Showing posts with label internal medicine. Show all posts
Showing posts with label internal medicine. Show all posts

Tuesday, May 21, 2019

Repeated USMLE Questions Step 2 CK- 269

A 26-year-old man is brought to the ER by a policeman because he was drunk while driving. He was arrested twice last year for the same reason. He also missed work for a few times because he was drunk. His girlfriend broke up with him 3 months ago because he promised her several times to stop drinking but he couldn’t. He mentioned that he couldn’t stop drinking because every time he quit, he feels horrible symptoms and he has to go back to drink more than before. His family and friends are not happy with him because of his drinking problems.

Which one of these factors suggests patient’s alcohol dependence rather than abuse?

A - The patient was arrested 3 times for drinking under the influence (DUI)

B - The patient missed work for a few times

C - The patient broke up with his girlfriend due to his drinking problems

D - The patient experienced withdrawal symptoms

E - His family and friends are not happy with him because of drinking


The two main features of drug dependence are tolerance and/or withdrawal symptoms. In this patient, the withdrawal symptoms that he experienced every time he quit are the clues for alcohol dependency. Other choices are considered substance abuse rather than dependence.

The correct answer is D

Thursday, March 21, 2019

Repeated USMLE Questions Step 2 CK- 268

A 40 year-old woman complains of fatigue, headache and generalized pain for 9 months. She presented to the clinic several times and had multiple negative workups. Her pain started as localized to her head, neck and shoulder but now it is generalized. On physical examination, there are multiple points of tenderness on bony prominences.

What is the most likely prognosis of this condition?

A - Symptomatic improvement with supportive therapy

B - Slow progression to permanent disability

C - Full recovery with specific medical therapy

D - Full recovery with multiple surgeries

E - Full recovery with radiation and chemotherapy


This is a classic presentation of fibromyalgia with multiple tender points and negative workup. Treatment of fibromyalgia is mainly symptomatic. There is no approved therapy or surgery that can lead to full recovery. Fibromyalgia is not accompanied by permanent disability.

The Correct Answer is A

Monday, January 22, 2018

Repeated USMLE Questions Step 2 CK- 258

A 26 year-old woman complains of left flank pain and fever for 2 days. She has a history of two episodes of urinary tract infections in the past three years treated with trimethoprim-sulfamethoxazole. She is married, sexually active and takes contraceptive pills. Her last menstrual period was 5 days ago. On physical examination, her pulse is 100/min., blood pressure is 120/80 and her temperature is 103 F. She has left costovertebral angle tenderness on palpation.

What is the best next step of management?

A-Admission to the intensive care unit (ICU)

B-Collection of urine and blood cultures

C-CT scan of abdomen and pelvis

D-MRI of the kidney

E-Administration of wide spectrum antibiotics


This patient history and clinical examination are consistent with acute pyelonephritis. In this case we should collect urine and blood samples for culture before we start empiric antibiotic treatment. Culture is important for prescribing the most effective antibiotic and for the follow up. The patient is stable and so there is no need for the ICU. Diagnosis of acute pyelonephritis can be reached by history and physical examination only. Imaging studies are not necessary in this case as it is straight forward. In case failure of medical treatment, imaging studies should be considered for further knowledge. Collection of urine and blood samples for culture should be done before administration of any antibiotics to achieve accurate results.

The correct answer is B