Repeated USMLE Questions Step 2 CK- Review- 44

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Q- A 68-year-old woman presents with a sudden onset of chest pain that radiates to her back. Blood pressure is 190/100 mmHg. She has a history of long-standing hypertension. CT angiography shows a tear in the intimal layer of the aorta.

Which of the following is the most appropriate initial treatment?

A- Give aspirin

B- Immediate surgical repair

C- Start IV beta blocker

D- Start IV nitroglycerin

C- Start IV beta blocker-In aortic dissection, initial management is IV beta-blocker (e.g., esmolol) to reduce heart rate and shear stress before blood pressure reduction. Surgery is needed for Type A dissections, but beta-blockade is the first step.

 

Q- A 32-year-old pregnant woman at 30 weeks of gestation presents with severe right upper quadrant pain, nausea, and vomiting. Labs show AST 380 U/L, ALT 320 U/L, and platelets 80,000/mm³. Blood pressure is 165/105 mmHg.

Which of the following is the most likely diagnosis?

A- Acute cholangitis

B- Acute fatty liver of pregnancy

C- HELLP syndrome

D- Hyperemesis gravidarum

C- HELLP syndrome- HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets. Occurs with preeclampsia and severe hypertension in pregnancy, usually >20 weeks.

 

Q- A 44-year-old man presents with fever, night sweats, weight loss, and a productive cough for 3 weeks. Chest X-ray shows cavitary lesions in the upper lobes. Sputum acid-fast stain is positive.

Which of the following is the best initial regimen?

A- Azithromycin

B- Isoniazid only

C- Isoniazid and rifampin

D- Rifampin, isoniazid, Pyrazinamide, and ethambutol

D- Rifampin, isoniazid, Pyrazinamide, and ethambutol -Active pulmonary tuberculosis requires RIPE therapy (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) initially.

 

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