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USMLE Step 2 CK → Pharmacotherapy and management

Pharmacotherapy and management for USMLE Step 2 CK

Pharmacotherapy and management accounts for roughly 10% of the USMLE Step 2 CK blueprint. This bank has 1 item tagged to it.

How much of USMLE Step 2 CK is pharmacotherapy and management?

Around 10% of the paper, per USMLE Content Outline and Specifications. That weighting is why the DocPasser mock builder samples sections in proportion rather than shuffling everything into one pile — practising a flat distribution trains you for a paper that does not exist.

Verification status. All 3 published figures on this page have been read in the source document and dated above. Source of truth: USMLE Content Outline and Specifications, NBME / FSMB. How we verify.

Sample pharmacotherapy and management questions

A 62-year-old woman is admitted with community-acquired pneumonia and started on levofloxacin. She takes amiodarone, citalopram and ondansetron. On day two her QTc is 520 ms and she has a run of polymorphic ventricular tachycardia with a twisting axis. What is the most appropriate immediate treatment?

  1. Intravenous magnesium sulfate and withdrawal of all QT-prolonging drugs correct Correct. This is torsades de pointes. Magnesium is the first-line treatment regardless of the serum magnesium level, and every contributing drug must stop. Correct potassium and calcium as well, and consider overdrive pacing or isoproterenol for recurrent episodes in bradycardia-dependent torsades.
  2. Intravenous amiodarone Wrong. Amiodarone prolongs the QT interval further and is one of the drugs contributing here.
  3. Immediate synchronized cardioversion regardless of hemodynamic state Wrong as the first step in a patient who is not in sustained arrest. Defibrillation is used if torsades degenerates to ventricular fibrillation or the patient becomes pulseless, but magnesium plus removing the causes is what treats the substrate.
  4. Intravenous procainamide Wrong. A class Ia agent that also prolongs the QT interval.
  5. Intravenous sotalol to suppress the arrhythmia Wrong. Sotalol is a class III agent that prolongs the QT interval and would worsen the situation.

The point: Stack QT-prolonging drugs and you get torsades: fluoroquinolones, macrolides, azoles, antipsychotics, methadone, ondansetron, SSRIs, class Ia and III antiarrhythmics. Magnesium first, stop the drugs, correct electrolytes. Never treat torsades with another QT-prolonging antiarrhythmic.

Source: AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias American College of Cardiology / AHA · tier 2, specialty society or college

The other sections of USMLE Step 2 CK

Internal medicine · Surgery · Obstetrics and gynaecology · Paediatrics · Psychiatry · Preventive medicine and population health · Emergency medicine · Professionalism, ethics and patient safety

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