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USMLE STEP2 Exam
Step2 (Page 6 )

Updated On: 19-Jan-2026
Page 6 of 149
PDF with 738 Questions

A 35-year-old woman comes into the ER after cutting her wrists for the 10th time. She did this after her boyfriend of 2 weeks left her yesterday. She reports a history of unstable interpersonal relationships, chronic feelings of emptiness, impulsive sexual relationships, and problems with her sense of identity.
The one psychotherapeutic technique to avoid would be:

  1. therapeutic physical holding sessions to help the patient feel in control
  2. clear roles and responsibilities of patient and therapist are established
  3. therapist conveys empathic validation
  4. flexibility
  5. patient and therapist mutually develop a hierarchy of priorities

Answer(s): A

Explanation:

Physically holding a patient would be a boundary violation. Conveying empathic validation, having clear roles and responsibilities, being flexible, and developing a hierarchy of priorities are all common features of recommended psychotherapy for a patient with borderline personality disorder.



A 40-year-old woman with no previous psychiatric history seeks help from her internist for a sleep problem. Initially, she is able to fall asleep but then sleeps fitfully, and finally around 4:00 a.m. decides to stay up. She averages approximately 34 hours of sleep per night, and this has been occurring for the last 3 weeks. She finds herself quite tired and "blue" during the day but is unable to nap. Mornings are "the worst" for her, but she feels better toward the end of the day. There has been a 15-lb weight loss because "I'm just not hungry." She denies any physical problems except for constipation. As a gradeschool teacher, she feels extremely stressed but sees no way out and no way to improve the situation. At times, suicide seems like a possible option, and she admits to spending long hours brooding on how to do it. A physical examination is unremarkable Which of the following is the most appropriate treatment choice?

  1. olanzapine
  2. paroxetine
  3. alprazolam
  4. tranylcypromine
  5. ECT

Answer(s): B

Explanation:

For a first, relatively acute episode of major depression, a tricyclic or SSRI is usually considered a first- choice drug. The SSRIs, considered as effective as the tricyclics, are often favored by clinicians because of their greater safety profiles. Olanzapine is an example of an antipsychotic drug. Alprazolam is a benzodiazepine that does have some anxiolytic value in depression. Its addictive potential does not make it a drug of choice for depression. Tranylcypromine is an effective MAO inhibitor antidepressant selected for use after a depression has failed to respond to the tricyclics and SSRIs. ECT is also used after other treatments have failed. In very severe, debilitating depressions, however, a clinician may choose ECT as a first treatment.



A 35-year-old woman comes into the ER after cutting her wrists for the 10th time. She did this after her boyfriend of 2 weeks left her yesterday. She reports a history of unstable interpersonal relationships, chronic feelings of emptiness, impulsive sexual relationships, and problems with her sense of identity.

Which of the following is the most likely axis II diagnosis?

  1. histrionic personality disorder
  2. borderline personality disorder
  3. antisocial personality disorder
  4. dependent personality disorder
  5. avoidant personality disorder

Answer(s): B

Explanation:

Recurrent suicidal behaviors, affective instability, unstable interpersonal relationships, chronic feelings of emptiness, and rejection sensitivity are all traits of borderline personality disorder.



A 25-year-old woman presents with a recurrent depression, and says she has taken many antidepressant medications from several different classes of drugs in the past. Which of the following atypical antidepressants is a presynaptic alpha-2 receptor noradrenergic antagonist and a 5-HT2 and 5-HT3 receptor serotonergic antagonist?

  1. bupropion
  2. trazodone
  3. nefazodone
  4. venlafaxine
  5. mirtazapine

Answer(s): E

Explanation:

Mirtazapine is a tetracyclic antidepressant that has both presynaptic alpha-2 receptor noradrenergic antagonist properties and 5-HT2 and 5-HT3 receptor serotonergic antagonist properties, which, taken together, result in a net increase in both noradrenergic and serotonergic neurotransmission. Bupropion may exert its antidepressant effects by acting on the noradrenergic system, but its method of action is currently being investigated. Trazodone and nefazodone are combined serotonin reuptake inhibitors and 5- HT2 serotonin antagonists. Venlafaxine is a combined norepinephrine and serotonin reuptake inhibitor



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.
Considering the information learned thus far, which of the following would be an appropriate first-line treatment for this patient?

  1. thiamine
  2. olanzapine
  3. amitriptyline
  4. lithium carbonate
  5. fluoxetine

Answer(s): B

Explanation:

The treatment of choice for patients with a schizophrenic disorder is an antipsychotic drug. Of the medications listed, only olanzapine is an antipsychotic drug. Olanzapine causes relatively fewer EPS than traditional neuroleptics, such as haloperidol, and seems to be substantially less likely to cause tardive dyskinesia than typical neuroleptics. Olanzapine blocks both dopamine D2 receptors and serotonin 5- HT2 receptors. Its use is often associated with some weight gain by patients.



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