USMLE Step 2 UWORLD EXAM UPDATED QUESTIONS AND
ACCURATE ANSWERS
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? -
CORRECT ANSWER✅✅✅Tuberculosis induced constrictive pericarditis
60yo man lost consciousness in bathroom after straining to urinate. PMHx BPH. No orthostatic
Hypotension on PE. What was diagnosis? - CORRECT ANSWER✅✅✅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? - CORRECT ANSWER✅✅✅CBC with ferritin - Breath holding spells - look for iron
deficiency anemia.
Splenic abscess - CORRECT ANSWER✅✅✅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? -
CORRECT ANSWER✅✅✅Secure the airway
Place bad lung down
If continued bleeding - bronchoscopy to localize the bleeding, suction, and electrocautery
Chlamydia trachomatis lymphogranuloma venereum - CORRECT ANSWER✅✅✅- large
and painful lymphadenopathy with occasional small, painless ulcers L1-L3
,What is the prophylaxis treatment for pt with a PMHx of Rheumatic Fever? - CORRECT
ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅AC > BC b/l = nl test
BC>AC in the affected ear = conductive hearing loss
Sensorineural = nL in both
Weber Test - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅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? -
CORRECT ANSWER✅✅✅Vancomycin
-staph aureus is the most common cause of pneumonia after URI in YOUNG CF patient. MRSA
should be assumed.
Pinealoma - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅Prodrome of diaphoresis, dizziness,
nausea
Diagnose with a table tilt test
Small intestinal bacterial overgrowth - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅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.
Disseminated Histoplasmosis - CORRECT ANSWER✅✅✅Ohio river valley in
immunocompromised patients
Look for
-B/L pulmonary infiltrates
-mucus ulcers
-cytopenias, hepatosplenomegaly
DDx: urine antigen test
Tx: Amphotericin B then itraconazole oral
Didanosine Adverse effect - CORRECT ANSWER✅✅✅pancreatitis
ACCURATE ANSWERS
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? -
CORRECT ANSWER✅✅✅Tuberculosis induced constrictive pericarditis
60yo man lost consciousness in bathroom after straining to urinate. PMHx BPH. No orthostatic
Hypotension on PE. What was diagnosis? - CORRECT ANSWER✅✅✅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? - CORRECT ANSWER✅✅✅CBC with ferritin - Breath holding spells - look for iron
deficiency anemia.
Splenic abscess - CORRECT ANSWER✅✅✅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? -
CORRECT ANSWER✅✅✅Secure the airway
Place bad lung down
If continued bleeding - bronchoscopy to localize the bleeding, suction, and electrocautery
Chlamydia trachomatis lymphogranuloma venereum - CORRECT ANSWER✅✅✅- large
and painful lymphadenopathy with occasional small, painless ulcers L1-L3
,What is the prophylaxis treatment for pt with a PMHx of Rheumatic Fever? - CORRECT
ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅AC > BC b/l = nl test
BC>AC in the affected ear = conductive hearing loss
Sensorineural = nL in both
Weber Test - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅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? -
CORRECT ANSWER✅✅✅Vancomycin
-staph aureus is the most common cause of pneumonia after URI in YOUNG CF patient. MRSA
should be assumed.
Pinealoma - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅Prodrome of diaphoresis, dizziness,
nausea
Diagnose with a table tilt test
Small intestinal bacterial overgrowth - CORRECT ANSWER✅✅✅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 - CORRECT ANSWER✅✅✅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.
Disseminated Histoplasmosis - CORRECT ANSWER✅✅✅Ohio river valley in
immunocompromised patients
Look for
-B/L pulmonary infiltrates
-mucus ulcers
-cytopenias, hepatosplenomegaly
DDx: urine antigen test
Tx: Amphotericin B then itraconazole oral
Didanosine Adverse effect - CORRECT ANSWER✅✅✅pancreatitis
