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USMLE Step 2 CK: KMLE/UW/Amboss Quiz

Quiz generated from USMLE Step 2 CK: KMLE/UW/Amboss

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Question 1

A patient presents with suicidal ideation, a stated intent to die, and a specific plan. He has already purchased the means he plans to use. What is the most appropriate management?

Immediate hospitalization, with constant observation and removal of objects that could be used for self-harm
Close outpatient follow-up with intensive outpatient treatment
Reassurance and a follow-up appointment in 4 weeks
Referral to a support group and reduction of access to firearms only

Question 2

A patient with suicidal ideation and a rehearsed plan can be safely managed with close outpatient follow-up.

True
False

Question 3

A 72-year-old man with a 15-year history of HIV, a CD4 count above 200, and an undetectable viral load has gradually progressive short-term memory loss, forgets recent conversations, and scores 22/30 on the MMSE with 0/3 word recall. MRI shows generalized cerebral atrophy without focal deficits. What is the most likely diagnosis?

Alzheimer disease
HIV-associated dementia
Delirium due to opportunistic infection
Normal-pressure hydrocephalus

Question 4

Which of the following is a recognized risk factor for HIV-associated neurocognitive disorder?

CD4 count under 200
CD4 count above 500
Age under 30
HIV diagnosis within the past 6 months

Question 5

A 33-year-old man has a painful, tender, erythematous swelling localized along the margin of the lower eyelid that began 2 days ago. There is no conjunctival injection, no ocular discharge, and visual acuity is normal. What is the diagnosis?

External hordeolum (stye)
Orbital cellulitis
Dacryocystitis
Preseptal cellulitis

Question 6

A woman who is exclusively breastfeeding 5 months postpartum reports pain and dryness during intercourse. Her menses have not returned. Examination shows minimal vaginal rugation with scant clear discharge and no tenderness. What is the most likely diagnosis?

Hypoestrogenism causing atrophic vulvovaginal changes
Bacterial vaginosis
Postpartum endometritis
Cervical insufficiency

Question 7

A short second-trimester cervical length on transvaginal ultrasound is by itself an indication for cerclage.

True
False

Question 8

Which infant is an appropriate candidate for palivizumab prophylaxis against respiratory syncytial virus?

An infant born at 28 weeks gestation
A full-term 6-month-old with acute bronchiolitis and wheezing
A 3-year-old with asthma exacerbation
A 2-year-old with a resolving viral upper respiratory infection

Question 9

A patient with salicylate toxicity has an arterial pH near 7.4. Which acid-base disturbance does this represent?

Mixed respiratory alkalosis and high anion gap metabolic acidosis
Pure high anion gap metabolic acidosis
Pure respiratory alkalosis
Pure respiratory acidosis

Question 10

Pellagra results from deficiency of which vitamin?

Fill in the blank

Question 11

Which medication commonly causes hyperkalemia by inhibiting the ENaC channel?

Trimethoprim
Furosemide
Albuterol
Regular insulin

Question 12

Which injury pattern in an infant is most suggestive of physical child abuse?

Posterior rib fractures
A single fracture of the distal radius after a fall while walking
A clavicle fracture after a witnessed delivery
Bruising over the anterior shins in an active toddler

Question 13

A 28-year-old woman with PCOS has irregular menses and hirsutism. Which treatment is first-line for both problems?

Combined oral contraceptive pills
Tibolone
Metformin monotherapy
Progesterone alone

Question 14

In polycystic ovary syndrome, the serum total testosterone level is always elevated.

True
False

Question 15

In PCOS, the LH/FSH ratio is persistently greater than ____.

Fill in the blank

Question 16

Which of the following is a recognized comorbidity of polycystic ovary syndrome?

Endometrial hyperplasia or cancer
Pheochromocytoma
Myasthenia gravis
Achalasia

Question 17

Which medication is the traditional first-line agent for ovulation induction in PCOS?

Clomiphene citrate
Gonadotropins (hMG)
Metformin alone
Laparoscopic ovarian diathermy

Question 18

Adjuvant chemotherapy is best defined as treatment given:

In addition to the standard therapy, which is usually surgery
Before the standard therapy
After the standard therapy has failed
To maintain remission after induction and consolidation

Question 19

A 63-year-old obese woman has leg swelling that is worse in the evening, dilated and tortuous superficial veins, and a small ulcer on the left medial ankle. Which finding best supports chronic venous insufficiency rather than arteriolar insufficiency?

Dilated superficial veins with pitting edema and a medial malleolar ulcer
Cool feet with absent distal pulses
Pale skin with dermal atrophy
Pain that worsens with leg elevation

Question 20

Venous stasis ulcers typically occur at the medial malleolus and improve with leg elevation.

True
False

Question 21

A young woman has almost daily band-like headaches, dizziness, poor concentration, and poor sleep one month after briefly losing consciousness when a box fell on her head. Neurologic examination and testing are normal. What is the appropriate management?

Reassurance, observation, and activity as tolerated
Urgent burr hole drainage
High-dose corticosteroids
Long-term anticoagulation

Question 22

Which finding most suggests delayed subdural hematoma rather than postconcussive syndrome after head trauma?

Focal neurologic deficits
Headache with light and noise sensitivity
Difficulty with multitasking
A normal neurologic examination

Question 23

Which disease-modifying therapy for multiple sclerosis is a monoclonal antibody against the leukocyte adhesion molecule VLA-4?

Natalizumab
Glatiramer acetate
Fingolimod
Mitoxantrone

Question 24

What is the most common psychiatric complication of multiple sclerosis?

Depression
Schizophrenia
Anorexia nervosa
Bipolar disorder

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