Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled six cases from Kaplan Medical involving senior patients. Each question comes with an expert explanation of the answer. You can check out all posts in this series.
Think you can answer these questions involving senior patients? Find out now.
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Managing a potassium abnormality
- A 66-year-old man comes to the emergency department because of leg weakness and dyspnea. He has end-stage renal disease due to diabetic and hypertensive nephropathy and has been receiving chronic hemodialysis treatments for the past year. His medications include lisinopril and nifedipine. He has not adhered to prescribed dietary sodium and potassium restrictions and has missed his last two hemodialysis treatments. What is the most appropriate next step in the management of the patient's potassium abnormality?
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Woman with pain in her mid-back
- A 72-year-old woman comes to the physician because of a three-day history of mid-back pain. She denies vany trauma to the back. Examination shows point tenderness over the T8 vertebra. X-ray of the spine shows a compression fracture of the T8 vertebral body. Dual energy x-ray absorptiometry shows a bone mineral density T-score of -2.7. What is the most likely diagnosis?
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Start of opacity in left eye
- A 66-year-old man who is a smoker and has diabetes is having his routine yearly ophthalmologic examination. He has been treated with an oral hypoglycemic agent for several years. The doctor dilates the pupils and in the left eye sees the beginning of an opacity that is cutting off visualization of part of the retina. The patient's visual acuity has not changed at this time. What is the most appropriate step in management?
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Woman with metastatic cancer, severe leg pain
- A 65-year-old woman with metastatic cancer is admitted to the hospital because of severe pain in her left leg for two weeks. The pain is in the left thigh near the hip. She has been having trouble walking because of the pain. The pain is worse at night. She has had no fever, morning stiffness, or trauma. Serum alkaline phosphatase level is 400 U/L. Plain X-ray shows a lytic lesion in the proximal femur. This patient most likely has a malignancy of which body part?
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Man has worsening cough
- A 72-year-old man comes to the physician because of a worsening cough productive of blood-tinged sputum and progressively darkening skin. He has a history of type 2 diabetes mellitus, hypertension, and obesity. Current medications include metformin, glyburide, lisinopril, hydrochlorothiazide and metoprolol. He has smoked two packs of cigarettes daily for 50 years. His blood pressure is 164/94 mm Hg. Examination shows truncal obesity with thin extremities. There are violaceous striae on the abdomen. What is the most likely cause of this patient's condition?
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Which is the appropriate pharmacotherapy?
- A 65-year-old man is brought to the emergency department because of a two-day history of fever, headache and confusion. He has a history of prostate cancer, type 2 diabetes mellitus, and hypertension. Current medications include lisinopril and metformin. He appears confused. His temperature is 39.7° C (103.5° F), blood pressure is 120/84 mm Hg, and pulse is 102 beats per minute. Examination shows neck stiffness. A lumbar puncture is performed. Gram stain of the cerebrospinal fluid shows lancet-shaped, gram-positive diplococci.
The AMA and Kaplan have teamed up to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. If you're looking for additional resources, Kaplan provides free access to tools for pre-clinical studies, including Kaplan’s Lecture Notes series, Integrated Vignettes, Shelf Prep and more.
For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.
