USMLE Sample Test Questions Step 2 CK- 2023- 6

I am going to answer the sample USMLE Step 2 CK Questions with Explanation. These questions are available at




A 4-month-old female infant is recovering in the hospital 5 days after uncomplicated surgical repair of a ventricular septal defect via median sternotomy utilizing cardiopulmonary bypass. She was extubated on postoperative day 1 and by postoperative day 4 she was no longer receiving any inotropic infusions or intravenous drugs. She is breast-feeding well; plans are made for discharge from the hospital the next morning. However, on the next morning she develops a temperature of 38.8°C (101.8°F), cool and clammy skin, cold distal extremities, delayed capillary refill, and minimal urine output. Cardiac rhythm strip and tracing of arterial blood pressure are shown.

Which of the following is the most appropriate next step in evaluation?

(A) Cardiac catheterization

(B) CT angiography

(C) Echocardiography

(D) Electrophysiology study

(E) MRI of the heart

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Given the clinical presentation of a 4-month-old female infant who recently underwent surgical repair of a ventricular septal defect (VSD) and is now presenting with signs of shock (fever, cool and clammy skin, cold distal extremities, delayed capillary refill, and minimal urine output), along with the provided cardiac rhythm strip and arterial blood pressure tracing, the most appropriate next step in evaluation is echocardiography.

Echocardiography is a non-invasive imaging modality that can provide real-time information about cardiac structure and function. In this case, echocardiography can help evaluate the integrity of the ventricular septal defect repair, assess for any residual defects or complications, and evaluate cardiac function, including the presence of any cardiac tamponade or other abnormalities that may be contributing to the patient’s shock.

Options (A) Cardiac catheterization, (B) CT angiography, (D) Electrophysiology study, and (E) MRI of the heart are not the most appropriate next steps in this scenario because they are either invasive procedures or imaging modalities that may not provide the necessary information needed to assess the current cardiac status and address the patient’s clinical presentation of shock.

The correct answer is (C) Echocardiography

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