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USMLE STEP2 Exam
Step2 (Page 32 )

Updated On: 30-Jan-2026
Page 29 of 149
PDF with 738 Questions

For each of the following scenarios, select the gas exposure responsible for the signs and symptoms.

A sewer worker has acute onset of nausea, headache, and shortness of breath, and has anosmia.

  1. carbon monoxide
  2. methane
  3. hydrogen sulfide
  4. ozone
  5. sulfur dioxide

Answer(s): C

Explanation:

Hydrogen sulfide is a colorless gas that rapidly paralyzes the nasal receptors, and is found in sewers.
Hydrogen sulfide produces nausea, headache, and shortness of breath. Because it paralyzes the nasal receptors at a concentration of 150 ppm and cannot be smelled shortly after exposure, it is highly dangerous, with instant death from a concentration as low as 1000 ppm.



A 44-year-old man presents with fears that his mathematical abilities have been slowly sucked out of his brain for the last 4 years. He believes an "alien force disguised as a human being" is responsible. To avoid contacting this being, he has isolated himself in a room in a boarding house. His wife divorced him and left with their children. After 10 years teaching math at a local high school, he resigned about 3 years ago. He supports himself by "collecting cans." His affect is blunted. His appearance is disheveled, unshaven, and unwashed.
Which of the following is the most likely diagnosis?

  1. paranoid schizophrenia
  2. alcohol abuse and dependence
  3. major depression with psychotic features
  4. Alzheimer's disease
  5. Huntington's disease

Answer(s): A

Explanation:

The preoccupation with a rather welldeveloped delusional system and later age at onset suggest paranoid schizophrenia. A case can be made for undifferentiated schizophrenia because of the apparent disorganization in personal habits and the flattening of affect. There is no history of alcohol abuse and dependence to support the diagnosis. The long period of symptoms, bizarreness of paranoid delusion, and decline in functioning are more characteristic of schizophrenia. The time course of a major depression is much shorter. Usually, in major depression there is not the profound decline in functioning. No symptoms of memory impairment or loss of cognitive functioning have occurred that would suggest Alzheimer or Huntington dementias. In addition, in Huntington dementia, one would expect a prominent movement disorder as seen in subcortical dementia.



Select the organism associated with the following clinical findings:

Aparent of a 4-year-old child who goes to nursery school develops a chronic cough and lowgrade fever.

  1. aureus
  2. beta-hemolytic Streptococcus
  3. respiratory syncytial virus (RSV)
  4. Mycoplasma pneumoniae
  5. Haemophilus pertussis
  6. Helicobacter pylori
  7. Escherichia coli
  8. Rickettsia prowazekii
  9. Giardia lamblia
  10. C. perfringens

Answer(s): D

Explanation:

Giardiasis may cause cramping and a chronic diarrheal syndrome, with malabsorption and weight loss. Its distribution is worldwide, particularly where hygienic standards are not high. It also occurs sporadically in high-risk individuals. Streptococcal pyoderma, including erysipelas and impetigo, has been demonstrated to precede acute glomerulonephritis. Even when appropriate antibiotics are given in adequate dosage and duration for these conditions, renal damage may still result. Prevention thus consists of wound care, including cleaning wounds well and removal of crust. Mycoplasma infections are particularly common in families with younger children. They are frequently imported to the family by school-aged children, leading to a low-grade fever and persisting tracheobronchitis in the parents, or more acutely, an atypical pneumonia. G. lamblia is found in up to 20% of homosexual males, and may cause chronic diarrhea, although in these patients it tends to be asymptomatic. E. coli was first reported as a cause of watery diarrhea in nurseries in the 1940s. Although nursery epidemics with enteropathogenic serotypes had decreased in recent years in the United States, the increase of infant- child day care centers has resulted in their relatively frequent occurrence. Furunculosis is most frequently caused by coagulase-positive staphylococcal infections. The public health significance of this largely relates to the hazards of skin infections in food handlers and subsequent staphylococcal toxin in the food, leading to staphylococcal intoxication food-borne disease. H. pylori has been associated with gastric ulcers, but not with duodenal ulcers. Otitis media, whether acute or with effusion, commonly results from viral infection, such as by RSV.
Various other organisms may be responsible including Streptococcu pneumoniae, H. influenzae, and others. C. perfringens, with rare exceptions, is transmitted in a meat dish prepared in bulk. Under propitious circumstances for the organism, especially on cooling of the food, bacterial multiplication can be very rapid.
Symptoms begin to occur in the affected population in about 12 hours. Epidemic typhus is a rickettsial illness. Man is the host and long-term reservoir. The vectors are body lice (P. humanus corporis). The rickettsia are not present in human excretions and cannot be transmitted by person-to-person contact.



Select the organism associated with the Nursery epidemics of watery diarrhea

  1. aureus
  2. beta-hemolytic Streptococcus
  3. respiratory syncytial virus (RSV)
  4. Mycoplasma pneumoniae
  5. Haemophilus pertussis
  6. Helicobacter pylori
  7. Escherichia coli
  8. Rickettsia prowazekii
  9. Giardia lamblia
  10. C. perfringens

Answer(s): G

Explanation:

Giardiasis may cause cramping and a chronic diarrheal syndrome, with malabsorption and weight loss. Its distribution is worldwide, particularly where hygienic standards are not high. It also occurs sporadically in high-risk individuals. Streptococcal pyoderma, including erysipelas and impetigo, has been demonstrated to precede acute glomerulonephritis. Even when appropriate antibiotics are given in adequate dosage and duration for these conditions, renal damage may still result. Prevention thus consists of wound care, including cleaning wounds well and removal of crust. Mycoplasma infections are particularly common in families with younger children. They are frequently imported to the family by school-aged children, leading to a low-grade fever and persisting tracheobronchitis in the parents, or more acutely, an atypical pneumonia. G. lamblia is found in up to 20% of homosexual males, and may cause chronic diarrhea, although in these patients it tends to be asymptomatic. E. coli was first reported as a cause of watery diarrhea in nurseries in the 1940s. Although nursery epidemics with enteropathogenic serotypes had decreased in recent years in the United States, the increase of infant- child day care centers has resulted in their relatively frequent occurrence. Furunculosis is most frequently caused by coagulase-positive staphylococcal infections. The public health significance of this largely relates to the hazards of skin infections in food handlers and subsequent staphylococcal toxin in the food, leading to staphylococcal intoxication food-borne disease. H. pylori has been associated with gastric ulcers, but not with duodenal ulcers. Otitis media, whether acute or with effusion, commonly results from viral infection, such as by RSV.
Various other organisms may be responsible including Streptococcu pneumoniae, H. influenzae, and others. C. perfringens, with rare exceptions, is transmitted in a meat dish prepared in bulk. Under propitious circumstances for the organism, especially on cooling of the food, bacterial multiplication can be very rapid.
Symptoms begin to occur in the affected population in about 12 hours. Epidemic typhus is a rickettsial illness. Man is the host and long-term reservoir. The vectors are body lice (P. humanus corporis). The rickettsia are not present in human excretions and cannot be transmitted by person-to-person contact.



In order to allocate health care resources in your community, you compare the health status of subpopulations by comparing infant mortality rates. Which of the following most accurately compares the infant mortality rates for children born to White mothers and for children born to Black or African- American mothers in 2004 in the United States?

  1. The infant mortality rate for children born to Black or African-American mothers was one-third the infant mortality rate for children born to White mothers.
  2. The infant mortality rate for children born to Black or African-American mothers was one-half the infant mortality rate for children born to White mothers.
  3. The infant mortality rate for children born to Black or African-American mothers was between one and two times the infant mortality rate for children born to White mothers.
  4. The infant mortality rate for children born to African-American mothers was between two and three times the infant mortality rate for children born to White mothers.
  5. The infant mortality rate for children born to Black or African-American mothers was six times the mortality rate for children born to White mothers.

Answer(s): D

Explanation:

In 2004, the infant mortality rate for children born to White mothers was 5.7 infant deaths/1000 live births.
The infant mortality rate for children born to Black or African- American mothers was 13.8 infant deaths/1000 live births.



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