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USMLE STEP2 Exam Questions
Step2 (Page 15 )

Updated On: 27-Feb-2026
Page 15 of 149
PDF with 738 Questions

A52-year-old woman has had diabetes mellitus since childhood. She has controlled her glucose well and kept her glycohemoglobin (HgbA1C) below 7% (normal, 26%). For which of the following complications is she still at risk, despite excellent glucose control? A. autonomic dysfunction

  1. coronary heart disease
  2. blindness
  3. peripheral neuropathy
  4. peripheral vascular disease

Answer(s): B

Explanation:

Diabetes mellitus is associated with hyperglycemia, disease of the microvasculature (retinopathy, nephropathy, neuropathy), and macrovascular disease, including CAD and peripheral vascular disease, The Diabetes Control and Complications Trial and other studies have demonstrated that tight control can decrease complications of microvascular disease significantly, but it does not seem to reduce CAD mortality to the same extent.



A middle-aged White male presents to your office complaining of arthralgias, diarrhea, abdominal pain, and weight loss. On examination, you note generalized increased skin pigmentation.

Which of the following is true regarding Whipple disease?

  1. Acute renal failure is a common complication.
  2. This disease usually strikes young adults before the third decade.
  3. It is predominantly a disease of women.
  4. Microscopic examination of duodenal biopsies show extensive periodic acid-Schiff (PAS) positive material in the lamina propria and villous atrophy.
  5. It is associated with gram-positive cocci.

Answer(s): D

Explanation:

Whipple disease is a systemic illness characterized by arthralgias, diarrhea, abdominal pain, and weight loss. The usual patient is a middle-aged White male. Reported in 1907 by George Whipple, it has been associated with a gram-positive bacillus related to Actinomycetes. The disease can affect nearly every organ system, although it usually involves the GI tract, heart, and CNS. Renal failure is not a common complication.



A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?

  1. jaundice
  2. asterixis of the hands
  3. spider angiomas on the face and chest
  4. heme-positive stool
  5. positive fluid wave on abdominal examination

Answer(s): B

Explanation:

Hepatic encephalopathy is a syndrome of declining intellectual function, altered state of consciousness, and neurologic abnormalities in the setting of advanced liver disease. Other findings include hyperactivity, delirium, agitation, and personality changes, progressing to confusion, somnolence, and coma. Asterixis (lapses of sustained muscle contraction) or "flapping tremor" is common. Jaundice, spider angiomas, and ascites can be present in alcoholic liver disease without the presence of encephalopathy. Precipitating factors must be looked for and reversed if possible. GI bleeding (due to esophageal varices, gastritis, ulcer, and so forth) increases the nitrogen load in the gut and reduces cerebral perfusion. Excessive diuresis with prerenal azotemia increases extrahepatic circulation of urea and ammonia production, so noncompliance with diuretics would decrease ammonia levels. Lactulose acidifies the stool, traps ammonia and other nitrogenous substances, and decreases their absorption from the gut so excessive lactulose would decrease ammonia levels. Excessive protein intake is a common precipitant.



A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?
In the patient above, his blood ammonia level is twice his baseline. Which of the following is a likely precipitating factor?

  1. bleeding esophageal varices
  2. noncompliance with diuretic therapy
  3. excessive lactulose therapy
  4. insufficient protein ingestion
  5. recent alcohol ingestion

Answer(s): A

Explanation:

Hepatic encephalopathy is a syndrome of declining intellectual function, altered state of consciousness, and neurologic abnormalities in the setting of advanced liver disease. Other findings include hyperactivity, delirium, agitation, and personality changes, progressing to confusion, somnolence, and coma. Asterixis (lapses of sustained muscle contraction) or "flapping tremor" is common. Jaundice, spider angiomas, and ascites can be present in alcoholic liver disease without the presence of encephalopathy. Precipitating factors must be looked for and reversed if possible. GI bleeding (due to esophageal varices, gastritis, ulcer, and so forth) increases the nitrogen load in the gut and reduces cerebral perfusion. Excessive diuresis with prerenal azotemia increases extrahepatic circulation of urea and ammonia production, so noncompliance with diuretics would decrease ammonia levels. Lactulose acidifies the stool, traps ammonia and other nitrogenous substances, and decreases their absorption from the gut so excessive lactulose would decrease ammonia levels. Excessive protein intake is a common precipitant.



A 78-year-old woman comes to your primary care office practice with her son who is concerned about changes in her mood. She is less interested in going out to dinner and does not want to visit family or friends. Her language skills seem to have deteriorated over the last few years and her memory is not as sharp. Her gait and motor strength are normal. Which of the following is the most likely diagnosis?

  1. Parkinson's disease
  2. anxiety disorder
  3. meningioma
  4. Alzheimer's disease
  5. dysthymia

Answer(s): D

Explanation:

Classic features of Alzheimer's syndrome include amnestic memory impairment, deterioration of language, and visuospatial deficits. Gait disturbances and motor and sensory changes are uncommon until late phases of the syndrome. Mood change and apathy are commonly seen in early stages of Alzheimer's syndrome and typically continue for the duration of the disease. Psychotic features may be seen in middle and late phases of the syndrome.






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