USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
When would you order a head CT with or without contrast? - correct answer With - looks
for abscesses or intracranial masses
WITHOUT - looks for acute bleeding which appears white. Contrast also appears white
and can obscure bleeding. Like in intracranial hemorrhage
Parents bring teen daughter to ED for cutting herself. No intent to commit suicide per
daughter. Does she require hospitalization while you work her up for safety reasons? -
correct answer NO. There is no intent to commit suicide in curing disorders. Just done
to cope w/emotions. Pt will need full psych work up.
Metzner's index - correct answer MCV/RBC. Helps to differentiate IDA from beta-
thalassemia.
Alpha or Beta-thalassemia if <13
IDA if > 13
The 4 types of shock and how they affect RAP, PCWP, CI, SVR - correct answer
Explain what SPIN and SNOUT mean for specificity and sensitivity - correct answer
Specificity = TN/(TN+FP)
- SP-P-IN - if a test is positive for a disease then it rules IN that disease. Use a highly
specific test after a screening test to confirm that the person actually has that disease
- low rate of false positives
Sensitivity = TP/(TP+FN)
- SN-N-OUT - if a test is negative for a disease then it rules OUT that disease. Use a
highly sensitive test on screening tests to rule out diseases
- low rate of false negatives
,USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
what is the formula for anion gap? what is normal anion gap? - correct answer Na+ -
(Cl- + HCO3-)
What is the order for family members designated as surrogate? - correct answer
Spouse, adult children, parent, adult sibling, nearest living relative, close friend
Define: Hirsutism - correct answer Hirsutism (HUR-soot-iz-um) is a condition in women
that results in excessive growth of dark or coarse hair in a male-like pattern
What is the normal range for bicarbonate? - correct answer 22-28
How can you tell the difference btw A fib w/RVR and multifocal atrial tachycardia? -
correct answer Both are narrow complex tachycardias (QRS<120 bc atrial) w/irregular
R-R intervals
AFRVR - No P waves
MAT - ≥3 different types of P waves seen, HR>100
How can you tell if a question is asking you to calculate the relative risk? The relative
risk reduction? Or the absolute risk reduction? - correct answer If the question says
"What is the reduction in risk?" then it wants the RRR.
If the question says "What is the magnitude of risk between these two treatment
groups?" then it wants RR
- RR = risk in exposed group/risk in control group
,USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
If the question says "What is the ARR?" Then it wants ARR
What is the mechanism behind tertiary hyperparathyroidism and what is the treatment?
- correct answer - Occurs in CKD and renal osteodystrophy when you have inability to
excrete phosphate and inability to convert inactive vitamin D3 to active 1,25
dihydroxyvitamin D resulting in hypercalcemia due to bone losses of Ca2+
- Initially you start making more PTH in response to hypocalcemia and
hyperphosphatemia. Then as Ca2+ and PO43- increase you have uncontrolled
secretion of PTH and elevation in Ca2+ and PO43-
- The only treatment is PARATHYROIDECTOMY bc the parathyroid will just continue
making PTH forever. A renal transplant will not fix this
Which fracture happens from falling on flexion vs extension of the wrist? - correct
answer Flexion - bending wrist forward. Smith fracture.
Extension - falling on an outstretched hand. They will term this "tripping and falling
forward", they don't say outstretched hand, you are to assume it. Colles fracture and
Ulnar styloid fracture
In a septic patient with hyperglycemia how can you tell if the hyperglycemia is due to
undiagnosed DM? What is another cause of hyperglycemia in these patients? - correct
answer - Septic patients often have high BG bc of elevated cortisol release, pro-
inflammatory cytokines and catecholamine release but they may not actually have DM.
This is called STRESS HYPERGLYCEMIA
- If the pt has random BG >200 + signs of hyperglycemia like polyuria, polydipsia,
weight loss (in children w/DM1), polyphagia OR HbA1c ≥ 6.5 OR fasting plasma
glucose >126 OR oral glucose tolerance test 2 hr later w/BG>200 then this is DM
, USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
- Always check an A1c and this will tell you if there is a chronic elevation in BG
signifying undx'd DM1 or 2
Slipped Capital Femoral Epiphysis on X ray and treatment - correct answer IMMEDIATE
SURGICAL PINNING
56 yo M w/ARDS intubated in ICU for 7d then extubated. 1 wk later he is irritable and
confused in evenings and prescribed zolpidem to help w/sleeping. Montreal Cognitive
assessment shows 25/30 w/deficits in memory and attention. He has flattened affect
and psychomotor retardation. Long term prognosis? - correct answer Dx: Post-intensive
Care Syndrome (PICS)
Risk factors: ARDS, prolonged ventilation, ICU delirium
Pathophysiology: CNS hypoxia, neuroinflmmation, metabolic dysruption, massive
inflammation
Outcome: LIKELY TO HAVE MEMORY AND CONCENTRATION DEFECTS FOR
YEARS
- Usually they have deficits in one or more of the three areas for years
How can you tell inflammatory acne from comedonal and nodular acne? What is the
difference in treatment? - correct answer - Basically inflammatory looks almost the
same as comedomal but in inflammatory the lesions are inflamed papules and pustules.
In comedomal they start off as closed or open comedones but can then progress to
inflamed populous and nodules.
CORRECT ANSWERS 2024
When would you order a head CT with or without contrast? - correct answer With - looks
for abscesses or intracranial masses
WITHOUT - looks for acute bleeding which appears white. Contrast also appears white
and can obscure bleeding. Like in intracranial hemorrhage
Parents bring teen daughter to ED for cutting herself. No intent to commit suicide per
daughter. Does she require hospitalization while you work her up for safety reasons? -
correct answer NO. There is no intent to commit suicide in curing disorders. Just done
to cope w/emotions. Pt will need full psych work up.
Metzner's index - correct answer MCV/RBC. Helps to differentiate IDA from beta-
thalassemia.
Alpha or Beta-thalassemia if <13
IDA if > 13
The 4 types of shock and how they affect RAP, PCWP, CI, SVR - correct answer
Explain what SPIN and SNOUT mean for specificity and sensitivity - correct answer
Specificity = TN/(TN+FP)
- SP-P-IN - if a test is positive for a disease then it rules IN that disease. Use a highly
specific test after a screening test to confirm that the person actually has that disease
- low rate of false positives
Sensitivity = TP/(TP+FN)
- SN-N-OUT - if a test is negative for a disease then it rules OUT that disease. Use a
highly sensitive test on screening tests to rule out diseases
- low rate of false negatives
,USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
what is the formula for anion gap? what is normal anion gap? - correct answer Na+ -
(Cl- + HCO3-)
What is the order for family members designated as surrogate? - correct answer
Spouse, adult children, parent, adult sibling, nearest living relative, close friend
Define: Hirsutism - correct answer Hirsutism (HUR-soot-iz-um) is a condition in women
that results in excessive growth of dark or coarse hair in a male-like pattern
What is the normal range for bicarbonate? - correct answer 22-28
How can you tell the difference btw A fib w/RVR and multifocal atrial tachycardia? -
correct answer Both are narrow complex tachycardias (QRS<120 bc atrial) w/irregular
R-R intervals
AFRVR - No P waves
MAT - ≥3 different types of P waves seen, HR>100
How can you tell if a question is asking you to calculate the relative risk? The relative
risk reduction? Or the absolute risk reduction? - correct answer If the question says
"What is the reduction in risk?" then it wants the RRR.
If the question says "What is the magnitude of risk between these two treatment
groups?" then it wants RR
- RR = risk in exposed group/risk in control group
,USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
If the question says "What is the ARR?" Then it wants ARR
What is the mechanism behind tertiary hyperparathyroidism and what is the treatment?
- correct answer - Occurs in CKD and renal osteodystrophy when you have inability to
excrete phosphate and inability to convert inactive vitamin D3 to active 1,25
dihydroxyvitamin D resulting in hypercalcemia due to bone losses of Ca2+
- Initially you start making more PTH in response to hypocalcemia and
hyperphosphatemia. Then as Ca2+ and PO43- increase you have uncontrolled
secretion of PTH and elevation in Ca2+ and PO43-
- The only treatment is PARATHYROIDECTOMY bc the parathyroid will just continue
making PTH forever. A renal transplant will not fix this
Which fracture happens from falling on flexion vs extension of the wrist? - correct
answer Flexion - bending wrist forward. Smith fracture.
Extension - falling on an outstretched hand. They will term this "tripping and falling
forward", they don't say outstretched hand, you are to assume it. Colles fracture and
Ulnar styloid fracture
In a septic patient with hyperglycemia how can you tell if the hyperglycemia is due to
undiagnosed DM? What is another cause of hyperglycemia in these patients? - correct
answer - Septic patients often have high BG bc of elevated cortisol release, pro-
inflammatory cytokines and catecholamine release but they may not actually have DM.
This is called STRESS HYPERGLYCEMIA
- If the pt has random BG >200 + signs of hyperglycemia like polyuria, polydipsia,
weight loss (in children w/DM1), polyphagia OR HbA1c ≥ 6.5 OR fasting plasma
glucose >126 OR oral glucose tolerance test 2 hr later w/BG>200 then this is DM
, USMLE EXAM WITH 100%
CORRECT ANSWERS 2024
- Always check an A1c and this will tell you if there is a chronic elevation in BG
signifying undx'd DM1 or 2
Slipped Capital Femoral Epiphysis on X ray and treatment - correct answer IMMEDIATE
SURGICAL PINNING
56 yo M w/ARDS intubated in ICU for 7d then extubated. 1 wk later he is irritable and
confused in evenings and prescribed zolpidem to help w/sleeping. Montreal Cognitive
assessment shows 25/30 w/deficits in memory and attention. He has flattened affect
and psychomotor retardation. Long term prognosis? - correct answer Dx: Post-intensive
Care Syndrome (PICS)
Risk factors: ARDS, prolonged ventilation, ICU delirium
Pathophysiology: CNS hypoxia, neuroinflmmation, metabolic dysruption, massive
inflammation
Outcome: LIKELY TO HAVE MEMORY AND CONCENTRATION DEFECTS FOR
YEARS
- Usually they have deficits in one or more of the three areas for years
How can you tell inflammatory acne from comedonal and nodular acne? What is the
difference in treatment? - correct answer - Basically inflammatory looks almost the
same as comedomal but in inflammatory the lesions are inflamed papules and pustules.
In comedomal they start off as closed or open comedones but can then progress to
inflamed populous and nodules.
