I will answer the sample USMLE Step 2 CK Questions with Explanations. These questions are available at USMLE.org
A 68-year-old man comes to the clinic because of a 6-month history of frequent falls. He sustained a fracture of the left wrist 4 weeks ago during a fall. He has not had loss of consciousness before or during the falls. He says that turning and pivoting often cause him to fall, and he has a tendency to fall backward when walking. He has Parkinson disease treated with carbidopa-levodopa and entacapone. Vital signs are within normal limits. Examination shows masked facies and a resting tremor of the right upper extremity. Romberg sign is absent. When the patient stands still and is pulled backward, he is unable to maintain his posture.
Which of the following is the most appropriate intervention to decrease this patient’s risk for future falls?
(A) Biofeedback
(B) Physical therapy
(C) Pramipexole therapy
(D) Ropinirole therapy
(E) Rotigotine therapy
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Answer
This patient with Parkinson’s disease presents with frequent falls, particularly when turning, pivoting, or walking backward, indicating postural instability. Postural instability and frequent falls are common in the later stages of Parkinson’s disease and are often resistant to dopaminergic therapy (such as carbidopa-levodopa and entacapone), which primarily addresses tremor, bradykinesia, and rigidity.
The pull test mentioned, where the patient cannot maintain posture when pulled backward, is a sign of postural instability, a core feature of Parkinson’s disease. Postural instability often does not respond well to adjustments in dopaminergic therapy and requires physical therapy interventions that focus on balance training, gait exercises, and fall prevention strategies.
The correct answer is B