Repeated USMLE Questions Step 2 CK- Review- 48

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Q- A 60-year-old man with a history of alcohol use presents with vomiting of bright red blood. He is hypotensive and tachycardic. Endoscopy reveals dilated veins in the lower esophagus.

What is the best initial management step?

A- Beta-blocker therapy

B- Endoscopic band ligation

C- IV octreotide and fluid resuscitation

D- IV proton pump inhibitor

C- IV octreotide and fluid resuscitation- Acute esophageal variceal bleeding requires hemodynamic stabilization and octreotide (a somatostatin analog that reduces portal pressure) as first-line therapy before definitive endoscopic intervention.

 

Q- A 35-year-old woman presents with recurrent episodes of palpitations and lightheadedness. ECG shows a narrow-complex tachycardia at 180 bpm with absent P waves.
Carotid sinus massage terminates the arrhythmia.

What is the most likely diagnosis?

A- Atrial fibrillation

B- Atrial flutter

C- Paroxysmal supraventricular tachycardia (PSVT)

D- Ventricular tachycardia

C- Paroxysmal supraventricular tachycardia (PSVT)- PSVT (often AV nodal reentrant tachycardia) presents with sudden-onset palpitations and a narrow QRS complex. It responds to vagal maneuvers such as carotid massage or Valsalva.

 

Q- A 45-year-old man presents with progressive weakness, weight gain, and easy bruising. On exam, he has a rounded “moon” face, central obesity, and purple abdominal striae. Serum cortisol levels remain elevated after low-dose dexamethasone suppression testing.

What is the most likely diagnosis?

A- Acromegaly

B- Addison’s disease

C- Cushing’s syndrome

D- Pheochromocytoma

C- Cushing’s syndrome- Cushing’s syndrome results from excess cortisol production. Classic signs include truncal obesity, muscle weakness, hypertension, and purple striae. Lack of suppression after dexamethasone confirms the diagnosis.

 

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