Practice Test 10 - USMLE Step 2
20 questions. Answer them in any order, then submit to see your score and every explanation.
- The patient's shock is most likely due to which of the following mechanisms?
- Which of the following is the most likely cause of this change?
- His resistant hypertension is most likely mediated by which of the following mechanisms related to his sleep disorder?
- Which of the following is the most appropriate next step to evaluate for a suspected cardiac injury?
- A 10-year-old girl is evaluated for dysuria and frequency. Urinalysis shows leukocyte esterase positive, nitrite negative, and 25–50 WBC/high-power field. She has no flank pain or fever. Which organism is the most likely etiology?
- What is the most likely diagnosis?
- Which of the following is the most likely type of shock in this patient?
- A 58-year-old woman is diagnosed with a 0.9-cm ductal carcinoma in situ (DCIS) detected on screening mammography as clustered microcalcifications. She has no palpable mass. Stereotactic core biopsy confirms DCIS, ER positive, with no invasion. Breast MRI shows no additional lesions. She prefers breast conservation. The surgeon explains that standard management is breast-conserving surgery (lumpectomy) with negative margins followed by whole-breast radiation to reduce local recurrence; sentinel lymph node biopsy is generally not required with lumpectomy for pure DCIS but may be considered with mastectomy. Which treatment option is most aligned with current clinical guidelines for this condition?
- Patient A is a 28-year-old woman at her six-week postpartum visit after an uncomplicated vaginal delivery. She asks about exercise and lifting. She has no perineal pain, lochia has resolved, and exam is normal. She has obesity and gestational diabetes during pregnancy, now resolved. Which advice should be given to the patient regarding postpartum recovery?
- Which of the following is the most appropriate next step to confirm the diagnosis?
- Which of the following patterns on pulmonary function testing is most expected in this patient?
- A 2-day-old newborn has poor feeding, temperature instability, and lethargy. Pregnancy was complicated by prolonged rupture of membranes; mother's GBS status is unknown. Exam: hypotonia, tachypnea, mottled skin; capillary refill 4 seconds. Labs: WBC 3,000/µL, ANC low; glucose 38 mg/dL; CRP elevated. Chest radiograph shows diffuse granular opacities. Which of the following is the most appropriate next step in management?
- Which of the following dietary patterns is most strongly recommended for lowering blood pressure and reducing cardiovascular risk?
- Which of the following is the most appropriate initial fluid for resuscitation in this patient?
- Which of the following is the best immediate management?
- A 70-year-old woman with obesity hypoventilation syndrome presents with lethargy and dyspnea. ABG shows acute respiratory acidosis with elevated PaCO2 and normal HCO3−. Potential causes of hypoxemia include hypoventilation, PE, pneumonia, and HF. What diagnostic test should be performed next?
- A 33-year-old G2P2 woman is evaluated 2 weeks after cesarean section. She reports continuous leakage of clear fluid from the vagina that soaks 3 pads daily. She denies dysuria or flank pain. Pelvic examination reveals a well-approximated uterine incision and a pool of clear fluid in the vagina that turns navy blue after administration of oral phenazopyridine earlier that day. What is the most likely cause of her symptom?
- Which of the following is the most likely diagnosis?
- Which of the following medications is the safest option for relapse prevention in this patient?
- A 61-year-old man with HFrEF (EF 22%) presents with acute dyspnea, orthopnea, and leg edema. Exam shows JVD, rales, S3. BP 158/90. Labs: BNP 1900 pg/mL; troponin negative. CXR shows pulmonary edema. He receives IV furosemide but has minimal urine output after 2 hours. Which of the following is the most appropriate next step in management?