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 Questions
Step2 (Page 23 )

Updated On: 24-Feb-2026
Page 23 of 149
PDF with 738 Questions

A 27-year-old female complains of dysuria and urinary frequency. Urinalysis reveals 1020 WBCs per high- power field and numerous gram-negative bacteria. She denies fevers, chills, and has no flank pain or tenderness.

Which of the following statements concerning urinary tract infections is true?

  1. A single dose of an antibiotic may be sufficient treatment.
  2. Pregnant women with bacteriuria should not be treated if asymptomatic.
  3. Patients with flank pain or fever should be hospitalized.
  4. Hematuria indicates renal involvement.
  5. Urologic investigation is indicated after the treatment course is completed.

Answer(s): A

Explanation:

Urinary tract infections are extremely common in young women. For simple infections uncomplicated by fever, chills, or flank pain, a single dose of an antibiotic may be curative. In the presence of symptoms suggesting renal parenchymal infection (i.e., pyelonephritis), treatment should continue for as long as 2 weeks, and parenteral antibiotics may be required (e.g., fluoroquinolone). Bacteriuria in pregnant women should be treated regardless of symptoms; whereas, bacteriuria in patients with indwelling catheters should probably be treated only in the presence of symptoms. Chronic suppressive antibiotic therapy in the latter group has not been shown to be useful. Radiologic investigation for underlying anatomic abnormalities should be undertaken in girls up to age 6, in all males after their first infection, and in women of any age with recurrent urinary tract infections. The most common pathogen is E. coli, accounting for greater than 80% of infections. Other organisms frequently encountered include Klebsiella, Proteus, and Enterobacter species.



A 27-year-old female complains of dysuria and urinary frequency. Urinalysis reveals 1020 WBCs per high- power field and numerous gram-negative bacteria. She denies fevers, chills, and has no flank pain or tenderness.

Which of the following bacteria is most likely responsible for this patient's urinary tract infection?

  1. Klebsiella
  2. Chlamydia
  3. Escherichia coli
  4. Pseudomonas
  5. Candida

Answer(s): C

Explanation:

Urinary tract infections are extremely common in young women. For simple infections uncomplicated by fever, chills, or flank pain, a single dose of an antibiotic may be curative. In the presence of symptoms suggesting renal parenchymal infection (i.e., pyelonephritis), treatment should continue for as long as 2 weeks, and parenteral antibiotics may be required (e.g., fluoroquinolone). Bacteriuria in pregnant women should be treated regardless of symptoms; whereas, bacteriuria in patients with indwelling catheters should probably be treated only in the presence of symptoms. Chronic suppressive antibiotic therapy in the latter group has not been shown to be useful. Radiologic investigation for underlying anatomic abnormalities should be undertaken in girls up to age 6, in all males after their first infection, and in women of any age with recurrent urinary tract infections. The most common pathogen is E. coli, accounting for greater than 80% of infections. Other organisms frequently encountered include Klebsiella, Proteus, and Enterobacter species.



A 49-year-old woman with a history of migraine headaches reports 6 days of persistent headache, nausea, and recurrent vomiting. On examination, the patient is orthostatic. Electrolytes show a bicarbonate of 42 and a blood gas is obtained revealing a pH of 7.53, carbon dioxide of 53, and PO2 of
85. What is the underlying acid-base abnormality?

  1. metabolic acidosis
  2. metabolic alkalosis
  3. respiratory acidosis
  4. respiratory alkalosis
  5. respiratory alkalosis and metabolic acidosis

Answer(s): B

Explanation:

The pH of 7.53 indicates alkalosis as the primary disorder (normal pH is 7.40). A high bicarbonate is consistent with a metabolic cause of the alkalosis. The high carbon dioxide of 53 (normal is 40) is compensating for the primary disorder (alkalosis) in an attempt to bring the pH closer to normal. Metabolic alkalosis results from renal bicarbonate reabsorption. Processes which maintain persistent high reclamation of bicarbonate include dehydration, hypokalemia, hypercapnea, and mineralocorticoid excess.



A 28-year-old man has the acute onset of colicky pain in the left costovertebral angle radiating into the groin, as well as gross hematuria. Abdominal x-ray discloses a stone in the left ureter. Which of the following is true concerning this disease?

  1. The majority of renal stones are radiolucent.
  2. Radiolucent stones are usually composed of uric acid.
  3. Staghorn calculi are associated with acid urine.
  4. Radiopaque stones usually contain cystine.
  5. Urate stones are associated with alkaline urine.

Answer(s): B

Explanation:

More than 90% of renal stones are visible on a plain abdominal x-ray, and the majority contain calcium oxalate. Staghorn calculi usually contain magnesium ammonium phosphate (triple phosphate or struvite) and are associated with alkaline urine. This is commonly encountered in chronic urinary tract infections with urea-splitting bacteria. Radiolucent stones often contain urea, which is associated with acidic urine. A small percentage (fewer than 10%) of renal stones contain cystine. The most common cause of calcium stone disease is idiopathic hypercalciuria. Almost half these patients will excrete more than 4 mg of calcium/kg body weight/24 h in the absence of hypercalcemia. Causes of hypercalciuria to be ruled out are sarcoidosis, hyperparathyroidism, and Paget's disease of bone. Idiopathic hypercalciuria is believed to result from either increased GI absorption of calcium, increased calcium resorption from bone, or excessive renal calcium leakage into the urine.



A 28-year-old man has the acute onset of colicky pain in the left costovertebral angle radiating into the groin, as well as gross hematuria. Abdominal x-ray discloses a stone in the left ureter. Which of the following is true concerning this disease?

The patient spontaneously passes the stone, which is found to contain calcium oxalate. Which of the following is the most likely cause of this stone?

  1. chronic urinary tract infection
  2. vitamin D excess
  3. primary hyperparathyroidism
  4. idiopathic hypercalciuria
  5. RTA

Answer(s): D

Explanation:

More than 90% of renal stones are visible on a plain abdominal x-ray, and the majority contain calcium oxalate. Staghorn calculi usually contain magnesium ammonium phosphate (triple phosphate or struvite) and are associated with alkaline urine. This is commonly encountered in chronic urinary tract infections with urea-splitting bacteria. Radiolucent stones often contain urea, which is associated with acidic urine. A small percentage (fewer than 10%) of renal stones contain cystine. The most common cause of calcium stone disease is idiopathic hypercalciuria. Almost half these patients will excrete more than 4 mg of calcium/kg body weight/24 h in the absence of hypercalcemia. Causes of hypercalciuria to be ruled out are sarcoidosis, hyperparathyroidism, and Paget's disease of bone. Idiopathic hypercalciuria is believed to result from either increased GI absorption of calcium, increased calcium resorption from bone, or excessive renal calcium leakage into the urine.






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

Join the STEP2 Discussion