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USMLE STEP2 Exam
Step2 (Page 4 )

Updated On: 1-Feb-2026
Page 4 of 149
PDF with 738 Questions

A46-year-old attorney is noted to have normal cholesterol levels but a very high fasting triglyceride level of 1600. He is otherwise healthy and has no risk factors for CAD. Which of the following statements is correct?

  1. Hypertriglyceridemia is a strong independent risk factor for premature CAD.
  2. Dietary modification is usually sufficient.
  3. High triglyceride levels are associated with elevated high-density lipoprotein (HDL) levels.
  4. Hypertriglyceridemia is usually associated with skin lesions.
  5. Control of triglyceride levels can prevent attacks of acute pancreatitis in patients with extreme hypertriglyceridemia.

Answer(s): E

Explanation:

Hypertriglyceridemia has not been shown to be a strong independent risk factor for CAD, however, epidemiologic data do suggest a relationship. According to the National Cholesterol Education Program, when tirglycerides are above 200 mg/dL then non-HDL (total HDL) cholesterol becomes a pharmacologic treatment target. Severely elevated triglycerides (1000 mg/dL) are a recognized risk factor for attacks of acute pancreatitis, and control of the triglycerides can prevent these attacks. Diet alone is usually not sufficient at these high levels. A National Institutes of Health Consensus Conference has recommended that treatment be initiated in all patients with triglycerides greater than 500 mg/ 100 mL to prevent acute pancreatitis. Skin lesions are not present with hypertriglyceridemia.



A 60-year-old patient with long-standing diabetes has a creatinine of 3.6, which has been stable for several years. Which of the following antibiotics requires the most dosage modification in chronic renal failure?

  1. tetracycline
  2. gentamicin
  3. erythromycin
  4. nafcillin
  5. chloramphenicol

Answer(s): B

Explanation:

Many drugs require dosage modifications in chronic renal insufficiency. Bioavailability, distribution, action, and elimination of drugs all may be altered. Drugs that are nephrotoxic may be contraindicated or used only with extreme care in renal insufficiency. The aminoglycosides, vancomycin, ampicillin, most cephalosporins, methicillin, penicillin G, sulfonamides, and trimethoprim all should be given in reduced dosage to patients with chronic renal failure. The aminoglycosides and vancomycin can be nephrotoxic and should be used with caution in renal insufficiency. The small group of antibiotics not needing dosage modification includes chloramphenicol, erythromycin, the isoxazolyl penicillins (nafcillin and oxacillin), and moxifloxacin.



A 57-year-old man is on maintenance hemodialysis for chronic renal failure. Which of the following metabolic derangements can be anticipated?

  1. hypercalcemia
  2. hypophosphatemia
  3. osteomalacia
  4. vitamin D excess
  5. hypoparathyroidism

Answer(s): C

Explanation:

Chronic renal failure treated with hemodialysis results in predictable metabolic abnormalities. The kidneys fail to excrete phosphate, leading to hyperphosphatemia, and fail to synthesize 1,25(OH)2D3. Vitamin D deficiency causes impaired intestinal calcium absorption. Phosphate retention, defective intestinal absorption, and skeletal resistance to parathyroid hormone (PTH) all result in hypocalcemia. Hypocalcemia causes secondary hyperparathyroidism, and the excess PTH production worsens the hyperphosphatemia by increasing phosphorus release from bone. These derangements impair collagen synthesis and maturation, resulting in skeletal abnormalities collectively referred to as renal osteodystrophy.
Osteomalacia, osteosclerosis, and osteitis fibrosa cystica may all be seen.



A 25-year-old man was admitted to the intensive care unit with a severe head injury, with fracture of the base of the skull. Approximately 18 hours after the injury, he developed polyuria. Urine osmolality was 150 mOsm/L and serum osmolality was 350 mOsm/L. IV fluids were stopped, and 3 hours later, urine output and urine osmolality remained unchanged. Five units of vasopressin were intravenously administered. Urine osmolality increased to 300 mOsm/L. Which of the following is the most likely diagnosis?

  1. central diabetes insipidus
  2. nephrogenic diabetes insipidus
  3. water intoxication
  4. solute overload
  5. syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer(s): A

Explanation:

Diabetes insipidus, a deficiency of pituitary antidiuretic hormone (ADH) (arginine vasopressin), causes water loss because of failure to facilitate reabsorption of water in the distal tubules and collecting ducts of the kidneys. In central diabetes insipidus, there is impaired production of vasopressin, and in nephrogenic diabetes insipidus, the distal renal tubules are refractory to vasopressin. In central diabetes insipidus, urine osmolality remains unchanged. If water intoxication were present, stopping IV fluids should have increased urine osmolality. With solute overload, serum osmolality would have been higher. In SIADH, urine osmolality is usually higher than serum osmolality.



A70-year-old man with a 60 pack-year smoking history presents with cough and weight loss. He describes recent diffuse darkening of his skin and his CXR shows a mass suspicious for lung cancer in the left hilum. His laboratory tests reveal hypokalemia. Which of the following is the most likely histology of his lung cancer?

  1. adenocarcinoma
  2. small cell
  3. squamous cell
  4. mesothelioma
  5. glioblastoma

Answer(s): B

Explanation:

Endocrine syndromes are seen in 12% of patients with lung cancer. Squamous cell carcinoma is associated with PTH-related peptide. Adrenocorticotrophic hormone (ACTH) and ADH secretion can be associated with small cell lung carcinoma. ACTH-secreting tumors are associated with darkening of the skin and hypokalemia.



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