idx stringlengths 3 3 | question stringlengths 321 1.52k | options dict | answer stringclasses 4
values | explanation stringlengths 1.38k 5.51k | link stringlengths 22 48 |
|---|---|---|---|---|---|
201 | A 62-year-old man presents to the emergency department with increased fatigue and changes in his vision. For the past month, he has felt abnormally tired and today noticed his vision is blurry. The patient also endorses increased sweating at night and new-onset headaches. He currently feels dizzy. The patient has a med... | {
"A": "IgA and IgG",
"B": "Calcium",
"C": "T-cells",
"D": "IgM",
"E": ""
} | D | This patient is presenting with symptoms of hyperviscosity, fatigue, and organomegaly suggestive of a diagnosis of Waldenstrom macroglobulinemia (WM). WM is characterized by increased IgM production.
WM occurs secondary to a clonal B-cell that pathologically overproduces IgM. High levels of IgM can lead to symptoms of... | https://step2.medbullets.com/testview?qid=109769 |
202 | A 37-year-old machinist presents to his primary care physician with eye problems. He has felt a mass in his eye that has persisted for the past month. The patient has a medical history of blepharitis treated with eye cleansing and squamous cell carcinoma of the skin treated with Mohs surgery. His temperature is 99.5°F ... | {
"A": "Chalazion",
"B": "Foreign body",
"C": "Hordeolum",
"D": "Meibomian cell carcinoma",
"E": ""
} | A | This patient presenting with a painless firm and rubbery nodule has symptoms that are suggestive of a chalazion.
Chalazion presents with a hard and painless eyelid nodule. This pathology occurs secondary to granulomatous inflammation of the Meibomian gland. The lesion can be treated with simple excision; however, recu... | https://step2.medbullets.com/testview?qid=109961 |
203 | A 55-year-old male bodybuilder presents to the emergency department with weakness of his right arm. The patient states he has experienced these symptoms for a few weeks; however, today his hand felt so weak he dropped his cup of tea. The patient has a medical history of diabetes. He drinks 2-7 alcoholic drinks per day ... | {
"A": "Apical lung tumor",
"B": "Brachial plexopathy",
"C": "Cerebral infarction",
"D": "Scalenus anticus syndrome",
"E": ""
} | A | This patient is presenting with unilateral upper extremity paresthesia and weakness suggestive of compression of the neurovascular structures of the upper extremity secondary to an apical lung tumor.
An apical lung tumor can compress the neurovascular structures in its proximity and cause pain, numbness, and weakness ... | https://step2.medbullets.com/testview?qid=109967 |
204 | A 55-year-old man presents to the emergency department with chest pain and shortness of breath. He has a medical history of hypertension, diabetes, and obesity. His temperature is 98.6°F (37.0°C), blood pressure is 177/118 mmHg, pulse is 127/min, respirations are 11/min, and oxygen saturation is 98% on room air. An ECG... | {
"A": "Cholesterol embolism",
"B": "Heart failure and reinfarction",
"C": "Pancreatitis",
"D": "Renal failure",
"E": ""
} | A | This patient is presenting with abdominal pain and livedo reticularis after a catheterization procedure. These symptoms are suggestive of a cholesterol embolism.
A cholesterol embolism typically presents after any vascular procedure due to a dislodged cholesterol emboli. Symptoms include livedo reticularis, gastrointe... | https://step2.medbullets.com/testview?qid=210075 |
205 | A 39-year-old man presents to his doctor for a wellness checkup. He is concerned about a rash that does not seem to be improving. He was recently exposed to his grandfather who has vesicular lesions on his skin and is being treated. He has a family history of skin cancer, colon cancer, and ovarian cancer. The patient h... | {
"A": "Benign capillary proliferation",
"B": "Edema of the epidermis",
"C": "Healthy dermatologic development",
"D": "Viral infection",
"E": ""
} | A | This patient who presents with red raised papules is presenting with a cherry angioma. These lesions are composed of benign capillary proliferations.
Cherry angiomas present with cherry red macules/papules that occur secondary to benign capillary and venule proliferation. The lesions are entirely benign and are cosmet... | https://step2.medbullets.com/testview?qid=210076 |
206 | A 23-year-old woman is admitted to the inpatient psychiatry unit after her boyfriend reported she was “acting funny and refusing to talk.” The patient’s boyfriend states that he came home from work and found the patient sitting up in bed staring at the wall. When he said her name or waved his hand in front of her, she ... | {
"A": "Benztropine",
"B": "Electroconvulsive therapy",
"C": "Haloperidol",
"D": "Lorazepam",
"E": ""
} | D | The patient has a history of depression and is presenting with decreased motor activity, waxy flexibility, lack of response to external stimuli, and mutism, suggesting the diagnosis of catatonia. Catatonia should initially be treated with benzodiazepines like lorazepam.
Catatonia is a state of psychomotor immobility a... | https://step2.medbullets.com/testview?qid=210373 |
207 | A 15-year-old boy presents to his pediatrician after an appendectomy 1 week ago. The patient denies any abdominal pain, fevers, chills, nausea, vomiting, diarrhea, or constipation. He eats solids and drinks liquids without difficulty. He is back to playing basketball for his school team without any difficulty. His urin... | {
"A": "CT scan abdomen and pelvis with contrast",
"B": "Renal biopsy",
"C": "Repeat urinalysis",
"D": "Urine dipstick in the morning and in the afternoon",
"E": ""
} | D | This patient is found to have proteinuria on urinalysis in the absence of clinical symptoms or signs of nephrotic syndrome. Given the likely diagnosis of transient proteinuria, the most appropriate next step is to repeat the urine dipstick in the morning and in the afternoon.
Transient proteinuria can be due to febril... | https://step2.medbullets.com/testview?qid=210475 |
208 | A 32-year-old man presents to the emergency department for evaluation of headache. His symptoms started last night and have persisted. He occasionally has migraine headaches, but he has not had a headache like this in the past. He reports associated nausea, vomiting, fevers, and neck pain. He has a medical history of a... | {
"A": "Acyclovir",
"B": "Ceftriaxone and vancomycin",
"C": "Ceftriaxone, vancomycin and steroids",
"D": "Supportive care and monitoring",
"E": ""
} | D | This patient with headache, fever, and neck stiffness has a presentation and CSF studies consistent with a diagnosis of viral or aseptic meningitis. Supportive care is the most appropriate management strategy for patients with viral meningitis.
Aseptic (viral) meningitis presents similarly to bacterial meningitis with... | https://step2.medbullets.com/testview?qid=210854 |
209 | A 70-year-old woman is brought to the emergency department by ambulance. She was found on the floor of her apartment after her neighbor called 911. She is confused and is unable to provide any history, but complains of generalized pain. Her temperature is 99.2°F (37.3°C), blood pressure is 129/64 mmHg, pulse is 63/min,... | {
"A": "Albuterol and IV fluid resuscitation",
"B": "Calcium gluconate",
"C": "IV fluid resuscitation",
"D": "Sodium polystyrene sulfonate",
"E": ""
} | B | This patient with confusion, dark urine, and peaked T waves on electrocardiogram in the setting of a prolonged time spent down likely has developed rhabdomyolysis with associated hyperkalemia. For patients with suspected hyperkalemia and electrocardiogram changes, the most appropriate next step in management is treatme... | https://step2.medbullets.com/testview?qid=210867 |
210 | A 31-year-old man presents to the emergency department for fever, malaise, and cough. For the last week, his cough has been progressively worsening, and he has been noticing blood in his sputum. He denies any recent travel or sick contacts and infrequently smokes cigarettes. Approximately 5 weeks ago, he presented with... | {
"A": "Continue current anti-retroviral treatment, antimicrobial, and anti-tuberculoid therapies",
"B": "Determine drug sensitivities against the patient’s pulmonary infection",
"C": "Discontinue antimicrobial treatment",
"D": "Obtain a D-dimer level",
"E": ""
} | A | This patient with recently diagnosed HIV and tuberculosis infection (upper lung lobe infiltrate) is presenting with worsening symptoms after being appropriately treated. Worsening of symptoms after initiation of these therapies is concerning for immune reconstitution inflammatory syndrome (IRIS), which is managed by co... | https://step2.medbullets.com/testview?qid=214791 |
211 | A 44-year-old homeless man presents to the emergency department after being stabbed multiple times in the abdomen. The patient is intoxicated and is unable to offer further history. His temperature is 97.5°F (36.4°C), blood pressure is 92/52 mmHg, pulse is 145/min, respirations are 33/min, and oxygen saturation is 90% ... | {
"A": "Thiamine",
"B": "Vitamin C",
"C": "Zinc",
"D": "Riboflavin",
"E": ""
} | C | This homeless patient who likely has poor nutritional status presents with angular cheilitis, sparse hair that is falling out, diarrhea, and poor wound healing, all of which are suggestive of zinc deficiency.
Zinc is involved in many physiologic processes and is an important mineral to include in the diet. Zinc defici... | https://step2.medbullets.com/testview?qid=214943 |
212 | A 51-year-old man presents to the emergency department complaining of fever and a cough with yellow-green sputum for the past 3 days. He denies any hemoptysis, facial pain, rhinorrhea, or night sweats. The patient reported similar symptoms 2 months ago. Chest radiograph performed at the time was notable for a right mid... | {
"A": "Interferon-gamma release assay",
"B": "CT of the chest without contrast",
"C": "Barium swallow",
"D": "Serum immunoglobulin levels",
"E": ""
} | B | This patient's presentation with recurrent pneumonia in the same anatomical location is concerning for an anatomic abnormality. Given his history of heavy smoking, lung cancer should be ruled out with a chest CT with possible subsequent bronchoscopy for tissue biopsy.
Recurrent pneumonia can be classified either as th... | https://step2.medbullets.com/testview?qid=214961 |
213 | A 27-year-old man presents to the emergency department with altered mental status. He was running a marathon but became confused halfway through the race. He arrives unable to coherently answer questions and is not sure where he is. He has a history of a seizure disorder. His temperature is 105°F (40.6°C), blood pressu... | {
"A": "Hyponatremia",
"B": "Hyperkalemia",
"C": "Hyperuricemia",
"D": "Hypocalcemia",
"E": ""
} | D | This patient is presenting after running a marathon with hyperthermia and altered mental status suggestive of heatstroke. In the setting of his recent exertion, tonic-clonic seizure, and urine dipstick positive for red blood cells, he is likely suffering from rhabdomyolysis, which most commonly causes hypocalcemia.
Rh... | https://step2.medbullets.com/testview?qid=214967 |
214 | A 17-year-old girl presents to the clinic reporting 7 months without a menstrual period. Menarche was at age 12 and she had regular periods up until 2 years ago. At that time, her periods became less regular until around 7 months ago when they ceased altogether. She is otherwise healthy, participates in multiple school... | {
"A": "Hypothyroidism",
"B": "Functional hypothalamic amenorrhea",
"C": "Anorexia nervosa",
"D": "Polycystic ovarian syndrome",
"E": ""
} | B | This patient presenting with secondary amenorrhea (defined as 6 or more consecutive months without menstruation in women who have passed menarche) and a history of rigorous exercise most likely has functional hypothalamic amenorrhea.
Functional hypothalamic amenorrhea is a condition in which relative caloric deficienc... | https://step2.medbullets.com/testview?qid=214976 |
215 | A 65-year-old man presents to his primary care physician for a routine appointment. He has no concerns. His past medical history is significant for human immunodeficiency virus (HIV) infection, diagnosed 15 years ago. The patient is intermittently compliant with his antiretroviral therapy (ART). His temperature is 99.0... | {
"A": "Azithromycin and pneumococcal vaccine",
"B": "Trimethoprim-sulfamethoxazole and varicella vaccine",
"C": "Trimethoprim-sulfamethoxazole and zoster vaccine",
"D": "Trimethoprim-sulfamethoxazole and pneumococcal vaccine",
"E": ""
} | D | This patient with HIV and a CD4 count of 150 cells/μL requires trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis and another dose of the 23-valent pneumococcal vaccine.
All HIV patients with a CD4 count < 200 cells/μL require TMP-SMX as prophylaxis against Pneumocystis jirovecci pneumonia. Patients with CD4 counts <... | https://step2.medbullets.com/testview?qid=215026 |
216 | A 59-year-old woman comes to the clinic due to a 3-month history of “always feeling the urge to urinate” as well as vaginal pruritis. She states that she has had involuntary loss of urine about 4 times each day over the past 3 months. It is not associated with coughing or sneezing. Menopause occurred at age 52. She has... | {
"A": "Metronidazole",
"B": "Nitrofurantoin",
"C": "Vaginal moisturizers",
"D": "Topical clobetasol",
"E": ""
} | C | This postmenopausal patient is presenting with vulvovaginal dryness and irritation, dyspareunia, urinary incontinence, and recurrent urinary tract infections, likely due to genitourinary syndrome of menopause (GSM). The most appropriate initial treatment is symptomatic relief with vaginal moisturizers and lubricants.
... | https://step2.medbullets.com/testview?qid=215032 |
217 | A 31-year-old man presents to clinic for evaluation of a 3-year history of infertility. He has no significant medical history and takes no medications. He exercises twice a day, often with heavy weightlifting, and eats a high-protein diet. He reports occasional alcohol use and remote marijuana use. His temperature is 9... | {
"A": "Klinefelter syndrome",
"B": "Cryptorchidism",
"C": "Anabolic steroid use",
"D": "Excess growth hormone use",
"E": ""
} | C | This patient with infertility is presenting with decreased testicular size, receding hairline, gynecomastia (palpable breast tissue), and transaminitis. This is most likely due to exogenous testosterone from anabolic (androgenic) steroid use.
Young people (especially athletes and heavy weightlifters) looking to improv... | https://step2.medbullets.com/testview?qid=215034 |
218 | A 52-year-old man presents to the clinic with a left foot ulcer that he noticed 6 days ago. He has a history of obesity, hypertension, type 2 diabetes mellitus, and depression. His current medications include metformin, aspirin, rosuvastatin, lisinopril, and fluoxetine. He has a 25-pack-year smoking history and drinks ... | {
"A": "Knee reflex testing",
"B": "Monofilament testing",
"C": "Contrast-enhanced foot magnetic resonance imaging",
"D": "Ankle-brachial index",
"E": ""
} | B | This patient with a history of diabetes, hypertension, and obesity now presenting with a foot ulcer most likely has a diabetic foot ulcer. He should undergo monofilament testing to assess the subsequent risk of developing foot ulcers.
Diabetic neuropathy is the most common underlying cause of diabetic foot ulcers. The... | https://step2.medbullets.com/testview?qid=215040 |
219 | A 4-year-old boy comes to the pediatrician with his mother with a 3-day history of cough and runny nose with decreased oral intake over the past 24 hours. His activity level has been normal and he has been attending school until this morning. He has no medical history or known allergies, but he has not received any of ... | {
"A": "Amoxicillin",
"B": "Obtain chest radiography and respiratory virus panel",
"C": "Supportive care with return precautions",
"D": "Administer antitoxin and toxoid vaccine",
"E": ""
} | C | This boy presenting with 3 days of progressive fever, rhinorrhea, cough, conjunctivitis, and tonsilar erythema most likely has viral pharyngitis. The appropriate treatment for this is supportive care with return precautions (instructing the mother to bring the child back to a physician if he becomes short of breath).
... | https://step2.medbullets.com/testview?qid=215042 |
220 | A 2-month-old girl is brought to the pediatrician by her mother for a follow-up visit. The patient was born at 29 weeks gestation to a G1P1 mother. Her postnatal course was complicated by a prolonged neonatal intensive care unit stay for neonatal respiratory distress syndrome (NRDS). Since discharge from the hospital, ... | {
"A": "Delay all vaccines for 2 months due to the infant's history of NRDS",
"B": "Administer DTaP, HAV, HBV, HiB, PCV 13, poliovirus, and rotavirus vaccines",
"C": "Administer DTaP, HBV, HiB, PCV 13, poliovirus, and rotavirus vaccines",
"D": "Delay all vaccines for 2 months because the infant was born 2 month... | C | This 2-month-old girl has a history of prematurity (born at 29 weeks gestation) complicated by a NICU stay for NRDS but is healthy at this time. It is recommended that she receive all vaccines (DTaP, HBV, HiB, PCV 13, poliovirus, and rotavirus vaccines) as scheduled during this visit.
Premature infants can safely be v... | https://step2.medbullets.com/testview?qid=215043 |
221 | A 47-year-old woman presents to the clinic with 3 weeks of increased thirst and urination. She has a history of obesity, hypertension, and depression for which she takes losartan and sertraline. She has smoked 1 pack of cigarettes per day for 30 years. Her temperature is 99.5°F (37.5°C), blood pressure is 148/90 mmHg, ... | {
"A": "Creatinine clearance",
"B": "Oral glucose tolerance test",
"C": "Urine albumin-to-creatinine ratio",
"D": "Hemoglobin A1c",
"E": ""
} | C | This patient with a history of obesity and hypertension presenting with polyuria and polydipsia in the setting of an elevated random blood glucose (> 200 mg/dL) likely has a new diagnosis of type 2 diabetes mellitus. The urine albumin-to-creatinine ratio is the most appropriate early test for diabetic nephropathy.
Ear... | https://step2.medbullets.com/testview?qid=215044 |
222 | A 46-year-old farmer presents to the office for a follow-up visit. He was seen 4 days ago for a new lesion on his arm that had been present for 1 week prior to that visit. A photograph of the lesion is shown in Figure A. At that time, he was prescribed treatment for the lesion and instructed to follow up as necessary. ... | {
"A": "Allergic reaction to prescribed therapy",
"B": "Progression of disease and alternative therapy is indicated",
"C": "Progression of disease and surgical debridement is necessary",
"D": "Adverse effect of doxycycline",
"E": ""
} | D | This farmer has a cutaneous black eschar most consistent with cutaneous anthrax for which doxycycline is an appropriate treatment. A new blistering, erythematous rash after spending an hour outside that appears 4 days after starting treatment is consistent with a photosensitivity reaction, a known adverse effect of dox... | https://step2.medbullets.com/testview?qid=215046 |
223 | A 24-year-old motorcyclist is involved in a head-on collision with a motor vehicle and suffers various traumatic injuries. She has no significant medical history, is up to date on all vaccinations, and her last tetanus shot was 3 years ago. On arrival, her temperature is 36.7°C (98°F), blood pressure is 82/63 mmHg, pul... | {
"A": "Insertion of a nasogastric tube",
"B": "Tetanus vaccination",
"C": "Insertion of a thoracostomy tube",
"D": "Vaccination against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae",
"E": ""
} | D | This patient has an extensive splenic injury and hemodynamic instability requiring splenectomy, as evidenced by trauma to the left posterior ribs and left flank, low blood pressures with reflex tachycardia, and evidence of splenic rupture and hemoperitoneum on computed tomography imaging. Subsequently, this asplenic pa... | https://step2.medbullets.com/testview?qid=215049 |
224 | A 65-year-old man presents to the emergency department with anxiety and intermittent palpitations. He began feeling the palpitations 3 days ago while eating dinner. He denies chest pain, shortness of breath, or loss of consciousness. He has a history of hypertension, major depressive disorder, Raynaud disease, and chro... | {
"A": "Amiodarone",
"B": "Digoxin",
"C": "Verapamil",
"D": "Metoprolol",
"E": ""
} | C | This patient’s new-onset palpitations, irregularly irregular pulse, and absent p-waves on ECG are consistent with atrial fibrillation. In hemodynamically stable patients with a relative contraindication to β-blockers (COPD on home oxygen with increasing oxygen need), rate control with a non-dihydropyridine calcium chan... | https://step2.medbullets.com/testview?qid=215054 |
225 | A 26-year-old woman presents to the clinic with diarrhea, bloating, flatulence, and abdominal cramps. These symptoms have been going on for 2 months. She has lost 6 pounds (2.7 kg) over these 2 months. Her medical history is significant for mild intermittent asthma for which she uses an albuterol inhaler as needed. She... | {
"A": "Celiac disease",
"B": "Crohn disease",
"C": "Whipple disease",
"D": "Tropical sprue",
"E": ""
} | D | The patient is presenting with chronic diarrhea, weight loss, megaloblastic anemia (low hemoglobin and elevated MCV), and a biopsy showing blunted villi and mixed infiltrate following significant travel to South India. This is consistent with tropical sprue.
Tropical sprue is characterized by chronic diarrhea that occ... | https://step2.medbullets.com/testview?qid=215056 |
226 | A 25-year-old man is brought to the emergency department by paramedics for altered mental status. He was found lying down at a bus stop unresponsive. On arrival, the patient has slurred speech and is somnolent. Further is unable to be elicited. His temperature is 98.0°F (36.7°C), blood pressure is 130/80 mmHg, pulse is... | {
"A": "Atropine",
"B": "Flumazenil",
"C": "Observation",
"D": "Naloxone",
"E": ""
} | C | This patient's presentation with altered mental status, pinpoint pupils, and decreased bowel sounds is most consistent with an opioid overdose. Given his stable respiratory status and oxygen saturation without notable bradypnea, observation alone until the patient is clinically sober is the most appropriate management.... | https://step2.medbullets.com/testview?qid=215094 |
227 | A 27-year-old man presents to the emergency department after a bar fight. He was punched in the eye and is having pain and blurry vision. The patient is otherwise healthy and does not take any medications. His temperature is 98.1°F (36.7°C), blood pressure is 132/84 mmHg, pulse is 103/min, respirations are 17/min, and ... | {
"A": "Lateral canthotomy",
"B": "Cyclopentolate",
"C": "Topical timolol and pilocarpine",
"D": "Orbital ultrasound",
"E": ""
} | A | This patient is presenting after blunt trauma to the eye with eye pain, blurry vision, conjunctival injection, a sluggish pupil, and elevated intraocular pressure (> 20 mmHg) suggesting a diagnosis of a retrobulbar hematoma/hemorrhage causing orbital compartment syndrome. The most important initial step in management i... | https://step2.medbullets.com/testview?qid=215169 |
228 | A 50-year-old man presents to the emergency department with chest pain. He states that the pain is dull in quality, started 30 minutes ago, has been gradually worsening, and is worse with exertion. He also endorses some shortness of breath. He also believes the pain is worse when leaning back and improved when leaning ... | {
"A": "Hypertrophic obstructive cardiomyopathy",
"B": "Hypokalemia",
"C": "Myocardial infarction",
"D": "Hyperkalemia",
"E": ""
} | C | This patient is presenting with chest pain and an ECG demonstrating hyperacute T waves (leads V2-V6) which is an early finding concerning for a myocardial infarction.
A myocardial infarction occurs when an atherosclerotic plaque ruptures causing occlusion of a coronary artery. Patients classically present with chest p... | https://step2.medbullets.com/testview?qid=215170 |
229 | A 59-year-old man presents to his primary care physician for abdominal pain and foul-smelling diarrhea that has persisted for the past 2 years. The patient has a medical history of alcoholism and has been admitted to the hospital multiple times for withdrawal, abdominal pain, and traumatic injuries from his drinking. T... | {
"A": "Pantoprazole",
"B": "Oral rehydration",
"C": "Ciprofloxacin",
"D": "Loperamide",
"E": ""
} | A | This patient with a history of alcoholism is presenting with steatorrhea (foul-smelling diarrhea that stains with Sudan Black, a stain that detects fat in the stool), hypocalcemia, and findings suggestive of chronic pancreatitis on CT scan (inflammatory changes and calcification). His steatorrhea can be improved with t... | https://step2.medbullets.com/testview?qid=215171 |
230 | A 43-year-old man presents to the emergency department with bright red blood in his stool this morning. He noticed this yesterday as well, but it was much scanter. The patient is otherwise healthy. He was celebrating his birthday last night and admits having "too much to drink" and vomited profusely overnight. He curre... | {
"A": "Erosion into a gastric vessel",
"B": "Submucosal esophageal tear",
"C": "Vascular malformation",
"D": "Malignancy",
"E": ""
} | C | This patient is presenting with bright red blood per rectum with a non-tender abdomen. Of the answer choices given, angiodysplasia is the most likely to cause such profuse and sudden bleeding.
Angiodysplasia is a vascular malformation found in the gastrointestinal (GI) tract, most commonly in the colon. The exposed ve... | https://step2.medbullets.com/testview?qid=215172 |
231 | A 56-year-old man presents from prison with 1 month of subjective fevers, chills, cough, and night sweats. He noticed a gradual weight loss over the past year despite no changes to his diet or physical activity. He has never smoked cigarettes but does have a history of opiate use prior to incarceration. He does not tak... | {
"A": "Vancomycin",
"B": "Ampicillin-sulbactam",
"C": "Rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy",
"D": "Itraconazole",
"E": ""
} | C | This patient likely has active tuberculosis (TB), as evidenced by his symptoms (fever, night sweats, cough, and weight loss), inmate status, and apical cavitary lesion on chest radiograph. He should be treated with RIPE therapy.
An active TB infection should be suspected in patients with a febrile illness, cough, nigh... | https://step2.medbullets.com/testview?qid=215176 |
232 | A 68-year-old man presents for evaluation by a neurologist for an involuntary hand tremor that started approximately 3 months ago. The shaking improves when he reaches for objects but returns when he is not using his hand. His temperature is 98.6°F (37.0°C), blood pressure is 115/70 mmHg, pulse is 70/min, and respirati... | {
"A": "Cerebellar stroke",
"B": "Essential tremor",
"C": "Lacunar stroke",
"D": "Parkinson disease",
"E": ""
} | D | This patient who presents with a low amplitude, 4-6 Hz resting tremor that resolves with voluntary movement and associated rigidity most likely has Parkinson disease.
Parkinson disease is caused by degeneration of dopaminergic neurons in the substantia nigra pars compacta of the basal ganglia. This neurodegenerative p... | https://step2.medbullets.com/testview?qid=215182 |
233 | A 55-year-old woman presents to the primary care clinic for her annual visit. She has no complaints and is asymptomatic. She has a history of hypertension, hyperlipidemia, and diabetes. Her medications are lisinopril, amlodipine, atorvastatin, and metformin. There is no family history of malignancy. She is a non-smoker... | {
"A": "Propylthiouracil",
"B": "Fine needle aspiration",
"C": "Radioiodine ablation",
"D": "Surgical removal of the mass",
"E": ""
} | B | This patient’s presentation with an asymptomatic thyroid nodule with suspicious ultrasound features (≥ 1 cm hypoechoic mass with microcalcifications) and elevated TSH is concerning for thyroid malignancy. The most appropriate next step in management is a fine needle aspiration (FNA).
The first step in the diagnostic w... | https://step2.medbullets.com/testview?qid=215183 |
234 | A 19-year-old man presents to his primary care physician. He is asymptomatic and has no acute complaints, has no medical problems, and takes no medications. He was born in the United States but moved to El Salvador at age 11 and has only recently moved back to the United States in the past year. He was up to date on hi... | {
"A": "Tetanus, diphtheria, acellular pertussis, and influenza",
"B": "Tetanus and diphtheria",
"C": "Influenza",
"D": "Tetanus, diphtheria, and acellular pertussis",
"E": ""
} | D | This patient has recently moved back to the United States after living in another country for several years and is behind on his tetanus, diphtheria, and pertussis vaccine series. The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is indicated at least once in adults who have not previously received Tdap.
... | https://step2.medbullets.com/testview?qid=215185 |
235 | A 24-year-old man presents to the emergency room after a motor vehicle collision. He was the driver in a head-on collision and was not wearing a seatbelt. The patient is acutely intoxicated and is attempting to attack the nurses. Soon after presentation, he is sedated, paralyzed, and intubated. His medical history is u... | {
"A": "Needle thoracostomy",
"B": "Pericardial window",
"C": "Tube thoracostomy",
"D": "Pericardiocentesis",
"E": ""
} | D | This patient is presenting after trauma with hypotension, tachycardia, jugular venous distension, and electrical alternans on ECG, which is concerning for cardiac tamponade. The most important initial step in management is pericardiocentesis.
Cardiac tamponade can occur after trauma, infections, or malignancy. It can ... | https://step2.medbullets.com/testview?qid=215186 |
236 | A 3-year-old girl is brought to the office for a routine well-child appointment. She was delivered preterm at 35 weeks, and her medical history is significant for several ear infections over the last year. Her older brother has been diagnosed with attention-deficit hyperactivity disorder (ADHD), but the rest of her fam... | {
"A": "Refer to genetic testing",
"B": "Speech and language assessment",
"C": "Audiometry testing",
"D": "Parent and teacher ADHD rating scales",
"E": ""
} | C | This patient who presents with trouble following directions, inconsistent response to the physician's questions, and lack of progression in her language skills may have an acquired hearing impairment. The patient should undergo audiometry testing.
Hearing impairment in children can be genetic or acquired. In a patient... | https://step2.medbullets.com/testview?qid=216239 |
237 | A 15-year-old girl presents to the clinic due to concern that she may be pregnant. She had unprotected sexual intercourse earlier that morning and requests emergency contraception. She has had regular menses since menarche, and her last menstrual period ended 8 days ago. She has no significant medical history. Her temp... | {
"A": "Prescribe misoprostol pill",
"B": "Prescribe levonorgestrel pill",
"C": "Obtain parental consent before providing emergency contraception",
"D": "Prescribe high-dose oral contraceptives",
"E": ""
} | B | This patient with recent unprotected intercourse and a negative pregnancy test is a candidate for postcoital emergency contraception. She should receive the levonorgestrel or ulipristal pill, which in most states does not require parental consent.
Patients with a positive pregnancy test are not candidates for emergenc... | https://step2.medbullets.com/testview?qid=216240 |
238 | A 67-year-old man presents to the emergency room reporting sudden-onset abdominal and back pain that began 3 hours ago. He was eating dinner when he started feeling severe pain in his abdomen that made him lose his appetite. He denies any diarrhea or hematochezia and says the pain is not affected by movement. He has a ... | {
"A": "Ischemic colitis",
"B": "Ruptured abdominal aortic aneurysm",
"C": "Aortic dissection",
"D": "Acute pancreatitis",
"E": ""
} | B | This patient who presents with sudden-onset abdominal pain, hemodynamic instability (symptomatic hypotension with tachycardia), and significant history of hypertension and smoking most likely has a ruptured abdominal aortic aneurysm (AAA).
Abdominal aortic aneurysms are dilations in the vessel wall that can predispose... | https://step2.medbullets.com/testview?qid=216244 |
239 | A 48-year-old man presents to the emergency room with a 2-hour history of severe abdominal pain, nausea, and vomiting. He states that he has not passed gas or had a bowel movement in 4 days and his pain has worsened and become constant over the past 2 hours. His only medical history includes an appendectomy that he und... | {
"A": "Supportive care, NPO, and intravenous fluids",
"B": "Urgent surgical intervention",
"C": "Nasogastric tube placement",
"D": "CT angiography of the abdomen and pelvis",
"E": ""
} | B | This patient with abdominal pain, vomiting, and obstipation is now hemodynamically unstable with fever, leukocytosis, rising lactate, and worsening pain. He most likely has a complicated small-bowel obstruction (SBO) and should undergo immediate surgical intervention.
SBO occurs when the normal progression of intralum... | https://step2.medbullets.com/testview?qid=216246 |
240 | A 52-year-old G3P3 woman presents to clinic with a 2-year history of urinary incontinence. She has had frequent, involuntary loss of urine over the last 2 years but presented today because of 10 days of dysuria. She has been treated for 2 urinary tract infections over the past 6 months. She does not endorse any loss of... | {
"A": "Urethral diverticulum",
"B": "Overflow incontinence",
"C": "Stress urinary incontinence",
"D": "Pelvic organ prolapse",
"E": ""
} | A | This patient is presenting with a history of dysuria, incontinence, and recurrent lower urinary tract infections in conjunction with a tender anterior vaginal wall mass. The most likely diagnosis is a urethral diverticulum.
A urethral diverticulum is an abnormal, localized outpouching of the urethral mucosa often due ... | https://step2.medbullets.com/testview?qid=216247 |
241 | A 48-year-old woman, gravida 3 para 3, presents to the clinic with a 5-month history of intermittent loss of urine. Her urinary leaking occurs throughout the day and night, and she often has to get up to use the bathroom while asleep. Exercising does not affect the loss of urine. She states that she often cannot make i... | {
"A": "Overflow incontinence",
"B": "Urge incontinence",
"C": "Stress incontinence",
"D": "Mixed urinary incontinence",
"E": ""
} | B | This patient with a sudden need to void followed by loss of urine with urgency (unable to make it to the bathroom in time) most likely has urinary urge incontinence.
Urge incontinence is a form of urinary incontinence characterized by a sudden urge to urinate, resulting in the involuntary leakage of urine. Normally, b... | https://step2.medbullets.com/testview?qid=216248 |
242 | A 42-year-old man presents to the urgent care clinic with low back pain. He was working on a home improvement project the day prior to presentation when the pain started. He describes the pain as "achy and sore." It is not positional and does not radiate. He denies fevers, chills, paresthesias, and bowel or bladder inc... | {
"A": "Osteoarthritis",
"B": "Vertebral compression fracture",
"C": "Lumbar strain",
"D": "Disc herniation",
"E": ""
} | C | This patient presents with low back pain after activity with paravertebral tenderness and without red flag signs/symptoms, such as history of trauma or malignancy, intravenous drug use, saddle anesthesia (reduced perineal sensation), or neurological deficits. The most likely diagnosis is a lumbar strain.
The different... | https://step2.medbullets.com/testview?qid=216255 |
243 | A 24-year-old woman presents to clinic for a routine annual exam. She has generally been feeling well, but notes feeling intermittent palpitations over the past few months. Her past medical history is unremarkable and she is not currently taking any medications. She denies drinking alcohol, smoking cigarettes, or using... | {
"A": "First degree atrioventricular block",
"B": "Sinus bradycardia",
"C": "Second degree atrioventricular block, Mobitz type II",
"D": "Second degree atrioventricular block, Mobitz type I",
"E": ""
} | D | This patient's progressively increasing PR intervals until a P wave is not followed by a QRS complex on ECG is consistent with second degree atrioventricular (AV) block, Mobitz type I, also referred to as Wenckebach phenomenon.
Second degree AV block, Mobitz type I can occur in a variety of settings, such as in the co... | https://step2.medbullets.com/testview?qid=216259 |
244 | A 28-year-old G1P0 woman presents to initiate prenatal care after a positive home pregnancy test. The first day of her last menstrual period was 7 weeks prior to presentation. The patient has no medical conditions and takes no medications. Her temperature is 98.6°F (37.0°C), blood pressure is 110/70 mmHg, pulse is 64/m... | {
"A": "Avoid soccer during pregnancy, continue other activities",
"B": "Avoid exercise during pregnancy",
"C": "Continue the current exercise regimen",
"D": "Reduce to walking only, beginning in the third trimester",
"E": ""
} | A | This healthy primigravida woman presents to the clinic inquiring about her current exercise regimen involving 285 minutes of moderate to exercise weekly. With the exception of soccer, a contact sport, her exercise regimen is appropriate throughout her pregnancy.
The American College of Obstetricians and Gynecologists ... | https://step2.medbullets.com/testview?qid=216262 |
245 | A 69-year-old man passes away after a 3-week hospitalization for liver failure, complicated by a myocardial infarction. A medical student rotating in the intensive care unit asked if she can practice performing intubations during her rotation. The resident suggests performing one on the deceased patient, as the student... | {
"A": "Ask the resident if the patient’s family or the patient has been consented for this procedure",
"B": "Contact the patient's family to ask for permission to perform the procedure",
"C": "Intubate the patient with the resident's supervision",
"D": "Report the resident to hospital administration",
"E": "... | A | This medical student wants to perform a procedure on a deceased patient for educational purposes. Before proceeding, the student should ensure that permission has been obtained from the patient's family or the patient when he was alive.
Performing procedures on deceased patients is ethically permissible with appropria... | https://step2.medbullets.com/testview?qid=216264 |
246 | A 30-year-old woman presents to the emergency department for palpitations. For 2 months, she has experienced intermittent palpitations along with menstrual irregularity and hair loss. At home, the air conditioner is at its coldest setting, but the patient still feels overheated. Her temperature is 99.5°F (37.5°C), bloo... | {
"A": "Exophthalmos",
"B": "Hair loss",
"C": "Heat intolerance",
"D": "Thyromegaly",
"E": ""
} | A | This patient presents with palpitations, tachycardia, tremor, heat intolerance, hair loss, menstrual irregularity, goiter, and exophthalmos concerning for hyperthyroidism due to Graves disease. Radioiodine ablation is the preferred definitive management for Graves disease, which can worsen exophthalmos.
Graves disease... | https://step2.medbullets.com/testview?qid=216266 |
247 | A 72-year-old man presents to the clinic for his annual exam. For the past few months, he has pain in his chest with physical activity. The pain goes away after he takes a break. He reports no chest pain while he is resting, and the pain is not worsening. His past medical history is notable for hypertension, type 2 dia... | {
"A": "Stable angina",
"B": "Costochondritis",
"C": "ST elevation myocardial infarction",
"D": "Unstable angina",
"E": ""
} | A | This patient who presents with exertional chest pain that is relieved with rest without increasing frequency or intensity of chest pain, a normal electrocardiogram (ECG), and normal troponin level most likely has stable angina.
Angina pectoris is chest pain secondary to myocardial ischemia and is most commonly caused ... | https://step2.medbullets.com/testview?qid=216268 |
248 | A 14-year-old boy is brought to the pediatrician for behavioral issues. At school, he interrupts class by making barking noises. His mother notes that he has been making throat-clearing noises daily for the past 2 years. He has no medical problems and takes no medications. He gets along with his 2 brothers, plays turn-... | {
"A": "Methylphenidate",
"B": "Fluoxetine",
"C": "Haloperidol",
"D": "Dextroamphetamine",
"E": ""
} | C | This patient presents with multiple motor tics (grimacing, eye blinking) and phonic tics (barking, throat-clearing) on a daily basis for more than 1 year, which are consistent with Tourette syndrome. Tourette syndrome can be medically treated with antipsychotic agents such as haloperidol.
Tourette syndrome presents wi... | https://step2.medbullets.com/testview?qid=216269 |
249 | A 52-year-old man presents to the emergency department by ambulance for evaluation of hematemesis. His wife states that he began vomiting bright red blood this evening while eating dinner, and has produced about 5 cups total. He has a history of alcohol use disorder and has vomited small streaks of blood in the past, b... | {
"A": "Octreotide",
"B": "Ceftriaxone",
"C": "Nadolol",
"D": "Platelet transfusion",
"E": ""
} | A | This patient with a history of alcohol use disorder and signs of liver failure (jaundice, ascites, spider angiomas, and ecchymoses) presents with acute hematemesis and hypovolemic shock (hypotension, tachycardia, tachypnea) most concerning for a variceal hemorrhage. The first step in the resuscitation of patients with ... | https://step2.medbullets.com/testview?qid=216270 |
250 | A 66-year-old man presents to the clinic with a 6-week history of bloody stools. He describes the blood as bright red wisps that float on the surface of the stool. He has no pain with bowel movements but notes on occasion he may strain. He does not endorse fatigue, fever, constipation, diarrhea, nausea, vomiting, abdom... | {
"A": "Increase fiber in diet",
"B": "Colonoscopy",
"C": "Observation",
"D": "Sigmoidoscopy",
"E": ""
} | B | This patient is presenting with painless bright red blood per rectum. Because he is over 50 years old and having rectal bleeding, he should be evaluated for malignancy with a colonoscopy.
Bright red blood per rectum has a broad differential diagnosis including anal fissures, hemorrhoids, angiodysplasia, inflammatory b... | https://step2.medbullets.com/testview?qid=216275 |
251 | A 77-year-old man presents to the emergency department with a complaint of sudden onset weakness in his right upper extremity. At home, the patient thought he was simply dehydrated, but he rapidly began to have trouble speaking. When his wife noted this she brought him into the hospital. On arrival to the emergency dep... | {
"A": "Intracerebral hemorrhage",
"B": "Subdural hematoma",
"C": "Subarachnoid hemorrhage",
"D": "Epidural hematoma",
"E": ""
} | A | This patient with a medical history of hypertension on blood thinners (apixaban) is presenting with rapidly progressive neurologic symptoms. Initially, his symptoms are in his right upper extremity, which then progresses to affect his speech and cause altered mental status, obtundation, and seizures, which is suggestiv... | https://step2.medbullets.com/testview?qid=216357 |
252 | A 75-year-old man presents to the emergency department with fatigue. He has had severe nausea, vomiting, and diarrhea for the past 3 days. Today, his wife noticed that he was confused. The patient has a history of coronary artery disease with a drug-eluting stent placed 1 year ago, obesity, hypertension, and dyslipidem... | {
"A": "Aspirin, heparin, clopidogrel, and cardiac catheterization",
"B": "Ringer lactate bolus",
"C": "Metoprolol and aspirin",
"D": "Obtain a urinalysis and creatine phosphokinase level",
"E": ""
} | B | This patient with likely gastroenteritis (given his nausea, vomiting, and diarrhea) is dehydrated, as indicated by his low blood pressure, tachycardia, dry mucous membranes, and prerenal kidney injury (elevated BUN and creatinine with BUN:creatinine ratio > 20:1) in the setting of an anion gap (anion gap = [Na+] - [Cl-... | https://step2.medbullets.com/testview?qid=216358 |
253 | A 65-year-old man presents to the emergency department with sudden-onset altered mental status. He was last seen normal 1 hour ago. His wife noticed that he was confused, slurring his speech, and had notable weakness that caused him to drop his cup of coffee. The patient is confused and not able to answer any questions... | {
"A": "CT head",
"B": "Fingerstick blood glucose",
"C": "Fresh frozen plasma and vitamin K",
"D": "Alteplase",
"E": ""
} | B | This patient is presenting with sudden onset confusion, slurred speech, asymmetric smile, and weakness in the setting of risk factors for stroke (atrial fibrillation, diabetes, and hypertension). The most important initial step in management in a patient with altered mental status and neurological deficits is to obtain... | https://step2.medbullets.com/testview?qid=216359 |
254 | A 55-year-old man with a history of polysubstance abuse is found down in his home acutely obtunded. Emergency medical services administered naloxone which immediately woke the patient up and improved his oxygen saturation from 40% to 90%. However, they noted subsequently that the patient demonstrated increased work of ... | {
"A": "Medication administration",
"B": "Community acquired pneumonia",
"C": "Atypical pneumonia",
"D": "Poor cardiac function",
"E": ""
} | A | This patient is presenting after administration of naloxone with respiratory distress, wheezing, crackles, and pulmonary edema on chest radiography, suggesting acute pulmonary edema. Given the presence of symptoms immediately following naloxone administration, the cause of the pulmonary edema is likely the naloxone (me... | https://step2.medbullets.com/testview?qid=216360 |
255 | A 68-year-old woman presents to the emergency room with several days of frequent, nonbloody, watery stools. She recently completed a course of clindamycin 2 weeks ago for a tooth infection. Her medical history is notable for hypertension and hyperlipidemia for which she takes amlodipine and atorvastatin. She traveled r... | {
"A": "CT imaging of abdomen and pelvis",
"B": "Rectal swab for selective anaerobic culture",
"C": "Abdominal radiograph",
"D": "Stool toxin assay",
"E": ""
} | D | This patient presenting with cramping abdominal pain and frequent watery diarrhea a few weeks after finishing a course of antibiotics most likely has Clostridioides difficile infection, for which the most appropriate confirmatory test is a stool toxin assay.
C. difficile infection should be suspected in patients with ... | https://step2.medbullets.com/testview?qid=216371 |
256 | A 49-year-old man presents with 3 months of generalized weakness. He has had a chronic cough and a 20 pound unintentional weight loss over the past 6 months. He has a medical history significant for high blood pressure, hyperlipidemia, and seasonal allergies with no prior surgical history. He has no history of tobacco ... | {
"A": "Prednisone taper",
"B": "Bilateral adrenalectomy, prednisone, and fludrocortisone",
"C": "Rifamycin, isoniazid, pyrazinamide, ethambutol, and hydrocortisone therapy",
"D": "Hydrocortisone and immunoglobulin therapy",
"E": ""
} | C | This man from India presents with generalized weakness, chronic cough, unintentional weight loss, skin hyperpigmentation, hyponatremia, hyperkalemia, hypocortisolism, cosyntropin stimulation test failure, elevated ACTH, and bilateral adrenal calcifications on radiography. These symptoms and signs in this patient are mo... | https://step2.medbullets.com/testview?qid=216385 |
257 | A 67-year-old man presents with a recurrent episode of syncope. He states that this has happened to him multiple times, particularly when he changes body position from sitting to standing, exerts himself, or turns his head quickly. He says that he notes numbness, vertigo, and sometimes even trouble with speaking immedi... | {
"A": "Vagal event",
"B": "Seizure",
"C": "Blood vessel narrowing",
"D": "Stroke",
"E": ""
} | C | This elderly patient with risk factors for vascular disease (diabetes, dyslipidemia, hypertension) is presenting with episodes of dizziness, vertigo, numbness/tingling, dysarthria, and syncope, which seem to be provoked by standing rapidly and changing head position. This is concerning for vertebrobasilar syndrome, cau... | https://step2.medbullets.com/testview?qid=216395 |
258 | A 67-year-old woman presents from a nursing home with altered mental status. She was last known to be normal the night before. The patient has dementia at baseline and is minimally interactive. This morning, she was found to be obtunded. No further history was provided from the nursing home, and the patient is unable t... | {
"A": "Perform an echocardiogram",
"B": "Administer glucagon",
"C": "Check serum TSH and free T4 levels",
"D": "Perform a CT scan of the head",
"E": ""
} | C | This patient is presenting with obtundation, bradycardia, hypotension, hypothermia, thinning of her hair, and hyponatremia, which are concerning for myxedema coma. A serum TSH and free T4 would be most informative in confirming this diagnosis.
Myxedema coma (decompensated hypothyroidism) is the most life-threatening m... | https://step2.medbullets.com/testview?qid=216396 |
259 | A 55-year-old man presents to the emergency department with epistaxis for the past hour. He has never had epistaxis before and has been unable to control it with pressure, head elevation, and ice. The patient has a past medical history of atrial fibrillation and is currently taking metoprolol and warfarin. His temperat... | {
"A": "Placement of posterior nasal packing",
"B": "Intravenous tranexamic acid",
"C": "Topical oxymetazoline",
"D": "Cauterization with silver nitrate",
"E": ""
} | C | This patient on warfarin is presenting with epistaxis from the anterior nares (and is currently hemodynamically stable) suggesting anterior epistaxis. Prior to more invasive measures, topical therapy with oxymetazoline should be tried as it is very successful in reducing or resolving epistaxis.
Epistaxis can be a beni... | https://step2.medbullets.com/testview?qid=216397 |
260 | A 59-year-old man presents to the emergency department after a sudden onset of slurred speech and right upper extremity weakness. His symptoms lasted 20 minutes but by the time he arrived at the emergency department he was symptom-free. The patient denies any preceding symptoms. He has a history of diabetes, obesity, a... | {
"A": "CTA head/neck",
"B": "MRI brain",
"C": "Labetalol",
"D": "Aspirin",
"E": ""
} | D | This patient is presenting with a transient episode of neurologic dysfunction (slurred speech and right upper extremity weakness) that has completely resolved, which is concerning for a transient ischemic attack. In the setting of his normal head CT, aspirin should be administered next.
A transient ischemic attack (TI... | https://step2.medbullets.com/testview?qid=216403 |
261 | A 27-year-old nurse presents to the emergency department with a 30-minute history of palpitations and chest pain. She has been experiencing nausea, vomiting, and diarrhea after eating leftovers 2 days ago. Her husband tells the physician that he is concerned that the patient has been increasingly obsessed about her wei... | {
"A": "Serum glucose",
"B": "Complete blood count",
"C": "Urine chloride",
"D": "Arterial blood gas",
"E": ""
} | C | This patient who presents with hypokalemia and metabolic alkalosis may either be vomiting or engaging in diuretic abuse. A urine chloride test can be used to distinguish between these possibilities because urine chloride will be high in diuretic abuse and will be low/normal in surreptitious vomiting.
Metabolic alkalos... | https://step2.medbullets.com/testview?qid=216419 |
262 | A 23-year-old man presents to the emergency department after he was rescued while hiking in Alaska. The patient was found on a mountain trail non-responsive. His temperature is 91°F (32.8°C), blood pressure is 103/61 mmHg, pulse is 60/min, respirations are 11/min, and oxygen saturation is 97% on room air. The patient i... | {
"A": "Hypocalcemia",
"B": "Hypophosphatemia",
"C": "Hypomagnesemia",
"D": "Red blood cells on urine microscopy",
"E": ""
} | A | This patient is presenting after being found outside with hypothermia and frostbite (dark bullae noted on the extremities in the setting of being out in the cold). Frostbite can lead to rhabdomyolysis, which may cause hyperkalemia (causing ECG changes including peaked T waves and QRS widening as seen in this patient) a... | https://step2.medbullets.com/testview?qid=216427 |
263 | A 32-year-old man presents to the emergency department with pain upon defecation. His symptoms started a few weeks ago but have been worsening. Sometimes he notes blood on the toilet paper. He has to strain to have bowel movements and has trouble defecating secondary to pain. He is generally healthy and does not smoke.... | {
"A": "Testing for HIV, fecal occult blood, and sexually transmitted diseases",
"B": "CT scan of the abdomen and pelvis",
"C": "Surgical excision",
"D": "Topical lidocaine, sitz baths, and fiber supplements",
"E": ""
} | A | This patient is presenting with pain upon defecation, constipation, and a fissure lateral to the midline which is suggestive of an anal fissure. Anal fissures lateral to the midline are associated with inflammatory and infectious etiologies; thus, further workup (testing for HIV, fecal occult blood testing, and sexuall... | https://step2.medbullets.com/testview?qid=216438 |
264 | A 66-year-old man presents to the emergency department with shortness of breath. He typically has poor exercise tolerance and is only able to walk from his house to his mailbox before becoming dyspneic. He now has shortness of breath even at rest. He had a cold recently but has no new medical problems. His past medical... | {
"A": "Digoxin",
"B": "Albuterol and prednisone",
"C": "Intubation",
"D": "Metoprolol",
"E": ""
} | A | This patient with a history of heart failure with reduced ejection fraction is presenting with respiratory distress (increased work of breathing, hypoxia, wheezes, and crackles) in the setting of atrial fibrillation (ECG with irregularly irregular rhythm without P waves) with rapid ventricular response and pulmonary ed... | https://step2.medbullets.com/testview?qid=216458 |
265 | A 37-year-old woman presents to the emergency department in cardiac arrest. She was found to have altered mental status at home, and during transport to the hospital, she became pulseless. Cardiopulmonary resuscitation is ongoing and 2 intravenous lines are placed. The patient is obese, and her only medication is an or... | {
"A": "Obstructive shock",
"B": "Hemorrhagic shock",
"C": "Cardiogenic shock",
"D": "Septic shock",
"E": ""
} | A | This obese patient on oral contraceptive pills with recent orthopedic surgery (Achilles tendon repair) is presenting in cardiac arrest. Given the bedside echocardiograph that is notable for a dilated and hypokinetic right ventricle with septal bowing into a hyperkinetic left ventricle, the most likely diagnosis is a pu... | https://step2.medbullets.com/testview?qid=216473 |
266 | A 57-year-old man is brought to the emergency department by his wife with confusion. He was seen in the emergency department 2 days ago for profuse epistaxis. His primary care provider was concerned and had advised him to go to the hospital, as the patient is on warfarin for atrial fibrillation. However, his bleeding r... | {
"A": "Penicillin",
"B": "Piperacillin-tazobactam",
"C": "Meropenem",
"D": "Clindamycin",
"E": ""
} | D | This patient is presenting with nasal packing, hypotension, tachycardia, a dark, purpuric rash, and confusion, which are concerning for toxic shock syndrome. The most important initial step in management is to administer clindamycin.
Toxic shock syndrome is a life-threatening diagnosis caused by Streptococcus pyogenes... | https://step2.medbullets.com/testview?qid=216474 |
267 | A 43-year-old man presents to the emergency department acutely with altered mental status. He uses intravenous drugs and is unable to offer a history. He was found unconscious in a park. His temperature is 99.0°F (37.2°C), blood pressure is 80/40 mmHg, pulse is 156/min, and respirations are 26/min. Physical exam reveal... | {
"A": "Cardioversion",
"B": "Epinephrine",
"C": "Phenylephrine",
"D": "Hydrocortisone",
"E": ""
} | B | This patient who uses intravenous drugs with skin abscesses (the likely source of his infection) is hypotensive and tachycardic, with a blood pressure that is not responding to IV fluids; this is concerning for septic shock. Given his persistent hypotension, he should be started on vasopressors of which norepinephrine ... | https://step2.medbullets.com/testview?qid=216495 |
268 | A 24-year-old man presents to his primary care physician with left groin pain. The pain started a year ago and has progressed. He now has 8/10 pain when climbing stairs or rising from a seated position. He localizes the pain to the front of his groin. He denies any erythema or swelling. He has a history of hypertension... | {
"A": "Low BMI",
"B": "Scuba diving",
"C": "Alcohol use",
"D": "History of sickle cell disease",
"E": ""
} | D | This patient with sickle cell disease (SCD) presents with anterior groin pain, especially with weight-bearing, and radiographic findings of amorphous lytic and sclerotic lesions of the femoral head, consistent with avascular necrosis. SCD is a predisposing factor for avascular necrosis.
Avascular necrosis has a multit... | https://step2.medbullets.com/testview?qid=216499 |
269 | A 26-year-old man presents to his primary care physician with a 6-month history of increasing lower back pain. He first felt the pain while lifting boxes at work but thought that he had just strained a muscle. The pain appears to be worse in the mornings and after rest. Exercise and physical activity appear to temporar... | {
"A": "Magnetic resonance imaging",
"B": "Bone scan",
"C": "Ultrasound",
"D": "Computed tomography",
"E": ""
} | A | This young man presents with low back pain that is relieved by physical activity, decreased spinal mobility, enthesitis of his patellar tendons, and elevated ESR/CRP values most likely has ankylosing spondylitis (AS). The most accurate diagnostic test for early ankylosing spondylitis is MRI.
Multiple imaging tests can... | https://step2.medbullets.com/testview?qid=216501 |
270 | A 7-year-old boy presents to the emergency department after an episode of jerking his extremities followed by confusion. This has happened in the past, but his mother thought he was fabricating his symptoms. She has taken him to a free health clinic to have him seen by a doctor who prescribed medication; however, she h... | {
"A": "Diazepam",
"B": "Observation",
"C": "Sumatriptan",
"D": "CT head",
"E": ""
} | B | This patient is presenting after a seizure (tonic-clonic jerking of his extremities) and is currently postictal given that he is obtunded. Given that the patient is not moving the left side of his body, he is likely suffering from Todd paralysis, which can occur after seizures and resolves on its own with only observat... | https://step2.medbullets.com/testview?qid=216507 |
271 | A 55-year-old man presents to the emergency department with worsening dyspnea over the past 48 hours. He recently had a cold that kept him home from work for the past week. He has a past medical history of diabetes, obesity, and hypertension. He had his Achilles tendon repaired 4 weeks ago and he has been less mobile. ... | {
"A": "Restrictive cardiomyopathy",
"B": "Myocardial infarction",
"C": "Constrictive pericarditis",
"D": "Pulmonary embolism",
"E": ""
} | C | This patient is presenting with a preceding viral illness, dyspnea, jugular venous distension, pulsus paradoxus (blood pressure drop from 150/85 to 130/70 mmHg during inspiration), an echocardiogram with impaired diastolic filling, and diffuse ST elevation with PR depression on ECG. This constellation of symptoms is co... | https://step2.medbullets.com/testview?qid=216508 |
272 | A 17-year-old boy presents to the emergency department after a car accident. He drove his car into a pole while speeding at night. He has no past medical history and takes no medications. The patient is unable to offer a history and repetitively asks the nurses what happened. He knows his name and address and is able t... | {
"A": "Diffuse axonal injury",
"B": "Epidural hematoma",
"C": "Concussion",
"D": "Subarachnoid hemorrhage",
"E": ""
} | C | This patient is presenting after a motor vehicle accident with confusion, repeated questioning, and a normal neurologic exam aside from his inability to remember the events that occurred. This constellation of symptoms is concerning for a concussion.
A concussion occurs after blunt trauma to the head and is common in ... | https://step2.medbullets.com/testview?qid=216509 |
273 | A 44-year-old man presents to the emergency department with palpitations. He has a history of anxiety managed with fluoxetine and lorazepam. He also has hypertension but does not take any medications. Today, his symptoms have been persistent despite taking his medications. He says that he feels lightheaded and can’t wa... | {
"A": "Adenosine",
"B": "Amiodarone",
"C": "Procainamide",
"D": "Cardioversion",
"E": ""
} | D | This patient is presenting with palpitations and an ECG demonstrating a wide complex tachycardia with a delta wave which are concerning for a tachydysrhythmia secondary to Wolff Parkinson White syndrome. Given his poor CNS perfusion (somnolence during his tachycardia despite a “normal” blood pressure), the most appropr... | https://step2.medbullets.com/testview?qid=216511 |
274 | A 23-year-old woman presents to labor and delivery at 40 weeks gestation with abdominal contractions and leakage of fluid from her vagina. She subsequently undergoes an uncomplicated vaginal delivery. The child is healthy and is heated, suctioned, and stimulated. While holding her newborn, the mother endorses a headach... | {
"A": "Magnesium",
"B": "Labetalol",
"C": "Ondansetron and morphine",
"D": "CT head",
"E": ""
} | A | This postpartum patient is presenting with hypertension, headache, blurry vision, and abdominal pain, which are concerning for a diagnosis of preeclampsia. The most appropriate initial intervention is magnesium.
Preeclampsia classically presents after 20 weeks gestation (or earlier in the setting of a molar pregnancy)... | https://step2.medbullets.com/testview?qid=216512 |
275 | A 33-year-old woman presents to the emergency department with foul-smelling vaginal discharge. She states that it started 1 day ago and has not improved with hygiene products. She is sexually active and uses condoms. She does not complain of any abdominal or pelvic pain but states she has some mild burning when urinati... | {
"A": "Metronidazole",
"B": "Ceftriaxone",
"C": "Ceftriaxone and doxycycline",
"D": "Ceftriaxone and azithromycin",
"E": ""
} | C | This nonpregnant woman is presenting with a thick, white cervical discharge, dysuria, and urethral discharge without cervical motion tenderness or adnexal tenderness which is concerning for urethritis without pelvic inflammatory disease. She should be treated with ceftriaxone and doxycycline to cover for the most commo... | https://step2.medbullets.com/testview?qid=216513 |
276 | A 15-month-old boy presents with his mother for his well-child exam. His mother is concerned about his vision, as she noticed him squinting while watching television. The patient was born at 39 weeks of gestation via spontaneous vaginal delivery. He is up to date with routine vaccinations. He is able to walk alone, spe... | {
"A": "Perform a Bielschowsky head tilt test",
"B": "Brain MRI",
"C": "Patch the left eye",
"D": "Patch the right eye",
"E": ""
} | D | This patient, with a history that suggests decreased visual acuity, a positive cover test (refixation of the misaligned eye upon covering the appropriately aligned eye), and an asymmetric corneal light reflex in Figure A, is presenting with strabismus. Of the answer choices, only patching the sound eye (right eye) is a... | https://step2.medbullets.com/testview?qid=216521 |
277 | A 67-year-old man presents to the emergency room with a 2 day history of progressively worsening fatigue and shortness of breath. His past medical history is significant for previous myocardial infarction, a 30-pack-year smoking history, gastroesophageal reflux disease, and poorly controlled hypertension. The patient’s... | {
"A": "Sacubitril and valsartan",
"B": "Furosemide",
"C": "Ivabradine",
"D": "Metoprolol",
"E": ""
} | B | This patient with multiple risk factors for heart failure (previous myocardial infarction, smoking history, hypertension), worsening fatigue, shortness of breath, respiratory alkalosis, and signs of fluid overload (S3 heart sound, elevated jugular venous pressure (JVP), bibasilar crackles, peripheral edema) most likely... | https://step2.medbullets.com/testview?qid=216576 |
278 | A 30-year-old man presents to the emergency department with diarrhea. He states he has had profuse, watery diarrhea for the past 24 hours. He notes that eating and drinking make him defecate more, thus he has been refraining from drinking. He is otherwise healthy and takes no medications. His temperature is 97.7°F (36.... | {
"A": "Stool PCR",
"B": "Ciprofloxacin",
"C": "Stool ova and parasite study",
"D": "Rest and oral rehydration",
"E": ""
} | D | This patient is presenting with a likely diarrheal illness given he has profuse, watery diarrhea and his vitals normalized with oral and IV hydration. Since the patient is young and healthy, oral hydration and rest are all that is needed for management.
Diarrheal illness is a common chief complaint with variable worku... | https://step2.medbullets.com/testview?qid=216584 |
279 | A 44-year-old man presents to the emergency department acutely confused. The patient’s wife states she found him lethargic at home. He has been sick the past week with diarrhea and has been staying home from work. He is otherwise healthy and does not take any medications. His temperature is 97.5°F (36.4°C), blood press... | {
"A": "Loperamide",
"B": "Norepinephrine",
"C": "Ceftriaxone",
"D": "Normal saline",
"E": ""
} | A | This patient is presenting with infectious diarrhea (given his bloody diarrhea and hypotension) with unstable vitals that improve with fluids. In bloody diarrhea, loperamide is contraindicated and could worsen illness.
Bacterial diarrhea is commonly caused by organisms such as Campylobacter, Shigella, and Escherichia ... | https://step2.medbullets.com/testview?qid=216585 |
280 | A 77-year-old man presents to the emergency department acutely obtunded. The patient lives alone and was found unresponsive by his son. Generally, the patient manages his own finances, medications, and works part-time. He has not been responding to phone calls for the past 3 days. The patient is unable to offer a histo... | {
"A": "Levothyroxine administration",
"B": "Free T4 level",
"C": "Thyroid stimulating hormone and free T4 level",
"D": "Triiodothyronine administration",
"E": ""
} | A | This elderly patient with a past medical history of hypothyroidism is presenting with altered mental status, hypotension, hypothermia, and bradycardia, which are concerning for myxedema coma. Empiric and immediate treatment with levothyroxine is the appropriate management of this condition prior to confirming the diagn... | https://step2.medbullets.com/testview?qid=216587 |
281 | A 22-year-old man presents to the emergency department with difficulty breathing. He has experienced similar symptoms before. Today, he was hit in the face with a football, followed by significant swelling of his lips and tongue. The patient speaks with a muffled voice. His temperature is 98.1°F (36.7°C), blood pressur... | {
"A": "Diphenhydramine",
"B": "Dexamethasone",
"C": "Fresh frozen plasma",
"D": "Epinephrine",
"E": ""
} | C | This patient is presenting with recurrent episodes of significant swelling of his lips and tongue with minor trauma, which are concerning for hereditary angioedema. Fresh frozen plasma is the most effective therapy for hereditary angioedema of the options listed.
Angioedema is a potentially life-threatening condition ... | https://step2.medbullets.com/testview?qid=216588 |
282 | A 64-year-old man presents with nausea, vomiting, and weakness. He states that his wife made him come in when he fainted today while attempting to stand up. He otherwise states he has noticed some visual changes, including noting a yellow tint to objects. He has a history of heart failure with reduced ejection fraction... | {
"A": "Amiodarone",
"B": "Digoxin",
"C": "Diltiazem",
"D": "Procainamide",
"E": ""
} | B | This patient with a history of heart failure with reduced ejection fraction and atrial fibrillation is presenting with nausea, vomiting, visual changes, bradycardia, and premature ventricular complexes, which are concerning for digoxin toxicity. Note that digoxin can be given in patients with poor cardiac function and ... | https://step2.medbullets.com/testview?qid=216589 |
283 | A 33-year-old man presents to the emergency department with dizziness. He states he has a constant sensation that the room is spinning. He is now having trouble walking and has been vomiting intermittently. He has no past medical history and takes no medications. His temperature is 98.0°F (36.7°C), blood pressure is 12... | {
"A": "Prednisone",
"B": "Epley maneuver",
"C": "MRI brain",
"D": "CT head",
"E": ""
} | A | This young, healthy patient is presenting with constant vertigo, ataxia, vomiting, and a head impulse test revealing a corrective saccade, nystagmus, and test of skew (HINTS) exam, which suggests a peripheral etiology of vertigo, most likely vestibular neuritis. As the diagnosis can be made clinically, steroids are the... | https://step2.medbullets.com/testview?qid=216590 |
284 | A 45-year-old man with a past medical history of obesity presents with a concern about his sexual performance. He has a history of depression which is well managed with fluoxetine. He states that since starting the medication, his sexual drive has increased, yet he is unable to achieve orgasm. As a result, he refuses t... | {
"A": "Electroconvulsive therapy",
"B": "Mirtazapine",
"C": "Bupropion",
"D": "Phenelzine",
"E": ""
} | C | This patient is presenting with anorgasmia in the setting of treatment with a selective serotonin reuptake inhibitor (SSRI). Given his obesity, worsening home blood glucose levels, and desire for improved sexual performance, bupropion is an appropriate medication.
Bupropion is an antidepressant that is not used first-... | https://step2.medbullets.com/testview?qid=216591 |
285 | A 55-year-old man presents to his primary care physician with persistent symptoms of depression. He started taking fluoxetine 3 weeks ago when he was diagnosed with major depressive disorder after a divorce. Since then, he notes that his symptoms are roughly unchanged. His other medications include albuterol. His tempe... | {
"A": "Change medication to bupropion",
"B": "Increase dose of current medication",
"C": "Maintain dose of current medication",
"D": "Change medication to escitalopram",
"E": ""
} | C | This patient is presenting with major depressive disorder but has not given his current selective serotonin reuptake inhibitor (SSRI) at least 4 weeks to begin working. Thus, he should be reassured and maintained on the current dose of his SSRI, with follow-up after the 4 week mark to see if his symptoms have improved.... | https://step2.medbullets.com/testview?qid=216593 |
286 | A 60-year-old man presents to his primary care physician with weight gain. He states that ever since his wife died 4 months ago, he has been eating and sleeping more and no longer engages in any activities he once enjoyed such as hiking or fishing. He feels guilty for not spending more time with his wife before she die... | {
"A": "Venlafaxine",
"B": "Bupropion",
"C": "Amitriptyline",
"D": "Escitalopram",
"E": ""
} | A | This patient is presenting with sleep changes, interest loss, guilt, decrease in energy, and trouble concentrating for greater than 2 weeks concerning for major depressive disorder. In the setting of his diabetic neuropathy (lower extremity burning pain in the setting of poorly managed diabetes), a serotonin-norepineph... | https://step2.medbullets.com/testview?qid=216594 |
287 | A resident physician places a patient’s home medications in for their admission orders during an overnight admission. They order the patient’s home medications including clobazam; however, they accidentally order clonazepam. Subsequently, the patient is over-sedated and has to be transferred to the ICU for airway monit... | {
"A": "Verify the patient’s home medications with the patient",
"B": "Add an alert in the electronic medical system for medications that sound similar",
"C": "Have nursing perform the medication reconciliation",
"D": "Reprimand and educate the resident to check medications more carefully",
"E": ""
} | B | A medical error occurred where 2 similar-sounding medications were confused, leading to an adverse event. The most appropriate way to prevent this error from occurring is a system-based approach, such as adding an alert in the electronic medical system for medications that sound similar.
Medical errors commonly occur ... | https://step2.medbullets.com/testview?qid=216598 |
288 | At a local community hospital staffed only by attending physicians, it is noted that the time to tissue plasminogen activator administration in suspected stroke patients is roughly 10 minutes from presentation. At a teaching hospital with residents, the time to tissue plasminogen activator administration is roughly 2 h... | {
"A": "Perform a systems-based approach implementation",
"B": "Perform a root cause analysis of the process",
"C": "Empirically scan patients with concerning neurologic symptoms",
"D": "Automatically consult neurology for patients with concerning neurologic symptoms",
"E": ""
} | B | This case outlines a delay in treating strokes at a teaching hospital. To determine the underlying cause, a root cause analysis to determine the underlying issue is the most appropriate way to begin to address this issue.
When a problem is found in healthcare, it is important to elucidate the underlying cause. A root ... | https://step2.medbullets.com/testview?qid=216599 |
289 | A study is performed that looks at individuals who suffer from opioid use disorder and the effect the disorder has on their daily life and functionality. Individuals are surveyed using a validated method and followed up in 6-month intervals for 5 years. At the end of the study period, 40% of individuals have replied to... | {
"A": "Confounding variable",
"B": "Recall bias",
"C": "Volunteer bias",
"D": "Attrition bias",
"E": ""
} | D | This study following individuals who abuse opioids with a 40% follow-up response rate suggests that opioid use disorder (known for impairing daily functioning) has only a minor effect on patient functionality. This is most likely secondary to attrition bias, or a loss to follow-up of participants in a non-random fashio... | https://step2.medbullets.com/testview?qid=216600 |
290 | A 55-year-old man presents to his primary care physician with fatigue, malaise, and a painful rash. The patient states that his symptoms have been worsening over the past week. He also has experienced abdominal pain and diarrhea. He has a medical history of obesity and smokes regularly. His temperature is 97.5°F (36.4°... | {
"A": "Alpha cell tumor",
"B": "Hypercortisolism",
"C": "Beta cell destruction",
"D": "Insulin resistance",
"E": ""
} | A | This patient is presenting with necrolytic migratory erythema (a painful, erythematous rash with papules and plaques) with gastrointestinal symptoms (abdominal pain and diarrhea) and hyperglycemia, which are concerning for a glucagonoma. A glucagonoma is a tumor of the alpha cells.
A glucagonoma is a tumor of the alph... | https://step2.medbullets.com/testview?qid=216609 |
291 | A 44-year-old nurse presents to the emergency department with confusion. This has happened several times this past month with increasing frequency. Each time her symptoms improved with eating. She is otherwise healthy. She lives with her mother who has diabetes whose medications include metformin, insulin, lisinopril, ... | {
"A": "Insulin overdose",
"B": "Beta cell tumor",
"C": "Sulfonylurea overdose",
"D": "Beta cell destruction",
"E": ""
} | B | This patient is presenting with confusion, profound hypoglycemia, an elevated C-peptide level, and a negative sulfonylurea level, which are concerning for an insulinoma. An insulinoma is a beta cell tumor that secretes insulin.
An insulinoma is a beta cell tumor of the pancreas. The beta cells normally secrete insulin... | https://step2.medbullets.com/testview?qid=216610 |
292 | A 72-year-old man presents to his primary care physician for a general checkup. He states that he has been a bit more fatigued lately but believes it is secondary to poor sleep at his new house. The patient is otherwise healthy and takes no medications. His temperature is 98.0°F (36.7°C), blood pressure is 141/90 mmHg,... | {
"A": "Chronic lymphocytic leukemia",
"B": "Acute lymphoblastic leukemia",
"C": "Hairy cell leukemia",
"D": "Chronic myelogenous leukemia",
"E": ""
} | A | This elderly patient is presenting with minor fatigue, anemia, thrombocytopenia, and a leukocyte count >50,000/mm^3, which is most likely caused by chronic lymphocytic leukemia (CLL).
CLL is a monoclonal proliferation of incompetent mature B-cells. It is common in elderly men and is the most common form of leukemia in... | https://step2.medbullets.com/testview?qid=216611 |
293 | A 57-year-old man presents to the emergency department with several days of malaise, weakness, and night sweats. Today, he experienced a headache with blurry vision, thus prompting his presentation. The patient has a history of diabetes and is followed closely by an endocrinologist. Otherwise, he has lost 10 pounds ove... | {
"A": "Acute lymphoblastic leukemia",
"B": "Chronic lymphocytic leukemia",
"C": "Multiple myeloma",
"D": "Chronic myelogenous leukemia",
"E": ""
} | D | This patient is presenting with symptoms of malignancy (malaise, weakness, and night sweats) and has a white blood cell count > 50,000/mm^3 in the setting of > 20% blasts, which are concerning for chronic myelogenous leukemia (CML). Given the blurry vision and ataxia in the setting of increased blasts, this patient may... | https://step2.medbullets.com/testview?qid=216612 |
294 | A 5-year-old boy presents to his primary care physician for recurrent colds, fatigue, and fussiness. Over the past several weeks, the child has been more fatigued and his parents state that “he always seems to be sick.” They state that sometimes he complains about his bones hurting and they note that he is less playful... | {
"A": "Parvovirus B19 infection",
"B": "Acute lymphoblastic leukemia",
"C": "Chronic myelogenous leukemia",
"D": "Acute myelogenous leukemia",
"E": ""
} | B | This pediatric patient is presenting with recurrent colds, fatigue, non-tender lymphadenopathy, hepatosplenomegaly, and leukocytosis with increased lymphoblasts, which are concerning for acute lymphoblastic leukemia (ALL).
ALL is the most common hematologic cancer in pediatric patients. It initially presents with a va... | https://step2.medbullets.com/testview?qid=216615 |
295 | A 67-year-old man presents to the emergency department after fainting. He was outside tending to his lawn for several hours in the heat, when he stood up suddenly from pulling weeds and fainted. He denies any preceding symptoms and returned to baseline within 1 minute. The patient is not aware of any medical problems a... | {
"A": "Previous myocardial ischemia",
"B": "Acute myocardial infarction",
"C": "Intermittent torsades des pointes",
"D": "Pulmonary embolism",
"E": ""
} | A | This patient is presenting after syncope, likely secondary to dehydration and orthostatic hypotension given his outdoor gardening in the heat and symptoms when standing up rapidly. The patient’s ECG reveals deep, pathologic Q waves, which in this case are an incidental finding indicative of a previous myocardial infarc... | https://step2.medbullets.com/testview?qid=216616 |
296 | A 55-year-old man presents to the emergency department with chest pressure and diaphoresis. His symptoms started at work when he was lifting boxes. He states that he currently feels crushing pressure over his chest. He is given aspirin and an ECG is performed in triage, as seen in Figure A. His past medical history is ... | {
"A": "Repeat ECG in 10 minutes",
"B": "Cardiac catheterization",
"C": "Heparin",
"D": "Chest radiograph",
"E": ""
} | A | This patient is presenting with a pattern of chest pain (pressure and diaphoresis) that is highly concerning for an acute myocardial infarction. This patient initially has ST depressions (in triage) followed by ST segment normalization and possibly hyperacute T waves which raises concern for an acute ST elevation myoca... | https://step2.medbullets.com/testview?qid=216617 |
297 | A previously healthy 15-year-old boy presents to the emergency department in cardiac arrest. He was in class when he suddenly fainted and became unresponsive. His teacher began chest compressions and he has received epinephrine and defibrillation from paramedics while in transport. On arrival, the patient remains pulse... | {
"A": "Short QT syndrome",
"B": "Ventricular tachycardia",
"C": "Complete heart block",
"D": "Torsades des pointes",
"E": ""
} | A | This healthy pediatric patient is presenting with cardiac arrest and an ECG demonstrating a short QT segment. Short QT syndrome is lethal and can lead to cardiac arrest in young, otherwise healthy patients.
Short QT syndrome is an inherited condition that is caused by ion channel mutations (the most common identified ... | https://step2.medbullets.com/testview?qid=216625 |
298 | A 55-year-old man presents to the emergency department after feeling lightheaded then fainting while he was carrying boxes upstairs. The patient works on a farm and does not see a doctor often. He has a history of hypertension but does not take medications routinely. He has not had any chest pain, dyspnea, or weakness ... | {
"A": "Wolff Parkinson White syndrome",
"B": "ST elevation myocardial infarction",
"C": "Torsades des pointes",
"D": "Left ventricular hypertrophy",
"E": ""
} | D | This patient with chronic untreated hypertension is presenting with syncope and an ECG demonstrating large voltages in leads V1-V6 and a left ventricular strain pattern (ST depressions in V5/V6 and aVL), which are concerning for left ventricular hypertrophy.
Left ventricular hypertrophy occurs secondary to chronic hyp... | https://step2.medbullets.com/testview?qid=216626 |
299 | A 7-year-old adopted boy presents to the emergency department after fainting. He just switched from being home-schooled to public school and joined the basketball team. He has fainted several times during basketball practices. He did not sustain any injuries or have any prodromes prior to these episodes. He is usually ... | {
"A": "Brugada syndrome",
"B": "Wolff Parkinson White syndrome",
"C": "Hypertrophic obstructive cardiomyopathy",
"D": "Arrhythmogenic right ventricular dysplasia",
"E": ""
} | D | This adopted pediatric patient is presenting with recurrent syncope and an ECG demonstrating an epsilon wave and T wave inversions, which are concerning for arrhythmogenic right ventricular dysplasia.
An epsilon wave is a small positive deflection at the end of the QRS complex. This is an ominous finding and suggests ... | https://step2.medbullets.com/testview?qid=216634 |
300 | A 55-year-old man presents to the emergency department after fainting while moving furniture. He states that he has been working in a hot, humid attic all day and forgot his water bottle. He felt dizzy when standing up and then fainted and was unconscious for roughly 1 minute. He awoke at his neurologic baseline afterw... | {
"A": "Atrial fibrillation",
"B": "Torsades des pointes",
"C": "Stroke",
"D": "Complete heart block",
"E": ""
} | D | This patient is presenting with dizziness and syncope in the setting of likely dehydration (working in a hot/humid environment without water) and feels better after rehydration, suggesting a diagnosis of orthostatic hypotension. An ECG is performed and incidentally demonstrates a bifascicular block, which is at high ri... | https://step2.medbullets.com/testview?qid=216637 |
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