USMLE Step 2 Rapid Review Part 3 Exam Questions With Verified Answers

Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management? - Answer Emergent laparotomy to repair perforated viscus, likely stomach The most likely cause of acute lower GI bleed in patients > 40 years old. - Answer Diverticulosis Diagnostic modality used when ultrasound is equivocal for cholecystitis. - Answer HIDA scan Sentinel loop on AXR. - Answer Acute pancreatitis Risk factors for cholelithiasis. - Answer Fat, female, fertile, forty, flatulent Inspiratory arrest during palpation of the RUQ. - Answer Murphy's sign, seen in acute cholecystitis Identify key organisms causing diarrhea: ■ Most common organism - Answer Campylobacter Identify key organisms causing diarrhea: ■ Recent antibiotic use - Answer Clostridium difficile Identify key organisms causing diarrhea: ■ Camping - Answer Giardia Identify key organisms causing diarrhea: ■ Traveler's diarrhea - Answer ETEC Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise - Answer S. aureus Identify key organisms causing diarrhea: ■ Uncooked hamburgers - Answer E. coli O157:H7 Identify key organisms causing diarrhea: ■ Fried rice - Answer Bacillus cereus Identify key organisms causing diarrhea: ■ Poultry/eggs - Answer Salmonella Identify key organisms causing diarrhea: ■ Raw seafood - Answer Vibrio, HAV Identify key organisms causing diarrhea: ■ AIDS - Answer Isospora, Cryptosporidium, Mycobacterium avium complex (MAC) Identify key organisms causing diarrhea: ■ Pseudoappendicitis - Answer Yersinia A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias. - Answer Crohn's disease Inflammatory disease of the colon with ↑ risk of colon cancer. - Answer Ulcerative colitis Extraintestinal manifestations of IBD. - Answer Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis Medical treatment for IBD. - Answer 5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations Difference between Mallory-Weiss and Boerhaave tears. - Answer Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture Charcot's triad. - Answer RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis Reynolds' pentad. - Answer Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis Medical treatment for hepatic encephalopathy. - Answer ↓ protein intake, lactulose, neomycin First step in the management of a patient with acute GI bleed. - Answer Establish the ABCs A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause? - Answer Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7 Post-HBV exposure treatment. - Answer HBV immunoglobulin Classic causes of drug-induced hepatitis. - Answer TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools. - Answer Biliary tract obstruction Hernia with highest risk of incarceration—indirect, direct, or femoral? - Answer Femoral hernia A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management? - Answer Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time" Four causes of microcytic anemia. - Answer TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia