USMLE Step 3: UWORLD Practice Test 2 With Questions And Answers All Are Correct Test

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USMLE Step 3: UWORLD Practice Test 2 With Questions And Answers All Are Correct Test 3 yo M has a 8 day hx of 3-4 daily episodes of soft, *foul-smelling diarrhea*. Increased belching & Flatus, decr... eased appetite but drinks liquids without difficulty. 6 yr old sister has same sx. Fam went on cruise to Mexico last month so he tried new foods and went swimming at beach&in cruise ship pool. Went on wkd camping trip 3 wks ago and ate the fresh fish. After vacation, he went back to reg diet fruits, veggies 7 meats. P 108, hyperactive bowel sounds. negative stool occult blood. CAUSE of sx? Correct Answer: *giardia lamblia* -greasy, foul-smelling diarrhea, bloating, flatus/belching, weight loss -transmitted thru *fecal-oral route* or thru *contaminated food or water* -ingestion of unfiltered water while *camping* or hiking --drinking, swimming or consuming food from contaminated water -sx DON't present ASAP b/c takes time for cysts to mature into trophozoites in host intestines -tx: *metronidazole* norovirus Correct Answer: -causes viral gastroenteritis -*cruise-ship* outbreaks -BRIEF duration: resolves within days -*VOMITING more common*rota rotavirus Correct Answer: *watery diarrhea* in kids age 2 and under -within 1-2 DAYS of exposure -also emesis, abd pain meta-analysis Correct Answer: -combines results of *several studies* to *increase statistical power* thru an *increased sample size* -ideally, the results are the same as produced by single study w/larger sample size -BUT *increase in statistical power may lead to *statistically SIGNIFICANT* effect sizes that maybe *CLINICALLY IRRELEVANT*=detects a very small effect(eg risk ratio)--not practical ---also, *validity depends on the design*-metanalysis isn't always more valid than other study designs cephalohematoma vs caput succedaneum Correct Answer: cephalohematoma: DOESN'T cross suture lines & resolves within WEEKS, *can lead to jaundice* b/c RBC breakdown&Calcification after resolution-located UNDER periosteum Caput succedaneum: like a CAP crosses suture lines&resolves DAYS after birth-serosanuineous fluid collection above periosteum/beneath scalp subgaleal hemorrhage Correct Answer: -bleeding under galea aponeurotica -fatal complication of vacuum-assisted deliveries -rapidly expanding swelling leading to hypovolemic shock from blood loss 2 week old girl has *asymmetric gluteal skinfolds&increased # thigh creases on right>left*. what else would be found? Correct Answer: *Apparent leg-length discrepancy* when pt lies supine w/knees flexed: affected leg looks shorter(Galeazzi test) DX: developmental dysplasia of hip -abnormal development of hip joint tht prevents femoral head from sitting properly in acetabulum -RF: *females, breech position, FH DDH, excessively tight swaddling* -instability during attempted dislocation&reduction if palpable clunk heard (Barlow and Ortolani maneuvers) who has asymmetric moro reflex? Correct Answer: erb palsy (seen in large for gestational age infants) who has sacral dimple? Correct Answer: neural tube defect (myelomeningocele) what's the next step after u/s shows dislocated right hip w/flat acetabulum and positive barlow and ortolani tests? Correct Answer: *Consult orthopedic surgeon* --when ID within first 6 months of life, treat by maintaining hip in *flexed&abducted position in Pavlik harness for 3 months* -when hip extension & adduction are limited, the dislocated hip is reduced and/or stabilized and normal acetabular development is promoted --monitor pavlik harness closely by orthopedic surgeon b/c associated risks( avascular necrosis, femoral nerve palsy) w/excessive hip flexion & abduction >hip radiograph if >4 months old prognosis for development dysplasia of hip Correct Answer: *most infants who are treated early have no long-term sequelae* -the need for surgical correction for DDH correlates w/increased age at diagnosis: <5% of pts dx & treated w/pavlik harness in early infancy require surgery vestibular neuritis(labyrinthitis) Correct Answer: -*single episode* of severe vertigo that can last for days & is self-limited -*labyrinthitis when associated w/unilateral hearing loss* -normal MRI -after viral infection -feeling of imabalnce and unsteady gait -*positive head-thrust test*:pt focuses on examiner's nose while examiner quickly rotates their head 10-15 degrees to the side; normally the eyes remain fixed on the target but in pt w/peripheral vestibular d/o, the eyes initially rotate w/the head before voluntarily redirecting back to the target (corrective saccade) first line treatment for MDD w/psychotic features (esp if severely depressed, psychotic, suicidal, refusing to eat &Drink) Correct Answer: ECT!!! -not mirtazapine -its not enuf alone to treat MDD w/psychotic features -combine it w/antipsychotic 17 yo girl has 3 week hx of rhinorrhea, paroyxyms of sneezing, nasal congestion, facial itching & Develops similar sx each spring. This yr, sx are more severe than usual &persistent. Pale nasal mucosa. Started on the most effective single treatment but what's a complication? Correct Answer: *epistaxis* dx: allergic rhinitis tx: *intranasal corticosteroids* (not antihistamines)-fluticasone, mometasone, budesonide -also give nasal saline rinses b/c they hydrate nasal mucosa &Can protect from steroid effect of epistaxis -second line: oral antihistamines(side effects acute angle-closure glaucoma, urinary retention, constipation, dry mouth) interstitial cystitis Correct Answer: idipathic bladder/suprapubic pain >=6 weeks -worse w/full bladder -relieved w/urination AN active study of 30 pts w/spinal deformity underwent 3 column osteotomy procedures for deformity correction is evaluating the following outcomes at 3,6,12 months. Research proposal was approved by IRB but on week 2, health-related quality-of-life questionnaire which serves to evaluate additional study outcomes is added to the protocol. What's true regarding need to resubmit study protocol to IRB? Correct Answer: *Required b/c all modifications to an already-approved research protocol need new IRB approval* This includes: study design, study protocols, informed consent procedures, principal investigator team(new research assistants) 82 yo M seen for initial physician evaluation at SNF. last colonoscopy age 70. For DM2: insulin glargine, sitagliptin. HgbA1c 6.5%. Appropriate intervention at this time? Correct Answer: *Decrease diabetes treatment regimen* b/c less stringent targets (hgba1c 7-8%) for those w/*limited life expectancy*, significant comorbidity or high risk of hypoglycemia, or w/longstanding DM w/chronic complications(nephropathy) -*Routine colon cancer screening NOT Recommended* for asymptomatic pts w/no personal or FH of colon cancer *past age 75 *or w/less than 10 yrs life expectancy Tx peripartum cardiomyopathy/HF Correct Answer: lasix & *Direct acting arterial vasodilator(hydralazine reduces afterload) & Nitrate(isosorbide mononitrate-venous dilator reduces preload)* -safe pregnancy meds: lasix, BB, hydralazine, nitrates, cardiac glycosides (digoxin) teratogenic effects of ACEI/ARBs Correct Answer: fetal renal toxicity persistent patent ductus neonatal death why are spironolactone(mineralocorticoid receptor antagonists) contraindicated in pregnancy? Correct Answer: feminization of male fetus in early gestation and other endocrine problems in both male & female fetuses in late gestation Researchers plan to carry out a study to evaluate dynamic effects of CPAP on cognitive function and neurocognitive architecture & Function int pts w/OSA. All eligible pts w/moderate-severe OSA will be randomly allocated to either CPAP + supportive care group or supportive care group only by independent statistics committee andassessed at 3,6,12 months. Participants & intervention assistants, but not data collectors, evaluators or study statisticians will be aware of participants' intervention assignment. What's the purpose of controlling for awareness of intervention assignment in this protocol? Correct Answer: *maximize unbiased ascertainment of outcomes* Ascertainment bias: when results of clinical study are distorted by knowledge of which intervention the participants are assigned to. allocation bias Correct Answer: results from the way subjects are assigned to treatment groups -may occur when subjects are NONRANDOMLY assigned to treatment groups of clinical study (Physicians may preferentially enroll sicker pts into a specific treatment group like Meredith grey with richard webber's wife) selection bias Correct Answer: inappropriate (random or nonrandom) selection METHODS or thru different attrition rates between study groups 2 yo boy is getting evaluated for a rash. Father first noticed a red rash on his stomach this AM & now spread to his arms. Last wk, the child had rhinorrhea, cough, fever 101F for 2 days. Yday, his* face appear flushed* but T is normal & Redness resolved w/o intervention. Received dtap but no other vaccines b/c parental preferences. Attends daycare during the week & other kids had fever & Rash and was admitted & Takes ASA everyday. Exam shows erythematous, nonblanching reticulated rash on UE &LE. Dx? Correct Answer: *erythema infectiosum/fifth disease* NOT measles Dx: parvovirus b19 Sx: flulike illness, slapped cheek rash, lacy&Reticular rash, small-joint symmetric polyarthritis, transient aplastic anemia TX: supportive, NSAIDs Prognosis: no long-term sequelae measles Correct Answer: URI sx, then diffuse maculopapular rash -*Conjunctivitis* -ill appearing 18 yo M has sudden onset CP, difficulty breathing & hoarseness 2 hrs after coughing. CP radiates into neck &worse w/deep breaths. For the last 3 days, nasal congestion, sore throat, persistent productive cough. Uses inhaled albuterol for asthma 2x weekly on avg due to wheezing w/exercise. VSS. Crunching sound heard over precordium during systole. CXR:Pneumomediastinum along left heart border & extends into upper mediastinum &lower neck. Next step in management? Correct Answer: *analgesics & supplemental O2* Dx: *spontaneous pneumomediastinum* -in young males w/hx of lung dx(asthma) or respiratory infxn(persistent cough) or who use inhalational drugs [Show More]

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