Repeated USMLE Questions Step 2 CK- Review- 53

Q- A 59-year-old man presents with progressive exertional dyspnea and fatigue. Cardiac exam reveals a harsh systolic murmur best heard at the right upper sternal border that radiates to the carotids.

What is the most likely diagnosis?

A- Aortic regurgitation

B- Aortic stenosis

C- Mitral regurgitation

D- Mitral stenosis

B- Aortic stenosis- Aortic stenosis causes a harsh crescendo–decrescendo systolic murmur radiating to the carotids and presents with dyspnea, syncope, or angina.

 

Q- A 26-year-old woman presents with lower abdominal pain, fever, and purulent cervical discharge. Pelvic exam reveals cervical motion tenderness.

What is the most appropriate initial treatment?

A- Azithromycin alone

B- Azithromycin plus doxycycline

C- Metronidazole alone

D- Oral fluconazole

B- Azithromycin plus doxycycline- Pelvic inflammatory disease requires empiric broad-spectrum coverage for Neisseria gonorrhoeae and Chlamydia trachomatis.

 

Q- A 71-year-old man presents with an acute onset of confusion, tachycardia, and fever after recent hip surgery. Labs show elevated creatine kinase and leukocytosis.

What is the most likely diagnosis?

A- Malignant hyperthermia

B- Neuroleptic malignant syndrome

C- Serotonin syndrome

D- Thyroid storm

A- Malignant hyperthermia- Malignant hyperthermia occurs after exposure to anesthetic agents and presents with hyperthermia, muscle rigidity, and elevated CK.

 

Q- A 33-year-old woman presents with episodic vertigo, tinnitus, and hearing loss. Symptoms last several hours and resolve spontaneously.

What is the most likely diagnosis?

A- Acoustic neuroma

B- Benign paroxysmal positional vertigo

C- Ménière disease

D- Vestibular neuritis

C- Ménière disease- Ménière disease causes episodic vertigo, tinnitus, and sensorineural hearing loss due to endolymphatic hydrops.

 

Q- A 48-year-old man presents with dark urine, jaundice, and fatigue. Labs show elevated indirect bilirubin and increased reticulocyte count.

What is the most likely diagnosis?

A- Acute viral hepatitis

B- Autoimmune hepatitis

C- Hemolytic anemia

D- Primary biliary cholangitis

C- Hemolytic anemia- Hemolytic anemia causes indirect hyperbilirubinemia, reticulocytosis, and dark urine due to increased red blood cell breakdown.

 

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