Practice Test 12 - USMLE Step 2
20 questions. Answer them in any order, then submit to see your score and every explanation.
- A 64-year-old woman with HFrEF (EF 30%) presents with dyspnea, fatigue, and edema. Exam shows JVD, rales, and S3. BP 126/74. Labs: BNP 1550 pg/mL; troponin negative; potassium 5.8 mEq/L; creatinine 2.3 mg/dL (baseline 1.8). CXR shows pulmonary congestion. Current meds include lisinopril, carvedilol, spironolactone, and furosemide. Which medication should be discontinued in light of her symptoms and labs?
- What is the most appropriate initial pharmacologic intervention?
- In addition to a complete blood count, blood type with Rh status, and urinalysis, which of the following is an essential component of the initial prenatal laboratory screening panel?
- A 55-year-old woman with progressive dyspnea and dry cough has bibasilar crackles; PFT shows low TLC with normal FEV1/FVC; HRCT shows reticular opacities. Next step?
- A 6-year-old girl has 2 days of high fever, severe abdominal pain, and frequent bloody diarrhea after eating undercooked ground beef. Exam: diffuse abdominal tenderness; no peritoneal signs. Labs: WBC 15,600/µL; platelets normal; creatinine normal. Stool is positive for Shiga toxin. Which of the following is the most appropriate next step in management?
- Patient A is a 25-year-old woman four weeks postpartum with depressed mood and anxiety. She reports intrusive worries about accidental harm to the baby and repeatedly checks if the infant is breathing, causing significant distress. She recognizes these thoughts as unwanted and denies intent to harm. No hallucinations or delusions. Past history includes generalized anxiety disorder. Which of the following is the most likely diagnosis given the symptoms?
- Which of the following is the most likely diagnosis?
- Which of the following sets of vaccines is most appropriate to administer at this visit?
- A 62-year-old woman presents with a palpable right breast mass and recent unintentional 6-kg weight loss. She went through menopause at 50 and never used hormone therapy. She has hypertension and type 2 diabetes. Exam reveals a 3.5-cm hard, irregular mass with nipple retraction and peau d'orange overlying skin; two right axillary nodes are enlarged. Diagnostic mammography and ultrasound show a suspicious mass and abnormal nodes. Core biopsy confirms invasive ductal carcinoma, triple-negative. Staging CT shows no distant metastases. She asks whether breast-conserving surgery is possible. The surgeon explains that lumpectomy requires negative margins and is typically followed by whole-breast radiation; mastectomy is an alternative. Neoadjuvant chemotherapy is often recommended for stage II–III triple-negative disease to downstage tumor and assess response. Which treatment option is most aligned with current clinical guidelines for this condition?
- After initiating fluid resuscitation with two large-bore IVs, which of the following is the most appropriate next step in management?
- The involuntary movements are best described as which of the following?
- 28yo with 4 months amenorrhea; progestin withdrawal bleeding occurs. Most likely diagnosis?
- A 55-year-old woman has severe MR and is otherwise healthy. Exam: holosystolic apical murmur radiating to axilla, S3. Echo: flail posterior leaflet, severe MR, LVEF 62%, LVESD 38 mm. Which management strategy is most appropriate?
- Which of the following is the most appropriate imaging study to diagnose pulmonary embolism in this patient?
- A 19-year-old woman at 11 weeks' gestation had a splenectomy 5 years ago after trauma. Her vaccination records are incomplete. She is eager to receive any recommended immunizations today. Which of the following vaccines is contraindicated during pregnancy and therefore should NOT be administered at this visit?
- What is the most appropriate recommendation regarding the duration of her antiplatelet therapy?
- At 12 weeks, nuchal translucency is 3.8 mm. Which diagnostic test is indicated now?
- An 84-year-old woman with hypertension, stage 4 chronic kidney disease (eGFR 22 mL/min/1.73 m²), and symptomatic nonvalvular atrial fibrillation is hospitalized for community-acquired pneumonia. Home medications include lisinopril, furosemide, simvastatin, and apixaban 5 mg twice daily started 4 months ago. Her serum creatinine has risen from 2.0 to 2.6 mg/dL since then. What is the most appropriate medication change to reduce adverse drug events?
- The MRI is most likely to show a lesion consistent with which of the following conditions?
- What is the most definitive management for this patient's condition?