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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. Infection of small airways with epidemics in winter and spring.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Osteoarthritis
RSV bronchiolitis
1

2. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
ACEI
Biliary tract obstruction
Highly sensitive for TB
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

3. Risk factors for cholelithiasis.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
? serum FSH
Fat - female - fertile - forty - flatulent
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

4. Administer to a symptomatic patient to diagnose myasthenia gravis.
M3
Edrophonium
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first - degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
DI

5. Hypercholesterolemia treatment that ? flushing and pruritus.
ALS
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Type IV (distal) RTA
Niacin

6. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Nephrotic syndrome
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Wait - surgical resection - radiation and/or androgen suppression
No. Parental consent is not necessary for the medical treatment of pregnant minors

7. Name the organism:
Pseudomonas
Cerebral berry aneurysms (AD PCKD)
False. Withdrawing and withholding life are the same from an ethical standpoint
Hypertrophic cardiomyopathy

8. A woman who was abused as a child frequently feels outside of or detached from her body.
Choriocarcinoma
Depersonalization disorder
Pseudogout
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.

9. True or false: Once patients sign a statement giving consent - they must continue treatment.
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
Bacterial meningitis
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Nitroprusside

10. Sensitive tests have few false negatives and are used to rule _____ a disease.
S. aureus or S. epidermidis.
Precocious puberty
Out
Administration of DDAVP ? serum osmolality and free water restriction

11. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
SIADH due to stress
Identify cause; pressors (e.g. - dobutamine)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Iatrogenic steroid administration. The second most common cause is Cushing's disease

12. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Neuroblastoma
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Cirrhosis - CHF - nephritic syndrome

13. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
Wrist drop - loss of thumb abduction
1
Non - Hodgkin's lymphoma

14. RTA associated with aldosterone defect.
1
Highly sensitive for TB
Type IV (distal) RTA
Conversion disorder

15. Eight surgically correctable causes of hypertension.

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16. Name the defense mechanism:
Isolation
A patient with chest trauma who was previously stable suddenly dies
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Angina - ST- segment changes on ECG - or ? BP

17. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Reaction formation
IV benzodiazepine
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

18. Describe a test that consistently gives identical results - but the results are wrong.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Varicella zoster
High reliability - low validity
Bacterial meningitis

19. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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20. Risk factors for pyelonephritis.
Guillain - Barr
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Panic disorder
Varicella zoster

21. Identify key organisms causing diarrhea:
ALS
Endometriosis
ETEC
Acute mania. Start a mood stabilizer (e.g. - lithium)

22. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Nephrolithiasis
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Consider Fitz - Hugh - Curtis syndrome

23. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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24. Nonpainful chancre.
Salmonella
RSV bronchiolitis
Multiple myeloma
1

25. Birth rate?
S. aureus or S. epidermidis.
Central pontine myelinolysis
Number of live births per 1000 population
Prevalence

26. First - line treatment for otitis media.
OCPs - danazol - GnRH agonists
Amoxicillin
7-10 days
Allergic interstitial nephritis

27. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Displacement
Lichen planus
Sulfonamides - antimalarial drugs - fava beans
Osmotic fragility test

28. Identify key organisms causing diarrhea:
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
S. aureus
Lichen sclerosus
Hypotension - distant heart sounds - and JVD

29. Medication used to induce ovulation.
Clomiphene citrate
Neither
Levodopa/carbidopa
Pasteurella multocida

30. Acceptable urine output in a stable patient.
Threatened abortion
30 cc/hour
'Sawtooth' P waves
Cluster headache

31. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Exercise stress treadmill with ECG
1
Lichen planus
Chronic lymphocytic leukemia (CLL)

32. Signs of active ischemia during stress testing.
105 bacteria/mL
Type I (distal) RTA
Prerenal
Angina - ST- segment changes on ECG - or ? BP

33. Differential of hypervolemic hyponatremia.
Reaction formation
Psoriasis
Cirrhosis - CHF - nephritic syndrome
Crohn's disease

34. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Reaction formation
Iron overload; use deferoxamine
HIDA scan

35. Therapy for polycystic ovarian syndrome.
Higher prevalence
Weight loss and OCPs
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

36. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Identify cause; fluid and blood repletion
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Febrile seizures (roseola infantum)

37. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Restrictive pulmonary disease
Seborrheic keratosis

38. Macrocytic - megaloblastic anemia with neurologic symptoms.
Highly sensitive for TB
B12 deficiency
Mycoplasma
7-10 days

39. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Parvovirus B19
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Osteoarthritis

40. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
50 cc/hour
Menometrorrhagia
Hypotension - distant heart sounds - and JVD
Kegel exercises - estrogen - pessaries for stress incontinence

41. Antihypertensive for a diabetic patient with proteinuria.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Hypoparathyroidism
Higher prevalence
ACEI

42. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
Displacement
ALS
Excessive EtOH

43. A patient fails to lactate after an emergency C- section with marked blood loss.

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44. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Biliary tract obstruction
Contact dermatitis
Acne vulgaris

45. 'Stones - bones - groans - psychiatric overtones.'
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care
Signs and symptoms of hypercalcemia
Huntington's disease
Infection - cancer - and autoimmune disease

46. The most common form of nephritic syndrome.
Membranous glomerulonephritis
Surfactant deficiency
Neither
ACEI

47. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
Prinzmetal's angina
Hypernatremia
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

48. The most common causes of hypercalcemia.
Small cell lung cancer (SCLC)
Malignancy and hyperparathyroidism
Erythema multiforme
Lesch - Nyhan syndrome (purine salvage problem with

49. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Pseudomonas
Broca's aphasia. Frontal lobe - left MCA distribution
Endometrial biopsy
HBV - DTaP - Hib - IPV - PCV

50. Erythema migrans.
Lobular carcinoma in situ
Rett's disorder
Lesion of 1
Streptococcus pneumoniae