Repeated USMLE Questions Step 2 CK- Review- 43

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Q- A 54-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and nystagmus. Which of the following is the most appropriate immediate treatment?

A- IV dextrose

B- IV thiamine

C- IV glucose followed by thiamine

D- Oral folic acid

B- IV thiamine- Wernicke encephalopathy is caused by thiamine deficiency. Thiamine must be given before glucose to prevent worsening of neurologic symptoms.

 

Q- A 72-year-old woman presents with shortness of breath and swelling of the ankles. She has a history of long-standing hypertension. Echocardiography shows a normal left ventricular ejection fraction but concentric left ventricular hypertrophy. Which of the following is the most likely diagnosis?

A- Dilated cardiomyopathy

B- Hypertrophic cardiomyopathy

C- Heart failure with preserved ejection fraction

D- Restrictive cardiomyopathy

C- Heart failure with preserved ejection fraction- Long-standing hypertension leads to diastolic dysfunction and concentric LV hypertrophy, resulting in heart failure with preserved ejection fraction, also known as diastolic heart failure.

 

Q- A 25-year-old man presents with fever, cough, and chest pain. He has a history of intravenous drug use. On examination, a new holosystolic murmur is heard at the left lower sternal border. Blood cultures grow Staphylococcus aureus. Which cardiac valve is most likely involved?

A- Aortic

B- Mitral

C- Pulmonic

D- Tricuspid

D- Tricuspid- IV drug users are at high risk for right-sided infective endocarditis, most commonly affecting the tricuspid valve.

 

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