Repeated USMLE Questions Step 2 CK- Review- 45

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Q- A 22-year-old man is brought to the emergency department after a motor vehicle accident. He is hypotensive, tachycardic, and has distended neck veins. Breath sounds are absent on the right, and the trachea is deviated to the left.

What is the best next step in management?

A- Give IV fluids

B- Insert a chest tube

C- Obtain a chest X-ray

D- Perform needle decompression

D- Perform needle decompression- The patient has tension pneumothorax — a clinical diagnosis. Immediate needle decompression should be done before imaging or chest tube placement.

 

Q- A 55-year-old man presents with progressive dyspnea and swelling of the legs. He has a history of chronic obstructive pulmonary disease (COPD). On examination, there is elevated jugular venous pressure, hepatomegaly, and bilateral pitting edema.

What is the most likely cause of his symptoms?

A- Cor pulmonale

B- Left-sided heart failure

C- Nephrotic syndrome

D- Pulmonary embolism

A- Cor pulmonale- Cor pulmonale is right-sided heart failure due to pulmonary hypertension, most commonly from chronic lung disease such as COPD.

 

Q- A 40-year-old woman presents with fatigue and pallor. Laboratory results show:

  • Hemoglobin: 8 g/dL
  • MCV: 72 fL
  • Ferritin: low
  • TIBC: high

Which of the following is the most likely diagnosis?

A- Anemia of chronic disease

B- Iron deficiency anemia

C- Sideroblastic anemia

D- Thalassemia minor

B- Iron deficiency anemia- The combination of microcytic anemia, low ferritin, and high TIBC is diagnostic of iron deficiency anemia.

 

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