USMLE Step 2 CS Sample Cases

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1. 32 year old male presents with complaint Orchiepidimytis 9. What is the workup for this woman with H Pylori serology,
of abdominal pain. He states that he has Gonococcal possible PUD? and stool Ag
pain in his right testicle. There is yellow Urethritis Upper GI
discharge, and burning with urination. He Non-gonoccal endoscopy
does not use condoms, and has many urethritis. CBC
sexual partners. PE shows CVA tenderness. Rectal
What is your differential? FOBT
2. What would be your workup for this UA 10. A 22 year old female presents with Menstrual history.
possible epidimyitis US of testes lower abdominal pain. What is the first
Urethral thing you should conduct a history
Culture about?
HIV testing
11. She states that she had her LMP 4 days PID
3. What ancillary maneuvers would you STD and ago, with abundant bleeding. 2 days Appendicitis
perform for this patient? condoms ago there was spotting. She is sexually Ectopic
active with her bf with no condom use. pregnancy
4. A 50 year old male presents with CAGE
What is your differential?
abdominal pain. He states this this pain has questionnaire.
been present for 2 days, and is located in 12. 46 year old female presents with Ectopic
the midepigastric region. He says that it is 1. Cut down? abrupt onset of RLQ abdominal pain. pregnancy
a tearing pain radiating to the back. He 2. Annoyed? Has vaginal discharge with irregular Ovarian torsion
feels sweaty at times, and has some RUQ 3. Guilty? periods. She is sexually active. PMH is + Ruptured ovarian
as well. He has a history of cirrhosis in his 4. Eye opener? for PID and appendectomy at 13. What cyst
family, and does drink 10 beers a night. is your differential? PID
What standardized history taking approach Vaginitis
would you do for this patient's social
13. What would your work-up be for this B-HcG
history?
patient? Pelvic/Rectal
5. What is your differential diagnosis for an Acute exam
alcoholic with abdominal pain? Pancreatitis. US Pelvis
Dissecting UA
aortic Cervix culture
aneurysm.
14. Diarrhea Cases Cases:
Pancreatic
Know about:
cancer.
-Travel
Alcoholic liver
-Joints
disease.
-Constitutional
6. What is the work-up you would order for Amylase/Lipase symptoms
this patient with abdominal pain? CBC
15. Abdominal pain in a 28 year old female Abdomen
Electrolyte
which occurs after bread, cereal, wheat. Lymphadenopathy
US Abdomen
Bloating with chronic diarrhea. What Oral mucosa
CT Abdomen
physical exam maneuvers are you Joints
7. 45 year old female presents with a chief NSAID usage. going to check?
complaint of abdominal pain. She says that
16. What is your differential? Celiac Disease
the pain is an epigastric burning pain that
Celiac Sprue
started an hour after she ate food. It is a
IBS
constant pain that does not radiate. She
Parasitic infection
feels nauseas at times. What is important
Whipple disease
to assess in terms of her PMH?
Lactose
8. What is your differential for a woman with PUD intolerance
burning epigastric pain? Gastritis C. difficile
Non-ulcer
dyspepsia
GERD
17. What is the workup for possible TTG 25. What is the workup for ED? Genital exam
Celiac or Lactose intolerance? Anti-endomysial CBC
Anti-gliadin Testosterone
Lactose breath test Prolactin
CBC TSH
Electrolytes Cholesterol
O/P the stool Lipid Panel
Small bowel biopsy. HbA1C
Glucose
18. 25 year old male with 2 weeks of Parasitic disease.
watery non-bloody diarrhea. Pseudomembranous 26. Musculoskeletal Cases ...
Abdominal pain and cramping, with colitis.
27. 31 year old female with groin pain. She has Hip strain
bloating and flatulence. Rectal pain. Tropical sprue
been training for a marathon. She was Hip sprain
Tried imodium, and ciprofloxacin
training and fell down and has had pain Femoral neck
and also went to Kenya. Vaccines
since. What is your differential? fracture
UTD. What is your differential?
Stress
19. If the patient says I have a 7 year Wash hands after fracture
old daughter at home, how can I toilet and before Avascular
prevent her from getting this preparing foods. necrosis
diarrhea. What will be your answer? HERNIA
20. Health maintenance. Hypertension 28. What is your work-up for hip pain? X-ray of the
Cholesterol hip.
MRI of the
21. Patient is here for a hypertension CHF
hip.
refill. He has 190/110 mm Hg BP, and Diabetic
Ingunial US
was on HCTZ and ACE. He has Polyneuropathy
fatigue and decreased energy for Anemia 29. 72 year old AA male who presents with Osteoarthritis
past 3-4 months. SOB on exertion. shoulder stiffness and hip pain. He says that Polymyalgia
No CP or ED. Was diagnosed with it is worse in the morning. He has BPH Rheumatica
diabetes with no treatment. Last treated with Tamulosin. What is your Polymyositis
check up 1 year ago. What is your differential?
differential?
30. What is your work-up for shoulder CBC
22. 34 year old male with erectile Poly's (dipsia, uria, weakness? ESR
dysfunction wants the blue pill. He phagia) CPK
has PMH of hypercholesterolemia. Changes in weight? Aldolase
What are some endocrinological Do you have morning RF
questions you should assess? erections? CXR
Do you have visual Hip and
defects? Shoulder X-
Do you have ray
abnormal milk
31. Patient is a heavy male that presents with Disc
production?
severe back pain. He carries heavy boxes. herniation
23. What other questions should you Martial problems Pain radiates to the left leg. What is your Lumbar
ask about in the social history? Morning erections differential? muscle
Smoking sprain.
Alcohol
32. 65 y/o AA female presents with neck pain Lhermite
24. What is your differential for ED? Hypercholesterolemia for two weeks after a yoga class. Has been Spurling
causing ED getting worse. She has numbness and
Smoking induced ED tingling in her right forearm and thumb. She
Psychogenic says that it got worse yesterday after
Hypogonadism moving. What are two proper name physical
Prolactinoma exam maneuvers you will do?
Hypo-thyroid.
33. Lhermitte 40. What is the work-up? X-ray of the
knee
MRI of the
knee
Lyme titers
CBC
Uric acid
Athrocentesis
Electric shock. Blood culture

34. Spurling 41. 50 yo male who presents with pain in the Foreign Body
right foot after he stepped on glass one Foot strain
week ago. What is the differential Plantar
diagnosis? fasciitis
DM
42. What is the work-up? X-ray of foot.
ESR
Glucose
Hb-A1C
43. Female comes in with ankle sprain after Ankle sprain
Electric shock.
twisting it on the curb. What is the Ankle
35. What is your differential Cervical disc herniation differential? fracture
for neck pain? Cervical muscle strain Ankle
Cervical vertebrae fracture dislocation
36. What is the workup? Neck X-ray 44. What is the work-up? Ankle x-ray
Neck MRI
45. A 75 year old woman presents with back Vertebral
Nerve conduction studies
pain after tripping on the sidewalk. She has fracture
CBC
a PMH of breast cancer. Mets Breast
Ca
Cancer
BUN/Cr
Osteoporosis
37. 70 year old female Angina Lumbar
presents with left arm MI Muscle Strain
pin after moving boxes. Tendonitis
46. What is the work-up? Spine X-ray
No lesions. What is Osteoarthritis
Spine MRI
differential diagnosis?
47. 35 yo male with left hip pain for past month. Trochnanteric
38. What is the workup? Troponin
Married with one child. Pain to palpation of Bursitis
Myoglobin
the hip. What is your differential? Avascular
EKG
necrosis
CPK MB
Hip fracture
Stress Test
CBC 48. What is the work-up? Hip X-Ray
ESR and MRI
Shoulder X-ray 49. 28 yo male with right shoulder pain after Rotator cuff
39. 40 year old female with Meniscal tear playing tennis. What is your differential? tear
right knee pain which Ligament tear Rotator cuff
started two weeks after Lyme disease sprain
going on a trail. She had Pseudogout Shoulder
the pain first week, and Gout dislocation
now she has a crutch to Septic arthritis Tendonitis
walk. What is your Reactive Arthritis 50. What is the work-up? Shoulder X-
differential? Ray and MRI
CBC
51. Urogyn cases Commence
52. Male who presents with blood in the urine Kidney stone 59. What is your work-up? Pelvic US
after 3 weeks ago URI. What is your IgA Endometrial
differential? nephropathy biopsy
PSGN CBC
Tumor Pap smear
('painless PT
hematuria) PTT
UTI Bleeding time
53. What is the work-up? UA 60. Patient is a smoker and requests birth No.
Urine Culture control. Should this be indicated? Contraindicated
Microscopic because she is
exam of urine. a smoker and
ASO above 35 years
DNA-ASE old.
BUN/Cr
61. Female with burning pain, itching, vaginal Trichmonas
CBC
discharge. Pain with penetration. Vaginal Candida
Renal US
discharge (yellow, malodorous). PMH of BV
Urine
HTN and DM. Takes metformin. Has some Cervicitis
Cytology
dryness in vagina. What is your Atrophic
54. 17 year old female with dysuria. Had UTI in Urethritis differential? Vaginitis
the past. Sexual history is slutty. What is Cystitis
62. What is your work-up? GU exam
your differential? UTI repeat
KOH prep
55. What is the work-up? UA GC PCR
Urine Culture Wet mount
GC/Chlamydia Cervical culture
US of kidney Gm stain
BUN/Cr
63. Pediatrics Cases Thats my ish.
56. 67 yo female with 2 week history of vaginal Endometrial
64. 4 year old male with a dry cough for the Asthma
spotting. Has been on HRT for 12 years. cancer
last 2 weeks that is worse with exercise. Pertussis
What is your ddx? Vaginal
He had a cold three weeks ago and his Reactive airway
trauma
DTAP is missing. He has some strain in Bronchitis
Cervical
family. He does smoke around the kid. His
cancer
mother has hay fever. What is the likely
Endometrial
differential?
hyperplasia
65. What is the work-up? CXR
57. What is the work-up? Pelvic exam
CBC
Pelvic US
Peak flow
Endometrial
Methacholine
biopsy
challenge
Pap Smear
Pertussis PCR
CBC
66. Phone case: 3.5 week female with Gastroenteritis
58. 40 year old female with heavy menses. No Uterine
diarrhea. Brown and non-bloody. No Osmotic
hair growth, no fatigue, no weight gain. fibroids
fever. Patient has no milk in the house. Diarrhea
What is your DDx? Endometrial
What is the differential?
polyps
Endometrial 67. What are the signs of dehydration in a Low tear output
hyperplasia baby? Dry mouth
LOW URINE
OUTPUT
68. What is the work-up for pediatric Electrolytes 78. 65 yo female with 5 day h/o dizziness. She BPPV
diarrhea? CBC has had 3 episodes started when she bent Meniere's
O&P over. Light headed. Decreased vision. Lower Vasovagal
Stool limb edema. Has hypertension, HCTZ, and syncope
exam/WBC diarrhea. What is your differential? Cerebellar
FOBT tumor
Orthostatic
69. 2 year old male with fever and ear OM
hypotension
pulling. PMH for OM. Premature, NICU OE
VBI
stay. +sick contact. What is your URI
Arrythmia
diagnosis?
79. 30 yo female with dizziness and light Orthostatic
70. What is your work-up for ear pain? Pneumatic
headedness x 2. Under a lot of stress. Has hypotension
otoscopy
palpitations. No passing out, no hear loss, no Alcohol
CBC
infections, no vertigo. Drinks ETOH and has intoxication
71. 12 year old female with 4 pounds of Type 1 DM heavy periods. What is your differential? Arrythmia
weight loss in past four days. Poly uria, DI
80. What is your work up? Orthostatic
poly dip, phagia. What is your Hyperthyroidism
vital signs
differential? UTI
CBC
72. What is your work-up? BMP Peripheral
Glucose checks blood smear
TSH/FT4 Electrolytes
UA FOB
Urine Audiogram
electrolytes Dix Hallpike
Serum and urine test
osmolality
81. What should you counsel her on? Safe sex
ESR
Alcohol
73. 15 year old female with weight loss. What Anorexia (possible
else should you think of? CAGE)
74. Neuro-Psych cases Commence 82. 65 yo female with bitemporal headache and Tension
75. 62 yo female with hearing loss. She has Rinne high BP. Has difficulty concentrating. Has headache
decreased hearing in both ears, and Weber nausea. Mother had migraine. What is your Hypertension
takes osteoporosis meds. She stopped differential? induced
using her hearing aids. She has no Migraine
support. What physical exam maneuvers TEMPORAL
are you going to perform? arteritis
Intracranial
76. What is your differential diagnosis? Ototoxicity:
mass
-trauma vs.
medications 83. What is the work-up? CBC
Presbycusis BMP
Acoustic CT head
neuroma ESR
Labryinthitis 84. 65 yo female with headache and BP of Hypertensive
77. What is your work-up? Audiometry 180/85. She uses aspirin. Has band-like crisis
Tympanography headache. No vision problems. What is your SAH
Brain stem differential? Tension
audiometry headache
evoked Caffeine
potentials withdrawal
CT of Head TEMPORAL
CBC arteritis
85. What is the work-up? CBC 93. What is your work-up? EKG
Electrolytes US of Doppler
ESR EEG
Non-contrast Glucose checks
head CT BMP
PT/PTT/INR (she CBC
is on aspirin)
94. LOC male with fainting while going to TIA
86. 32 yo male with a headache. He is in the Drug induced get mail. No aura. No shaking, tongue Cardiac
dark. Started 4-5 hours ago. Cocaine user. vaso-spasm biting, or loss of bladder control. No arrhythmia
Had sex and starting getting headache. Meningitis post-ictal. Homosexual with no condom Syncope
Has kidney problems in FMH. What is SAH use. PMH MI, and CAD, Seizures
your differential? Tension hypercholesterolemia, takes CCB. What Hypoglycemia
headache is your differential?
Intracranial
95. 35 year old female with cc of fatigue. Sheehan
venous
Had baby 4 months ago. Bleeding syndrome.
thrombosis
some days after delivery. She does not Hypothyroid
87. What is your work-up? CBC produce milk. Gaining weight. What is Anemia.
BMP your differential? Depression.
Urine Tox
96. What is your workup? TSH FT4
PT/INR/PTT
Prolactin level
Non-contrast
CBC
CT head
CT head
88. Young bball male with LOC and no other HOCOM
97. 32 yo female who presents with 8 mo Sheehan
symptoms. What is your differential? Cardiac
h/o fatigue . Falls asleep in cinema. Dry Syndrome
arrhythmia
skin, cold intolerance, weight gain. Hypothyroid
Seizure
Snores at night. Had hemorrhage from Obstructive sleep
Vasovagal
pregnancy. What is your differential? apnea
89. What is your work-up? EKG
98. What is your work-up? TSH Free T4
EEG
Prolactin
Echocardiogram
Polysomnography
CT brain
CT head
CBC
CBC
Electrolytes
Fasting glucose
90. LOC male comes after falling at bus stop. Seizure
99. Young man with weight loss and Hypothyroidism
He peed himself. Several episodes, bad Drug overdose
appetite changes, he has night sweats. Leukemia,
attitude, alcoholic, smoker, unemployed. Syncope-TIA
Has stress. Very tired. URI 6 weeks ago. lymphoma
What is your differential? Hypoglycemia
What is your differential? Depression
Arrhythmia
Fibromyalgia
91. What is your work up? EKG TB? wtf
EEG
100. What is your work up? Hormone assays
Holter monitor
Iron Level
Urine tox
TSH FT4
CBC
Chest X-ray
BMP
Glucose 101. 16 year old female with tiredness and Anemia
CAROTID heavy periods. She is sexually active. Depression
Doppler Weight gain. Sad and down. Has to take Hypothyroidism
care of her siblings. What is your
92. LOC male with HTN on vitals sign was at Arrythmia
differential?
grocery with wife. Wife saw episode. He TIA
has no aura. No shaking, tongue biting or Seizures 102. What is your work up? CBC
loss of bladder control. PMH of MI. What Hypoglycemia Iron level
is your differential? Syncope TSH FT4
103. 30 yo AA male with weight loss and HIV infection 115. 65 yo male comes in with 15 lb weight DM
fatigue. Homosexual with a lot of Mono loss in 3 months. Fatigued. Polyuria. Takes DI
sexual partners. What is your Depression OTC PPI. Has colonoscopy 15 years ago. Colon Cancer
differential? Hypothyroidsm What is your differential?
104. What is your work up? HIV PCR and Ab 116. What is your work-up? BMP
FT4 and TSH Glucose
CBC HBA1C
Serum Osm
105. 75 yo with memory loss. He is lost Alzeihmers
Urine Osm
everywhere. Cant do ADLs. Is in denial. Vascular
FOBT
What is your differential? Depression
Iron
106. What is your work up? CBC CBC
VDRL/RPR Colonoscopy
Serum B12
117. 60 yo male presents with 18 lb weight loss CHF
TSH
in past 8 months. Not depressed. He has Hidden
CT Brain
poor diet. Gets tired. Has medicare. Has malignancy
107. 20 yo female who is anxious. Drinks a Amphetamine aortic valve replacement. What is your Hypercalcemia
lot of coffee. Heart racing Takes induced insomnia differential? (stones, bones,
Adderol. Caffeine induced and psychic
insomnia undertones)
GAD Renal failure
Hyperthyroidism
118. What is going to be your work-up? ECG
108. What is your work-up? Urine Toxicology Echo
CBC Cardiac
TSH enzymes
MSE BNP
Polysomnography CBC
109. Female with jaw pain who says Domestic abuse Iron studies
boyfriend hits her. What is your Mandible fracture Calcium
differential? TMJ dysfunction TSH
FOBT
110. What is the work up you will do? X-ray of head
BUN/Cr
111. 57 yo F with sleeping problems. Son Normal grief Colonoscopy
died 3 weeks ago. She is not suicidal Major depressive
119. Cardiorespiratory Cases ...
has good support system. Has disorder
hallucinations of son. Takes 5 Ambien, Adjustment 120. 16 y/o male with racing heart. Has an SAT Generalized
and 3 glasses of wine. What is your disorder with book in his hand. Having insonia. Slight anxiety
differential? depressed mood SOB. Coffee intake a lot. Sexually active, Substance
PTSD uses condoms. Smokes weed. What is abuse
your differential? Cardiac
112. What is the work up? CBC
Arrythmia
TSH
Hyperthyroid
MSE
Polysomnography 121. What is your work-up? Urine
Toxicology
113. 22 yo female with insomnia. She awakes Circadian rhythm
EKG
at night and difficult to fall asleep. disorder
CBC
Father died one year ago. No stress. No Insomnia
TSH, T4
Caffeine. Gained 12 pounds. Heavy OSA
periods. What is your differential? Hypothyroid 122. 24 year old with chest pain and 3 day h/o Pneumonia
cold. Gay, but HIV negative. Worse when Pericarditis
114. What is your work-up? CBC
breathing. Has some sputum. Has a fever Costochondritis
TSH
and hx of pneumonia. What is your Pleurisy
MSE
differential? Muscle strain
U Toxicology
123. What is your work-up? CXR 131. What is your work-up? CBC
CBC CXR
Troponin Peak-flow
CK-MB PFT
EKG CT-chest
PPD
124. 40 yo male with chest pain on left side. Pneumonia
Gram-stain and
Very acute happened in 4-5 hours. MI
culture.
Stabbing pain that is pleuritic. SOB. Dry PE
cough. URI last week. Smokes. Agressive. Pericarditis 132. 45 yo female with a cough for 5 months. GERD
What is your differential? Pleurisy Dry and nagging cough. Got worse. Post nasal drip
Pneumothorax Wakes her up. Has pillows to sleep. PMH Heart failure
Muscle strain asthma as child. 1 glass of wine drinker. Asthma
Coronary What is your differential?
vasospasm
133. What is your work-up? CBC
thru cocaine
trial of PPI
125. What is your work-up? EKG BNP
Troponin CXR
CK-MB
134. 50 yo female with cough. Heavy smoker Lung cancer
CBC
and drinker. SOB on exertion. Mad. What COPD
CXR
is your differential? Pneumonia
126. 40 yo female with chest pain. Tachycardic PE
135. What is your work-up? CBC
and Tachypnic. Acute distress. Radiates to Pericarditis
CXR
left shoulder, better with leaning forward, Pleurisy
PFTs
worse with lying down. On OCP, smoker, MI
CT-Chest
sitting for a while. FMH of MI. What is your Pneumonia
Gram stain and
differential? Pleurisy
culture
127. What is your work-up? CXR
136. 30 yo male with SOB and CP. Chest pain Uremic
Non-contrast
on right that worsens with breathing. pericarditis
helical CT
Stabbing pain. Has a cough. Sweats at Pneumonia
EKG
night. Has Hodgkins Lymphoma in PMH. TB
CK-MB
What is your differential? Recurrence of
Troponin
tumor
CBC with diff
137. What is the work-up? CXR
128. 17 yo male with cough. Non-productive. Asthma
CT Chest
Dry. Drinks 2-3 beers/weekend. FMH Viral URI
CBC diff
asthma. Foreign body
Uric Acid
*counsel on alcohol at young age* Atypical
LDH
What is your differential? pneumonia
138. 60 yo male with SOB fatigued. CHF
129. What is your work-up? CBC
Uncontrolled BP. Has check-up 20 years Colon cancer
CXR
ago. Colonoscopy. Leg swelling. Smoker. Lung cancer
Peak flow
What is your differential?
Methacholine
challenge 139. What is your work-up? BNP
Echocardiogram
130. 50 yo male with cough. Mild productive 6 COPD
Colonscopy
month. Sputum is white. 20 year smoker. Lung cancer
CXR
What is differential? TB
FOBT
Bronchiectasis