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Practice Test 1 - USMLE Step 2

20 questions. Answer them in any order, then submit to see your score and every explanation.

  1. A 55-year-old man with NSTEMI is started on aspirin, heparin, and ticagrelor. He also takes sildenafil. He is hypotensive and has ongoing chest pain. Which medication should be discontinued?
  2. Which of the following is the most likely diagnosis?
  3. A 64-year-old woman treated with lumpectomy and radiation for breast cancer 6 years ago presents with a 2-cm violaceous, indurated plaque over the lumpectomy scar. Biopsy shows dermal angiosarcoma. Which prior treatment is the most significant risk factor for this malignancy?
  4. Which of the following is the most likely cause of this patient's acute hypoxemia?
  5. In addition to a hemoglobin/hematocrit level, which of the following screening tests is most indicated for this child?
  6. What is the most appropriate next step in management?
  7. A 60-year-old man with anterior STEMI is going for PCI. He has no contraindications. Which is the most appropriate initial treatment in addition to aspirin?
  8. According to surveillance guidelines, when should his next colonoscopy be performed?
  9. This patient's condition is caused by which of the following viruses?
  10. A 65-year-old man with heart failure presents with acute dyspnea, orthopnea, and pink frothy sputum. SpO2 is 81% on room air; exam shows diffuse crackles and S3. Chest X-ray shows bilateral perihilar infiltrates and pleural effusions. Potential causes of hypoxemia include pulmonary edema, pneumonia, PE, and COPD. What diagnostic test should be performed next?
  11. A 66-year-old woman presents with progressive right breast skin thickening and redness for 3 weeks. She was treated with oral antibiotics for presumed mastitis without improvement. She denies breastfeeding and has no fever. Exam shows diffuse erythema involving more than one-third of the breast with peau d'orange and a poorly defined underlying firmness; ipsilateral axillary nodes are palpable. Diagnostic mammography and ultrasound show skin thickening and an ill-defined mass. Core biopsy confirms invasive carcinoma with dermal lymphatic invasion. The team discusses that inflammatory breast cancer is aggressive and typically managed with neoadjuvant systemic therapy followed by mastectomy and radiation, not upfront lumpectomy. Which of the following is the most likely diagnosis given the patient's presentation and test results?
  12. After sending a sample of the peritoneal fluid for analysis, which of the following is the most appropriate next step?
  13. Which of the following is the most likely diagnosis?
  14. A 19-year-old college student presents with fever, headache, and stiff neck for 12 hours. He is photophobic and vomited once. Exam shows T 39.2°C, petechial rash on the trunk, and nuchal rigidity. He is alert without focal deficits. Platelets are 180,000/µL; INR is normal. The ED plans immediate antibiotics and lumbar puncture. There is no papilledema, seizure, or focal neurologic deficit. Which is the most appropriate next step regarding neuroimaging and CSF sampling?
  15. Which of the following is the most appropriate next step in management?
  16. A 60-year-old woman with rheumatoid arthritis presents with progressive dyspnea and dry cough. SpO2 is 90% at rest and 84% with exertion. Exam shows bibasilar crackles. ABG: PaO2 62 mm Hg, PaCO2 35 mm Hg. Chest X-ray shows reticular opacities. Potential causes of hypoxemia include interstitial lung disease, PE, pneumonia, and HF. What is the most likely cause of hypoxemia in this patient?
  17. Which of the following is the most likely diagnosis?
  18. A 62-year-old woman is scheduled for elective laparoscopic cholecystectomy. She has hypertension, type 2 diabetes, and coronary artery disease with a drug-eluting stent placed 5 months ago after NSTEMI. She has been asymptomatic since. Physical exam: - BP 126/74 mm Hg, HR 64 - Normal cardiopulmonary exam Pertinent studies: - ECG: Q waves in inferior leads, no acute changes - Troponin: not obtained Current medications: - Aspirin 81 mg daily - Clopidogrel 75 mg daily - Metoprolol - Rosuvastatin - Metformin What is the best next step in optimizing this patient's medical condition before surgery?
  19. A 55-year-old man with COPD presents with worsening shortness of breath and confusion. ABG shows pH 7.28, PaCO2 68 mm Hg, PaO2 52 mm Hg. CXR shows hyperinflation. Potential causes of acute hypoxemia include COPD exacerbation, pneumonia, PE, and pulmonary edema. What is the most likely cause of hypoxemia in this patient?
  20. Which of the following laboratory tests would be most helpful in confirming the underlying etiology of his diabetes?

Practice tests