Practice Test 9 - USMLE Step 2

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

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1. At 34 weeks' gestation, a woman presents with painless vaginal bleeding. Ultrasound confirms complete placenta previa. She is contracting every 6 minutes but not bleeding actively. Fetal monitoring is reassuring. What is the appropriate management of labor and delivery?
2. Which of the following is the most appropriate next step in management?
3. Which of the following neuroimaging findings would support the suspected diagnosis?
4. A 45-year-old woman has 2 months of intermittent hematochezia and fatigue; family history of colon cancer; exam shows no external hemorrhoids; CBC: Hgb 9.8. Next test?
5. This patient's hepatobiliary condition is most strongly associated with which of the following underlying diagnoses?
6. A 22-year-old man falls from a skateboard onto his outstretched right hand. He presents with wrist pain and tenderness in the anatomic snuffbox. Plain radiographs show no fracture. What is the most appropriate next step in management?
7. Which of the following is the most appropriate next imaging study to evaluate the cause of the biliary obstruction?
8. Which of the following is the most important initial intervention to prevent acute kidney injury in this patient?
9. Which of the following interventions would be most helpful in confirming the diagnosis?
10. In addition to glycemic control, which of the following is the most appropriate initial pharmacologic treatment for this patient's symptoms?
11. A 45-year-old man with prior endocarditis now has severe AR. Exam: early diastolic murmur at LSB and wide pulse pressure. Echo shows regurgitant jet and LV dilation. Which diagnostic test best confirms severity and guides timing of surgery?
12. A 40-year-old man presents with acute onset headache and fever. He is confused and has left arm weakness. CT head shows a right frontal ring-enhancing lesion with surrounding edema and mild midline shift. The team suspects a brain abscess and is considering lumbar puncture to evaluate for meningitis. Which is the most appropriate next step regarding CSF sampling in this patient?
13. Which of the following is the most likely cause of this patient's clinical presentation?
14. A 24-year-old woman is 3 days postpartum after a spontaneous vaginal delivery. She complains of severe right breast pain and chills. Examination shows a temperature of 39.2 °C (102.6 °F); the right breast is erythematous, warm, and tender with focal induration but no fluctuant mass. She continues to breastfeed. What is the most appropriate next step?
15. Which of the following medications is most appropriate for managing this patient's acute agitation?
16. Which diagnostic study is most appropriate next to differentiate primary achalasia from malignancy-related pseudoachalasia?
17. Which of the following neuroimaging findings would be most expected?
18. In addition to aspirin and a statin, which of the following is the most appropriate initial intervention for this patient's primary complaint?
19. A 56-year-old woman hospitalized with pulmonary embolism develops a 50% drop in platelet count to 70,000/µL on day 6 of unfractionated heparin therapy. She now has tender, dusky discoloration of the right fifth toe. The 4T score is 7 (high probability). What is the most appropriate next step in anticoagulation management?
20. Which of the following is the most likely diagnosis?

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