USMLE Step 2 Block 2 2025

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Q41- Patient Information Age: 14 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: "I feel light-headed." History of Present Illness: • 1-week history of episodes of light-headedness • almost lost consciousness during three episodes • experienced tunnel vision and almost fell when getting out of bed this morning • evaluated 10 days ago for follow-up of attention-deficit/hyperactivity disorder; clonidine therapy initiated at that time • sister is currently hospitalized for meningitis; patient has been receiving prophylactic rifampin Past Medical History: • moderate persistent asthma that is well controlled • last asthma exacerbation was 1 week ago; 5-day course of prednisone was initiated at that time, which she completed • attention-deficit/hyperactivity disorder diagnosed at age 8 years; has been on numerous different medications Medications: • albuterol • fluticasone • methylphenidate • clonidine • rifampin Vaccinations: • up-to-date Allergies: • no known drug allergies Family History: • mother and father: alive with no chronic conditions • sister: currently being treated for meningitis Psychosocial History: • lives with parents, 18-year-old sister, and 2-year-old sister • has difficulty in school because of attention-deficit/hyperactivity disorder • does not smoke cigarettes, drink alcoholic beverages, or use nonprescribed medications or other substances. The image below shows physical examination. An adverse effect of which of the following medications is the most likely cause of this patient's current condition?

A) Rifampin B) Prednisone C) Methylphenidate D) Clonidine E) Amoxilin

Q42- A 60-year-old lady comes to the OPD for a routine exam. She is a known case of type 2 diabetes mellitus. During the past 3 months, her fingerstick blood glucose ranged from 80 mg/dL to 230 mg/dL; previously, they were from 80 mg/dL to 140 mg/dL. She is on metformin and aspirin. During the last 3 months, she has exercised thrice weekly; previously, she exercised once weekly. She takes a balanced diet. Despite exercise and diet, there is no weight loss. She is 157 cm (5 ft 2 in) tall and weighs 72 kg (160 lb); BMI is 29 kg/m2 . Examination shows over the posterior plantar aspect of the left foot, a 1 × 2-cm, erythematous, soft lesion . Sensation to pinprick and touch is decreased over feet and the ankles. HbA1c is 7%. Which of the following findings are most likely to be present in this patient? A) Increased Glucose, increased insulin, decreased Insulin responsiveness B) Increased Glucose, increased insulin, normal Insulin responsiveness C) Increased Glucose, normal insulin, decreased Insulin responsiveness D) Increased Glucose, normal insulin, normal Insulin responsiveness E) NormalGlucose, normal insulin, normal Insulin responsiveness

Q43- A 50-year-old lady comes to the clinic for a health routine exam. She is well. There is no H/O serious illness and takes no medications. She smoked one pack of cigarettes daily for 28 years but quit 6 years ago. Pulse is 80/min, respirations are 12/min, and blood pressure is 122/78 mm Hg. On examination, pedal pulses are absent bilaterally. A femoral bruit is heard in the left lower extremity. Which of the following is the most appropriate next step in management? ( A) Pentoxifylline therapy (B) Peripheral artery catheterization (C) Serum lipid studies (D) Warfarin therapy (E) No further management is indicated A) No further management B) Warfarin C) Serum lipid D) Peripheral artery catheter E) Pentoxifylline

Q44- A 15-year-old girl is brought to the clinic for short stature evaluation. Since birth, she is below the 3rd percentile for height and at the 3rd percentile for weight. She has never had a menstrual period. There is no family H/O short stature, but her maternal uncle did not begin puberty until the age of 18 yrs. Her current height is consistent with a 9½-year-old girl. Her pulse is 83/min and BP is 110/70 mm Hg. Sexual maturity rating is stage 1 for breast development and stage 2 for pubic hair development. Which of the following is the most appropriate next step for the diagnosis? A) X-ray skull B) X-rays spine ans of the long bones C) X-rays of the left hand and wrist D) Urine free cortisol test E) CBC and serum chemistry testing

Q45- A 21-year-old lady comes to the clinic with a one year H/O left ear lump that appeared 2 months after she had the ear piercering. Physical exam shows the findings in the image below. Which of the following is the most appropriate initial treatment ?

A) Wide local excision B) Needle aspiration C) Laser ablation D) Cryotherapy E) Corticosteroid injection

Q46- 25-year-old male is brought to ER by his friend 33 minutes after they found him unconscious. They last saw him yesterday and he was well. He has a H/O cocaine and heroin use, and also prescription narcotic analgesics that he gets from friends. On arrival, he is lethargic. Temperature is 35.0°C (95.0°F), pulse is 68/min, R/R 9/min, and BP is 96/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. The left lower extremity is cyanotic and cold on touch. The remainder of the examination shows no abnormalities. Results of serum studies are shown in the image below. This patient is at greatest risk of which of the following ?

A) Hypophosphatemia B) Hypocalcemia C) Arrhythmia D) Acute kidney injury

Q47- A 33-year-old man presents with fatigue, pallor, and a sore tongue. His MCV is elevated, and peripheral smear shows hypersegmented neutrophils. What is the most likely cause? A) Lead poisoning B) Thalassemia C) Anemia of chronic disease D) Iron deficiency anemia E) Vitamin B12 deficiency

Q48- A 22-year-old woman presents with abdominal pain and diarrhea after eating ice cream. She reports frequent bloating. What is the most likely diagnosis? A) Irritable bowel syndrome B) Celiac disease C) Lactose intolerance D) Ulcerative colitis E) Crohn’s disease

Q49- A 65-year-old man presents with painless jaundice, dark urine, and weight loss. His CA 19-9 is elevated. What is the most likely diagnosis? A) Acute hepatitis B) Hepatocellular carcinoma C) Pancreatic head cancer D) Gallstones E) Cholengitis

Q50- A 50-year-old woman presents with weakness, skin hyperpigmentation, and hypotension. Labs show hyponatremia and hyperkalemia. What is the most likely diagnosis? A) Cushing syndrome B) Addison disease C) Hyperaldosteronism D) Pheochromocytoma E) Hypopituitarism

Q51- A 7-year-old boy presents with hematuria 2 weeks after a sore throat. His blood pressure is elevated, and complement levels are low. What is the most likely diagnosis? A) IgA nephropathy B) Post-streptococcal glomerulonephritis C) Nephrotic syndrome D) Minimal change disease E) Hemolytic uremic syndrome

Q52- A 24-year-old man presents with bilateral testicular masses and gynecomastia. Serum hCG is elevated. What is the most likely diagnosis? A) Leydig cell tumor B) Seminoma C) Teratoma D) Choriocarcinoma E) Sertoli cell tumor

Q53- A 40-year-old woman presents with dry eyes, dry mouth, and dental caries. Anti-Ro/SSA antibodies are positive. What is the most likely diagnosis? A) Scleroderma B) Sjogren’s syndrome C) Rheumatoid arthritis D) Lupus E) Dermatomyositis

Q54- A 6-year-old child presents with petechiae and bleeding gums after a viral illness. Platelet count is 15,000/μL. What is the most likely diagnosis? A) Hemophilia A B) Immune thrombocytopenia (ITP) C) Von Willebrand disease D) Aplastic anemia E) DIC

Q55-A 48-year-old man presents with tremors, rigidity, and bradykinesia. What is the most likely underlying neurotransmitter deficiency? A) Serotonin B) Acetylcholine C) Dopamine D) GABA E) Glutamate

Q56- A 36-year-old woman presents with amenorrhea, galactorrhea, and headaches. Serum prolactin is elevated. What is the next best step in management? A) MRI of the brain B) Serum FSH and LH C) CT of the abdomen D) TSH level E) Visual field testing

Q57-A 55-year-old man with a history of cirrhosis presents with confusion and asterixis. His serum ammonia is elevated. What is the first-line treatment? A) Neomycin B) Rifaximin C) Lactulose D) Metronidazole E) Loperamide

Q58- A 25-year-old man presents with urethral discharge and dysuria. Gram stain shows no organisms but many neutrophils. What is the most likely organism? A) Escherichia coli B) Chlamydia trachomatis C) Neisseria gonorrhoeae D) Mycoplasma genitalium E) Treponema pallidum

Q59-A 70-year-old woman presents with sudden painless vision loss in her right eye. Funduscopy reveals a cherry-red spot at the macula. What is the most likely diagnosis? A) Retinal detachment B) Central retinal artery occlusion C) Central retinal vein occlusion D) Optic neuritis E) Temporal arteritis

Q60- A 60-year-old man with long-standing GERD presents to the surgical OPD with difficulty swallowing solids and weight loss. What is the most likely diagnosis? A) Esophageal adenocarcinoma B) Achalasia C) Peptic stricture D) Schatzki ring E) Esophageal candidiasis

Q61-A 12-year-old boy has joint pain, fever, and a new murmur after a sore throat. ASO titers are high. What is the most likely diagnosis? A) Infective endocarditis B) Rheumatic fever C) Kawasaki disease D) Juvenile idiopathic arthritis E) Viral myocarditis

Q62- A 25-year-old woman presents with double vision and drooping eyelids that worsen throughout the day. What is the next best test to confirm diagnosis? A) MRI of the brain B) Acetylcholine receptor antibody test C) EMG D) Tensilon test E) Lumbar puncture

Q63- A 70-year-old man presents with urinary retention, back pain, and elevated PSA. Bone scan reveals osteoblastic lesions. What is the most likely diagnosis? A) Renal cell carcinoma B) Bladder cancer C) Prostate cancer D) Multiple myeloma E) Osteosarcoma

Q64-A 16-year-old boy presents with fatigue and enlarged posterior cervical lymph nodes. Heterophile antibody test is positive. What is the most likely diagnosis? A) HIV infection B) Streptococcal pharyngitis C) Infectious mononucleosis D) CMV infection E) Toxoplasmosis

Q65-A 22-year-old woman presents with lower abdominal pain and cervical motion tenderness. What is the most appropriate initial treatment? A) Azithromycin and ceftriaxone B) Metronidazole and ampicillin C) Doxycycline alone D) Ciprofloxacin E) Vancomycin

Q66-A 4-year-old child presents with barking cough and inspiratory stridor. What is the most likely diagnosis? A) Epiglottitis B) Asthma C) Croup D) Bronchiolitis E) Pertussis

Q67- A 26-year-old woman presents with fever, flank pain, and dysuria. Urinalysis shows WBC casts. What is the most likely diagnosis? A) Cystitis B) Glomerulonephritis C) Pyelonephritis D) Interstitial nephritis E) Kidney stone

Q68-A 30-year-old man presents with fever, malaise, and a target-shaped rash on his leg. What is the most likely diagnosis? A) Cellulitis B) Erythema multiforme C) Erythema migrans D) Stevens-Johnson syndrome E) Tinea corporis

Q69-A 42-year-old woman presents with fatigue, constipation, and brittle hair. TSH is high, T3/T4 low. What is the next best step? A) Administer levothyroxine B) Start propylthiouracil C) MRI of the pituitary D) Biopsy of the thyroid E) Observation

Q70-A 60-year-old man presents with left-sided weakness and slurred speech. He takes warfarin. CT shows no bleed. INR is 3.2. What is the next step? A) Administer tPA B) Administer vitamin K C) Administer fresh frozen plasma D) Perform mechanical thrombectomy E) Monitor in ICU

Q71-A 5-year-old boy presents with hematuria and periorbital edema after a diarrheal illness. Labs show thrombocytopenia, anemia, and renal failure. What is the most likely diagnosis? A) Post-streptococcal GN B) Minimal change disease C) Hemolytic uremic syndrome D) IgA nephropathy E) Lupus nephritis

Q72- A 55-year-old man presents with chest pain that occurs after exertion and is relieved by rest. His ECG shows no abnormalities during an episode. What is the most likely diagnosis? A) Acute myocardial infarction B) Stable angina C) Unstable angina D) Pericarditis E) Aortic dissection

Q73- A 45-year-old woman presents with a rash on her hands, arthralgias, and fatigue. Lab results show elevated anti-dsDNA and low complement levels. What is the most likely diagnosis? A) Rheumatoid arthritis B) Systemic lupus erythematosus C) Dermatomyositis D) Scleroderma E) Sjogren's syndrome

Q74- A 30-year-old woman presents with sudden-onset, severe headache, nausea, and vomiting. On examination, she has photophobia and a positive Brudzinski sign. What is the most likely diagnosis? A) Cluster headache B) Migraine C) Tension headache D) Subarachnoid hemorrhage E) Meningitis

Q75- A 50-year-old man presents with sudden-onset dyspnea, chest pain, and hemoptysis. His D-dimer level is elevated. What is the next best step in management? A) Start heparin and perform a CT pulmonary angiogram B) Perform a ventilation-perfusion scan C) Order a chest X-ray D) Start antibiotics for suspected pneumonia E) Start warfarin therapy

Q76- A 75-year-old man presents with progressive memory loss, difficulty with language, and difficulty with performing daily activities. What is the most likely diagnosis? A) Delirium B) Depression C) Alzheimer's disease D) Vascular dementia E) Parkinson's disease

Q77-A 40-year-old woman presents with excessive thirst, frequent urination, and unexplained weight loss. Urine is positive for glucose, but her blood glucose is 300 mg/dL. What is the best next step in management? A) Administer insulin B) Prescribe metformin C) Perform a fasting glucose test D) Measure HbA1c E) Perform a glucose tolerance test

Q78- A 60-year-old man with a history of smoking presents with a persistent cough, hemoptysis, and weight loss. Chest X-ray shows a solitary pulmonary nodule. What is the next best step in management? A) Observe the nodule with serial imaging B) Perform a biopsy of the nodule C) Start antibiotics for presumed pneumonia D) Start chemotherapy E.)Perform a sputum culture

Q79- A 40-year-old woman with a history of hyperthyroidism presents with palpitations, sweating, and irritability. She has a low TSH and high free T4. What is the most likely cause of her hyperthyroidism? A) Graves' disease B) Hashimoto thyroiditis C) Toxic multinodular goiter D) Thyroid cancer E) Thyroiditis

Q80- A 50-year-old man presents with difficulty swallowing and hoarseness. He has a history of heavy smoking and alcohol use. What is the most likely diagnosis? A) Esophageal stricture B) Esophageal cancer C) Gastroesophageal reflux disease (GERD) D) Laryngeal cancer E) Silent aspiration

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