Practice Test 2 - USMLE Step 2

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

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1. Which of the following is the most appropriate empiric antibiotic regimen?
2. Which of the following is the most appropriate long-term treatment?
3. What is the most appropriate next step in management?
4. A 73-year-old man is admitted with hypotension after a large upper gastrointestinal bleed. Two hours after resuscitation with 1 unit of packed red blood cells he remains oliguric (urine output = 12 mL/h). Laboratory studies: serum creatinine 2.1 mg/dL (baseline 1.0), BUN 56 mg/dL, urine sodium 8 mEq/L, fractional excretion of sodium (FENa) $=0.3\%$, urine osmolality 560 mOsm/kg. Which of the following best explains the mechanism of this patient's acute kidney injury?
5. A 41-year-old man with no prior headache history presents with severe head pain provoked by coughing and straining. Neurologic examination reveals ataxia and dysmetria. Funduscopic examination shows no papilledema. Which of the following diagnostic tests is most appropriate to obtain first?
6. A lesion in which of the following structures is most likely responsible for his symptoms?
7. In addition to a dermatologic follow-up, which of the following is the most appropriate next step in this patient's management?
8. Which of the following is the most appropriate approach to microbiologic diagnostic testing for this patient?
9. Which is the most appropriate next step in management?
10. The sleep-related symptom described in this patient is most strongly associated with which of the following underlying pathologies?
11. Which of the following is the most appropriate initial pharmacologic treatment for this patient's symptoms?
12. A 60-year-old man with STEMI receives aspirin and is headed to PCI. He has SpO2 98% on room air and no respiratory distress. Which is the most appropriate initial treatment regarding oxygen?
13. Which of the following medication classes should be initiated first as part of her long-term management?
14. A renal biopsy in this patient would most likely show which finding on light microscopy?
15. A 60-year-old patient undergoes hip replacement. During surgery, they have transient hypotension to 78/40 mm Hg for 20 minutes after blood loss of 1.2 L; they receive 1 unit packed RBCs and 1 L crystalloid. On post-op day 1, urine output is low despite additional fluids. Vitals: BP 104/66 mm Hg, HR 102/min. Exam shows dry mucous membranes; no edema; lungs clear. Labs: creatinine increases from 1.0 to 1.9 mg/dL, BUN 44 mg/dL. Urinalysis is bland. The team suspects reduced kidney perfusion from perioperative volume loss and low blood pressure.
16. Which of the following is the most appropriate initial pharmacologic treatment?
17. Which of the following is the most appropriate medication to treat this patient's condition?
18. The use of which of the following supplements is the most likely cause for her subtherapeutic INR?
19. A 4-kg term infant of a mother with poorly controlled type II diabetes is 1 hour old. Bedside glucose measurement is 28 mg/dL (normal ≥45 mg/dL). The infant is asymptomatic and has normal physical findings. Which of the following is the most appropriate initial management?
20. Which of the following is the most appropriate next therapeutic intervention?

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