Repeated USMLE Questions Step 2 CK- Review- 19

Q- A 45-year-old man travels to Mexico 2 days ago. Today, he develops severe crampy abdominal pain with watery diarrhea. Which of the following is the most appropriate treatment at this time?

A- Ciprofloxacin

B- Metronidazole

C- Tetracycline

D- Vancomycin

A- Ciprofloxacin- Most cases of traveler’s diarrhea are caused by E-Coli. Ciprofloxacin is the most appropriate treatment for Gram negative bacteria such as E-Coli.

Q- A 37-year-old man presents to the clinic due to muscle weakness. Examination reveals a periorbital heliotrope rash with erythema and edema of the face, neck and upper chest. Which of the following is most likely revealed on further examination?

A- Distal muscle weakness

B- Hyperactive tendon reflexes

C- Proximal muscle weakness

D- Upward subluxation of the lens

C- Proximal muscle weakness- This is a typical case of dermatomyositis. The patient may complain of difficulty getting up from a chair or climbing stairs due to proximal muscle weakness. Upward subluxation of the lens occurs in Marfan syndrome.

Q- A 16-year-old woman is brought to the emergency room by her mother following a seizure. She is 30-week pregnant with twins. Her mother told you that her daughter was eating lunch and when she stood up, she fell on the floor and started shaking. She never had any seizures before. During last week, she complained of headache and swelling of her face. She missed her last two obstetrician’s appointments.

On Examination, she is unresponsive and difficult to arouse. Her blood pressure is 210/120. There is edema of her face and both hands. Fetal heart rate is 140/min.

What is the next step of management of this patient?

A- Hospitalization and treatment with antihypertensive and epileptic drugs and wait until delivery at term

B- Hospitalization and observation until delivery at term

C- Hospitalization and induction of labor

D- Outpatient treatment and recommend regular visits to the clinic

C- Hospitalization and induction of labor- This pregnant woman has eclampsia. It is diagnosed clinically and characterized by seizures which differentiate it from pre-eclampsia. Treatment of this patient is induction of labor. Other options will lead to danger to both mother and child.

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