1 | Page
USMLE Step 2 CK Questions and Answers
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? Ans: 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
© 2025 All rights reserved
, 2 | Page
Limited abduction and internal rotation. Atrophy of proximal thigh
muscles.
Diagnosis & Tx? Ans: 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
© 2025 All rights reserved
, 3 | Page
fall in systemic arterial pressure by more than 10mmHg during
inspiration. What is it? and what cardiac problem is it associated
with? Ans: 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
© 2025 All rights reserved
, 4 | Page
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? Ans: aortic stenosis
Most common causes:
1. senile calcific aortic stenosis (Elderly)
© 2025 All rights reserved
USMLE Step 2 CK Questions and Answers
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? Ans: 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
© 2025 All rights reserved
, 2 | Page
Limited abduction and internal rotation. Atrophy of proximal thigh
muscles.
Diagnosis & Tx? Ans: 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
© 2025 All rights reserved
, 3 | Page
fall in systemic arterial pressure by more than 10mmHg during
inspiration. What is it? and what cardiac problem is it associated
with? Ans: 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
© 2025 All rights reserved
, 4 | Page
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? Ans: aortic stenosis
Most common causes:
1. senile calcific aortic stenosis (Elderly)
© 2025 All rights reserved
