Repeated USMLE Questions Step 2 CK | Review

Q- A 62-year-old man presents with fever, dyspnea, urinary frequency, and perineal pain. Digital rectal examination reveals a tender, boggy prostate.

Which of the following is the most appropriate next step in management?

A- Begin empiric antibiotics

B- Perform prostate massage for culture

C- Schedule transurethral resection of the prostate

D- Treat with an alpha-blocker only

A- Begin empiric antibiotics- Acute bacterial prostatitis is diagnosed clinically. A tender, boggy prostate is classic. Prostate massage is contraindicated because it may precipitate bacteremia.

Q- A 54-year-old woman is admitted with severe community-acquired pneumonia. 48 hours later, blood cultures grow methicillin-sensitive Staphylococcus aureus (MSSA).

Which one of the following antibiotics is preferred?

A- Cefepime

B- Nafcillin

C- Vancomycin

D- Piperacillin-tazobactam

B- Nafcillin- Nafcillin is preferred for MSSA bacteremia because it is more effective than vancomycin for methicillin-sensitive strains.

Q- A 76-year-old woman presents with abdominal pain and bright red blood per rectum. She recently underwent repair of an abdominal aortic aneurysm.

Which of the following is the most likely diagnosis?

A- Diverticular bleeding

B- Infectious colitis

C- Ischemic colitis

D- Ulcerative colitis

C- Ischemic colitis- Recent vascular surgery and acute abdominal pain followed by hematochezia strongly suggest ischemic colitis, particularly in watershed areas of the colon.

Repeated USMLE Questions Step 2 CK- Review- 64

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