Repeated USMLE Questions Step 2 CK | Review

Q- A 45-year-old woman presents with fever and a productive cough. She has been started on antibiotics for community-acquired pneumonia. Two days later, she develops profuse watery diarrhea. The stool test is positive for toxin.

What is the most appropriate treatment?

A-Ciprofloxacin

B-Loperamide

C-Oral vancomycin

D-Stop antibiotics only

C-Oral vancomycin- This case is Clostridioides difficile infection. First-line treatment for initial severe infection is oral vancomycin.

Q- A 72-year-old woman presents with sudden, severe abdominal pain that is out of proportion to physical findings. She has atrial fibrillation. Lactate is elevated.

What is the most appropriate next diagnostic step?

A-Abdominal ultrasound

B-Colonoscopy

C-CT angiography

D-Plain abdominal X-ray

C-CT angiography- This is classic acute mesenteric ischemia (pain out of proportion, AFib embolus). The best diagnostic test is CT angiography.

Q- A 58-year-old man presents with severe chest pain for 45 minutes. ECG shows ST elevations in leads II, III, and aVF. Blood pressure is 78/50 mmHg, and jugular venous distention is present. Lungs are clear on auscultation.

What is the most appropriate next step in management?

A-Administer intravenous fluids

B-Give intravenous furosemide

C-Start nitroglycerin infusion

D-Start morphine for pain

A-Administer intravenous fluids- This is inferior MI with right ventricular infarction. Hypotension with clear lungs indicates decreased preload. IV fluids increase right ventricular preload and improve cardiac output. Nitrates and diuretics would worsen hypotension.

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