USMLE STEP 2 QUESTIONS AND
OUTLINED ANSWERS || CLINICAL
KNOWLEDGE || SKILLS || CLINICAL
SCIENCE || ALL TESTED QUESTIONS
\.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? - Answer-Slipped Capital Femoral Epiphysis
requires immediate surgical screw fixation to reduce risk of AVN
\.chronic, progressive leg pain and limp in a 3-12 yo Boy
Limited abduction and internal rotation. Atrophy of proximal thigh muscles.
Diagnosis & Tx? - Answer-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
\.fall in systemic arterial pressure by more than 10mmHg during inspiration. What is it? and
what cardiac problem is it associated with? - Answer-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.
\.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? - Answer-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.
\.Bounding or "water hammer" pulses, with widened pulse pressure and head bob with
heartbeat are associated with what cardiac defect? Common etiologies? Treatment? - Answer-
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.
\.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? - Answer-meniscal tear
-MRI for diagnosis
-Mild, older patient: REST, NSAID
-Impaired activity, young: SURGERY
\.postprandial pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested
acid 3 months ago.
diagnosis? common causes? - Answer-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.
\.Chronic nausea, vomiting and early satiety in a chronic diabetic.
What is the diagnosis? How is it treated? - Answer-diabetic gastroparesis
-Treat with pro-motility agent such as metoclopramide, exercise, and low fat diet
-Gastric Emptying study would be helpful in evaluating
\.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? - Answer-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.
\.Child with conjunctival injection, watery discharge, tarsal inflammation, and pale follicles. As
well as rhinorrhea, Pharyngitis.
OUTLINED ANSWERS || CLINICAL
KNOWLEDGE || SKILLS || CLINICAL
SCIENCE || ALL TESTED QUESTIONS
\.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? - Answer-Slipped Capital Femoral Epiphysis
requires immediate surgical screw fixation to reduce risk of AVN
\.chronic, progressive leg pain and limp in a 3-12 yo Boy
Limited abduction and internal rotation. Atrophy of proximal thigh muscles.
Diagnosis & Tx? - Answer-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
\.fall in systemic arterial pressure by more than 10mmHg during inspiration. What is it? and
what cardiac problem is it associated with? - Answer-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.
\.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? - Answer-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.
\.Bounding or "water hammer" pulses, with widened pulse pressure and head bob with
heartbeat are associated with what cardiac defect? Common etiologies? Treatment? - Answer-
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.
\.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? - Answer-meniscal tear
-MRI for diagnosis
-Mild, older patient: REST, NSAID
-Impaired activity, young: SURGERY
\.postprandial pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested
acid 3 months ago.
diagnosis? common causes? - Answer-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.
\.Chronic nausea, vomiting and early satiety in a chronic diabetic.
What is the diagnosis? How is it treated? - Answer-diabetic gastroparesis
-Treat with pro-motility agent such as metoclopramide, exercise, and low fat diet
-Gastric Emptying study would be helpful in evaluating
\.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? - Answer-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.
\.Child with conjunctival injection, watery discharge, tarsal inflammation, and pale follicles. As
well as rhinorrhea, Pharyngitis.
