USMLE STEP 3 UWORLD PRACTICE
TEST 2 QUESTIONS WITH CORRECT
ANSWERS
3 ffyo ffM ffhas ffa ff8 ffday ffhx ffof ff3-4 ffdaily ffepisodes ffof ffsoft, ff*foul-smelling ffdiarrhea*.
ffIncreased ffbelching ff& ffFlatus, ffdecreased ffappetite ffbut ffdrinks ffliquids ffwithout
ffdifficulty. ff6 ffyr ffold ffsister ffhas ffsame ffsx. ffFam ffwent ffon ffcruise ffto ffMexico fflast
ffmonth ffso ffhe fftried ffnew fffoods ffand ffwent ffswimming ffat ffbeach&in ffcruise ffship ffpool.
ffWent ffon ffwkd ffcamping fftrip ff3 ffwks ffago ffand ffate ffthe fffresh fffish. ffAfter ffvacation, ffhe
ffwent ffback ffto ffreg ffdiet fffruits, ffveggies ff7 ffmeats. ffP ff108, ffhyperactive ffbowel
ffsounds. ffnegative ffstool ffoccult ffblood. ffCAUSE ffof ffsx? ff- ffAnswer ff*giardia fflamblia*
-greasy, fffoul-smelling ffdiarrhea, ffbloating, ffflatus/belching, ffweight ffloss
-transmitted ffthru ff*fecal-oral ffroute* ffor ffthru ff*contaminated fffood ffor ffwater*
-ingestion ffof ffunfiltered ffwater ffwhile ff*camping* ffor ffhiking ff
--drinking, ffswimming ffor ffconsuming fffood fffrom ffcontaminated ffwater
-sx ffDON't ffpresent ffASAP ffb/c fftakes fftime fffor ffcysts ffto ffmature ffinto fftrophozoites ffin
ffhost ffintestines
-tx: ff*metronidazole*
norovirus ff- ffAnswer ff-causes ffviral ffgastroenteritis
-*cruise-ship* ffoutbreaks
-BRIEF ffduration: ffresolves ffwithin ffdays
-*VOMITING ffmore ffcommon*rota
rotavirus ff- ffAnswer ff*watery ffdiarrhea* ffin ffkids ffage ff2 ffand ffunder
-within ff1-2 ffDAYS ffof ffexposure
-also ffemesis, ffabd ffpain
meta-analysis ff- ffAnswer ff-combines ffresults ffof ff*several ffstudies* ffto ff*increase
ffstatistical ffpower* ffthru ffan ff*increased ffsample ffsize*
-ideally, ffthe ffresults ffare ffthe ffsame ffas ffproduced ffby ffsingle ffstudy ffw/larger ffsample
ffsize
-BUT ff*increase ffin ffstatistical ffpower ffmay fflead ffto ff*statistically ffSIGNIFICANT* ffeffect
ffsizes ffthat ffmaybe ff*CLINICALLY ffIRRELEVANT*=detects ffa ffvery ffsmall ffeffect(eg
ffrisk ffratio)--not ffpractical
,---also, ff*validity ffdepends ffon ffthe ffdesign*-metanalysis ffisn't ffalways ffmore ffvalid ffthan
ffother ffstudy ffdesigns
cephalohematoma ffvs ffcaput ffsuccedaneum ff- ffAnswer ffcephalohematoma: ffDOESN'T
ffcross ffsuture fflines ff& ffresolves ffwithin ffWEEKS, ff*can fflead ffto ffjaundice* ffb/c ffRBC
ffbreakdown&Calcification ffafter ffresolution-located ffUNDER ffperiosteum
Caput ffsuccedaneum: fflike ffa ffCAP ffcrosses ffsuture fflines&resolves ffDAYS ffafter ffbirth-
serosanuineous fffluid ffcollection ffabove ffperiosteum/beneath ffscalp
subgaleal ffhemorrhage ff- ffAnswer ff-bleeding ffunder ffgalea ffaponeurotica
-fatal ffcomplication ffof ffvacuum-assisted ffdeliveries
-rapidly ffexpanding ffswelling ffleading ffto ffhypovolemic ffshock fffrom ffblood ffloss
2 ffweek ffold ffgirl ffhas ff*asymmetric ffgluteal ffskinfolds&increased ff# ffthigh ffcreases ffon
ffright>left*. ffwhat ffelse ffwould ffbe fffound? ff- ffAnswer ff*Apparent ffleg-length
ffdiscrepancy* ffwhen ffpt fflies ffsupine ffw/knees ffflexed: ffaffected ffleg fflooks
ffshorter(Galeazzi fftest)
DX: ffdevelopmental ffdysplasia ffof ffhip
-abnormal ffdevelopment ffof ffhip ffjoint fftht ffprevents fffemoral ffhead fffrom ffsitting
ffproperly ffin ffacetabulum
-RF: ff*females, ffbreech ffposition, ffFH ffDDH, ffexcessively fftight ffswaddling*
-instability ffduring ffattempted ffdislocation&reduction ffif ffpalpable ffclunk ffheard ff(Barlow
ffand ffOrtolani ffmaneuvers)
who ffhas ffasymmetric ffmoro ffreflex? ff- ffAnswer fferb ffpalsy ff(seen ffin fflarge fffor
ffgestational ffage ffinfants)
who ffhas ffsacral ffdimple? ff- ffAnswer ffneural fftube ffdefect ff(myelomeningocele)
what's ffthe ffnext ffstep ffafter ffu/s ffshows ffdislocated ffright ffhip ffw/flat ffacetabulum ffand
ffpositive ffbarlow ffand ffortolani fftests? ff- ffAnswer ff*Consult fforthopedic ffsurgeon*
--when ffID ffwithin fffirst ff6 ffmonths ffof fflife, fftreat ffby ffmaintaining ffhip ffin
ff*flexed&abducted ffposition ffin ffPavlik ffharness fffor ff3 ffmonths*
-when ffhip ffextension ff& ffadduction ffare fflimited, ffthe ffdislocated ffhip ffis ffreduced
ffand/or ffstabilized ffand ffnormal ffacetabular ffdevelopment ffis ffpromoted
--monitor ffpavlik ffharness ffclosely ffby fforthopedic ffsurgeon ffb/c ffassociated
ffrisks( ffavascular ffnecrosis, fffemoral ffnerve ffpalsy) ffw/excessive ffhip ffflexion ff&
ffabduction
>hip ffradiograph ffif ff>4 ffmonths ffold
prognosis fffor ffdevelopment ffdysplasia ffof ffhip ff- ffAnswer ff*most ffinfants ffwho ffare
fftreated ffearly ffhave ffno fflong-term ffsequelae*
-the ffneed fffor ffsurgical ffcorrection fffor ffDDH ffcorrelates ffw/increased ffage ffat
ffdiagnosis: ff<5% ffof ffpts ffdx ff& fftreated ffw/pavlik ffharness ffin ffearly ffinfancy ffrequire
ffsurgery
, vestibular ffneuritis(labyrinthitis) ff- ffAnswer ff-*single ffepisode* ffof ffsevere ffvertigo ffthat
ffcan fflast fffor ffdays ff& ffis ffself-limited
-*labyrinthitis ffwhen ffassociated ffw/unilateral ffhearing ffloss*
-normal ffMRI
-after ffviral ffinfection
-feeling ffof ffimabalnce ffand ffunsteady ffgait
-*positive ffhead-thrust fftest*:pt fffocuses ffon ffexaminer's ffnose ffwhile ffexaminer ffquickly
ffrotates fftheir ffhead ff10-15 ffdegrees ffto ffthe ffside; ffnormally ffthe ffeyes ffremain fffixed ffon
ffthe fftarget ffbut ffin ffpt ffw/peripheral ffvestibular ffd/o, ffthe ffeyes ffinitially ffrotate ffw/the
ffhead ffbefore ffvoluntarily ffredirecting ffback ffto ffthe fftarget ff(corrective ffsaccade)
first ffline fftreatment fffor ffMDD ffw/psychotic fffeatures ff(esp ffif ffseverely ffdepressed,
ffpsychotic, ffsuicidal, ffrefusing ffto ffeat ff&Drink) ff- ffAnswer ffECT!!!
-not ffmirtazapine ff-its ffnot ffenuf ffalone ffto fftreat ffMDD ffw/psychotic fffeatures ff-combine
ffit ffw/antipsychotic
17 ffyo ffgirl ffhas ff3 ffweek ffhx ffof ffrhinorrhea, ffparoyxyms ffof ffsneezing, ffnasal
ffcongestion, fffacial ffitching ff& ffDevelops ffsimilar ffsx ffeach ffspring. ffThis ffyr, ffsx ffare
ffmore ffsevere ffthan ffusual ff&persistent. ffPale ffnasal ffmucosa. ffStarted ffon ffthe ffmost
ffeffective ffsingle fftreatment ffbut ffwhat's ffa ffcomplication? ff- ffAnswer ff*epistaxis*
dx: ffallergic ffrhinitis
tx: ff*intranasal ffcorticosteroids* ff(not ffantihistamines)-fluticasone, ffmometasone,
ffbudesonide
-also ffgive ffnasal ffsaline ffrinses ffb/c ffthey ffhydrate ffnasal ffmucosa ff&Can ffprotect fffrom
ffsteroid ffeffect ffof ffepistaxis
-second ffline: fforal ffantihistamines(side ffeffects ffacute ffangle-closure ffglaucoma,
ffurinary ffretention, ffconstipation, ffdry ffmouth)
interstitial ffcystitis ff- ffAnswer ffidipathic ffbladder/suprapubic ffpain ff>=6 ffweeks
-worse ffw/full ffbladder
-relieved ffw/urination
AN ffactive ffstudy ffof ff30 ffpts ffw/spinal ffdeformity ffunderwent ff3 ffcolumn ffosteotomy
ffprocedures fffor ffdeformity ffcorrection ffis ffevaluating ffthe fffollowing ffoutcomes ffat
ff3,6,12 ffmonths. ffResearch ffproposal ffwas ffapproved ffby ffIRB ffbut ffon ffweek ff2, ffhealth-
related ffquality-of-life ffquestionnaire ffwhich ffserves ffto ffevaluate ffadditional ffstudy
ffoutcomes ffis ffadded ffto ffthe ffprotocol. ffWhat's fftrue ffregarding ffneed ffto ffresubmit
ffstudy ffprotocol ffto ffIRB? ff- ffAnswer ff*Required ffb/c ffall ffmodifications ffto ffan ffalready-
approved ffresearch ffprotocol ffneed ffnew ffIRB ffapproval*
This ffincludes: ffstudy ffdesign, ffstudy ffprotocols, ffinformed ffconsent ffprocedures,
ffprincipal ffinvestigator ffteam(new ffresearch ffassistants)
82 ffyo ffM ffseen fffor ffinitial ffphysician ffevaluation ffat ffSNF. fflast ffcolonoscopy ffage ff70.
ffFor ffDM2: ffinsulin ffglargine, ffsitagliptin. ffHgbA1c ff6.5%. ffAppropriate ffintervention ffat
ffthis fftime? ff- ffAnswer ff*Decrease ffdiabetes fftreatment ffregimen*
TEST 2 QUESTIONS WITH CORRECT
ANSWERS
3 ffyo ffM ffhas ffa ff8 ffday ffhx ffof ff3-4 ffdaily ffepisodes ffof ffsoft, ff*foul-smelling ffdiarrhea*.
ffIncreased ffbelching ff& ffFlatus, ffdecreased ffappetite ffbut ffdrinks ffliquids ffwithout
ffdifficulty. ff6 ffyr ffold ffsister ffhas ffsame ffsx. ffFam ffwent ffon ffcruise ffto ffMexico fflast
ffmonth ffso ffhe fftried ffnew fffoods ffand ffwent ffswimming ffat ffbeach&in ffcruise ffship ffpool.
ffWent ffon ffwkd ffcamping fftrip ff3 ffwks ffago ffand ffate ffthe fffresh fffish. ffAfter ffvacation, ffhe
ffwent ffback ffto ffreg ffdiet fffruits, ffveggies ff7 ffmeats. ffP ff108, ffhyperactive ffbowel
ffsounds. ffnegative ffstool ffoccult ffblood. ffCAUSE ffof ffsx? ff- ffAnswer ff*giardia fflamblia*
-greasy, fffoul-smelling ffdiarrhea, ffbloating, ffflatus/belching, ffweight ffloss
-transmitted ffthru ff*fecal-oral ffroute* ffor ffthru ff*contaminated fffood ffor ffwater*
-ingestion ffof ffunfiltered ffwater ffwhile ff*camping* ffor ffhiking ff
--drinking, ffswimming ffor ffconsuming fffood fffrom ffcontaminated ffwater
-sx ffDON't ffpresent ffASAP ffb/c fftakes fftime fffor ffcysts ffto ffmature ffinto fftrophozoites ffin
ffhost ffintestines
-tx: ff*metronidazole*
norovirus ff- ffAnswer ff-causes ffviral ffgastroenteritis
-*cruise-ship* ffoutbreaks
-BRIEF ffduration: ffresolves ffwithin ffdays
-*VOMITING ffmore ffcommon*rota
rotavirus ff- ffAnswer ff*watery ffdiarrhea* ffin ffkids ffage ff2 ffand ffunder
-within ff1-2 ffDAYS ffof ffexposure
-also ffemesis, ffabd ffpain
meta-analysis ff- ffAnswer ff-combines ffresults ffof ff*several ffstudies* ffto ff*increase
ffstatistical ffpower* ffthru ffan ff*increased ffsample ffsize*
-ideally, ffthe ffresults ffare ffthe ffsame ffas ffproduced ffby ffsingle ffstudy ffw/larger ffsample
ffsize
-BUT ff*increase ffin ffstatistical ffpower ffmay fflead ffto ff*statistically ffSIGNIFICANT* ffeffect
ffsizes ffthat ffmaybe ff*CLINICALLY ffIRRELEVANT*=detects ffa ffvery ffsmall ffeffect(eg
ffrisk ffratio)--not ffpractical
,---also, ff*validity ffdepends ffon ffthe ffdesign*-metanalysis ffisn't ffalways ffmore ffvalid ffthan
ffother ffstudy ffdesigns
cephalohematoma ffvs ffcaput ffsuccedaneum ff- ffAnswer ffcephalohematoma: ffDOESN'T
ffcross ffsuture fflines ff& ffresolves ffwithin ffWEEKS, ff*can fflead ffto ffjaundice* ffb/c ffRBC
ffbreakdown&Calcification ffafter ffresolution-located ffUNDER ffperiosteum
Caput ffsuccedaneum: fflike ffa ffCAP ffcrosses ffsuture fflines&resolves ffDAYS ffafter ffbirth-
serosanuineous fffluid ffcollection ffabove ffperiosteum/beneath ffscalp
subgaleal ffhemorrhage ff- ffAnswer ff-bleeding ffunder ffgalea ffaponeurotica
-fatal ffcomplication ffof ffvacuum-assisted ffdeliveries
-rapidly ffexpanding ffswelling ffleading ffto ffhypovolemic ffshock fffrom ffblood ffloss
2 ffweek ffold ffgirl ffhas ff*asymmetric ffgluteal ffskinfolds&increased ff# ffthigh ffcreases ffon
ffright>left*. ffwhat ffelse ffwould ffbe fffound? ff- ffAnswer ff*Apparent ffleg-length
ffdiscrepancy* ffwhen ffpt fflies ffsupine ffw/knees ffflexed: ffaffected ffleg fflooks
ffshorter(Galeazzi fftest)
DX: ffdevelopmental ffdysplasia ffof ffhip
-abnormal ffdevelopment ffof ffhip ffjoint fftht ffprevents fffemoral ffhead fffrom ffsitting
ffproperly ffin ffacetabulum
-RF: ff*females, ffbreech ffposition, ffFH ffDDH, ffexcessively fftight ffswaddling*
-instability ffduring ffattempted ffdislocation&reduction ffif ffpalpable ffclunk ffheard ff(Barlow
ffand ffOrtolani ffmaneuvers)
who ffhas ffasymmetric ffmoro ffreflex? ff- ffAnswer fferb ffpalsy ff(seen ffin fflarge fffor
ffgestational ffage ffinfants)
who ffhas ffsacral ffdimple? ff- ffAnswer ffneural fftube ffdefect ff(myelomeningocele)
what's ffthe ffnext ffstep ffafter ffu/s ffshows ffdislocated ffright ffhip ffw/flat ffacetabulum ffand
ffpositive ffbarlow ffand ffortolani fftests? ff- ffAnswer ff*Consult fforthopedic ffsurgeon*
--when ffID ffwithin fffirst ff6 ffmonths ffof fflife, fftreat ffby ffmaintaining ffhip ffin
ff*flexed&abducted ffposition ffin ffPavlik ffharness fffor ff3 ffmonths*
-when ffhip ffextension ff& ffadduction ffare fflimited, ffthe ffdislocated ffhip ffis ffreduced
ffand/or ffstabilized ffand ffnormal ffacetabular ffdevelopment ffis ffpromoted
--monitor ffpavlik ffharness ffclosely ffby fforthopedic ffsurgeon ffb/c ffassociated
ffrisks( ffavascular ffnecrosis, fffemoral ffnerve ffpalsy) ffw/excessive ffhip ffflexion ff&
ffabduction
>hip ffradiograph ffif ff>4 ffmonths ffold
prognosis fffor ffdevelopment ffdysplasia ffof ffhip ff- ffAnswer ff*most ffinfants ffwho ffare
fftreated ffearly ffhave ffno fflong-term ffsequelae*
-the ffneed fffor ffsurgical ffcorrection fffor ffDDH ffcorrelates ffw/increased ffage ffat
ffdiagnosis: ff<5% ffof ffpts ffdx ff& fftreated ffw/pavlik ffharness ffin ffearly ffinfancy ffrequire
ffsurgery
, vestibular ffneuritis(labyrinthitis) ff- ffAnswer ff-*single ffepisode* ffof ffsevere ffvertigo ffthat
ffcan fflast fffor ffdays ff& ffis ffself-limited
-*labyrinthitis ffwhen ffassociated ffw/unilateral ffhearing ffloss*
-normal ffMRI
-after ffviral ffinfection
-feeling ffof ffimabalnce ffand ffunsteady ffgait
-*positive ffhead-thrust fftest*:pt fffocuses ffon ffexaminer's ffnose ffwhile ffexaminer ffquickly
ffrotates fftheir ffhead ff10-15 ffdegrees ffto ffthe ffside; ffnormally ffthe ffeyes ffremain fffixed ffon
ffthe fftarget ffbut ffin ffpt ffw/peripheral ffvestibular ffd/o, ffthe ffeyes ffinitially ffrotate ffw/the
ffhead ffbefore ffvoluntarily ffredirecting ffback ffto ffthe fftarget ff(corrective ffsaccade)
first ffline fftreatment fffor ffMDD ffw/psychotic fffeatures ff(esp ffif ffseverely ffdepressed,
ffpsychotic, ffsuicidal, ffrefusing ffto ffeat ff&Drink) ff- ffAnswer ffECT!!!
-not ffmirtazapine ff-its ffnot ffenuf ffalone ffto fftreat ffMDD ffw/psychotic fffeatures ff-combine
ffit ffw/antipsychotic
17 ffyo ffgirl ffhas ff3 ffweek ffhx ffof ffrhinorrhea, ffparoyxyms ffof ffsneezing, ffnasal
ffcongestion, fffacial ffitching ff& ffDevelops ffsimilar ffsx ffeach ffspring. ffThis ffyr, ffsx ffare
ffmore ffsevere ffthan ffusual ff&persistent. ffPale ffnasal ffmucosa. ffStarted ffon ffthe ffmost
ffeffective ffsingle fftreatment ffbut ffwhat's ffa ffcomplication? ff- ffAnswer ff*epistaxis*
dx: ffallergic ffrhinitis
tx: ff*intranasal ffcorticosteroids* ff(not ffantihistamines)-fluticasone, ffmometasone,
ffbudesonide
-also ffgive ffnasal ffsaline ffrinses ffb/c ffthey ffhydrate ffnasal ffmucosa ff&Can ffprotect fffrom
ffsteroid ffeffect ffof ffepistaxis
-second ffline: fforal ffantihistamines(side ffeffects ffacute ffangle-closure ffglaucoma,
ffurinary ffretention, ffconstipation, ffdry ffmouth)
interstitial ffcystitis ff- ffAnswer ffidipathic ffbladder/suprapubic ffpain ff>=6 ffweeks
-worse ffw/full ffbladder
-relieved ffw/urination
AN ffactive ffstudy ffof ff30 ffpts ffw/spinal ffdeformity ffunderwent ff3 ffcolumn ffosteotomy
ffprocedures fffor ffdeformity ffcorrection ffis ffevaluating ffthe fffollowing ffoutcomes ffat
ff3,6,12 ffmonths. ffResearch ffproposal ffwas ffapproved ffby ffIRB ffbut ffon ffweek ff2, ffhealth-
related ffquality-of-life ffquestionnaire ffwhich ffserves ffto ffevaluate ffadditional ffstudy
ffoutcomes ffis ffadded ffto ffthe ffprotocol. ffWhat's fftrue ffregarding ffneed ffto ffresubmit
ffstudy ffprotocol ffto ffIRB? ff- ffAnswer ff*Required ffb/c ffall ffmodifications ffto ffan ffalready-
approved ffresearch ffprotocol ffneed ffnew ffIRB ffapproval*
This ffincludes: ffstudy ffdesign, ffstudy ffprotocols, ffinformed ffconsent ffprocedures,
ffprincipal ffinvestigator ffteam(new ffresearch ffassistants)
82 ffyo ffM ffseen fffor ffinitial ffphysician ffevaluation ffat ffSNF. fflast ffcolonoscopy ffage ff70.
ffFor ffDM2: ffinsulin ffglargine, ffsitagliptin. ffHgbA1c ff6.5%. ffAppropriate ffintervention ffat
ffthis fftime? ff- ffAnswer ff*Decrease ffdiabetes fftreatment ffregimen*
