Repeated USMLE Questions Step 2 CK | Review

Q- A 72-year-old man with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea and cough producing purulent sputum. His O₂ saturation is 85% on room air.

Which of the following is the best initial treatment?

A- Oral prednisone and broad-spectrum antibiotics

B- Oxygen to maintain SpO₂ between 88% and 92%

C- Immediate intubation and mechanical ventilation

D- Chest physiotherapy and mucolytic agents only

B- Oxygen to maintain SpO₂ between 88% and 92%- In COPD exacerbations, oxygen should be administered to maintain moderate oxygenation and prevent worsening hypercapnia from loss of hypoxic drive. Further treatment includes bronchodilators, systemic corticosteroids, and antibiotics if bacterial infection is suspected.

Q- A 32-year-old woman presents with 2 weeks of fatigue, weight gain, constipation, and cold intolerance. Physical exam reveals coarse hair and dry skin. Labs are TSH 12 mIU/L (↑), free T₄ low.

Which of the following is the most likely diagnosis?

A- Graves’ disease

B- Hashimoto thyroiditis

C- Iodine insufficiency

D- Pituitary adenoma

B- Hashimoto thyroiditis- The most common cause of hypothyroidism in developed countries is autoimmune thyroiditis (Hashimoto’s disease), characterized by anti-thyroid peroxidase antibodies infiltration of the thyroid.

Q- A 56-year-old man presents with sudden-onset chest pain and shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF. His blood pressure is 80/50 mmHg, and his jugular venous pressure is elevated. Lungs are clear to auscultation.

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

A- Administer intravenous furosemide

B- Give immediate nitroglycerin

C- Initiate aggressive intravenous fluid resuscitation

D- Start high-dose beta-blocker therapy

C- Initiate aggressive intravenous fluid resuscitation- This is an inferior wall myocardial infarction complicated by right ventricular infarction. These patients are preload-dependent, so fluid administration helps maintain cardiac output. Nitroglycerin and diuretics would worsen hypotension.

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