Repeated USMLE Questions Step 2 CK- Review- 49

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Q- A 65-year-old woman with long-standing rheumatoid arthritis presents with progressive shortness of breath and dry cough. Chest X-ray shows bilateral interstitial infiltrates.

Which of the following medications is most likely responsible?

A- Etanercept

B- Hydroxychloroquine

C- Methotrexate

D- Prednisone

C- Methotrexate- Methotrexate can cause pulmonary fibrosis and pneumonitis as an adverse effect, leading to restrictive lung disease. Symptoms improve with discontinuation of the drug.

 

Q- A 70-year-old man presents with progressive difficulty walking. He reports urinary incontinence and mild memory problems. On exam, his gait is broad-based and magnetic.

What is the most likely diagnosis?

A- Alzheimer disease

B- Amyotrophic lateral sclerosis

C- Normal pressure hydrocephalus

D- Parkinson disease

C- Normal pressure hydrocephalus- The triad of gait disturbance, urinary incontinence, and cognitive decline (“wet, wobbly, and wacky”) is classic for normal pressure hydrocephalus, caused by impaired CSF absorption.

 

Q- A 24-year-old man presents with pain and swelling in his right knee. He had a recent episode of dysuria after unprotected intercourse. Synovial fluid analysis shows a high neutrophil count but no organisms on Gram stain.

What is the most likely diagnosis?

A- Gout

B- Reactive arthritis

C- Rheumatoid arthritis

D- Septic arthritis

D- Septic arthritis- In young sexually active adults, gonococcal arthritis is the most common cause of septic arthritis. Gram stain is often negative; culture or NAAT confirms the diagnosis.

 

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