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2024 USMLE STEP 2 CK WITH COMPLETE SOLUTION, EXAMS OF NURSING
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2024 USMLE STEP 2 CK WITH COMPLETESOLUTION, EXAMS OF NURSING
Slipped Capital Femoral Epiphysis
requires immediate surgical screw fixation to reduce risk of AVN
Correct Answer Obese Child
with dull hip PAIN or referred knee pain and a painful limp
with restricted ROM and inability to bear weight
on exam has limited rotation and abduction of the hip
Diagnosis & Tx?
Legg-Calve-Perthes Disease or Idiopathic Osteonecrosis
(avascular necrosis) of the femoral epiphysis.
-Flattened and fragmented femoral head on radiograph
Tx:
Mild: Observation
Moderate: bracing, hip abduction with a petrie cast
Extensive: osteotomy Correct Answer chronic, progressive leg
pain and limp in a 3-12 yo Boy
Limited abduction and internal rotation. Atrophy of proximal thigh
muscles.
Diagnosis & Tx?
pulsus paradoxus
-Associated with cardiac Tamponade
-Becktriad can diagnose acute cardiac tamponade:
1. JVD (Kussmaul sign (increased JVD on inspiration))
2. Hypotension
,3. Distant heart sounds
fluid accumulation in pericardial cavity increases intrapericardial
pressure restricting venous return to the heart lowering R & L
ventricular filling. Net result = Decreased Preload, Stroke Volume
, Cardiac output. Correct Answer fall in systemic arterial
pressure by more than 10mmHg during inspiration. What is it?
and what cardiac problem is it associated with?
aortic stenosis
Most common causes:
1. senile calcific aortic stenosis (Elderly)
2. bicuspid aortic valve (<70 yo)
3. rheumatic heart disease
high resistance generated by stenosed aortic valve causes
concentric hypertrophy and stiffening of the left ventricle (S4)
leading to CHF. Correct Answer Pulsus Parvus (decreased
pulse amplitude) and Pulsus Tardus (delayed pulse upstroke)
(weak,delayed carotid upstroke) and a single or paradoxically split
S2 sound;
systolic murmur radiating to the carotids.
associated with what cardiac defect?
aortic regurgitation
-Congenital Bicuspid Aortic Valve, Rheumatic Heart Disease,
Endocarditits, Aortic Root Dilation (Marfan, Syphilis)
-tx: Vasodilator therapy (dihydropyridines or ACEIs) for isolated
aortic regurgitation until symptoms become severe enough to
warrant valve replacement. Correct Answer Bounding or "water
hammer" pulses, with widened pulse pressure and head bob with
,heartbeat are associated with what cardiac defect? Common
etiologies? Treatment?
meniscal tear
-MRI for diagnosis
-Mild, older patient: REST, NSAID
-Impaired activity, young: SURGERY Correct Answer Acute
popping sensation in knee with catching, and locking, and slow
onset joint effusion. patient complains of sensation of instability.
with joint line tenderness on exam.
What is the problem, Diagnosis, and management?
Pyloric stricture
-Upper Endoscopy required to confirm diagnosis and treatment is
surgical.
-Common causes of GASTRIC OUTLET OBSTRUCTION: Gastric
malignancy, PUD, Crohns, Strictures from caustic ingestion,
gastric bezoars. Correct Answer postprandial pain, vomiting with
early satiety. Abdominal succussion splash. Patient ingested acid
3 months ago.
diagnosis? common causes?
diabetic gastroparesis
-Treat with pro-motility agent such as metoclopramide, exercise,
and low fat diet
-Gastric Emptying study would be helpful in evaluating Correct
Answer Chronic nausea, vomiting and early satiety in a chronic
diabetic.
, What is the diagnosis? How is it treated?
Friedreich's ataxia
-AR (loss of function trinucleotide repeat (GAA) in Frataxin gene
-Mortality due to cardiac dysfunction (hypertrophic
cardiomyopathy)
Genetic testing required to confirm diagnosis.
Management is supportive as no disease modifying therapies are
available. Correct Answer Adolescent with progressive gait
instability, dysarthria, wide based gait, marked atrophy of medulla
and dorsal columns of the spinal cord (loss of vibration and
position sense), and scoliosis.
What is the diagnosis? Risk of mortality?
TRACHOMA ( due to Chlamydia trachomatis)
-Treat with Oral Azithromycin Correct Answer Child with
conjunctival injection, watery discharge, tarsal inflammation, and
pale follicles. As well as rhinorrhea, Pharyngitis.
Diagnosis? Cause? Treatment?
Gonococcal conjunctivitis Correct Answer Conjunctival injection,
eye discharge and swollen eyelids 2-5 days after birth?
Chlamydial conjunctivitis Correct Answer Conjunctival injection,
eye discharge and swollen eyelids 5-14 days after birth?
Orbital cellulitis (Infection posterior to orbital septum)
Most common risk factor = SINUSITIS (ethmoid or maxillary)
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