More than half of residency programs require medical students to have taken both the USMLE Step 1 and Step 2 exams to apply, according to the National GME Census, jointly conducted by the AMA and the AAMC. Many medical students like to spend three to four months studying for the Step 2 exam. Considering those factors, now is as good a time as any for third-year medical students to begin preparing.

Over the years, AMA Wire® has run dozens of example questions from Kaplan Medical. Here is a look at our most popular USMLE Step 2 stumpers. Each of them comes with an expert explanation of the answer. Also check out all posts in this series.

Which screening for a patient with 29 BMI?

A 48-year-old man comes to the physician for a routine health maintenance examination. He has had no chest pain, shortness of breath or palpitations. His medical history is unremarkable and he takes no medications. He does not smoke cigarettes, drink alcohol or use illicit drugs. He weighs 203 pounds and he is 5 feet 8 inches tall. Body mass index is 29. His blood pressure is 145/82 mm Hg and his pulse is 92/minute. Examination shows no other abnormalities. Serum electrolyte levels, complete blood count and cholesterol levels are within normal limits. Which screening test is most appropriate in this patient?

Diagnose the cause of diarrhea, fatigue, dyspnea

A 54-year-old lawyer presents to the emergency department with diarrhea for the past two months. He has associated fatigue, shortness of breath and weight loss. He has lost approximately 10 pounds over the last few months, during which time the symptoms have worsened. He has no related medical history and does not smoke or drink. He takes no medications. On examination his blood pressure is 115/75 mm Hg and his pulse is 108 per minute. His skin is pale. Neurologic examination reveals loss of vibration sense, spasticity and a positive Babinski sign. Consider the laboratory studies (pictured below), what is the most likely diagnosis?


Determine the cause of pain and weight loss

A 43-year-old woman with HIV comes to the physician because of painful swallowing, substernal chest pain and weight loss for one month. She takes no medications. Her temperature is 37.8 °C (100 °F). Her CD4+ T-lymphocyte count is 41/mm3. Upper endoscopy shows inflammation and a large, deep ulceration of the distal esophagus. A biopsy specimen of the esophagus shows inflammation and small blood vessel endothelial cells with markedly enlarged, smudgy, eosinophilic nuclei. Which of the following is the most likely cause of this patient's symptoms?

What is the next step in managing chest pain?

A 59-year-old ranch hand presents to the outpatient department with chest pain. Over the past eight months, he has noticed a dull, central chest pain that radiates to his left arm and jaw while walking. The pain subsides after about two minutes of rest but quickly returns upon walking again. This is severely affecting his work, and he is concerned that he will lose his job because of poor productivity. His vital signs are: temperature, 37 ºC (98.6 ºF); pulse, 74 beats per minute; and blood pressure, 135/82 mm Hg. Stress test reveals ST-segment depression in leads I, aVL, V4, V5 and V6.

Aspirin, nitrates and metoprolol are initiated. A 12-hour fasting serum LDL cholesterol concentration is 140 mg/dL. He is also started on atorvastatin and advised to implement a low-fat diet. Two months later, the patient returns and is still experiencing chest pain during exercise. However, he states that his productivity at the farm has increased. His resting pulse is 58 beats per minute. Echocardiogram reveals an ejection fraction of 55 percent. What is the next best step in management?

For more prep questions on USMLE Steps 1, 2 and 3,view other posts in this series.

The AMA selected Kaplan as a preferred provider to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. AMA members can save 30 percent on access to additional study resources, such as Kaplan’s Qbank and High-yield courses. Learn more.

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