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USMLE Step 2

Subjects : health-sciences, usmle-step-2

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Difference between a cohort and a case - control study.
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR
Squamous cell carcinoma
Salmonella
Diverticulosis

2. First - line medication for status epilepticus.
Squamous cell carcinoma
Wrist drop - loss of thumb abduction
IV benzodiazepine
Treat immediately. Consent is implied in emergency situations

3. Extraintestinal manifestations of IBD.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
They can mask symptoms of hypoglycemia

4. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Osgood - Schlatter disease
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Chronic granulomatous disease
Iron overload; use deferoxamine

5. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Trichomonas vaginitis
Levodopa/carbidopa
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

6. Cause of neonatal RDS.
Lyme disease - Ixodes tick - doxycycline
AP chest - AP/lateral C- spine - AP pelvis
Surfactant deficiency
Hypertrophic cardiomyopathy

7. Cross - sectional survey
Nephritic syndrome
Neuroleptics
Prevalence
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed

8. Four characteristics of a nevus suggestive of melanoma.
Kwashiorkor (protein malnutrition)
Wegener's granulomatosis and Goodpasture's syndrome
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Asymmetry - border irregularity - color variation - large diameter

9. Signs of neurogenic shock.
Duodenal atresia
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Hypotension and bradycardia
Pasteurella multocida

10. Charcot's triad.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Number of deaths per 1000 population
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

11. Treatment of tension pneumothorax.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Immediate needle thoracostomy
Partial mole
Parkinson's disease

12. Caf
Neurofibromatosis 1
Continuous positive airway pressure
Administration of DDAVP ? serum osmolality and free water restriction
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

13. An active 13-year - old boy has anterior knee pain. Diagnosis?
IgA nephropathy (Berger's disease)
Osgood - Schlatter disease
Nephrogenic diabetes insipidus (DI)
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

14. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Broca's aphasia. Frontal lobe - left MCA distribution
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
MAOIs
No. Parental consent is not necessary for the medical treatment of pregnant minors

15. Salicylate ingestion ? In What type of acid - base disorder?
Anion gap acidosis and 1
Hypotension - distant heart sounds - and JVD
Kl
Endometrial biopsy

16. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Alopecia areata (autoimmune process)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
1

17. Appropriate diagnostic test?
Colposcopy and endocervical curettage
Exercise stress treadmill with ECG
Bacillus cereus
Pentad of TTP

18. ? risk of what infection with silicosis?
Excessive EtOH
Incidence and prevalence
a - antagonists (phentolamine and phenoxybenzamine)
Mycobacterium tuberculosis

19. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Elevated ICP - RBCs - xanthochromia
Anemia of chronic disease
Hashimoto's thyroiditis

20. A fall in systolic BP of > 10 mmHg with inspiration.
Fat - female - fertile - forty - flatulent
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Nephritic syndrome
Pulsus paradoxus (seen in cardiac tamponade)

21. Causes of hypoxemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Conflict of interest
Mycoplasma
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

22. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Substance abuse
Nephrogenic diabetes insipidus (DI)
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity

23. Presence of red cell casts in urine sediment.
1
Sarcoidosis
Glomerulonephritis/nephritic syndrome
'Chocolate cysts -' powder burns

24. CSF findings:
Subarachnoid hemorrhage (SAH)
MS
Huntington's disease
Observational bias

25. Treatment for ventricular fibrillation.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Treat existing heart failure and replace the tricuspid valve
Immediate cardioversion
Calcium oxalate

26. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Nitroprusside
Pseudomonas
Stasis - hypercoagulability - endothelial damage

27. Name the defense mechanism:
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Folate deficiency
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Isolation

28. Name the organism:
Salmonella
Fluid restriction - demeclocycline
Stasis - hypercoagulability - endothelial damage
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing

29. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Radiation
Klebsiella

30. Identify key organisms causing diarrhea:
OCPs - danazol - GnRH agonists
S. aureus
Cerebral berry aneurysms (AD PCKD)
Protamine

31. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy
Clomiphene citrate
Ulcerative colitis
ACEI

32. May be seen in children who are accused of inattention in class and confused with ADHD.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Osteoarthritis
Absence seizures
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

33. Acceptable urine output in a trauma patient.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Benzodiazepines
Squamous cell carcinoma
50 cc/hour

34. Findings in 3
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Continuous - painful vaginal bleeding

35. Risk factors for cholelithiasis.
Giardia
Fat - female - fertile - forty - flatulent
Coarctation of the aorta
Beta- blockers - Ca2+ channel blockers - TCAs

36. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Identify cause; fluid and blood repletion
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
1

37. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Rett's disorder
Cellulitis
Threatened abortion
Fanconi's anemia

38. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Rett's disorder
Mycoplasma
Lobular carcinoma in situ
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

39. Name the defense mechanism:
Herpes simplex
Displacement
SIADH due to stress
Chronic lymphocytic leukemia (CLL)

40. Perinatal mortality?

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41. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Lobular carcinoma in situ
Non - Hodgkin's lymphoma
Osgood - Schlatter disease

42. Three systemic diseases ? nephrotic syndrome.
DM - SLE - and amyloidosis
Excessive EtOH
HBV immunoglobulin
Alopecia areata (autoimmune process)

43. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Self - limited - painless vaginal bleeding
Osteoarthritis
Conduct disorder

44. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Parkland formula
Pharmacologic stress test (e.g. - dobutamine echo)
SIADH due to stress

45. Name the organism:
Ophthalmologic exam - CT - and MRI
Neisseria meningitidis
Sheehan's syndrome (postpartum pituitary necrosis)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough

46. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
A patient with chest trauma who was previously stable suddenly dies
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Septic or anaphylactic shock

47. True or false: Once patients sign a statement giving consent - they must continue treatment.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
IVIG or plasmapheresis
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Neisseria meningitidis

48. Acceptable urine output in a stable patient.
CML
Kwashiorkor (protein malnutrition)
30 cc/hour
Hypoparathyroidism

49. What % lesion is an indication for carotid endarterectomy?
Osteogenesis imperfecta
Third - degree heart block
Seventy percent if the stenosis is symptomatic
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

50. Name the organism:
Pentad of TTP
a - antagonists (phentolamine and phenoxybenzamine)
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Toxoplasma gondii