First Aid USMLE Step 2 CS: Challenging Questions And Answers
2024
26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the
limbs, bit his tongue, and lost control of his bladder. He was subsequently confused after regaining
consciousness (as witnessed by his colleagues) - (answer)Differential:
*Generalized tonic-clonic seizure*
Convulsive syncope
Substance abuse/overdose
Malingering
Hypoglycemia
Workup:
CBC
Electrolytes, glucose
Urine toxicology
EEG
MRI—brain
CT—head
LP—CSF analysis
ECG
34 yo F nurse presents with worsening cough of 6 weeks' duration accompanied by weight loss, fatigue,
night sweats, and fever. She has a history of contact with tuberculosis at work. - (answer)Differential:
*Tuberculosis*
Pneumonia
Lung abscess
Vasculitis
Lymphoma
Metastatic cancer
HIV/AIDS
,Sarcoidosis
Workup:
CBC
PPD/QuantiFERON-TB Gold
Sputum Gram stain, acid-fast stain, and culture
CXR
CT-chest
Bronchoscopy
HIV antibody
Lymph node biopsy
55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She
takes furosemide for hypertension. On examination, she feels dizzy upon standing. - (answer)Differential:
*Orthostatic hypotension due to dehydration* (diarrhea, diuretic use)
Vertebrobasilar insufficiency
Cardiac arrhythmias
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Workup:
Orthostatic vital signs
Rectal exam
CBC
Urea, electrolytes
Stool for occult blood
Stool leukocytes
,65 yo M presents after falling and losing consciousness for a few seconds. He had no warning before
passing out but recently had palpitations. His history includes a coronary artery bypass graft. -
(answer)Differential:
*Cardiac arrhythmia (causing syncope)*
Severe aortic stenosis
Syncope (other causes)
Seizure
Pulmonary embolism
Workup:
ECG
Holter monitoring
CBC
Electrolytes, glucose
Echocardiography
CT—head
12 yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents
recently divorced, and she just started school in a new district. Before her parents divorced, she was an
average student with no behavioral problems. - (answer)Differential:
*Adjustment disorder*
Substance intoxication, abuse, or dependence
Oppositional defiant disorder
Conduct disorder
Manic episode
Workup:
Physical exam
Mental status exam
Urine toxicology
, 1-month-old F is brought in because she has been spitting up her milk for the last 10 days. The vomiting
episodes have increased in frequency and forcefulness. Emesis is nonbloody and nonbilious. The
episodes usually occur immediately after breastfeeding. She has stopped gaining weight. -
(answer)Differential:
*Pyloric stenosis*
Partial duodenal atresia
GERD
Gastroenteritis
Hepatitis
UTI
Workup:
CBC
Electrolytes
U/S—abdomen
Barium swallow
Esophageal pH probe
Endoscopy
LFTs, alkaline phosphatase
UA, urine culture
12-month-old M presents with fever for the past 2 days accompanied by a maculopapular rash on his
face and body. He has not yet received the MMR vaccine. - (answer)Differential:
*Measles (or other viral exanthem)*
Rubella
Roseola
Fifth disease
Varicella
Scarlet fever
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