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

Answer






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

Repeated USMLE Questions Step 2 CK- 267

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

Answer






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.

The correct answer is C

Repeated USMLE Questions Step 2 CK- 266

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

Answer






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.

The correct answer is D

Repeated USMLE Questions Step 2 CK- 265

A 62-year-old farmer visits his physician at his wife’s request who noticed that he had an irregular dark pigmented lesion on his back. According to his wife, he has had this lesion since their wedding 35 years ago but lately it became darker and irregular.

What is the most important prognostic factor in this case?

A-Age of the patient

B-Color of the lesion

C-Depth of the lesion

D-Diameter of the lesion

Answer






This patient has melanoma which is characterized by ABCDE, Asymmetric, Border irregular, Color darker, Diameter greater and Evolving over time. Melanoma is confirmed by skin biopsy. The most important prognostic factor is the depth of the lesion.

The correct answer is D

Repeated USMLE Questions Step 2 CK- 264

A 32 year old woman who is recently divorced visits her physician for visual disturbances. The patient complains of trouble vision for 3 days. On examination, tunnel vision is detected along with marked weakness of planter flexion although the patient can walk on her tiptoes without any complaint. All laboratory tests and imaging studies are normal.

What is the most likely diagnosis of this patient?

A- Conversion disorder

B-  Meningioma

C-  Multiple sclerosis

D- Transient ischemic attack

Answer






This patient’s history is significant for a recent stressful event and sudden progressive visual disturbance. Conversion disorder is diagnosed when thorough physical examination and tests are normal and don’t match with the patient’s symptoms. Other options show physical signs along with abnormal lab tests and/or imaging.

The correct answer is A

Repeated USMLE Questions Step 2 CK- 263

A 31-year-old woman has just suffered from an ectopic pregnancy. She had multiple partners before she finally get married about a year ago. In this scenario, which of the following situations would most likely indicate a predisposition to an ectopic pregnancy?

A- Exposure in utero to DES (diethylstilbestrol)

B- Induction of ovulation

C- Pelvic inflammatory disease (PID)

D- Use of an IUD (intrauterine device) as a contraceptive

Answer






PID or pelvic inflammatory disease is a condition where the fallopian tubes, ovaries, or the uterus becomes infected. Usually, PID happens after the woman gets a sexually transmitted disease, particularly gonorrhea or chlamydia. If PID is left untreated, it can cause an ectopic pregnancy, infertility, or even ongoing pelvic pain.

The correct answer is C

Repeated USMLE Questions Step 2 CK- 262

A 9-year old child falls off the back of a tricycle and hits his head hard. However, there is no loss of consciousness. The boy is taken to the emergency room by his parents. He seems to be well-oriented and alert, and there are no focal findings upon examination. There is, however, blood found behind his left tympanic membrane.

Keeping these findings in mind, what will a CT scan of his skull likely show?

A- Basilar skull fracture

B- Epidural hematoma

C- Hydrocephalus

D- Subdural hematoma

Answer






Due to the nature of the fall, the child has suffered a basilar skull fracture. This means that there is a break in the bone at the base of his skull. The common symptoms of a basilar skull fracture include blood behind the eardrum, bruising around the eyes, or bruising behind the ears. Diagnosis of a basilar skull fracture is typically done by a CT scan.

The correct answer is A

Repeated USMLE Questions Step 2 CK- 302

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

Answer:

This is a typical presentation of eclampsia. The only effective treatment of eclampsia is delivery. There is no role of epileptic drugs in this case. Induction of labor is mandatory to save mother’s life. Meanwhile her babies don’t have a lot of risks on their 30th week pregnancy.

The correct answer is C