Repeated USMLE Questions Step 2 CK-1

Q- Achalasia is a motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter.

Which of the following is the most likely etiology of this condition?

A- Adenocarcinoma of the lower esophagus

B- Degeneration of the inhibitory neurons of the myenteric plexus

C- Obstruction caused by Schatzki rings

D- Prolonged intubation

B- Degeneration of the inhibitory neurons of the myenteric plexus- This is a straight question and you can figure out the correct answer out of the scenario as it is the case in some of USMLE Step 1 questions. It is a motility disorder and the only option to match it is B which mentions myenteric plexus (muscle control).

Q- Which of the following is the most common cause of infertility in women in the United States of America?

A- Congenital adrenal hyperplasia

B- Pelvic inflammatory disease

C- Polycystic ovarian syndrome

D- Uterine fibroids

C- Polycystic ovarian syndrome- It has a prevalence of 6-10% among women of reproductive age in USA. It is the leading cause of infertility.

Q- A 55-year-old man underwent internal fixation of fractured femur after a motorcar accident and massive bleeding 24 hours ago. He was stable after the surgery and his urine output was normal after he received intravenous fluids. Now he complains of substernal chest pain and shortness of breath. On examination, His temperature is 98.8 F, Pulse is 110/min, blood pressure is 160/100 mmHg and his respiratory rate is 24/min. There is no jugular vein distention. His extremities have established pulses bilaterally and good perfusion. Auscultation reveals harsh systolic murmur across the precordium and crackles on both lung bases. ECG shows sinus tachycardia with delayed precordial transition and no other changes. Laboratory tests including cardiac enzymes are all normal.

What is the most likely diagnosis?

A- Acute myocardial infarction

B- Left bundle branch block

C- Septic shock

D- Hypertrophic cardiomyopathy

E- Pericardial effusion

D- Hypertrophic cardiomyopathy- This patient has a typical presentation of hypertrophic cardiomyopathy with outflow obstruction, which is exacerbated due to excessive loss of blood. It is suggested by systolic murmur, vital signs and ECG findings. Negative ECG for coronary obstruction and laboratory findings exclude MI and LBBB. There is no signs suggest septic shock. Normal jugular venous pressure, clinical findings and ECG changes make pericardial effusion less likely the correct diagnosis.

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4 thoughts on “Repeated USMLE Questions Step 2 CK-1”

  1. Yes. In the majority of cases. Thanks Dear Dr.

  2. So Dr does It mean that in all cases of pericardial effusion there must be jugular distention???

  3. Thank you Dr Abubakar

  4. Tricky question but thanks for the explanation

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