USMLE STEP 2 CK EXAM UPDATED QUESTIONS AND
ANSWERS
Slipped Capital Femoral Epiphysis
requires immediate surgical screw fixation to reduce risk of AVN - CORRECT
ANSWER✅✅✅Obese Child
with dull hip PAIN or referred knee pain and a painful limp
with restricted ROM and inability to bear weight
on exam has limited rotation and abduction of the hip
Diagnosis & Tx?
Legg-Calve-Perthes Disease or Idiopathic Osteonecrosis (avascular necrosis) of the femoral
epiphysis.
-Flattened and fragmented femoral head on radiograph
Tx:
Mild: Observation
Moderate: bracing, hip abduction with a petrie cast
Extensive: osteotomy - CORRECT ANSWER✅✅✅chronic, progressive leg pain and limp
in a 3-12 yo Boy
Limited abduction and internal rotation. Atrophy of proximal thigh muscles.
Diagnosis & Tx?
pulsus paradoxus
-Associated with cardiac Tamponade
,-Becktriad can diagnose acute cardiac tamponade:
1. JVD (Kussmaul sign (increased JVD on inspiration))
2. Hypotension
3. Distant heart sounds
fluid accumulation in pericardial cavity increases intrapericardial pressure restricting venous
return to the heart lowering R & L ventricular filling. Net result = Decreased Preload, Stroke
Volume , Cardiac output. - CORRECT ANSWER✅✅✅fall in systemic arterial pressure by
more than 10mmHg during inspiration. What is it? and what cardiac problem is it associated
with?
aortic stenosis
Most common causes:
1. senile calcific aortic stenosis (Elderly)
2. bicuspid aortic valve (<70 yo)
3. rheumatic heart disease
high resistance generated by stenosed aortic valve causes concentric hypertrophy and stiffening
of the left ventricle (S4) leading to CHF. - CORRECT ANSWER✅✅✅Pulsus Parvus
(decreased pulse amplitude) and Pulsus Tardus (delayed pulse upstroke)
(weak,delayed carotid upstroke) and a single or paradoxically split S2 sound;
systolic murmur radiating to the carotids.
associated with what cardiac defect?
aortic regurgitation
-Congenital Bicuspid Aortic Valve, Rheumatic Heart Disease, Endocarditits, Aortic Root
Dilation (Marfan, Syphilis)
,-tx: Vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation until
symptoms become severe enough to warrant valve replacement. - CORRECT
ANSWER✅✅✅Bounding or "water hammer" pulses, with widened pulse pressure and head
bob with heartbeat are associated with what cardiac defect? Common etiologies? Treatment?
meniscal tear
-MRI for diagnosis
-Mild, older patient: REST, NSAID
-Impaired activity, young: SURGERY - CORRECT ANSWER✅✅✅Acute popping
sensation in knee with catching, and locking, and slow onset joint effusion. patient complains of
sensation of instability. with joint line tenderness on exam.
What is the problem, Diagnosis, and management?
Pyloric stricture
-Upper Endoscopy required to confirm diagnosis and treatment is surgical.
-Common causes of GASTRIC OUTLET OBSTRUCTION: Gastric malignancy, PUD, Crohns,
Strictures from caustic ingestion, gastric bezoars. - CORRECT ANSWER✅✅✅postprandial
pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested acid 3 months
ago.
diagnosis? common causes?
diabetic gastroparesis
-Treat with pro-motility agent such as metoclopramide, exercise, and low fat diet
, -Gastric Emptying study would be helpful in evaluating - CORRECT
ANSWER✅✅✅Chronic nausea, vomiting and early satiety in a chronic diabetic.
What is the diagnosis? How is it treated?
Friedreich's ataxia
-AR (loss of function trinucleotide repeat (GAA) in Frataxin gene
-Mortality due to cardiac dysfunction (hypertrophic cardiomyopathy)
Genetic testing required to confirm diagnosis.
Management is supportive as no disease modifying therapies are available. - CORRECT
ANSWER✅✅✅Adolescent with progressive gait instability, dysarthria, wide based gait,
marked atrophy of medulla and dorsal columns of the spinal cord (loss of vibration and position
sense), and scoliosis.
What is the diagnosis? Risk of mortality?
TRACHOMA ( due to Chlamydia trachomatis)
-Treat with Oral Azithromycin - CORRECT ANSWER✅✅✅Child with conjunctival
injection, watery discharge, tarsal inflammation, and pale follicles. As well as rhinorrhea,
Pharyngitis.
Diagnosis? Cause? Treatment?
Gonococcal conjunctivitis - CORRECT ANSWER✅✅✅Conjunctival injection, eye
discharge and swollen eyelids 2-5 days after birth?
ANSWERS
Slipped Capital Femoral Epiphysis
requires immediate surgical screw fixation to reduce risk of AVN - CORRECT
ANSWER✅✅✅Obese Child
with dull hip PAIN or referred knee pain and a painful limp
with restricted ROM and inability to bear weight
on exam has limited rotation and abduction of the hip
Diagnosis & Tx?
Legg-Calve-Perthes Disease or Idiopathic Osteonecrosis (avascular necrosis) of the femoral
epiphysis.
-Flattened and fragmented femoral head on radiograph
Tx:
Mild: Observation
Moderate: bracing, hip abduction with a petrie cast
Extensive: osteotomy - CORRECT ANSWER✅✅✅chronic, progressive leg pain and limp
in a 3-12 yo Boy
Limited abduction and internal rotation. Atrophy of proximal thigh muscles.
Diagnosis & Tx?
pulsus paradoxus
-Associated with cardiac Tamponade
,-Becktriad can diagnose acute cardiac tamponade:
1. JVD (Kussmaul sign (increased JVD on inspiration))
2. Hypotension
3. Distant heart sounds
fluid accumulation in pericardial cavity increases intrapericardial pressure restricting venous
return to the heart lowering R & L ventricular filling. Net result = Decreased Preload, Stroke
Volume , Cardiac output. - CORRECT ANSWER✅✅✅fall in systemic arterial pressure by
more than 10mmHg during inspiration. What is it? and what cardiac problem is it associated
with?
aortic stenosis
Most common causes:
1. senile calcific aortic stenosis (Elderly)
2. bicuspid aortic valve (<70 yo)
3. rheumatic heart disease
high resistance generated by stenosed aortic valve causes concentric hypertrophy and stiffening
of the left ventricle (S4) leading to CHF. - CORRECT ANSWER✅✅✅Pulsus Parvus
(decreased pulse amplitude) and Pulsus Tardus (delayed pulse upstroke)
(weak,delayed carotid upstroke) and a single or paradoxically split S2 sound;
systolic murmur radiating to the carotids.
associated with what cardiac defect?
aortic regurgitation
-Congenital Bicuspid Aortic Valve, Rheumatic Heart Disease, Endocarditits, Aortic Root
Dilation (Marfan, Syphilis)
,-tx: Vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation until
symptoms become severe enough to warrant valve replacement. - CORRECT
ANSWER✅✅✅Bounding or "water hammer" pulses, with widened pulse pressure and head
bob with heartbeat are associated with what cardiac defect? Common etiologies? Treatment?
meniscal tear
-MRI for diagnosis
-Mild, older patient: REST, NSAID
-Impaired activity, young: SURGERY - CORRECT ANSWER✅✅✅Acute popping
sensation in knee with catching, and locking, and slow onset joint effusion. patient complains of
sensation of instability. with joint line tenderness on exam.
What is the problem, Diagnosis, and management?
Pyloric stricture
-Upper Endoscopy required to confirm diagnosis and treatment is surgical.
-Common causes of GASTRIC OUTLET OBSTRUCTION: Gastric malignancy, PUD, Crohns,
Strictures from caustic ingestion, gastric bezoars. - CORRECT ANSWER✅✅✅postprandial
pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested acid 3 months
ago.
diagnosis? common causes?
diabetic gastroparesis
-Treat with pro-motility agent such as metoclopramide, exercise, and low fat diet
, -Gastric Emptying study would be helpful in evaluating - CORRECT
ANSWER✅✅✅Chronic nausea, vomiting and early satiety in a chronic diabetic.
What is the diagnosis? How is it treated?
Friedreich's ataxia
-AR (loss of function trinucleotide repeat (GAA) in Frataxin gene
-Mortality due to cardiac dysfunction (hypertrophic cardiomyopathy)
Genetic testing required to confirm diagnosis.
Management is supportive as no disease modifying therapies are available. - CORRECT
ANSWER✅✅✅Adolescent with progressive gait instability, dysarthria, wide based gait,
marked atrophy of medulla and dorsal columns of the spinal cord (loss of vibration and position
sense), and scoliosis.
What is the diagnosis? Risk of mortality?
TRACHOMA ( due to Chlamydia trachomatis)
-Treat with Oral Azithromycin - CORRECT ANSWER✅✅✅Child with conjunctival
injection, watery discharge, tarsal inflammation, and pale follicles. As well as rhinorrhea,
Pharyngitis.
Diagnosis? Cause? Treatment?
Gonococcal conjunctivitis - CORRECT ANSWER✅✅✅Conjunctival injection, eye
discharge and swollen eyelids 2-5 days after birth?
