Repeated USMLE Questions Step 2 CK- Review- 33

Q- A 28-year-old female presents to the emergency department with severe abdominal pain. Physical examination reveals tenderness in the right lower quadrant. Laboratory studies show an elevated white blood cell count. An ultrasound is performed and reveals an inflamed appendix.

Which of the following is the most appropriate treatment plan for this patient?

A- Intravenous ceftriaxone and metronidazole

B- Intravenous fluids and bowel rest

C- Laparoscopic appendectomy

D- Observation with serial abdominal exams

E- Oral ciprofloxacin and metronidazole

C- Laparoscopic appendectomy- Acute appendicitis is a surgical emergency that requires prompt intervention. The most appropriate initial treatment for this patient is surgical removal. Laparoscopic appendectomy has become the preferred approach due to its advantages in terms of reduced postoperative pain, shorter hospital stay, and quicker recovery compared to open appendectomy. Intravenous antibiotics may be administered perioperatively, but the primary intervention is surgical removal of the inflamed appendix. Observation, intravenous fluids, and bowel rest alone are not sufficient for the definitive treatment of acute appendicitis.

Q- A 45-year-old male with a history of type 2 diabetes mellitus presents to the clinic for a routine follow-up. He reports increased thirst and urination over the past few weeks. His blood pressure is 140/90 mm Hg, and his BMI is 30 kg/m². Laboratory studies reveal a fasting blood glucose of 200 mg/dL and an HbA1c of 8.5%.

Which of the following medications is the most appropriate initial choice for managing this patient’s hyperglycemia?

A- Glipizide

B- Insulin glargine

C- Metformin

D- Pioglitazone

E- Sitagliptin

B- Insulin glargine- Given the patient’s elevated HbA1c and fasting blood glucose levels, indicating poor glycemic control, and the presence of symptoms suggestive of hyperglycemia, initiation of insulin therapy is warranted. Insulin glargine is a long-acting basal insulin that provides a consistent and sustained reduction in blood glucose levels. It is commonly used as an initial choice in patients with significant hyperglycemia.

Metformin is often considered the first-line oral agent for type 2 diabetes, but in cases of severe hyperglycemia or symptomatic patients, insulin may be preferred for a more rapid and effective reduction in blood glucose. Glipizide, pioglitazone, and sitagliptin are alternative oral agents but are not the most appropriate initial choice in this scenario.

Q- A 66-year-old woman presents to the emergency department with sudden-onset severe chest pain radiating to her left arm. She appears diaphoretic and is hypotensive. Electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF.

Which of the following is the most appropriate initial pharmacotherapy for this patient?

A- Aspirin

B- Heparin

C- Metoprolol

D- Nitroglycerin

E- Streptokinase

A- Aspirin- This patient’s presentation is consistent with an acute ST-segment elevation myocardial infarction (STEMI). The most appropriate initial treatment is aspirin. Aspirin irreversibly inhibits platelet aggregation and is a cornerstone in the management of acute coronary syndromes. It helps reduce mortality and the risk of recurrent myocardial infarction.

Heparin is often used for anticoagulation in acute coronary syndromes but is not the initial therapy of choice in this scenario. Nitroglycerin is used for symptomatic relief of angina but does not address the underlying cause of the STEMI. Metoprolol is a beta-blocker that may be used later in the management but is not the initial therapy. Streptokinase is a fibrinolytic agent that may be considered in certain cases of STEMI, but it is not the initial pharmacotherapy in this patient with ongoing chest pain and hypotension.

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2 thoughts on “Repeated USMLE Questions Step 2 CK- Review- 33”

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