USMLE Step 2 2023 Questions and Answers 100% Correct

Cx of Kawasaki disease? - ANSWER-Coronary artery aneurysm formation Babesiosis 1. Vector: 2. PE: 3. Rx: - ANSWER-1. Tick bite 2. Jaundice, hemolytic anemia, NO RASH 3. Quinine-Clindamycin or Atovaquone-Azithromycin Ehricholisis 1. Vector: 2. PE: 3. Why susceptible to candidia? 3. Rx: - ANSWER-1. Tick 2. Fever, malaise, H/A, N/V, NIL Jaundice, hemolysis, rash (uncommon) 3. Infect and kills WBC -- neutropenia 4. Chloramphenicol Q fever 1. Organism: 2. MC patient: 3. PE: 4. Rx: - ANSWER-1. Coxiella burnetti 2. Meat worker, veterinarian 3. Flu-like, hepatitis, pneumonia, endocarditis 4. Tetracycline or fluoroquinolone 15 yo PE: dysarthria, ataxia, scoliosis, hammer toes Dx: MCC of death: - ANSWER-Friedrich ataxia (MC spinocerebellar ataxia) - think neuro, skeletal, cardiac Cardiomyopathy Rheumatic fever Onset: PE: - ANSWER-1-3 weeks post Strep pyogenes infection (GAS) Arthritis, carditis, chorea, subcutaneous nodules, erythema marginatum Language development: Babbles 2 words, obeys 1-step command 2-3 word phrases, obeys 2-step command - ANSWER-babbles = 6 months 2 words = 1 year 2-3 word phrases = 2 years Gross motor development Holds head Sits unsupported Walks alone Walks up and down stairs - ANSWER-Holds head = 3 months Sit unsupported = 6 months Walks alone = 1 year Walks up and down stairs = 2 years Fine motor development Raking grasp Throws objects Builds tower of 2 blocks Builds tower of 6 blocks/turn pages - ANSWER-Raking grasp = 6 months Throws objects = 12 months Builds tower of 2 blocks = 15 months 6 blocks / turns pages = 2 years Social development Recognizes parents Stranger fear Plays w/ others Parallel play - ANSWER-Recognizes parents = 2 months Stranger fear = 6 months Plays w/ others = 18 months Parallel play = 2 years Croup (larngotracheobronchitis) PE: MCC: - ANSWER-Hoarseness, barking cough (laryngeal inflammation) Parainfluenza Meningococcemia Rx: - ANSWER-Immediate! 3rd generation ceph: ceftriaxone or cefotaxime If penicillin susceptible, may switch to penicillin after blood tests confirm Brochogenic cysts are located where in mediastinum? Nuerogenic tumors? AAA Thymoma? - ANSWER-Bronchogenic cysts = middle mediastinum Neurogenic tumor: posterior mediastinum AAA = posterior mediastinum Thymoma = anterior mediastinum DUB in women >35 yo BIT? - ANSWER-Endometrial biopsy Effects of high cortisol: vascular: insulin: electrolytes: - ANSWER-Vasoconstriction Insulin resistance (hyperglycemia) Hypokalemia Reye Syndrome 1. Also known as what? 2. Prodrome? 3. Rx? - ANSWER-1. Fatty liver w/ encephalopathy (mitochondrial damage) 2. URTI 3. Glucose, FFP, mannitol Treatment of choice for adjustment disorder? - ANSWER-Psychodynamic psychotherapy Absence of lower esophagus peristaltic waves and increased LES tone? Rx? Cx? - ANSWER-Achalasia Rx: Esophageal balloon dilation Cx: Heartburn PE of congenital rubella? - ANSWER-Deafness, cataract, cardiac PE of congenital toxoplasmosis? - ANSWER-Chorioretinitis, hydrocephalus, intracranial calcification 1. Causes of protracted labor? 2. Treatment for a women in protracted labor? - ANSWER-1. Power, Passenger, Pelvis 2. Oxytocin or amniotomy If protracted labor becomes arrested labor, CS is next option Cardiac tamponade EKG? Pulmonary findings? What other sign? - ANSWER-1. Electrical alternans (varying QRS lengths) 2. Lungs are clear! 3. Pulsus paradoxus Constrictive pericarditis Auscultation? Sign? - ANSWER-1. Pericardial knock (diastolic, S3) 2. Kussmaul's sign CSF lab findings in HSV encephalitis 1. Lympocytes? 2. RBC? - ANSWER-1. increased lymphocytes 2. increased RBC (hemorrhagic fronto-temporal lobe) Which 1 has oral lesions: pemphigus vulgaris or bullous pemphigoid? - ANSWER-pemphigus vulgaris TB pleural exudate 1. Protein? 2. Glucose? 3. WBCs? - ANSWER-1. Increased protein 2. Normal glucose 3. Lots of lymphocytes Empyema pleural exudate 1. Glucose? 2. WBCs? - ANSWER-1. Low glucose 2. Neutrophils thick pus 1. BDT for spontaneous bacterial peritonitis? 2. Abdomen on palpation? 3. Rx? - ANSWER-1. Paracentesis: >250 neutrophils 2. No guarding or palpation 3. IV antibiotics anti-centromere? - ANSWER-Scleroderma --> CREST SIADH Define: Plasma Os? Plasma Na? Urine Os? Urine Na? - ANSWER-Free water retention Plasma Os: decreased Plasma Na: decreased Urine Os: Increased Urine Na: Increased TB CXR? - ANSWER-Unilateral upper lobe infiltrate w/ cavitation Hilar lymphadenopathy Etiology of SIADH? Rx? - ANSWER-Any lung malignancy (SCC, sarcoid, TB) Drugs eg SSRI Rx: fluid restriction DI Define: PE: Serum Os Serum Na Urine Os Urine Na - ANSWER-Define: Inability to concentrate urine PE: polyuria, polydipsia Serum Os increased Serum Na increased (hypernatremia) Urine Os decreased Urine Na decreased Rx of Peripheral DI - ANSWER-Diuretics: HCTZ (increase Na excretion) NSAIDS Takayasu's vasculitis 1. What type of vasculitis? 2. PE - ANSWER-1. Granulomatous vasculitis 2. Absent upper extremity pulse (pulseless disease), vision problems, stroke) Wegener's 1. What type of vasculitis? 2. PE? - ANSWER-1. Granulomatous 2. Upper and lower respiratory tract! (+kidney!) Churg-Strauss 1. Vasculitis? 2. PE? - ANSWER-Granulomatous Allergic rhinitis, eosinophils Kawasaki Disease 1. Vasculitis? 2. PE 3. Rx? 4. Cx of Kawasaki? - ANSWER-1. Necrotizing 2. Fever, red conjunctiva, oral mucous membrane involvement, erythema of palms and soles, cervical lymphadenopathy 3. IVIG + aspirin 4. Heart failure, Coronary occlusion Pupil size 1. Opiod OD 2. Benzo OD - ANSWER-1. Miosis 2. Normal size Rx of Opiod OD? - ANSWER-Naloxene Beta-blocker OD 1. PE? 2. Rx? - ANSWER-1. Bradycardia and hypotension 2. Glucagon Rx of Benzo intox - ANSWER-Flumazenil Farmer who OD's on organophosphates. Best 1st 2 things to do? - ANSWER-Remove all clothing and wash body. Give atropine TCA overdose 1. What will be on EKG? 2. Rx? 3. If pt died, MCC? - ANSWER-1. Prolonged QRS (decreases myocardial conduction velocity by inhibiting fast Na channels) 2. Sodium bicarbonate (shortens QRS) 3. Ventricular arrythmia Distinguish ethylene glycol and methanol OD - ANSWER-Ethylene glycol: kidneys Methanol: eyes Aspirin OD PE? - ANSWER-Tinnitus, fever, hyperventilation Cohort study with ~40% of participants lost to follow-up creates what type of bias? - ANSWER-Selection bias Observer bias or ascertainment bias come about how? - ANSWER-Flaws in study design Recall bias is a potential problem in what type of study? - ANSWER-case-control z-test or t-test do what? - ANSWER-Compare 2 means (not proportions) ANOVA test is used for what? - ANSWER-Compare means of 3 or more variables Chi-square is used for what? - ANSWER-Compare proportions Is a case control study a prospective or retrospective study? - ANSWER-retrospective. The movement if from the EFFECT to the CAUSE Best study to calculate incidence? Best study to calculate prevalence? - ANSWER-Incidence = Cohort Prevalence = Cross-sectional Positive predictive value is related to what? - ANSWER-PPV = prevalance. The higher the prevalance the higher the PPV Null value of correlation coefficient? Range? - ANSWER-0 -1 to 1 Calculate Sn Calculate Sp - ANSWER-Sn = TP / (TP+FN) Sp = TN / (TN+FP) What is the purpose of randomization? - ANSWER-To reduce confounding factors Calculate attributable risk percent - ANSWER-ARP = RR - 1 / RR Rx for Tourette syndrome? - ANSWER-Typical anti-psychotics (eg pimozide or haloperidol) Nueroleptic Malignant Syndrome Typical pt? PE? Rx? Cx? - ANSWER-Schizophrenic pt taking anti-psychotic (Dopamine antagonists) PE: Fever, muscle rigidity, autonomic instability, mental status change Rx: Dantrolene (muscle relaxant) followed by bromocriptine and amantadine Cx: Rhabdomyolysis -> AKI What is the defense mechanism; conversion? - ANSWER-Emotional conflicts are transformed into physical symptoms. eg hearing bad news and becoming mute Time length criteria to diagnose generalized anxiety disorder (GAD)? Rx? - ANSWER->6 months of excessive worry/anxiety Buspirone What is trichotillomania? - ANSWER-Impulse-control disorder characterized by compulsive hair pulling 1. What is reaction formation? 2. What is sublimation? 3. What is altruism? 4. What is projection? - ANSWER-1. Transformation of an unwanted thought into it's opposite (immigrants --> help immigrant families) 2. Unacceptable impulses channeled into acceptable activities (anger --> boxing classes) 3. Provide a helpful service as a means of reducing their own anxiety (rape --> establish rape crisis center) 4. Attributing unacceptable internal thoughts onto others (eg unfaithful husband accuses his wife of cheating) 1. MC side effect of olanzapine? 2. MC side effect of clozapine? - ANSWER-1. weight gain (diabetes mellitus) 2. agranulocytosis DOC for pts presenting w/ alcohol withdrawal? - ANSWER-Chlordiazepoxide (long-acting benzo) Donepezil, rivastigmine, galantamine, and tacrine are used for what? - ANSWER-Alzheimer's dementia Bereavement Timeline? - ANSWER-Should taper w/in 2 months Guidelines for stopping Li for a bipolar patient? - ANSWER-Single manic episode: Li for at least 1 yr. Then may taper off and discontinue >3: lifelong Li therapy Major depressive disorder + impotent. DOC? MOA? CI to the drug? - ANSWER-- Bupropion - Inhibits norepi and dopamine reuptake - Hx of seizures What's the difference b/t PTSD and acute stress disorder? - ANSWER-Both cause pt to persistently re- experience event. Acute stress disorder lasts less than 1 month Time line of schizophrenia vs schizophreniform - ANSWER-Schizophrenia: >6 months Schizophreniform: >1 month but <6 months What anti-depressant is also approved for quitting smoking? - ANSWER-Bupropion 1st line drug for social phobia? - ANSWER-SSRI Adjustment disorder Timeline? Define? Rx? - ANSWER-- Develop w/in 3 months of stressor, lasts under 6 months - Emotional/behavioral symptoms beyond what is expected of stressed event. - Cognitive or psychodynamic psychotherapy Anterior cord syndrome Ax w/ what type of fracture? MOA? PE? Rx? - ANSWER-Fracture: Ax w/ burst fracture of a vertebrae MOA: Trauma from a fall PE: Loss of motor function below level of lesion + pain and temperature loss. Proprioception remains intact. Rx: ABCs -->High-dose corticosteroid --> CT + MRI imaging Central cord syndrome PE? MOA - ANSWER-Elderly patient Burning pain and paralysis in upper limbs. Lower limbs fine. MOA: Forced hyperextension type injury to neck Fracture of mid-shaft of humerus. MC nerve effected? - ANSWER-Radial nerve PE: popping sound and severe pain in knee. Swelling occurs hours later Dx? Tender? Clinical test? - ANSWER-Medial meniscus tear Tender on palpation medial side McMurray's (+) Leg Calves Perthes Define? Patient subtype? Clinical exam findings? Imaging? - ANSWER-Avascular necrosis of the femoral head 4-10 yo Limitation of internal rotation and abduction at hip joint MRI or bone scan will show pathology earlier than XR Todd's Paralysis Define - ANSWER-Post tonic-clonic seizure transient unilateral paralysis At what rib level is a gunshot wound considered to involve the abdomen? After ABCs, BIT? - ANSWER-Below 4th intercostal space (below nipple) Exploratory laparotomy **Stab wound or other blunt trauma you do FAST, but not Sp or Sn to do in gunshot wound PE: Fever, flank pain, chills, w/in 1 hour of blood tranfusion. Dx? Coombs (+) or (-)? Cx? - ANSWER-Acute Hemolytic Transfusion Reaction (AHTR) Coombs (+) Cx: DIC, ARF, shock Reaction to cytokines stored in blood. What blood transfusion reaction? How to prevent? - ANSWER-Febrile non-hemolytic reactions (MCC of bad blood transfusion) Leukoreduced blood products + washing of RBCs Reaction to blood transfusion w/in minutes. What type of blood transfusion rxn? - ANSWER-IgA deficiency Motor Femoral: Tibial: Obturator: Common peroneal / Fibular - ANSWER-Femoral: Knee extension, hip flexion Tibial: Flexion of knee and flexion of foot Obturator: Adduction of thigh Common peroneal: Anterior and lateral leg Sensory Femoral: Tibial: Obturator: Common peroneal / Fibular - ANSWER-Femoral: anterior thigh, medial leg Tibial: leg (except medial) and plantar foot Obturator: medial thigh Common peroneal: anterolateral leg and dorsum of foot Antibiotics for pregnancy - ANSWER-Amoxicillin, nitrofurantoin, oral cephalosporin Viral meningitis MCC? Rx? - ANSWER-Enteroviruses (echovirus and coxsackie) PE: Ab pain, N/V, Diarrhea, red eyes, periorbital edema, muscle pain, tenderness, splinter hemorrhages? Dx? Transmitted? Elevated WBC? - ANSWER-Trichenollosis Undercooked pork Eosinophilia Mucormycosis Ax w/ what disease? MCC? Rx? - ANSWER-DM The Fungus Rhizopus Surgical debridement + IV amphotericin B Nosocomial pneumonia in an intubated patient Common gram (-) rod? Rx? - ANSWER-Pseudomonas aeruginosa Rx: 4th generation cephalosporin (cefepime) or piperacillin/tazobactam Mycobacterium avium