Usmle step 2 ck march 2021 recalls USMLE Recalls USMLE, USMLE Step 2, USMLE CK, USMLE Recalls, Uworld

1. March 2021
USMLE Recalls
Actual Exam Questions
Click To get More :
usmlematerials.net

2. 1. Dawra question: Photo for Allopurinol caused Steven Johnson Syndrome
2. Patient presented with gastric ulcer how to confirm response to treatment – Urea breath test
3. Risperidone started on psych patient, started to have bilateral breast enlargements? Which
pathway? Tubloinfindibular, Mesolimbic, Corticolimbic, Nigrostatial
4. Gastric ulcer on the second part of duodenum which artery supplies this area? Right gastric
artery, gastroduodenal artery - superior mesenteric artery
5. Fell on feet from high distance- where you suspect fracture? Lumbosacral – thoracic – cervical
6. Patient with a PMHx of asthma and eczema. Has anaphylactic shock after eating in a
restaurant. What is the most significant risk factor for anaphylactic shock? Absence of rash, hx
of eczema, hx of asthma, symptoms within 30 minutes of eating food
7. Patient with prior TIA, Hx of HTN, Afib on warfarin. What is the most important risk factors of
having a stroke? Prior TIA- DM, HTN, Hx of Afib
8. Acute frontal headache with conjunctival injection, decrease visual acuity and blurry vision
with constricted right pupil Dx? Acute angle glaucoma
9. 67 yo Chinese patient with dysphagia. Next step EGD
10. A 70 yo man with a 2.5 cm nodule in right lower lobe seen on CT chest. Hx of smoking for 40
years. Next step: CT guided FNA, Repeat CT in 3 month, bronchoscopy
11. 19 yo AAF last seen normal 8 months ago. Came to your clinic with hairs falling out easily.
The hair without bulb. Reason? Excessive oil use, poor nutrition
12. A 50 yo female with chronic lower back pain. Hx of mild scoliosis since childhood. Exam
normal except very large breasts! Reason for back pain? Large breasts, scoliosis
Visit usmlematerials.net
March 2021 Recalls

3. 13. Decrescendo diastolic murmur? AR, AS, MR, MS
14. Symptoms go Neurosyphilis what to check? PPR, I am not sure if there was an LP!
15. Infant on goat milk for feeding. MCV of 105. Reason? Nutritional deficiency
16. What to monitor after bariatric surgery? Folate, VitK , VitA, INR, PTT
17. Left arm 2/5, left leg 3/5, right facial droop, dizziness with dysphagia. Which artery?
MCA, PCA, ACA, Vestibulobasilar
18. What to check in RA? RF
19. Reason for inability to extend finger in RA patient? Involvement of MCP
20. A 70 yo Female with Hx of hystectomy 20 years ago, K of 3.4, Came in with constipation and
abdominal distension. Abdominal Xray showed bowel distension. Reason for constipation?
Hypokalemia, adhesion
21. Patient with bipolar, on lithium (Subtherapeutic based on level they showed) Came in with
confusion. Recently was added on Sertraline. Na of 128. Reason? Nephrogenic Diabetes
Insipidus vs SIADH
22. ECG showed Torsade de point. What is important to check on physical exam? BP, heart
exam, lung exam
23. Leukemia was on Idarubicin. Now with crackles and lower extremity edema. What is the
pathophysiology? Increased hydrostatic pressure
24. Kid on long term corticosteroids came in with fever, weight loss and low appetite. No PPD
was done. CXR with superior cavity lesion. What to do next to determine next step in
management? PPD, Sputum for TB, Repeat Xray, start treatment for TB right away.
25. A 44 female patient with no physical exam findings came in with BP in 150s/90s. K of 2.9. Cr
0.9 Why? Adrenal adenoma, renal arteries stenosis
26. A Case with cluster headache, what MOA for medications? Works of serotonin receptors
27. Diabetic patient was started on metoclopramide. MOA? Works on motilin
28. An Elderly patient was agitated in hospital what to do? Give Haloperidol. After that she
calmed down but still wants to get out of bed? 4- Point restraints, assign a bedside nurse
29. Cellulitis due to Staph asked about how to describe the organism under microscope.
30 PNA due to Strep Pneumonia asked about how to describe the organism under microscope
31. No less than 8 question to calculate NNT
32. 1 for PPV
33. 1 to compare sensitivity and specificity of 2 tests
Visit usmlematerials.net

4. 34. Patient came in to hospital for something. His hospital course was complicated by AKI. FeNa
of 4% Where is the problem? Glomeruli, Tubules, Renal arterioles
35. A 12 yo female with ALL very involved in her disease, poor prognosis. New clinical trial for a
new drug. Wants to try it. Who should you get the consent from? Parents, child
36. A case of child abuse. Who should you report to? Child protective service
37. Elderly abuse where to report? Sorry choices were very close
38. A house was built in 1928, Child lead level of 24 what should you do? DSMA, EDTA, report
39. Pregnant female with BP of 150/90s, UA showed 2+, what should you do next? 24 hour urine
protein, no further tests
40. Vaginal bleeding with lesion in elderly female. What to do next? Shave biopsy, excision
biopsy and involve surrounding skin.
41. PD pathology? Loss dopamine in Nigrostriatal area
42. Pain and unilateral parotid gland enlargement while chewing food? Stone
43. Subclavian steal syndrome. What to do next? CTA to involve chest arteries
44. Easy Vit B12 deficiency case in elderly
45. Patient with worsening dementia for the past 2 years. Urinary urgency. MRI was shown
(Please pay attention this a dawra question but People were answering NPH, MRI showed
significant tempo-frontal lobe atrophy! I went with Pick Disease.
46. A Grand mal seizure in a child after common cold was associated with fever. Now child is
afebrile. Further investigations? Nothing, EEG
47. Aunt came with a child for broken bone. Before fixing. From whom you should get consent?
Aunt, child, call parents, no one
48. Graves’ disease what to order next? RAIU
49. Ischemic colitis. How to confirm it? Angiogram
50. Postpartum thyroiditis. Negative depression screening test. Asked about TSH and FT4 level
(Normal, increased, undetectable …)
51. Aortic dissection case. How to confirm it? CTA
52. Diabetic lady with poorly controlled DM, loss sensation in bilateral LE, came in with diplopia,
exam showed normal size pupils that reactive to light bilaterally. Abnormal adduction of the
right eye with restriction of upward and downward gaze. Ptosis was seen. No significant findings
on upper extremities. Where is the lesion? Orbit, Cranial nerves nucleus, upper chest.
53. What do you see on physical exam after C-section with 1000L blood loss? Uterine atony
Visit usmlematerials.net

5. 54. Elderly with new vesicular rash on his belly after a trauma (Didn’t say clearly CMV) What is
the most common organ for complications? Brain, pancreas, liver, kidney, Bone marrow
55. Diaphragmatic hernia in a child will affect the development of what? Lung (CXR was shown)
56. HCV Abs positive what to do next? PCR
57. Female with severe vaginal pain that prevents her from urinating. Picture was shown (Looks
like HSV). How to confirm the Dx? PCR from lesion
58. Pain in lady with lactating. Physical exam normal. Lactating duct obstruction vs mastitis
59. Pleural effusion after breast cancer. Gives you the lab of pleural fluids. Asked something
about fluids analysis
60. Picture with keloid in a patient who has previous history of keloid. What is the most
significant factor for the current findings? Hx of previous keloid
61. Fever with RUQ pain, elevated WBCs and jaundice. Next step? ERCP
62. Question about digoxin toxicity
63. A lot of questions about CTA and D-Dimer. Please review the guidelines how to proceed with
PE and DVT evaluation
64. Easy question about panic attack
65. A question about when to do surgery on varicose
66. Patient was newly diagnosed with GBM. Wife requested PET scan to rule out metastasis.
What is your response? No need for that, get MRI chest and abdomen instead, PET within brain.
67. Patient is highly risk for suicide. You decided to admit him. You contacted his health
insurance for preauthorization. But they refused to pay for that admission. They agreed to
manage patient as an outpatient. What to do? Contact hospital risk management, file against his
insurance, call his insurance and told them we will appeal your decision and admit the patient.
68. Patient with hx of COPD came in with worsening dyspnea. Upon on exam crackles were
heard bilaterally. Clubbing bilaterally. FEV1/FVC 83, FEV 60, FVC was low, DLco 35% predictable.
Patient worked in old navy with shipbuilding. Show you Lateral and PA CXR. What Dx?
Emphysema, Silicosis, Asbestosis
69. Sinusitis was managed conservatively. After 10 days of observation patient with frontal
headache that worsen when he leans forward, white sputum production. What is the indication
to start abx? Not resolving symptoms in more than 10 days, headache, sputum
70. A 3 yo boy with worsening developmental milestones, started to suck his left thumb and
hold his neck with his hand, patient is dragging his right leg while walking. No abnormalities in
physical exam. How to confirm Dx? CK level, NCS, long bone Xray
71. Duchenne Dystrophy. Where is the problem? Dystrophin deletion.
Visit usmlematerials.net

6. 72. Patient with CHF on Lasix, metoprolol and spironolactone, he has an EF of 15% what to add
to decrease risk of death in this patient? Lisinopril, thiazide, defibrillator
73. A 40 yo lady BMI of 40, on OCPs has a severe headache for the past 2 months, worsening in
the morning with blurry vision. Show you funduscopic examination with bilateral papilledema.
What is the next step? MRI, LP, DC OCPs. Second question after you did MRI what next? LP, Dc
OCPs
74. An Elderly female with a PMHx of recent MCA stroke, residual left sided weakness and
dysphagia. She was discharged to Nursing Home. She had an episode of vomiting. They showed
CXR (I didn’t see consolidation) She is afebrile, WBC of 10000. What to do? Clindamycin,
levofloxacin or observe.
75. A 22 yo boy with cough after playing soccer at school. How to prevent that? Add albuterol
before exercise.
76. Veteran decides to go to Brazil for vacation. He was previously vaccinated against VZV, Hep
B, and Hep A. What is the indication to receive yellow fever vaccine? Distention or not being
vaccinated against yellow fever before
77. Patient Severe liver failure due to chronic Hep C I think! They showed you labs with elevated
PT, INR and total bili. Recently having renal failure too. Cr of 3. Abdominal US showed normal
Kidneys size. What to tell him? You aren’t a candidate for transplant due to 2 organs failure, you
are a candidate for liver transplant, you are a candidate for kidney transplant
78. Patient was hospitalized for PNA, got worse then intubated. They didn’t mention that he was
getting GI prophylaxis. Now he is vomiting blood, Stomach with multiple ulcers. What is the
immediate action? IV ranitidine, Vagotomy
79. Question about the treatment of seborrheic dermatitis in a child
80. Diaper rash but involves the skin folds. What to do? Nystatin
81. Patient requested HSV screening after he knows that his ex-girlfriend was having HSV
infection when she was dating him in the past. Patient is asymptomatic. What to do? HSV IgM,
HSV IgG, HSV PCR, Nothing
82. Patient with typical PAD symptoms. You started him on Plavix, Statin, cilostazol, ACEI. After
you advise him to exercise as tolerated what else you need to do? Nothing, Stent or bypass
83. Patient with refractory HTN after you maximized him on Medical therapy. Echo showed
elevated right atrial and ventricular pressure. He is complaining of headache. In addition to
CPAP at night what med you need to add? Epoprostenol
84. Patient with severe RLQ abdominal pain with nausea and vomiting. Guarding and rebound
tenderness on physical exam. LMP 3 weeks ago. Pelvic US with RLQ mass no intrauterine
gestational sac. What to do next? Laparotomy, D&C, MTX
Visit usmlematerials.net

7. 85. Patient with subdural hematoma after accident (Didn’t say that but showed you a CTH).
What to do next? Craniotomy “Note that right lateral and third ventricle are completely
collapsed”
86. One question I had second day was similar to one on prior day. It was about what is the most
important risk factor to have a second stroke? PMHx of stroke or TIA, Not DM or HTN
87. Essential tremor? Propranolol
88. Elderly with PD, minimal improvement on Sinemet. Having frequent falls recently. What to
do? Discuss the possibility of DBS, increase the dose of Sinemet or try to switch the dose to PM
dose just before sleep
89. Patient with Dx of PKD. What is the favorable prognosis in this patient? Being diagnosed at
late age >40, No FH of PKD, other stuff. (Read about the good and bad prognosis in PKD)
Cases:
- Endometrial Hyperplasia: 55 yo female. She had her menopause about 5 years ago. She
came in with vaginal spotting. Physical exam and initial labs were normal. Order
endometrial biopsy and turned out to be endometrial hyperplasia WITHOUT atypia.
Note that in this case medroxyprogesterone acetate is enough. You don’t need
hysterectomy
- Sarcoidosis: A 30 yo female with SOB. NO FEVER for the past few months. CXR showed
bilateral hilar adenopathy. CT chest suggests sarcoidosis. I admitted her to hospital and
got pulmonary consult. I ordered everything you can imagine like ACE level, Ca, VitD
then I started her on Steroids. I ordered bronchoscopy with biopsy which confirmed the
diagnosis of non-caseating granuloma. However he kept telling me that her symptoms
are about the same. Patient is still SOB!! I am not sure if she needs to be on MTX also.
Please read more about the treatment of Sarcoidosis
- Atypical depression: A 13 yo AAM with no PMHx came in with some signs of depression.
He is overweight. But physical exam is completely normal beside obesity. Patient said
that his friends make some jokes about him in school. He is sad but still has some
interests. I ordered all the labs which was WNL. I typed in the order list depression and I
chose something called “Depression Index or something” The index showed some signs
for Mild depression. I ordered psych and behavioral therapy consult. Patient needs to be
educated about weight loss. I also started him on SSRIs. Not that SSRIs needs 6-8 weeks
to work.
- Secondary syphilis: Maculopapular rash on 23 yo AAF with fever. It turned out to be
Secondary syphilis. Started her on penicillin and she improved
Visit usmlematerials.net

8. - PE: Patient who is already in hospital for PNA treatment and he is getting DVT
prophylaxis. He developed SOB. I ordered CTA and confirmed PE. Started him on heparin
drip
- Cardiac tamponade. After a MVA. Similar to Uworld
- Osteoporosis. Elderly with a severe back pain after sneezing. Xray showed compression
fracture. DEXA confirmed osteoporosis. Don’t forget to start him on bisphosphonate
- IDA. Easy case, Chinese kid with fatigue. Labs suggested IDA. Hgb of 6.7 however family
refused transfusion. He got better on iron pills
- Pyelonephritis with obstructive stone. Severe RLQ abdominal pain with fever. CT
showed stone there was obstruction on CT. Don’t forget to get urology consult in
addition to Abx
- DKA due to UTI
- Amphetamine overdose. Agitation in a 20 yo patient after a party. UDS showed it. Benzo
and psych consult
- Adenocarcinoma of lung. Non-smoker man with a fatigue!! Mild weight loss. It turned
out to be adenocarcinoma of lung. Surgery, pulm consult for biopsy and Hem-Onc for
chemotherapy
- Sigmoid volvulus. Elderly with severe abdominal pain. Needs GI consult for colonoscopy
and rectal tube.
Visit usmlematerials.net