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USMLE STEP2 Exam
Step2 (Page 8 )

Updated On: 19-Jan-2026
Page 8 of 149
PDF with 738 Questions

A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities.
Which of the following is the most likely diagnosis?

  1. myocardial infarction
  2. panic attack
  3. hypochondriasis
  4. multiple sclerosis
  5. generalized anxiety disorder

Answer(s): B

Explanation:

Panic attacks most frequently have their onset sometime between the late teens and early thirties. Most patients describe their initial panic attack as coming out of the blue. They frequently suffer from palpitations, sweating, trembling, shortness of breath, a feeling of choking, chest pain, nausea, light headedness, derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of going crazy, fear of dying, numbness, and hot flashes or chills. Individuals who suffer from recurrent, unexpected panic attacks with at least 1 month of persistent concern about the attacks or their implications, or a significant change of behavior related to the attacks suffer from panic disorder. If a patient with panic disorder avoids situations in which panic attacks have occurred or endures the situations, such as shopping in a mall, with marked distress or anxiety about having a panic attack, the patient is said to suffer from panic disorder with agoraphobia. This patient's negative ECG makes myocardial infarction an unlikely diagnosis. Hypochondriasis is the term given to a longterm preoccupation with fears of having a serious disease based on the misinterpretation of bodily symptoms; it does not generally present in the sudden manner in which panic attack presents. Multiple sclerosis usually causes many neurologic disturbances which vary across time. Generalized anxiety disorder is not typified by the sudden onset of severe anxiety characteristic of a panic attack.



A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities

If this patient continues to experience similar episodes over the next 2 months, with substantial apprehension about the episodes, which of the following drugs would be most appropriate for the treatment of this patient's condition?

  1. paroxetine
  2. buspirone
  3. ziprasidone
  4. propranolol
  5. haloperidol

Answer(s): A

Explanation:

If the patient continues to suffer panic attacks for a substantial period, he is said to be suffering from panic disorder. SSRIs, such as paroxetine, are frequently effective and generally safe drugs for the treatment of panic disorder. Despite its usefulness in treating generalized anxiety disorder, buspirone seems to be ineffective in treating panic. Beta-blockers such as propranolol may block symptoms of palpitations or tremor, but are generally not as effective against panic attacks as are SSRIs. Antipsychotic medications such as ziprasidone and haloperidol are not appropriate medications for the first-line treatment of uncomplicated panic disorder.



A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities You encounter this patient 1 year after the onset of his symptoms. He has not been very compliant with his medications, or appointments. Now he reports he rarely leaves his home and avoids places and social situations where he feels he cannot readily escape. When he does go places, he reports having an escape plan arranged. Which of the following best describes this condition?

  1. social phobia
  2. claustrophobia
  3. arachnophobia
  4. agoraphobia
  5. simple phobia

Answer(s): D

Explanation:

Agoraphobia is most often associated with panic disorder. It involves a severe fear of and avoidance of entering social situations where it is difficult to get help or escape from. Arachnophobia is the phobia of spiders, claustrophobia is a phobia of closed spaces. Social phobia is an excessive, persisting fear of social situations in which embarrassment can occur.
Specific (simple) phobias are among the most common mental disorders and involve an excessive fear of an object or specific situation which produces an avoidance of the object or situation.



A70-year-old woman was brought to the emergency department following her involvement in a minor car accident. She had sustained no injuries but was very upset and was, therefore, referred to a psychiatrist. After speaking at length about her part in the accident and sharing her reactions, she still remained tremulous, anxious, and tearful. She has no history of addiction. You decide to use an anxiolytic to help her.
Which of the following is the best choice?

  1. diazepam
  2. clorazepate
  3. lorazepam
  4. buspirone
  5. temazepam

Answer(s): C

Explanation:

Lorazepam, because of its relatively short half-life, intermediate rate of onset, and absence of active metabolites, would be an appropriate medication for this elderly woman. Diazepam and clorazepate both have long half-lives as well as active metabolites. These properties lead to more severe side effects in older patients, such as prolonged sedation, respiratory depression, confusional states, and disorientation.
Temazepam, although it has no active metabolites and a relatively short halflife, is very sedating and is used to promote sleep. Buspirone, a nonbenzodiazepine, is an effective antianxiety agent, but it may take up to a week to exert its effect. The woman in this case needs medication that will help her quickly



Which of the following delusions would most likely be observed in a psychotically depressed person?

  1. "My mind's eye is perfused with a radiance of the gods."
  2. "I've been targeted by the FBI."
  3. "My body is rotting inside out."
  4. "I have been hand-picked to be the world's leader; I am awaiting the signal to bring the masses together."
  5. "All I need to do is clutch the book to myself and all the knowledge pours into me."

Answer(s): C

Explanation:

Patients with severe psychotic depression will often have delusions that are mood congruent and reflect the depth of their despair and self-abhorrence. Patients with mania are more likely to have delusions that are mood congruent that would reflect their grandiosity, paranoid feelings, inflated self-esteem, and feelings of having special powers.



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