Repeated USMLE Questions Step 2 CK- Review- 40

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Q- A 25-year-old woman presents with a sudden-onset severe headache, photophobia, and neck stiffness. She has a fever of 38.9°C (102°F). Lumber puncture shows:

  • Opening pressure: 280 mm H₂O
  • WBC count: 2200/mm³ (90% neutrophils)
  • Protein: 220 mg/dL
  • Glucose: 30 mg/dL

Which of the following is the most likely diagnosis?

A- Bacterial meningitis

B- Fungal meningitis

C- Subarachnoid hemorrhage

D- Viral meningitis

A- Bacterial meningitis- The CSF findings of very high WBC count with neutrophilic predominance, high protein, and very low glucose are characteristic of bacterial meningitis.

 

Q- A 62-year-old man with a history of hypertension and type 2 diabetes presents with sudden-onset right-sided weakness and difficulty speaking. On exam, he has expressive aphasia and right hemiparesis. A CT scan shows an ischemic stroke.

Which of the following is the most appropriate initial management?

A- Administer IV alteplase if within 4.5 hours of onset

B- Begin IV heparin infusion

C- Observe and repeat the CT scan in 6 hours

D- Start aspirin immediately

A- Administer IV alteplase if within 4.5 hours of onset- In ischemic stroke, IV alteplase (tPA) is indicated within 4.5 hours if there are no contraindications. Aspirin is used if the patient presents outside the tPA window or if tPA is contraindicated.

 

Q- A 30-year-old woman presents with episodic palpitations, sweating, and headaches. Her blood pressure is persistently elevated. Laboratory evaluation shows elevated plasma catecholamines. MRI of the abdomen reveals an adrenal mass.

Which of the following is the best initial preoperative management?

A- Clonidine

B- Labetalol

C- Phenoxybenzamine

D- Propranolol

C- Phenoxybenzamine- In pheochromocytoma, alpha-blockade with phenoxybenzamine is required before any beta-blockade. Giving beta-blockers first, such as propranolol, can precipitate a hypertensive crisis due to unopposed alpha stimulation.

 

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4 thoughts on “Repeated USMLE Questions Step 2 CK- Review- 40”

  1. Thank you, dear Dr.

  2. 3/3, i still got it!

  3. Thank you Dr. Liam

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