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USMLE STEP2 Exam Questions
Step2 (Page 12 )

Updated On: 27-Feb-2026
Page 12 of 149
PDF with 738 Questions

For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 45-year-old woman has noticed changes in the fat distribution on her body with excess fat over the posterior neck and upper back. On examination, she has high BP and abdominal striae. Laboratory evaluation shows a high glucose intolerance.

  1. Cushing's syndrome
  2. Addison's disease
  3. Klinefelter syndrome
  4. hyperparathyroidism
  5. hypothyroidism
  6. pheochromocytoma
  7. acromegaly
  8. diabetes insipidus
  9. diabetes mellitus
  10. polycystic ovarian disease

Answer(s): A

Explanation:

Cushing's syndrome is caused by overproduction of cortisol by the adrenal gland. Centripetal obesity occurs in 97% of patients, increased body weight in 94%, fatigability and weakness in 87%, and hypertension in 82%. Impaired glucose tolerance is common and attributable to increased hepatic gluconeogenesis and insulin resistance.



For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 55-year-old man complains of abdominal pain and is found to have a kidney stone. Laboratory evaluation reveals hypercalcemia.

  1. Cushing's syndrome
  2. Addison's disease
  3. Klinefelter syndrome
  4. hyperparathyroidism
  5. hypothyroidism
  6. pheochromocytoma
  7. acromegaly
  8. diabetes insipidus
  9. diabetes mellitus
  10. polycystic ovarian disease

Answer(s): D

Explanation:

In primary hyperparathyroidism, increased levels of PTH lead to hypercalcemia and hypophosphatemia.
Patient symptoms and signs on presentation include kidney stones, peptic ulcers, mental status changes and less commonly, extensive bony resorption.



For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated.
A 60-year-old man with morbid obesity

pH PaO2 PaCO2

  1. 7.23 64 80
  2. 7.39 88 40
  3. 7.22 74 33
  4. 7.54 75 24
  5. 7.37 67 52

Answer(s): E

Explanation:

ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome.
Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.



For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated.
A30-year-old woman with salicylate intoxication

pH PaO2 PaCO2

  1. 7.23 64 80
  2. 7.39 88 40
  3. 7.22 74 33
  4. 7.54 75 24
  5. 7.37 67 52

Answer(s): D

Explanation:

ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome.
Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.



For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated.
A 29-year-old diabetic with blood glucose of 280 mg/dL

pH PaO2 PaCO2

  1. 7.23 64 80
  2. 7.39 88 40
  3. 7.22 74 33
  4. 7.54 75 24
  5. 7.37 67 52

Answer(s): C

Explanation:

ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome.
Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.






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