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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#6 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Amoxicillin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: infectious_disease

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submitted by โˆ—derpymd(20)
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So we just assume all women of childbearing age are pregnant? I knew amoxicillin is 2nd line treatment, but chose propranolol because I knew stage 2 lyme has cardiac manifestations, I just couldn't remember what they were (AV block, by the way -- improves with antibiotics).

I suppose it's just safer to treat with amoxicillin than doxycycline just in case she's pregnant. ยฏ\(ใƒ„)/ยฏ

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bluebul  I didn't even get that far. Only way to prevent long term complications is with abx and we know metro isn't an option. Leaves only Amox. +4
machetebetty  I know that both Sketchy and Divine agree with doxy-except-when-pregnant-or-pediatric, but fwiw, to the extent the CDC is a "source of truth" for the USMLEs, they seem to regard them as equivalent (for this scenario). https://www.cdc.gov/lyme/treatment/index.html ...This also helps me feel less perturbed about the possible [ridiculous] assume-she's-pregnant thing, to @derpymd's point!! +



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submitted by โˆ—step_prep5(246)
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  • Young patient with headache, arthritis, fever several weeks after a red rash who has IgM antibodies (indicator of recent infection) positive for Borrelia burgdorferi, most consistent with Lyme disease
  • Lyme disease often treated with doxycycline, but in pregnant women and children it is often treated with amoxicillin or cefuroxime (due to teratogenic effects of doxycycline)

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