Practice Test 4 - USMLE Step 2
20 questions. Answer them in any order, then submit to see your score and every explanation.
- A 32-year-old G0 with infertility and irregular cycles has obesity and hirsutism. Meds: none. Exam: BMI 35, acanthosis nigricans. Labs: urine hCG negative, TSH normal, prolactin normal, total testosterone elevated, 17-hydroxyprogesterone normal. She is starting ovulation induction. What is the first-line treatment for this condition?
- A 60-year-old man has anterior STEMI and receives fibrinolysis at a rural hospital. Ninety minutes later, chest pain persists and ST elevation is unchanged. Which is the most appropriate next step in management?
- Which of the following is the most appropriate next step in diagnosis and management?
- The mother of a 15-year-old female patient calls the physician's office. She sounds angry and says, "I am her mother and I have a right to know. I want you to tell me if you prescribed my daughter birth control pills." The physician recalls a recent confidential visit where the daughter was prescribed oral contraceptives. Which of the following is the most appropriate response to the mother?
- In addition to adjuvant radiation therapy, which of the following is the most appropriate long-term therapy for this patient?
- Which of the following is the most likely diagnosis?
- This patient's clinical presentation is most concerning for which of the following neurologic emergencies?
- Which of the following is the most important component of safe sleep counseling to reduce the risk of Sudden Infant Death Syndrome (SIDS)?
- Which of the following is an appropriate next step in the pharmacologic management of her constipation?
- A term neonate with a family history of cystic fibrosis has not passed meconium at 48 hours. Examination shows abdominal distension but no evidence of Hirschsprung-associated syndromic features. Abdominal radiograph demonstrates dilated small bowel loops with a soap-bubble appearance in the right lower quadrant. Which of the following is the most appropriate next diagnostic step?
- A 39-year-old man with episodic migraine uses sumatriptan 100 mg tablets. He presents with chest tightness and throat pressure 30 minutes after taking a dose, but vital signs and ECG are normal. Which pharmacologic mechanism most likely explains his symptoms?
- Which of the following interventions exemplifies the avoidance of a 'prescribing cascade'?
- What is the most likely diagnosis?
- A 44-year-old woman takes high-dose alprazolam daily and stops abruptly 3 days ago. She has tremor, insomnia, and a seizure. Which medication is best?
- A 10-year-old girl is brought for evaluation of pubertal development. Her mother notes breast budding began 6 months ago. Today, exam confirms Tanner stage II breasts and no pubic hair. Height velocity is 9 cm/year (accelerated for age). Bone age radiograph equals chronological age. Which statement best explains the next step in management?
- Which of the following is the most appropriate next medication to administer?
- This patient's constellation of findings is most characteristic of which of the following disorders?
- A 30-year-old woman has episodic wheeze with exercise; spirometry shows obstruction that improves 15% after albuterol. Which next step confirms diagnosis and starts care?
- Which of the following is the most important ethical consideration for the transplant committee when evaluating this patient?
- A 69-year-old woman with HFrEF (EF 32%) presents with dyspnea, fatigue, and edema. Exam shows JVD, rales, S3. BP 134/78. Labs: BNP 1700 pg/mL; troponin negative. CXR shows pulmonary edema. She has a new fever and productive cough; WBC 15,000/µL. Which of the following is the most appropriate next step in management?