USMLE Step 2 UWORLD Missed Question and answers 2023

USMLE Step 2 UWORLD Missed Question and answers 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)