Master the boards usmle step 2 ck 6th ed sample

© Kaplan
All USMLE Study Materials from usmlematerials.net

Source: Farnoosh Farrokhi, MD, and Michael F. Vaezi, MD

Source: Conrad Fischer, MD

Source: WikiCommons
A 43-year-old man recently diagnosed with AIDS comes to the ED with pain on swallowing that has become progressively worse over
recent weeks. There is pain only when swallowing. CD4 count is 43 mm3
. The patient is not currently taking any medications. What is the
most appropriate next step in management?
Esophagram
a.
Upper endoscopy
b.
Oral nystatin swish and swallow
c.
Intravenous amphotericin
d.
Oral fluconazole
e.

Source: Azmeena Laila, MD
▶
▶

A 44-year-old woman comes in reporting pain in the epigastric area for several months. She denies nausea, vomiting, weight loss, and
blood in the stool. On physical examination no abnormalities are found. What is the most likely diagnosis?
▶
Duodenal ulcer disease
a.
Gastric ulcer disease
b.
Gastritis
c.
Pancreatitis
d.
Functional dyspepsia
e.
Pancreatic cancer
f.

▶
A 42-year-old man comes to the office with several weeks of epigastric pain radiating up under his chest which becomes worse after lying
flat for an hour. He also has a “brackish” taste in his mouth and a sore throat. What is the next step in management?
Ranitidine
a.
Liquid antacid
b.
Lansoprazole
c.
Endoscopy
d.
Barium swallow
e.
24-hour pH monitoring
f.

▶

A 56-year-old woman comes to the clinic because her symptoms of epigastric pain from an endoscopically confirmed duodenal ulcer have
not responded to several weeks of a PPI, clarithromycin, and amoxicillin. What is the most appropriate next step in management?
Refer for surgery
a.
Switch the PPI to H2 blocker
b.
Abdominal CT scan
c.
Capsule endoscopy
d.
Urea breath testing
e.
Vagotomy
f.
Add sucralfate
g.

A 64-year-old patient with diabetes for 20 years comes to the office with several months of abdominal fullness, intermittent nausea,
constipation, and a sense of “bloating.” On physical examination, a “splash” is heard over the stomach on auscultation of the stomach
when moving the patient. What is the most appropriate next step in management?

Abdominal CT scan
a.
Colonoscopy
b.
Erythromycin
c.
Upper endoscopy
d.
Nuclear gastric emptying study
e.

A 69-year-old woman comes to the ED with multiple red/black stools over the last day. Her medical history is significant
for aortic stenosis. Her pulse is 115/min and blood pressure is 94/62 mm Hg. Physical examination is otherwise normal.
What is the most appropriate next step in management?
Colonoscopy
a.
Nasogastric tube placement
b.
Upper endoscopy
c.
Bolus of normal saline
d.
CBC
e.
Bolus of 5% dextrose in water
f.
Consult gastroenterology
g.
Check for orthostasis
h.

A 75-year-old man is admitted to the hospital with pneumonia. Several days after the start of antibiotics, he begins to have diarrhea. The
stool C. diff toxin is positive, and he is started on vancomycin, which resolves the diarrhea after a few days. Two weeks later the diarrhea
recurs and the C. diff toxin is again positive. What is the most appropriate next step in management?
▶
Treat with metronidazole orally.
a.
Retreat with vancomycin.
b.
Perform sigmoidoscopy, and treat only if pseudomembranes are found.
c.
Treat with metronidazole intravenously.
d.
Wait for stool culture.
e.
Treat with vancomycin intravenously.
f.

Source: Conrad Fischer, MD.
Source: Conrad Fischer, MD

Which of the following is the most effective method of screening for colon cancer?
Colonoscopy
a.
Sigmoidoscopy
b.
Fecal occult blood testing (FOBT)
c.
Barium enema
d.
Virtual colonoscopy with CT scanning
e.
Capsule endoscopy
f.

▶
Which of the following is associated with the worst prognosis in pancreatitis?
Elevated amylase
a.
Elevated lipase
b.
Intensity of the pain
c.
Low calcium
d.
C-reactive protein (CRP) rising
e.

A 54-year-old man is evaluated for fatigue, erectile dysfunction, and skin darkening. He is found to have transferrin
saturation (iron divided by TIBC) >50%. His AST is 2× the upper limit of normal. What is the next step to confirm the
diagnosis?
Echocardiography
a.
Glucose level
b.
Abdominal MRI and HFE (C282y) gene testing
c.
Liver biopsy
d.
Prussian blue stain of the bone marrow
e.
Deferoxamine
f.
Deferasirox
g.

Which of the following correlates best with an increased likelihood of mortality?
Which of the following is the best indicator that a pregnant woman will transmit infection to her child?
Which of the following will become abnormal first after acquiring hepatitis B infection?
Which of the following indicates that a patient is no longer a risk for transmitting infection to another person (active
infection has resolved)?
Bilirubin
a.
Prothrombin time
b.
ALT
c.
AST
d.
Alkaline phosphatase
e.
Bilirubin
a.
e-Antigen
b.
Surface antigen
c.
Core IgM antibody
d.
ALT
e.
Anti-hepatitis B, e-antibody
f.
Bilirubin
a.
e-Antigen
b.
Surface antigen
c.
Core IgM antibody
d.
ALT
e.
Anti-hepatitis B e-antibody
f.
Bilirubin normalizes
a.
No e-antigen found
b.
No surface antigen found
c.
No core IgM antibody found
d.
ALT normalizes
e.
f.

Which of the following best indicates the need for treatment with antiviral medication in chronic disease?
▶
Bilirubin
a.
e-Antigen
b.
Surface antigen
c.
Core IgM antibody
d.
ALT
e.
f.

Source: Herbert L. Fred, MD, and Hendrik A. van Dijk, MD

A 46-year-old woman presents with a small mass she found on palpation of her own thyroid. A small nodule is found in
the thyroid. There is no tenderness. She is otherwise asymptomatic and uses no medications. What is the most
appropriate next step in management?
Fine-needle aspiration
a.
Radionuclide iodine uptake scan
b.
T4 and TSH levels
c.
Thyroid ultrasound
d.
Surgical removal (excisional biopsy)
e.

A 46-year-old woman with a thyroid nodule is found to have normal thyroid function on testing. The fine-needle aspirate
comes back as “indeterminant for follicular adenoma.” What is the most appropriate next step in management?
Neck CT
a.
Surgical removal (excisional biopsy)
b.
Ultrasound
c.
Calcitonin level
d.

A 75-year-old man with a history of malignancy is admitted with lethargy, confusion, and abdominal pain. His calcium is
found to be markedly elevated. After 3 liters of normal saline and zoledronic acid, his calcium is still markedly elevated
the next day. What is the most appropriate next step?
Calcitonin
a.
Pamidronate
b.
Plicamycin
c.
Gallium
d.
Dialysis
e.
Cinacalcet
f.

Master the boards usmle step 2 ck 6th ed sample

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Master the boards usmle step 2 ck 6th ed sample