Repeated USMLE Questions Step 2 CK- Review- 1

by

Q- A 45-year-old man presents with a 2-day history of severe low back pain radiating to both legs. He now reports new-onset urinary retention and decreased sensation in the perianal region. On examination, there is bilateral lower extremity weakness and decreased anal sphincter tone. Which of the following is the most appropriate next step in management?

A- MRI of the lumbosacral spine

B- Plain radiograph of the lumbar spine

C- Outpatient physical therapy referral

D- Oral corticosteroids

E- Lumbar puncture

A- MRI of the lumbosacral spine- Cauda equina syndrome is a surgical emergency caused by compression of the lumbosacral nerve roots, presenting with saddle anesthesia, bowel/bladder dysfunction, and bilateral leg weakness. Urgent MRI is required to confirm the diagnosis and guide emergency surgical decompression, as delay increases the risk of permanent neurologic damage.

 

Q- A 32-year-old woman at 34 weeks gestation presents with a blood pressure of 168/112 mmHg on two occasions four hours apart and a mild headache. Urinalysis shows 2+ protein. She has no visual changes or epigastric pain. Which of the following is the most appropriate next step in management?

A- Reassurance and follow-up in one week

B- Admit for blood pressure control and fetal monitoring

C- Immediate delivery regardless of gestational age

D- Start oral iron supplementation

E- Outpatient 24-hour urine protein collection only

B- Admit for blood pressure control and fetal monitoring- Severe-range blood pressure with proteinuria meets criteria for preeclampsia with severe features. This patient should be admitted for blood pressure control, fetal monitoring, and magnesium sulfate for seizure prophylaxis. Delivery timing depends on gestational age and disease severity.

 

Q- A 50-year-old man with a history of chronic alcohol use presents with severe epigastric pain radiating to the back, nausea, and vomiting for the past 12 hours. On examination, he has epigastric tenderness with voluntary guarding. Lipase is 3 times the upper limit of normal. Which of the following is the most appropriate initial step in management?

A- Aggressive intravenous fluid resuscitation

B- Emergency ERCP

C- Immediate surgical debridement

D- Broad-spectrum prophylactic antibiotics

E- NPO with total parenteral nutrition indefinitely

A- Aggressive intravenous fluid resuscitation- The cornerstone of initial management of acute pancreatitis is early, aggressive IV fluid resuscitation to prevent hypovolemia and pancreatic necrosis. ERCP is reserved for gallstone pancreatitis with cholangitis or biliary obstruction. Prophylactic antibiotics and routine TPN are not indicated in most cases; early enteral feeding is preferred once tolerated.

 

Q- A 22-year-old woman with type 1 diabetes mellitus presents with nausea, vomiting, and abdominal pain for one day. She appears lethargic with deep, labored breathing. Laboratory studies show glucose of 480 mg/dL, pH 7.12, bicarbonate 9 mEq/L, and positive serum ketones. Her potassium is 3.2 mEq/L. Which of the following is the most appropriate initial step in management?

A- Intravenous isotonic saline

B- Intravenous insulin bolus followed by infusion

C- Intravenous potassium repletion before fluids

D- Intravenous sodium bicarbonate

E- Subcutaneous insulin

A- Intravenous isotonic saline- The first step in managing diabetic ketoacidosis is aggressive isotonic fluid resuscitation to restore intravascular volume, which also helps lower glucose and correct electrolyte disturbances. Insulin therapy should be started only after ensuring the potassium level is at least 3.3 mEq/L, since insulin drives potassium intracellularly and can precipitate life-threatening hypokalemia and arrhythmias if given first in a hypokalemic patient.

 

Q- A 60-year-old woman who underwent hip replacement surgery 5 days ago develops sudden-onset dyspnea and pleuritic chest pain. Her heart rate is 118/min, respiratory rate is 26/min, and oxygen saturation is 89% on room air. She is hemodynamically stable otherwise. Which of the following is the most appropriate next step in management?

A- CT pulmonary angiography

B- D-dimer testing

C- Empiric anticoagulation while awaiting imaging

D- Ventilation-perfusion scan

E- Lower extremity Doppler ultrasound only

C- Empiric anticoagulation while awaiting imaging- In a patient with high pretest probability for pulmonary embolism (recent major surgery, tachycardia, hypoxia, and classic symptoms) who is hemodynamically stable but at risk of clinical deterioration, empiric anticoagulation should be started while confirmatory imaging (CT pulmonary angiography, the gold standard) is arranged, provided there is no contraindication to anticoagulation. D-dimer is not useful in high pretest probability patients since a negative result does not reliably exclude PE.

 

Q- Achalasia is a motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter.

Which of the following is the most likely etiology of this condition?

A- Adenocarcinoma of the lower esophagus

B- Degeneration of the inhibitory neurons of the myenteric plexus

C- Obstruction caused by Schatzki rings

D- Prolonged intubation

B- Degeneration of the inhibitory neurons of the myenteric plexus- This is a straight question and you can figure out the correct answer out of the scenario as it is the case in some of USMLE Step 1 questions. It is a motility disorder and the only option to match it is B which mentions myenteric plexus (muscle control).

 

Q- Which of the following is the most common cause of infertility in women in the United States of America?

A- Congenital adrenal hyperplasia

B- Pelvic inflammatory disease

C- Polycystic ovarian syndrome

D- Uterine fibroids

C- Polycystic ovarian syndrome- It has a prevalence of 6-10% among women of reproductive age in USA. It is the leading cause of infertility.

 

Q- A 55-year-old man underwent internal fixation of fractured femur after a motorcar accident and massive bleeding 24 hours ago. He was stable after the surgery and his urine output was normal after he received intravenous fluids. Now he complains of substernal chest pain and shortness of breath. On examination, His temperature is 98.8 F, Pulse is 110/min, blood pressure is 160/100 mmHg and his respiratory rate is 24/min. There is no jugular vein distention. His extremities have established pulses bilaterally and good perfusion. Auscultation reveals harsh systolic murmur across the precordium and crackles on both lung bases. ECG shows sinus tachycardia with delayed precordial transition and no other changes. Laboratory tests including cardiac enzymes are all normal.

What is the most likely diagnosis?

A- Acute myocardial infarction

B- Left bundle branch block

C- Septic shock

D- Hypertrophic cardiomyopathy

E- Pericardial effusion

D- Hypertrophic cardiomyopathy- This patient has a typical presentation of hypertrophic cardiomyopathy with outflow obstruction, which is exacerbated due to excessive loss of blood. It is suggested by systolic murmur, vital signs and ECG findings. Negative ECG for coronary obstruction and laboratory findings exclude MI and LBBB. There is no signs suggest septic shock. Normal jugular venous pressure, clinical findings and ECG changes make pericardial effusion less likely the correct diagnosis.

 

Read the Book, Repeated USMLE Questions Step 2 CK

More Repeated USMLE Questions step 2 CK

 

author avatar
Dr Ray Makar
See Full Bio

4 thoughts on “Repeated USMLE Questions Step 2 CK- Review- 1”

  1. Yes. In the majority of cases. Thanks Dear Dr.

  2. So Dr does It mean that in all cases of pericardial effusion there must be jugular distention???

  3. Thank you Dr Abubakar

  4. Tricky question but thanks for the explanation

Leave a Comment