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USMLE STEP2 Exam
Step2 (Page 9 )

Updated On: 30-Jan-2026
Page 9 of 149
PDF with 738 Questions

A fourth-year medical student on an emergency medicine clerkship is fascinated by the number of personality disordered patients who come to the emergency room on weekends. Which of the following personality disorders belongs to cluster A (odd, eccentric) in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision) classification of personality disorders?

  1. schizoid personality disorder
  2. borderline personality disorder
  3. antisocial personality disorder
  4. avoidant personality disorder
  5. obsessive-compulsive personality disorder

Answer(s): A

Explanation:

Schizoid personality disorder is characterized by a pattern of pervasive social detachment with a narrow range of emotional expression. Schizoid persons seem to be fairly content with a lack of intimacy and are considered odd by persons around them. This contrasts with the picture of individuals with avoidant personality disorder, who long for social interaction, but feel inadequate and riddled with self-doubt in social situations. Like individuals with obsessive-compulsive disorder, people with avoidant personality disorder are categorized as having a cluster C (anxious, fearful) personality disorder; whereas, those with borderline personality disorder or antisocial personality disorder have problems characterized by engaging in impulsive behaviors and are classified as having a cluster B (dramatic, impulsive) personality disorder.



A5-year-old girl had been doing well at home and with her playmates until she started kindergarten 1 month ago. She cries whenever her mother and father go to drop her off at school, and she complains of fearing that she will never see them again. She complains of nightmares and refuses to go to school due to severe stomachaches.
Which of the following is the most likely diagnosis?

  1. generalized anxiety disorder
  2. separation anxiety disorder
  3. social phobia
  4. specific phobia
  5. obsessive-compulsive disorder

Answer(s): B

Explanation:

Separation anxiety disorder is the name given to the problem of a child's developmentally excessive anxiety concerning separation from home and parents. Children who are more globally anxious may suffer from generalized anxiety disorder, while children who avoid playmates may suffer from social phobia.
Children who have an unrealistic fear of, for example, dogs, have a specific phobia; whereas, those who suffer from intrusive anxious thoughts that lead them to spend much time performing rituals such as hand washing suffer from obsessive-compulsive disorder.



Afamily brings in their 7-year-old boy because he has not been fitting in at school. The mother says he has not made any friends and tends to play mostly by himself. He exhibits repetitive hand flapping. When you interview him, he does not provide any eye contact, and the mother says this is typical for him. His speech seems age appropriate and per history has developed normally. This past year his IQ was tested to be normal.
Which of the following is the most likely diagnosis?

  1. autism
  2. Asperger disorder
  3. Rett disorder
  4. attention deficit hyperactivity disorder (ADHD)
  5. borderline personality disorder

Answer(s): B

Explanation:

Children with Asperger disorder show severe sustained impairment in social interaction, and restricted repetitive patterns of behavior. Unlike autistic disorder, in Asperger disorder language and cognitive development are not delayed. In Rett disorder, a child shows deterioration of developmental milestones, head circumference, and overall growth. In Rett disorder, verbal abilities are usually lost completely.



An 8-year-old boy suffers from compulsive eating, obesity, small stature, hypogonadism, and mental retardation. Which of the following is his most likely diagnosis?

  1. phenylketonuria
  2. Prader-Willi syndrome
  3. Down syndrome
  4. fragile X syndrome
  5. Cri-du-chat syndrome
  6. disorientation

Answer(s): B

Explanation:

All of the listed syndromes cause mental retardation, but Prader-Willi syndrome is also typified by compulsive eating and obesity, hypogonadism, and small stature. It is thought to be due to a small deletion on chromosome 15. Phenylketonuria is an autosomal-recessive trait which can cause mental retardation in children who do not eat a low phenylalanine diet. Down syndrome, or trisomy 21, causes mental retardation and distinctive facies. Fragile X syndrome causes mental retardation, short stature, and postpubertal macroorchidism. Cri-du-chat syndrome, caused by a deletion on chromosome 5, is characterized by severe mental retardation, microcephaly, and a cat-like cry in infants due to laryngeal abnormalities



You are called to the ICU to see a 65-year-old female who is 2 days status post hip surgery. The medical team is concerned because the patient is having visual hallucinations and did not sleep last night. She scored 21/30 on a Mini-Mental Status Examination (MMSE) with 5 points off for disorientation and 2 off for both concentration and shortterm memory. The patient is restrained because she pulled out her IV last night. Records indicate she has no previous psychiatric history and that her cognitive functioning presurgery was normal.
Which of the following is the most likely axis I diagnosis?

  1. bipolar disorder manic phase
  2. schizophrenia, undifferentiated
  3. dementia NOS (not otherwise specified)
  4. delirium NOS
  5. psychosis NOS

Answer(s): D

Explanation:

The hallmark of delirium is fluctuation in level of consciousness. Periods of lucency may be interspersed with periods of clouding and unresponsiveness. Impaired judgment, impaired memory, and disorientation are seen in both delirium and dementia. Disordered thought is seen in both and tends to be disorganized in delirium and impoverished in dementia. Another distinguishing feature is that the onset of delirium usually occurs within hours or days, whereas, the onset of dementia may be insidious throughout a period of weeks to months.



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