,USMLE Step 2 – 147 Missed UWorld Questions
| High-Yield Clinical Q&A with Explanations
(2025 Edition).
45 yo Chinese immigrant with edema, abdominal girth, JVD with prominent x/y waves, decreased heart
sounds with ring of calcification around the heart. What caused the symptoms?
Tuberculosis induced constrictive pericarditis
60yo man lost consciousness in bathroom after straining to urinate. PMHx BPH. No orthostatic
Hypotension on PE. What was diagnosis?
Situational Syncope - autonomic dysregulation due to straining and rapid bladder emptying.
Previous healthy 15month girl for excessive crying and screaming that led to turning blue and loss of
consciousness for a few seconds. She was fine after the episode. What should you order next?
CBC with ferritin - Breath holding spells - look for iron deficiency anemia.
Splenic abscess
Classic triad of Fever, leukocytosis, LUQ pain
Left sided pleural effusion, splenomegaly, pleuritic chest pain
MC associated with splenic abscess = infective endocarditis
Risk factors
-hematogenous spread ( TQ infective endocarditis)
-immunosuppression
-IVDU
-Hemoglobinopathies
What do you do with a patient with massive hemoptysis ( >600mL over 24hr or 100mL/hr?
Secure the airway
Place bad lung down
If continued bleeding - bronchoscopy to localize the bleeding, suction, and electrocautery
Chlamydia trachomatis lymphogranuloma venereum
- large and painful lymphadenopathy with occasional small, painless ulcers L1-L3
What is the prophylaxis treatment for pt with a PMHx of Rheumatic Fever?
Penicillin G every 4 weeks
5 years or until 21 without carditis (whichever is longer)
10 years or until 21 with carditis but without heart or valvular disease
10 years or until 40 with carditis and valve disease
, Rhinne Test
AC > BC b/l = nl test
BC>AC in the affected ear = conductive hearing loss
Sensorineural = nL in both
Weber Test
Place tuning fork on the middle head
NL = equal B/L hearing
abnormal conductive - Lateralizes to the affected side bc conductive hearing loss allows to block out
ambient noise and focus on the vibrating sound better than a normal ear
abnormal sensoneural - lateralizes away from the affected ear
Otospongiosis Otosclerosis
F 20s-30s with conductive hearing loss
CT scan lucent focus in the temporal bone near the oval window
tx surgical stadepectomy
Young child with CF, 2 week hx of URI, presents with pneumonia. What is the treatment?
Vancomycin
-staph aureus is the most common cause of pneumonia after URI in YOUNG CF patient. MRSA should be
assumed.
Pinealoma
Develops in the dorsal aspect of the midbrain
-Intracranial HTN Obstructive Hydropcephalus
-Parinaud's sign - (paralysis of vertical gaze) - dorsal midbrain syndrome
-Collier's sign - retraction of the eyelid
Vasovagal Syncope
Prodrome of diaphoresis, dizziness, nausea
Diagnose with a table tilt test
Small intestinal bacterial overgrowth
Caused by Anatomic abnormalities, Motility disoders(DM, TQ### scleroderma)
-Malsbsorption symptoms
-Diagnose with jejunal aspirate showing >10organisms/mL
Glucose breath testing
Tx: Antibiotics (rifaximin, augmentin), high fat low sugar diet, avoid anti-moility agents, trial of pro
motility agents (metoclopromide)
Gun shot wounds in the thorax
Any penetrating injury in the thorax below the level of the nipples has potential to also involve the
abdomen through the diaphragm and is assumed to involve both compartments until proven otherwise.
| High-Yield Clinical Q&A with Explanations
(2025 Edition).
45 yo Chinese immigrant with edema, abdominal girth, JVD with prominent x/y waves, decreased heart
sounds with ring of calcification around the heart. What caused the symptoms?
Tuberculosis induced constrictive pericarditis
60yo man lost consciousness in bathroom after straining to urinate. PMHx BPH. No orthostatic
Hypotension on PE. What was diagnosis?
Situational Syncope - autonomic dysregulation due to straining and rapid bladder emptying.
Previous healthy 15month girl for excessive crying and screaming that led to turning blue and loss of
consciousness for a few seconds. She was fine after the episode. What should you order next?
CBC with ferritin - Breath holding spells - look for iron deficiency anemia.
Splenic abscess
Classic triad of Fever, leukocytosis, LUQ pain
Left sided pleural effusion, splenomegaly, pleuritic chest pain
MC associated with splenic abscess = infective endocarditis
Risk factors
-hematogenous spread ( TQ infective endocarditis)
-immunosuppression
-IVDU
-Hemoglobinopathies
What do you do with a patient with massive hemoptysis ( >600mL over 24hr or 100mL/hr?
Secure the airway
Place bad lung down
If continued bleeding - bronchoscopy to localize the bleeding, suction, and electrocautery
Chlamydia trachomatis lymphogranuloma venereum
- large and painful lymphadenopathy with occasional small, painless ulcers L1-L3
What is the prophylaxis treatment for pt with a PMHx of Rheumatic Fever?
Penicillin G every 4 weeks
5 years or until 21 without carditis (whichever is longer)
10 years or until 21 with carditis but without heart or valvular disease
10 years or until 40 with carditis and valve disease
, Rhinne Test
AC > BC b/l = nl test
BC>AC in the affected ear = conductive hearing loss
Sensorineural = nL in both
Weber Test
Place tuning fork on the middle head
NL = equal B/L hearing
abnormal conductive - Lateralizes to the affected side bc conductive hearing loss allows to block out
ambient noise and focus on the vibrating sound better than a normal ear
abnormal sensoneural - lateralizes away from the affected ear
Otospongiosis Otosclerosis
F 20s-30s with conductive hearing loss
CT scan lucent focus in the temporal bone near the oval window
tx surgical stadepectomy
Young child with CF, 2 week hx of URI, presents with pneumonia. What is the treatment?
Vancomycin
-staph aureus is the most common cause of pneumonia after URI in YOUNG CF patient. MRSA should be
assumed.
Pinealoma
Develops in the dorsal aspect of the midbrain
-Intracranial HTN Obstructive Hydropcephalus
-Parinaud's sign - (paralysis of vertical gaze) - dorsal midbrain syndrome
-Collier's sign - retraction of the eyelid
Vasovagal Syncope
Prodrome of diaphoresis, dizziness, nausea
Diagnose with a table tilt test
Small intestinal bacterial overgrowth
Caused by Anatomic abnormalities, Motility disoders(DM, TQ### scleroderma)
-Malsbsorption symptoms
-Diagnose with jejunal aspirate showing >10organisms/mL
Glucose breath testing
Tx: Antibiotics (rifaximin, augmentin), high fat low sugar diet, avoid anti-moility agents, trial of pro
motility agents (metoclopromide)
Gun shot wounds in the thorax
Any penetrating injury in the thorax below the level of the nipples has potential to also involve the
abdomen through the diaphragm and is assumed to involve both compartments until proven otherwise.
