Repeated USMLE Questions Step 2 CK | Review

Q- A 63-year-old woman with diabetes presents with fever, flank pain, and dysuria. CT scan shows gas within the renal parenchyma.

What is the most likely diagnosis?

A- Acute pyelonephritis

B- Emphysematous pyelonephritis

C- Renal abscess

D- Xanthogranulomatous pyelonephritis

B- Emphysematous pyelonephritis- Gas-forming infection of the kidney, most commonly seen in diabetic patients, is diagnostic of emphysematous pyelonephritis, a life-threatening condition.

Q- A 74-year-old woman presents with acute onset right-sided weakness and slurred speech that began 2 hours ago. CT scan of the head shows no hemorrhage. Her blood pressure is 210/115 mmHg.

What is the most appropriate next step in management?

A- Administer intravenous alteplase immediately

B- Lower blood pressure with intravenous labetalol

C- Start aspirin therapy

D- Wait 24 hours and repeat CT scan

B- Lower blood pressure with intravenous labetalol- Thrombolysis requires BP <185/110 mmHg. In acute ischemic stroke with very high BP, the first step is careful BP reduction before alteplase can be given.

Q- A 61-year-old man presents with severe abdominal pain that began suddenly after a large meal. Pain radiates to the back. Lipase is markedly elevated. Ultrasound shows gallstones without bile duct dilation.

What is the most appropriate next step in management?

A- Cholecystectomy during the same hospitalization

B- Endoscopic retrograde cholangiopancreatography (ERCP)

C- Immediate laparotomy

D- Start antibiotics

A- Cholecystectomy during the same hospitalization- Gallstone pancreatitis without cholangitis or obstruction is treated with supportive care followed by cholecystectomy during the same admission to prevent recurrence.

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