Repeated USMLE Questions Step 2 CK- Review- 405

Q- A 63-year-old man with atrial fibrillation presents for routine follow-up. He has no history of stroke, diabetes, or heart failure. His blood pressure is well controlled.

Which of the following is the most appropriate long-term management to reduce stroke risk?

A- Aspirin only

B- Dual antiplatelet therapy

C- Oral anticoagulation

C- Oral anticoagulation- Patients with atrial fibrillation and a CHA₂DS₂-VASc score ≥2 require oral anticoagulation to reduce the risk of thromboembolic stroke.

 

Q- A 19-year-old man is referred to the clinic for a positive purified protein derivative (PPD) test for tuberculosis. He moved to the United States from Egypt 2 years ago and has been in good health. He has no history of fever, cough, weight loss, or night sweats. He has no family history or contacts with tuberculosis. His physical examination is normal. His chest x-ray shows no cavitation or hilar adenopathy.

What is the best next step in management for this patient?

A- Repeat the PPD test and x-ray after 6 months

B- Start treatment with isoniazid for 9 months

C- Start treatment with multiple-drug antituberculosis therapy

D- Isolation and full anti-tuberculosis therapy for 6 months

B- Start treatment with isoniazid for 9 months- This man has a previous exposure to TB, which caused subclinical infection. His history, physical examination, and chest x-ray exclude current active TB. He does not need multiple drug treatment at this time, but he should take prophylactic treatment in case there is any dormant infection in his body. The best treatment for this case is isoniazid for 9 months.

 

Q- A 27-year-old woman presents with fatigue and shortness of breath. She recently delivered a baby 3 weeks ago. Echocardiography shows dilated cardiomyopathy with reduced ejection fraction.

What is the most likely diagnosis?

A- Peripartum cardiomyopathy

B- Restrictive cardiomyopathy

C- Takotsubo cardiomyopathy

D- Viral myocarditis

A- Peripartum cardiomyopathy- Peripartum cardiomyopathy occurs in the last month of pregnancy or within 5 months postpartum and presents with heart failure due to dilated cardiomyopathy.

 

Q- A 52-year-old woman presents with progressive muscle weakness and a heliotrope rash around her eyes. Laboratory testing shows elevated creatine kinase levels.

Which of the following conditions is most strongly associated with this disease?

A- Chronic kidney disease

B- Recent vaccination

C- Underlying malignancy

D- Viral infection

C- Underlying malignancy- Dermatomyositis is associated with paraneoplastic syndromes, particularly ovarian, lung, breast, and gastrointestinal cancers.

 

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11 thoughts on “Repeated USMLE Questions Step 2 CK- Review- 405”

  1. Thank you for clarifying this point

  2. Thank you Dr Hana

  3. BCG make it subclinical infection which means there are mycobacterium in the bloodstream but they don’t cause clinical picture of TB. Thank you for your question.

  4. Doctor I want to know why insipite of bcg vaccine during childhood ,a person may get infected to tuberculosis??

  5. Thank you so much. I appreciate spending sometime visiting our website. We will be glad to see you coming back.

  6. Its a nice!.

  7. A know a few doctors in USA who send the patient for a Xray. If the xray is negative then they only repeat it every year. How about that?

  8. Personally, I agree with you but unfortunately neither USA Doctors nor USMLE agree with you. I know BCG vaccine is mandatory in some countries like Egypt and it can lead to a positive reaction but also remember that there is still a quiet few cases of active TB even of those who took vaccine. The reason I put this question is that: In order to pass the USMLE, you have to answer it the way they believe is the correct answer in USA even if it is different from what you were taught in schools. Thank you for this great question.

  9. why i give him a prophylactic therapy while he give positive because he was immunized obligatory in egypt previously while he wwas a child

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