USMLE Step 2 CS Sample Cases Questions And Answers
With Complete Test
32 year old male presents with complaint of abdominal pain. He states that he has pain in his right
testicle. There is yellow discharge, and burning with urination. He does not use condoms, and has many
sexual partners. PE shows CVA tenderness. What is your differential? Correct Answer: Orchiepidimytis
Gonococcal Urethritis
Non-gonoccal urethritis.
What would be your workup for this possible epidimyitis Correct Answer: UA
US of testes
Urethral Culture
HIV testing
What ancillary maneuvers would you perform for this patient? Correct Answer: STD and condoms
A 50 year old male presents with abdominal pain. He states this this pain has been present for 2 days,
and is located in the midepigastric region. He says that it is a tearing pain radiating to the back. He feels
sweaty at times, and has some RUQ as well. He has a history of cirrhosis in his family, and does drink 10
beers a night. What standardized history taking approach would you do for this patient's social history?
Correct Answer: CAGE questionnaire.
1. Cut down?
2. Annoyed?
3. Guilty?
4. Eye opener?
What is your differential diagnosis for an alcoholic with abdominal pain? Correct Answer: Acute
Pancreatitis.
Dissecting aortic aneurysm.
Pancreatic cancer.
Alcoholic liver disease.
What is the work-up you would order for this patient with abdominal pain? Correct Answer:
Amylase/Lipase
CBC
Electrolyte
US Abdomen
CT Abdomen
45 year old female presents with a chief complaint of abdominal pain. She says that the pain is an
epigastric burning pain that started an hour after she ate food. It is a constant pain that does not
radiate. She feels nauseas at times. What is important to assess in terms of her PMH? Correct Answer:
NSAID usage.
What is your differential for a woman with burning epigastric pain? Correct Answer: PUD
Gastritis
,Non-ulcer dyspepsia
GERD
What is the workup for this woman with possible PUD? Correct Answer: H Pylori serology, and stool Ag
Upper GI endoscopy
CBC
Rectal
FOBT
A 22 year old female presents with lower abdominal pain. What is the first thing you should conduct a
history about? Correct Answer: Menstrual history.
She states that she had her LMP 4 days ago, with abundant bleeding. 2 days ago there was spotting. She
is sexually active with her bf with no condom use. What is your differential? Correct Answer: PID
Appendicitis
Ectopic pregnancy
46 year old female presents with abrupt onset of RLQ abdominal pain. Has vaginal discharge with
irregular periods. She is sexually active. PMH is + for PID and appendectomy at 13. What is your
differential? Correct Answer: Ectopic pregnancy
Ovarian torsion
Ruptured ovarian cyst
PID
Vaginitis
What would your work-up be for this patient? Correct Answer: B-HcG
Pelvic/Rectal exam
US Pelvis
UA
Cervix culture
Diarrhea Cases Correct Answer: Cases:
Know about:
-Travel
-Joints
-Constitutional symptoms
Abdominal pain in a 28 year old female which occurs after bread, cereal, wheat. Bloating with chronic
diarrhea. What physical exam maneuvers are you going to check? Correct Answer: Abdomen
Lymphadenopathy
Oral mucosa
Joints
What is your differential? Correct Answer: Celiac Disease
Celiac Sprue
IBS
Parasitic infection
Whipple disease
, Lactose intolerance
C. difficile
What is the workup for possible Celiac or Lactose intolerance? Correct Answer: TTG
Anti-endomysial
Anti-gliadin
Lactose breath test
CBC
Electrolytes
O/P the stool
Small bowel biopsy.
25 year old male with 2 weeks of watery non-bloody diarrhea. Abdominal pain and cramping, with
bloating and flatulence. Rectal pain.
Tried imodium, and ciprofloxacin and also went to Kenya. Vaccines UTD. What is your differential?
Correct Answer: Parasitic disease.
Pseudomembranous colitis.
Tropical sprue
If the patient says I have a 7 year old daughter at home, how can I prevent her from getting this
diarrhea. What will be your answer? Correct Answer: Wash hands after toilet and before preparing
foods.
Health maintenance. Correct Answer: Hypertension
Cholesterol
Patient is here for a hypertension refill. He has 190/110 mm Hg BP, and was on HCTZ and ACE. He has
fatigue and decreased energy for past 3-4 months. SOB on exertion. No CP or ED. Was diagnosed with
diabetes with no treatment. Last check up 1 year ago. What is your differential? Correct Answer: CHF
Diabetic Polyneuropathy
Anemia
34 year old male with erectile dysfunction wants the blue pill. He has PMH of hypercholesterolemia.
What are some endocrinological questions you should assess? Correct Answer: Poly's (dipsia, uria,
phagia)
Changes in weight?
Do you have morning erections?
Do you have visual defects?
Do you have abnormal milk production?
What other questions should you ask about in the social history? Correct Answer: Martial problems
Morning erections
Smoking
Alcohol
What is your differential for ED? Correct Answer: Hypercholesterolemia causing ED
Smoking induced ED
Psychogenic
With Complete Test
32 year old male presents with complaint of abdominal pain. He states that he has pain in his right
testicle. There is yellow discharge, and burning with urination. He does not use condoms, and has many
sexual partners. PE shows CVA tenderness. What is your differential? Correct Answer: Orchiepidimytis
Gonococcal Urethritis
Non-gonoccal urethritis.
What would be your workup for this possible epidimyitis Correct Answer: UA
US of testes
Urethral Culture
HIV testing
What ancillary maneuvers would you perform for this patient? Correct Answer: STD and condoms
A 50 year old male presents with abdominal pain. He states this this pain has been present for 2 days,
and is located in the midepigastric region. He says that it is a tearing pain radiating to the back. He feels
sweaty at times, and has some RUQ as well. He has a history of cirrhosis in his family, and does drink 10
beers a night. What standardized history taking approach would you do for this patient's social history?
Correct Answer: CAGE questionnaire.
1. Cut down?
2. Annoyed?
3. Guilty?
4. Eye opener?
What is your differential diagnosis for an alcoholic with abdominal pain? Correct Answer: Acute
Pancreatitis.
Dissecting aortic aneurysm.
Pancreatic cancer.
Alcoholic liver disease.
What is the work-up you would order for this patient with abdominal pain? Correct Answer:
Amylase/Lipase
CBC
Electrolyte
US Abdomen
CT Abdomen
45 year old female presents with a chief complaint of abdominal pain. She says that the pain is an
epigastric burning pain that started an hour after she ate food. It is a constant pain that does not
radiate. She feels nauseas at times. What is important to assess in terms of her PMH? Correct Answer:
NSAID usage.
What is your differential for a woman with burning epigastric pain? Correct Answer: PUD
Gastritis
,Non-ulcer dyspepsia
GERD
What is the workup for this woman with possible PUD? Correct Answer: H Pylori serology, and stool Ag
Upper GI endoscopy
CBC
Rectal
FOBT
A 22 year old female presents with lower abdominal pain. What is the first thing you should conduct a
history about? Correct Answer: Menstrual history.
She states that she had her LMP 4 days ago, with abundant bleeding. 2 days ago there was spotting. She
is sexually active with her bf with no condom use. What is your differential? Correct Answer: PID
Appendicitis
Ectopic pregnancy
46 year old female presents with abrupt onset of RLQ abdominal pain. Has vaginal discharge with
irregular periods. She is sexually active. PMH is + for PID and appendectomy at 13. What is your
differential? Correct Answer: Ectopic pregnancy
Ovarian torsion
Ruptured ovarian cyst
PID
Vaginitis
What would your work-up be for this patient? Correct Answer: B-HcG
Pelvic/Rectal exam
US Pelvis
UA
Cervix culture
Diarrhea Cases Correct Answer: Cases:
Know about:
-Travel
-Joints
-Constitutional symptoms
Abdominal pain in a 28 year old female which occurs after bread, cereal, wheat. Bloating with chronic
diarrhea. What physical exam maneuvers are you going to check? Correct Answer: Abdomen
Lymphadenopathy
Oral mucosa
Joints
What is your differential? Correct Answer: Celiac Disease
Celiac Sprue
IBS
Parasitic infection
Whipple disease
, Lactose intolerance
C. difficile
What is the workup for possible Celiac or Lactose intolerance? Correct Answer: TTG
Anti-endomysial
Anti-gliadin
Lactose breath test
CBC
Electrolytes
O/P the stool
Small bowel biopsy.
25 year old male with 2 weeks of watery non-bloody diarrhea. Abdominal pain and cramping, with
bloating and flatulence. Rectal pain.
Tried imodium, and ciprofloxacin and also went to Kenya. Vaccines UTD. What is your differential?
Correct Answer: Parasitic disease.
Pseudomembranous colitis.
Tropical sprue
If the patient says I have a 7 year old daughter at home, how can I prevent her from getting this
diarrhea. What will be your answer? Correct Answer: Wash hands after toilet and before preparing
foods.
Health maintenance. Correct Answer: Hypertension
Cholesterol
Patient is here for a hypertension refill. He has 190/110 mm Hg BP, and was on HCTZ and ACE. He has
fatigue and decreased energy for past 3-4 months. SOB on exertion. No CP or ED. Was diagnosed with
diabetes with no treatment. Last check up 1 year ago. What is your differential? Correct Answer: CHF
Diabetic Polyneuropathy
Anemia
34 year old male with erectile dysfunction wants the blue pill. He has PMH of hypercholesterolemia.
What are some endocrinological questions you should assess? Correct Answer: Poly's (dipsia, uria,
phagia)
Changes in weight?
Do you have morning erections?
Do you have visual defects?
Do you have abnormal milk production?
What other questions should you ask about in the social history? Correct Answer: Martial problems
Morning erections
Smoking
Alcohol
What is your differential for ED? Correct Answer: Hypercholesterolemia causing ED
Smoking induced ED
Psychogenic
