Practice Test 5 - USMLE Step 2

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

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1. History: A 35-year-old woman, G2P2, with obesity and hypothyroidism (often misses levothyroxine) presents with 4 months of heavy menstrual bleeding with clots. She recently started a high-stress job and reports poor sleep. She uses a copper IUD placed 2 years ago and takes ibuprofen intermittently. Presenting issue: Menses now last 9–10 days and she feels fatigued and lightheaded. Exam shows conjunctival pallor; uterus is normal size and nontender. Diagnostics: Urine pregnancy test is negative. Hgb 9.4 g/dL, MCV 72 fL, ferritin low. TSH is mildly elevated. Transvaginal US shows a normal endometrial stripe and no masses. Considerations: She wants contraception to continue and prefers to avoid surgery. What is the most appropriate initial treatment for this condition?
2. What is the primary clinical significance of this measurement?
3. 80yo, distension, crampy pain, obstipation. Imaging: sigmoid volvulus; no peritonitis. Best initial step?
4. Which of the following is the most appropriate next step to confirm the diagnosis?
5. A 16-year-old female presents for a well-child check. When asked about her sexual health history, she seems hesitant but eventually asks, "What's the best way to not get an STD?" She has not been sexually active yet. Which of the following is the most comprehensive and appropriate response?
6. What is the most likely diagnosis?
7. A 30-year-old woman with IBS has frequent loose stools and urgency during exams; no alarm features; normal labs. What is the most appropriate initial management?
8. Administration of which of the following is most likely to rapidly reverse this patient's condition?
9. A 34-year-old gravida 2 para 1 woman is at 30 weeks' gestation. She received an inactivated influenza vaccine earlier in pregnancy. She has never had pertussis vaccination as an adult. Which of the following is the most appropriate timing for Tdap administration during this pregnancy?
10. In a 55-year-old man with chronic gastroesophageal reflux disease and newly diagnosed nondysplastic Barrett esophagus (C2M3 Prague classification), which surveillance strategy is most consistent with guideline recommendations?
11. This patient's labor is best described as which of the following?
12. What is the most appropriate management for this patient?
13. What is the most likely diagnosis based on these imaging findings?
14. What is the most likely diagnosis?
15. What is the most likely diagnosis?
16. A 75-year-old man with HFrEF (EF 20%) presents with dyspnea, fatigue, and edema. Exam shows JVD, rales, S3. BP 118/70. Labs: BNP 2300 pg/mL; troponin negative. CXR shows pulmonary edema. Echo shows EF 20% with left bundle branch block on ECG and QRS 170 ms. After stabilization on guideline-directed therapy, which of the following is the most appropriate next step in management?
17. Which of the following is the most appropriate treatment for this condition?
18. An MRI of the brain is most likely to show an infarct in which of the following locations?
19. This infant's failure to thrive is most likely due to which of the following?
20. A 55-year-old woman has chronic severe MR with palpitations and dyspnea. Exam: holosystolic murmur at apex radiating to axilla; displaced apical impulse. Echo confirms severe MR. Which chamber change is most expected over time?

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