Practice Test 8 - USMLE Step 2

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

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1. What is the most appropriate initial step in her management?
2. What is the most appropriate next step in management?
3. A 35-year-old woman palpates a 2-cm, mobile, rubbery mass in the upper inner quadrant of her right breast. Ultrasound demonstrates a well-circumscribed, homogeneous hypoechoic lesion. Core biopsy reveals a fibroadenoma. She requests removal because of anxiety, and the surgeon agrees. Which factor favors open excision rather than vacuum-assisted percutaneous removal?
4. Which of the following is the most appropriate initial addition to her medical regimen?
5. Which of the following CT findings would be most concerning for transmural bowel necrosis requiring surgical intervention?
6. The patient's hypotension and oliguria are most likely due to which of the following mechanisms?
7. What is the most appropriate initial action by the medical team?
8. Which of the following is the most appropriate next step in management?
9. Which of the following is the most appropriate next step in management?
10. A 14-year-old girl with stage 3 CKD has 3 months of worsening pruritus and bone aches. Labs: phosphorus 6.5 mg/dL, Ca 8.4 mg/dL, PTH elevated; creatinine stable. She admits skipping phosphate binders because they are "too many pills," and her diet is high in cola and packaged snacks. What is the next best step in management?
11. Which type of organism is most likely to be isolated from the pleural fluid?
12. The patient's acute neurologic decline is most likely a complication of which of the following?
13. Which of the following is the most appropriate next step in managing her severe acidemia?
14. Which of the following is the most likely diagnosis?
15. What is the most likely diagnosis?
16. According to current guidelines, which of the following is the most appropriate management for this patient?
17. This clinical presentation is most consistent with which of the following complications?
18. In addition to initiating fluid resuscitation, which of the following is the most appropriate initial step to manage her hemodynamic instability?
19. Patient A is a 28-year-old woman six weeks postpartum after vaginal delivery who asks when she can start contraception. She is exclusively breastfeeding, has no menses yet, and wants a highly effective method. She has a history of migraine with aura. Exam is normal. Which of the following is the most appropriate management step?
20. A 50-year-old woman with IBS has diarrhea-predominant symptoms triggered by stress and coffee; exam normal. What dietary modification should be recommended?

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