{"id":681,"date":"2022-05-04T01:31:00","date_gmt":"2022-05-04T01:31:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=681"},"modified":"2026-02-19T16:48:46","modified_gmt":"2026-02-20T00:48:46","slug":"usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Second Degree Mobitz type II AV block"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#D_Transcutaneous_pacing\" >D. Transcutaneous pacing<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#A_Left_heart_catheterization\" >A. Left heart catheterization<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#B_Intubation\" >B. Intubation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#C_Defibrillation\" >C. Defibrillation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#E_No_Treatment_Is_Required\" >E. No Treatment Is Required<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today, we\u2019re examining a clinical case of a <strong>61-year-old man<\/strong> with stage II chronic kidney disease who has experienced <strong>two weeks of fevers and chills<\/strong> and presents with a <strong>regularly irregular heartbeat and a high-pitched, early diastolic<\/strong> <strong>decrescendo murmur<\/strong>. What&#8217;s next in determining how to manage his condition?<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 61-year-old man comes to the emergency department with two weeks of fevers and chills. He also reports a poor appetite and has noticed a weight loss of 2.3 kg (5 lb) over the past month. He also complains of malaise with intermittent headaches, muscle aches, and night sweats over this same time period. Medical history is significant for\u00a0<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Chronic_kidney_disease\" target=\"_blank\" rel=\"noreferrer noopener\">chronic kidney disease<\/a>\u00a0(CKD)<\/strong> stage II due to hypertension. Medications include lisinopril and hydrochlorothiazide. He was born in India, and he does not drink alcohol or use recreational drugs. His <strong>temperature is 39.4\u00b0C (102.9\u00b0F), pulse is 45\/min, respirations are 23\/min, blood pressure is 100\/50 mmHg, and oxygen saturation is 95%<\/strong> on room air. He appears ill. Physical exam shows a regularly irregular heartbeat with a high-pitched, early diastolic decrescendo murmur. Lung auscultation reveals <strong>crackles at the bilateral lung bases.<\/strong> Laboratory studies show renal function at baseline and normal cardiac enzymes. An ECG is obtained and shows the following:<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"126\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unnamed-file.jpg?w=1024\" alt=\"ECG image from Wikipedia.\" class=\"wp-image-683\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unnamed-file.jpg 1386w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unnamed-file.jpg?resize=300,37 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unnamed-file.jpg?resize=768,95 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unnamed-file.jpg?resize=1024,126 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\">Source:&nbsp;<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:B9431a_copy_alt_copy.png\" target=\"_blank\" rel=\"noreferrer noopener\">Wikimedia Commons<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the <em>most appropriate<\/em> management of this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Left heart catheterization<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Intubation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Defibrillation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Transcutaneous pacing<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. No treatment is required<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Thailand learns by Osmosis.org!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/4yByzXT31VQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Studying for Step 2? Check out our free <a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-2\" target=\"_blank\" rel=\"noreferrer noopener\">USMLE\u00ae Step 2 Ultimate Guide!<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Transcutaneous_pacing\"><\/span>D. Transcutaneous pacing<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Left_heart_catheterization\"><\/span>A. Left heart catheterization<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0Left heart catheterization<\/strong> lets interventional cardiologists visualize the anatomy and patency of the coronary arteries and deploy stents to obstructed vessels. Patients with acutely obstructed coronary arteries who need left heart catheterization would instead present with ST-segment changes and elevated cardiac enzymes.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Intubation\"><\/span>B. Intubation<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>Patients with acute or worsening hypoxia, severely altered mental status, or airway obstruction should be <strong>intubated <\/strong>to provide\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Acute_respiratory_distress_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">mechanical ventilation<\/a>\u00a0while the underlying problem is fixed. This patient has a peripheral oxygen saturation greater than 90% on room air and does not require mechanical ventilation.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Defibrillation\"><\/span>C. Defibrillation<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0Defibrillation <\/strong>refers to the application of electricity across the chest to shock the heart back into sinus rhythm, and it only works on\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Ventricular_tachycardia\" target=\"_blank\" rel=\"noreferrer noopener\">ventricular tachycardia<\/a>\u00a0(VT) and\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Ventricular_fibrillation\" target=\"_blank\" rel=\"noreferrer noopener\">ventricular fibrillation<\/a>\u00a0(VF). Defibrillating a patient who does not have VT or VF can cause a deadly arrhythmia.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_No_Treatment_Is_Required\"><\/span>E. No Treatment Is Required<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0Second-degree type II AV block<\/strong> is a dangerous arrhythmia that can develop into a complete heart block and cause circulatory collapse at any time. It must be treated urgently and will require pacemaker placement.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s ECG shows a&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>second-degree Mobitz type II&nbsp;atrioventricular (AV) block<\/strong><\/a>. This heart block is characterized by \u201call-or-nothing\u201d conduction of electrical impulses through the AV node, leading to&nbsp;<strong>dropped beats&nbsp;that appear as a P wave without a subsequent QRS complex.<\/strong> Compared to the lengthening PR intervals in second-degree Mobitz type I (Wenckebach) AV block, Mobitz type II AV block demonstrates a&nbsp;<strong>stable PR interval<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"325\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/96.png\" alt=\"2nd Degree AV Block\nMobitz I: PR interval progressively\nBenign, no treatment required\nMobitz II: Normal PR intervals\nMay result in severe bradycardia and decreased cardiac output\" class=\"wp-image-684\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/96.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/96.png?resize=300,161 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Causes of Mobitz type II AV block overlap with the causes of other AV blocks, including myocardial ischemia, <a href=\"https:\/\/www.osmosis.org\/learn\/Cardiomyopathies:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">cardiomyopathy<\/a> (e.g.,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Amyloidosis\" target=\"_blank\" rel=\"noreferrer noopener\">amyloidosis<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sarcoidosis\" target=\"_blank\" rel=\"noreferrer noopener\">sarcoidosis<\/a>), <a href=\"https:\/\/www.osmosis.org\/learn\/Myocarditis\" target=\"_blank\" rel=\"noreferrer noopener\">myocarditis&nbsp;<\/a>(e.g.,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Borrelia_burgdorferi_(Lyme_disease)\" target=\"_blank\" rel=\"noreferrer noopener\">Lyme disease<\/a>),&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperkalemia\" target=\"_blank\" rel=\"noreferrer noopener\">hyperkalemia<\/a>, and medication effects. This patient is presenting with signs and symptoms of&nbsp;<strong>infective endocarditis<\/strong>, including high fevers, night sweats, anorexia, weight loss, and myalgias. Infective endocarditis of the aortic valve may lead to a <strong>periannular abscess at the base of the valve<\/strong>, which places pressure on the adjacent AV node, leading to heart block. An abscess in this location may also lead to <strong>aortic insufficiency<\/strong>, which is consistent with the murmur present on this patient\u2019s exam.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Atrioventricular (AV) block - first, second, third (complete) degree\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/VWZC8QehNJc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Initial management of all patients with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">Mobitz type II AV block<\/a>&nbsp;involves the <strong>placement of<\/strong>&nbsp;<strong>transcutaneous pacer pads<\/strong>, as this block may cause profound&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Supraventricular_arrhythmias:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">bradycardia<\/a><\/strong>&nbsp;and progress to third-degree heart block at any time. If no reversible cause is found, patients will require&nbsp;<strong>permanent pacemaker<\/strong>&nbsp;<strong>implantation<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">Second-degree Mobitz type II AV block<\/a>&nbsp;is characterized by a stable PR interval with dropped beats, <\/strong>and it most often occurs in patients with underlying heart disease.<strong> Treatment typically requires permanent pacemaker implantation.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Puech P, Wainwright RJ.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/6544636\/\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical electrophysiology of atrioventricular block<\/a>.&nbsp;<em>Cardiol Clin<\/em>. 1983;1(2):209-224.<\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30412709\/\" target=\"_blank\" rel=\"noreferrer noopener\">Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay<\/a>&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more \u00a0<strong>USMLE\u00ae Step 2 CK practice questions<\/strong>?\u00a0Try <strong>Osmosis from Elsevier<\/strong> today!\u00a0Get a <a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a>\u00a0and find out why millions of current and future <strong>clinicians and caregivers love learning by Osmosis<\/strong>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enhance your USMLE\u00ae Step 2 CK exam prep with this clinical case involving a 66-year-old woman with left-sided weakness and symptoms suggestive of cardiac issues. Test your clinical knowledge and improve your diagnostic skills for effective patient care!<\/p>\n","protected":false},"author":202,"featured_media":682,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,16,1366,1370,45],"tags":[580,581,218,431,440,582,448,579,245,279,185],"class_list":["post-681","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-av-block","tag-cardiac-conditions","tag-clinical-skills","tag-ecg-interpretation","tag-emergency-medicine","tag-heart-condition","tag-medical-diagnosis","tag-mobitz-type-ii","tag-nursing-education","tag-patient-assessment","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Second Degree Mobitz type II AV block - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-second-degree-mobitz-type-ii-av-block\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Second Degree Mobitz type II AV block - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Enhance your USMLE\u00ae Step 2 CK exam prep with this clinical case involving a 66-year-old woman with left-sided weakness and symptoms suggestive of cardiac issues. 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Which structure is affected in a child presenting with pain, limited motion, and forearm pronation?","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE Step 2 CK Question of the Day Elbow pain","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/USMLE-Step-2-CK-Question-of-the-Day-Elbow-pain.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/USMLE-Step-2-CK-Question-of-the-Day-Elbow-pain.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/USMLE-Step-2-CK-Question-of-the-Day-Elbow-pain.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/USMLE-Step-2-CK-Question-of-the-Day-Elbow-pain.png 2x"},"classes":[]},{"id":3842,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-abdominal-hernia","url_meta":{"origin":681,"position":4},"title":"USMLE\u00ae Step 2 Question of the Day: Abdominal hernia","author":"Marina Horiates Kerekes, MD &amp; Team","date":"March 27, 2024","format":false,"excerpt":"Prepare for USMLE Step 2 with our QOTD on limited hip abduction, Developmental Dysplasia of the Hip, & Barlow maneuver. 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