RE: Treatment of a large scar on the back of her left arm. While

meenaxi — Fri, 20 Nov 2009 08:30:39 GMT

Author: meenaxi
Posted: Fri Nov 20, 2009 2:00 pm (GMT 5.5)

C. Intralesional corticosteroids

USMLE Step 2 CK :: Treatment of a large scar on the back of her left arm. While

meenaxi — Fri, 20 Nov 2009 08:30:04 GMT

Author: meenaxi
Subject: Treatment of a large scar on the back of her left arm. While
Posted: Fri Nov 20, 2009 2:00 pm (GMT 5.5)

A 19-year-old African American woman comes to see you for treatment of a large scar on the back of her left arm. While trying to replace a mirror in her bathroom last month, the mirror slipped and the broken glass cut her arm. The wound was sutured in the emergency department and originally healed well. Since then, however, the scar has become large, disfiguring, and painful. She had a similar problem at age 16 years. At that time she had both her ears pierced and had to have scar tissue surgically removed 6 months later. Aside from an appendectomy at age 14 years, her past medical history is unremarkable. Vital signs are: temperature 37.0 C (98.6 F), blood pressure 118/70 mm Hg, pulse 62/min, and respirations 20/min. Examination of her skin shows a 4-cm scar on her left arm with heaped-up margins approximately 1 cm above the skin. Examination of her abdomen shows an additional hypertrophic scar with margins approximately 0.5 cm above the surface of the abdomen. Which of the following is the most appropriate first-line treatment for this patient?

A. Cryosurgery
B. Empiric antibiotics
C. Intralesional corticosteroids
D. Radiation therapy
E. Surgical resection

USMLE Step 2 CK :: RE: A 40-year-old female complains of lower back pain for the la

meenaxi — Fri, 20 Nov 2009 08:26:29 GMT

Author: meenaxi
Posted: Fri Nov 20, 2009 1:56 pm (GMT 5.5)

D.

Back pain is an extremely common occurrence. Normally, the presence of back pain in a young woman would not prompt further evaluation. However, concerning features here are the lack of trauma or exertion to explain the onset of pain and the prior history of malignancy. Patients with cancer who develop back pain must be evaluated for spinal cord compression as quickly as possible. Symptoms may precede neurologic changes by many weeks to months. Treatment is far more successful in ambulatory patients with minimal symptoms than it is in patients with significant neurologic compromise. Indeed, only 10% of patients with paraplegia recover the ability to walk. Conservative measures such as observations, serial examinations, and physical therapy are therefore not options. Imaging of the spine should be done. Plain films may show obvious erosion of the bony architecture. Bone scans may show metabolic changes throughout the spine. However, their sensitivity in evaluating the spinal cord is limited. For proper visualization of the spinal cord and nerve roots, an MRI of the spine is mandatory. If evidence of neurologic compromise develops or metastatic disease is definitively identified, glucocorticoids are required and consultation with the radiation oncology department is necessary. In tumors that are less radiosensitive or in selected patients, surgical laminectomy may be considered.

USMLE Step 2 CK :: A 40-year-old female complains of lower back pain for the la

meenaxi — Fri, 20 Nov 2009 08:25:44 GMT

Author: meenaxi
Subject: A 40-year-old female complains of lower back pain for the la
Posted: Fri Nov 20, 2009 1:55 pm (GMT 5.5)

A 40-year-old female complains of lower back pain for the last 2 weeks. She denies recent trauma or exertion. She also denies radiation down her legs, fevers, chills, or sweats. The past medical history is significant for treated stage II breast cancer. Her treatment chemotherapy and radiation ended 1 year ago. The patient is currently on tamoxifen. The physical examination is notable for a left lumpectomy scar. There is no point tenderness over the spine. The straight leg test is negative bilaterally. Sphincter tone and reflexes are normal. What is the most appropriate management?

A. Observation
B. Physical therapy
C. X-ray of the spine
D. Magnetic resonance imaging (MRI) of the spine
E. Bone scan

USMLE Step 2 CK :: RE: A 30-year-old male is admitted for acute myeloid leukemia.

meenaxi — Fri, 20 Nov 2009 08:25:05 GMT

Author: meenaxi
Posted: Fri Nov 20, 2009 1:55 pm (GMT 5.5)

B.

Long-term complications of cancer treatment are common. Because the care of cured oncology patients often is the responsibility of primary care specialists, awareness of potential long-term complications is crucial. Patients treated with radiation therapy have a significantly increased risk of developing second solid tumors, usually in or adjacent to the radiation field. Some populations followed for 25 years or more have more than a 25% chance of developing a second treatment-related tumor. The risk of hematologic malignancy is much lower. Tobacco poses a risk of malignancy, particularly lung, bladder, esophageal, and head and neck cancer. It does not pose a significant risk for leukemia. Lynch syndrome refers to genetic defects in mismatch repair that predispose to a variety of malignancies. It encompasses the hereditary nonpolyposis colon cancer syndrome. Establishment of the familial nature of the disorder often requires identification of multiple individuals with cancer in different generations. Certain chemotherapeutics pose risks for myelodysplasia and acute leukemia. Patients treated with alkylating agents in combination with radiation therapy may develop malignant leukemic cells that typically carry deletions in chromosome 5 or 7. The peak incidence is 4 to 6 years after treatment. Topoisomerase II inhibitors used at high doses may result in leukemias showing defects in particular chromosomes (e.g., 11q23). The incidence of leukemia in this situation peaks 1 to 3 years after treatment.

USMLE Step 2 CK :: A 30-year-old male is admitted for acute myeloid leukemia.

meenaxi — Fri, 20 Nov 2009 08:23:52 GMT

Author: meenaxi
Subject: A 30-year-old male is admitted for acute myeloid leukemia.
Posted: Fri Nov 20, 2009 1:53 pm (GMT 5.5)

A 30-year-old male is admitted for acute myeloid leukemia. His past medical history is significant for treatment of early-stage non-Hodgkin's lymphoma (cyclophosphamide, doxorubicin, vincristine, prednisone) and involved-field radiation 9 years earlier. He has a 12 pack-year history of tobacco and works as a welder. He has no family history of cancer. The examination is notable only for pallor and some petechiae on the torso and lower extremities. Complete blood counts show that all three cell lineages are low. Cytogenetics shows a deletion in chromosome 5. What is the most likely cause of his acute myeloid leukemia?

A. Chemotherapy
B. Radiation
C. Combined modality therapy
D. Tobacco
E. Lynch syndrome

USMLE Step 2 CK :: RE: Substernal chest pain with radiation of pain down the left a

meenaxi — Fri, 20 Nov 2009 08:22:00 GMT

Author: meenaxi
Posted: Fri Nov 20, 2009 1:52 pm (GMT 5.5)

E. Isolated right ventricular infarction