Cisco
CompTIA
ISC
EC-Council
EXIN
Fortinet
ITIL
Juniper
Microsoft
VMware
Avaya
SAP
Google
NVIDIA
Salesforce
Amazon
Palo Alto Networks
ISC2
Splunk
ServiceNow
All Vendors
  2. Home
  3. Exams
  4. USMLE
  5. STEP2

USMLE STEP2 Exam
Step2 (Page 14 )

Updated On: 30-Jan-2026
Page 14 of 149
PDF with 738 Questions

A 16-year-old girl with a history of ulcerative colitis managed with steroid therapy presents to the emergency department with a 36-hour history of nausea, crampy abdominal pain, and severe bloody diarrhea. On examination, the patient is febrile and pale, with a blood pressure of 90/60 mmHg and heart rate of 130 beats/min. Her abdomen is distended and diffusely tender. Acomplete blood count (CBC) demonstrates a leukocytosis with a left shift. The patient receives IV fluid resuscitation and nasogastric (NG) tube decompression.
After 48 hours, there is no clinical improvement. Which of the following is the most appropriate next step in management?

  1. colonoscopic decompression
  2. cyclosporine
  3. abdominal colectomy and ileostomy and Hartmann's procedure
  4. proctocolectomy with ileal pouch-anal anastomosis
  5. abdominal colectomy with ileorectal anastomosis

Answer(s): C

Explanation:

This patient presents with an acute exacerbation of ulcerative colitis with systemic toxicity. Toxic megacolon is potentially life threatening and requires aggressive fluid resuscitation, bowel rest, and systemic antibiotics. High-dose steroids are initiated to treat the colonic inflammation. If there is no clinical improvement after 48 hours of medical therapy, urgent surgery is indicated. Azathioprine and 6- mercaptopurine are immunosuppressive agents that may be beneficial in the treatment of steroid refractory colitis, but they are not indicated in the management of an acute toxic exacerbation. Opioid antidiarrheals are contraindicated, because they may increase colonic distention and increase the risk of perforation.
Colonoscopy may also cause increased colonic distention with perforation. Urgent surgery in a patient with toxic megacolon should consist of abdominal colectomy, Hartmann's procedure (closure of the rectal stump), and ileostomy. Ileal pouchanal anastomosis is a lengthy procedure, and is considered only for elective reconstruction.
When performed in a systemically ill patient undergoing emergency colectomy of an unprepped colon, there are increased risks of anastomotic complications. Ileorectal anastomosis is no longer appropriate for the management of ulcerative colitis because of the retained diseased rectal mucosa, with concomitant risk of malignancy.



A term infant is born at a small community hospital by cesarean section for failure to progress. The infant is noted to have the following abnormality at birth



Which of the following is the most likely diagnosis?

  1. umbilical hernia
  2. omphalitis
  3. omphalocele
  4. gastroschisis
  5. traumatic evisceration

Answer(s): C

Explanation:

This infant has an omphalocele. This is a result of failure of the abdominal muscles to close in the midline at the umbilical cord. The abdominal wall defect is therefore midline, with viscera enclosed in a sac composed of amniotic membranes. Children with omphalocele may have other associated anomalies.
Infants with abdominal wall defects are at risk for fluid and temperature loss, and infection. Therefore, the initial management consists of measures to decompress the gastrointestinal tract, fluid resuscitation, IV antibiotics, and placing the viscera in a warm, moist occlusive dressing. An umbilical hernia results when the umbilical ring does not close, with viscera enclosed in a sac covered by peritoneum and skin. Many of these may spontaneously close on their own. Therefore, surgical intervention is restricted to those children with a persistent fascial defect. Omphalitis results from bacterial infection at the base of the cord and is well treated with antibiotics to cover skin organisms. Gastroschisis is a congenital evisceration, located to the right of the umbilical cord, and thought to be related to obliteration of one of the umbilical veins prior to birth. As with omphalocele, the child needs NG decompression, IV fluids and antibiotics, and a warm moist occlusive dressing. In gastroschisis, the bowel may be at risk of mechanical or vascular compromise, thus urgent surgical intervention is required.



A term infant is born at a small community hospital by cesarean section for failure to progress. The infant is noted to have the following abnormality at birth



Which of the following is the most appropriate initial management?

  1. IV antibiotics alone
  2. emergency surgery for reduction
  3. monitor for spontaneous closure, with surgical intervention for persistent fascialdefect
  4. IV fluids, IV antibiotics, warm occlusive dressing, and transfer to a center with apediatric surgeon
  5. elective umbilical exploration

Answer(s): D

Explanation:

This infant has an omphalocele. This is a result of failure of the abdominal muscles to close in the midline at the umbilical cord. The abdominal wall defect is therefore midline, with viscera enclosed in a sac composed of amniotic membranes. Children with omphalocele may have other associated anomalies.
Infants with abdominal wall defects are at risk for fluid and temperature loss, and infection. Therefore, the initial management consists of measures to decompress the gastrointestinal tract, fluid resuscitation, IV antibiotics, and placing the viscera in a warm, moist occlusive dressing. An umbilical hernia results when the umbilical ring does not close, with viscera enclosed in a sac covered by peritoneum and skin. Many of these may spontaneously close on their own. Therefore, surgical intervention is restricted to those children with a persistent fascial defect. Omphalitis results from bacterial infection at the base of the cord and is well treated with antibiotics to cover skin organisms. Gastroschisis is a congenital evisceration, located to the right of the umbilical cord, and thought to be related to obliteration of one of the umbilical veins prior to birth. As with omphalocele, the child needs NG decompression, IV fluids and antibiotics, and a warm moist occlusive dressing. In gastroschisis, the bowel may be at risk of mechanical or vascular compromise, thus urgent surgical intervention is required



A2-year-old child presents with a 2-day history of painless rectal bleeding. On examination, the child is pale with tachycardia. The abdomen is nondistended and nontender. There is dark blood on rectal examination. The child has the following imaging study. Which of the following is the most appropriate management?

  1. surgical exploration
  2. aggressive resuscitation followed by surgical exploration
  3. colonoscopy
  4. acid suppression therapy
  5. IV steroids

Answer(s): B

Explanation:

Meckel's diverticulum typically presents in young children with painless rectal bleeding. The etiology of the bleeding is from ulceration of the adjacent ileum that is bathed by the acid produced from the ectopic gastric mucosa in the diverticulum. Bleeding may result in hypovolemia, requiring aggressive resuscitation before any surgical intervention. Diagnosis is made by technetium scan, with the child pretreated with H2 blocks to increase the sensitivity. Colonoscopy is reserved for those children with a negative Meckel's scan.
Acid suppression therapy is not indicated. At surgical exploration, the diverticulum and adjacent ileum are removed.



A 55-year-old-woman presents to the physician's office for evaluation of mammographic findings on a screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for insulin-dependent diabetes. Family history is positive for postmenopausal breast cancer in her mother. She has a normal breast examination and no axillary adenopathy. A mediolateral oblique (MLO) view of the right breast is shown in the figure below.



Which of the following is the most likely diagnosis?

  1. milk of calcium
  2. lobular carcinoma in situ (LCIS) with or without an invasive component
  3. ductal carcinoma in situ (DCIS) with or without an invasive component
  4. involuting fibroadenoma
  5. phyllodes tumor

Answer(s): D

Explanation:

The mammographic appearance of popcornlike, coarse calcifications in the breast is characteristic of an involuting, or degenerating fibroadenoma in a postmenopausal woman. Mammographic follow-up is appropriate. A repeat study at 6 months would be considered if no prior films are available in order to assess stability of a new mammographic finding. Though ultrasound is often performed for solid masses, the amount of calcification in the mass would lead to artifact, making interpretation difficult. Biopsy would not be suggested based on the characteristic mammographic findings. Other surgical procedures would not be indicated.



Viewing page 14 of 149
Viewing questions 66 - 70 out of 738 questions



Post your Comments and Discuss USMLE STEP2 exam prep with other Community members:

Join the STEP2 Discussion