Preparing for the USMLE Step 2 is a daunting task. There are so many questions in so many categories, it can be hard to know where to even start. Each scenario is different from the next, and since you can’t guess which questions you’ll be asked, it can be nerve-wracking to say the least. Here are some examples of particularly difficult USMLE Step 2 questions to study alone or with a group.
Which Screening Would You Recommend?
In this scenario, a man who is 48 years old visits his doctor for a routine checkup. He appears healthy and has no complaints. He weighs 203 pounds, is 5’ 8” tall, and has a BMI of 29. His blood pressure is 145/82, and his pulse is 92bpm. Upon questioning, the patient reports he does not drink alcohol, smoke cigarettes, or use any drugs, and he has had no chest pains, palpitations, or shortness of breath. The physician cannot find any abnormalities in this man’s exam, and his medical history is unremarkable. Blood tests reveal normal serum electrolytes, normal blood count, and normal cholesterol. Which screening test would you recommend for this patient?
Why Does This Patient Have Diarrhea and Fatigue?
In another case, a 54-year-old man comes to the emergency room claiming he has had diarrhea for two months. He says he is a lawyer, and he also notes fatigue, weight loss, and shortness of breath. He says he has lost 10 pounds over the last few months, and the symptoms are worsening progressively. He doesn’t smoke or drink, and he does not take any medications. His medical history reveals no related conditions or episodes. During the exam, his blood pressure is 115/75 and his pulse is 108bpm. The physician notes the patient’s skin is pale, and upon a neuro exam, it is revealed that he has a positive Babinski sign, spasticity, and a loss of vibration sense. Lab results are as follows:
- Hematocrit – 26%
- WBC – 3700/mm3
- Platelets – 110,000 mm3
- MCV – 116 um3
- Reticulocytes – 0.5%
- Serum lactate dehydrogenase – 650 U/L
- Serum total bilirubin – 2mg/dL
What is this patient’s most likely diagnosis?
Why Is This Patient Losing Weight and In Pain?
Finally, in this scenario, an HIV-positive woman who is 45 years old comes to her doctor because she has been losing weight for a month, is experiencing pain when she swallows, and has substernal chest pain. She reports she is taking no medications. Her temperature is roughly 100 degrees, and her T-cell count is 41/mm3. An upper endoscopy is performed, and it reveals a large and deep ulcer in the distal esophagus as well as significant inflammation. A biopsy shows inflammation and small blood vessel endothelial cells along with large and smudged eosinophilic nuclei. Why is this patient experiencing pain and weight loss?
These are some of the toughest questions asked on the USMLE Step 2, and they provide a good indication of other questions you may encounter. The ability to accurately recommend treatments and diagnose these conditions will serve you well when it is time to sit for the real exam.