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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. True or false: Once patients sign a statement giving consent - they must continue treatment.
Elevated ICP - RBCs - xanthochromia
Acute myelogenous leukemia (AML)
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
Intussusception

2. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Actinomyces israelii
Osgood - Schlatter disease
68% - 95.5% - 99.7%
MS

3. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Polymyalgia rheumatica

4. Classic physical findings for endocarditis.

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5. RTA associated with abnormal HCO3 - and rickets.
Lung - breast - skin (melanoma) - kidney - GI tract
Bullous pemphigoid
Type II (proximal) RTA
Protamine

6. Presents with a herald patch - Christmas - tree pattern.
PT
Pityriasis rosea
Number of deaths per 1000 population
Out

7. Peaked T waves and widened QRS.
Uterine massage; if that fails - give oxytocin
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Hyperkalemia
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

8. Causes of exudative effusion.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
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
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

9. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
Non - Hodgkin's lymphoma
Emergent laparotomy to repair perforated viscus - likely stomach
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

10. 'Doughy skin.'
Bladder rupture or urethral injury
Conversion disorder
PT
Hypernatremia

11. Identify key organisms causing diarrhea:
Salmonella
Surfactant deficiency
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
HIDA scan

12. Name the organism:
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
7-10 days
Clostridium difficile
Klebsiella

13. Antidepressants associated with hypertensive crisis.
Seventy percent if the stenosis is symptomatic
MAOIs
Febrile seizures (roseola infantum)
Placental abruption and placenta previa

14. CSF findings:
Wernicke's encephalopathy due to a deficiency of thiamine
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Fatigue and impending respiratory failure
Bacterial meningitis

15. Signs of active ischemia during stress testing.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Pulsus paradoxus (seen in cardiac tamponade)
Angina - ST- segment changes on ECG - or ? BP
Lobular carcinoma in situ

16. Inflammatory disease of the colon with ? risk of colon cancer.
Ulcerative colitis
Lobular carcinoma in situ
Partial mole
Kl

17. The most common form of glomerulonephritis.

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18. Radiographic evidence of aortic disruption or dissection.
Inhaled Beta- agonists and inhaled corticosteroids
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Betamethasone or dexamethasone

19. Treatment for acetaminophen overdose.
Regresses after menopause
N- acetylcysteine
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Iatrogenic steroid administration. The second most common cause is Cushing's disease

20. What % lesion is an indication for carotid endarterectomy?
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Sarcoidosis
Seventy percent if the stenosis is symptomatic
Fanconi's anemia

21. Salicylate ingestion ? In What type of acid - base disorder?
Low - voltage - diffuse ST- segment elevation
Emergent laparotomy to repair perforated viscus - likely stomach
Glanzmann's thrombasthenia
Anion gap acidosis and 1

22. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
Diamond - Blackfan anemia
Parvovirus B19
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

23. Cause of neonatal RDS.
Betamethasone or dexamethasone
Anticoagulation - rate control - cardioversion
Surfactant deficiency
Hypoparathyroidism

24. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Hypernatremia
Cluster headache
Iron deficiency anemia
Kegel exercises - estrogen - pessaries for stress incontinence

25. Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP
Femoral hernia
Parainfluenza virus type 1
Kegel exercises - estrogen - pessaries for stress incontinence

26. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Hyperkalemia
Nephrotic syndrome
Identify cause; fluid and blood repletion
Panic disorder

27. Infant mortality?
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Sulfonamides - antimalarial drugs - fava beans
Diamond - Blackfan anemia

28. First - line pharmacotherapy for depression.
Depersonalization disorder
Anticoagulation - rate control - cardioversion
Selective IgA deficiency
SSRIs

29. T- wave flattening and U waves.
Beta- blockers - digoxin - calcium channel blockers
Hypokalemia
Uterine massage; if that fails - give oxytocin
Prinzmetal's angina

30. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Hypotension - distant heart sounds - and JVD
IV hydration and loop diuretics (furosemide)
Murphy's sign - seen in acute cholecystitis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)

31. Auer rods on blood smear.
Hypertension - bradycardia - and abnormal respirations
Giardia
Factor V Leiden mutation
Acute myelogenous leukemia (AML)

32. Classic ECG finding in atrial flutter.

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33. Key side effects of atypical antipsychotics.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Weight gain - type 2 DM - QT prolongation
Uterine massage; if that fails - give oxytocin
Diamond - Blackfan anemia

34. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Pseudogout
Crohn's disease

35. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Klebsiella
SIADH due to stress
Emergent laparotomy to repair perforated viscus - likely stomach

36. Name the defense mechanism:
HIDA scan
Pseudogout
Reaction formation
Nephrolithiasis

37. Vaccinations at a six- month well - child visit.
Neuroleptics
HBV - DTaP - Hib - IPV - PCV
TICS
Fluid restriction - demeclocycline

38. The most common cancer in men and the most common cause of death from cancer in men.
Ulcerative colitis
Menometrorrhagia
Retinoic acid
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

39. The first test to perform when a woman presents with amenorrhea.
Hodgkin's lymphoma
Beta- hCG; the most common cause of amenorrhea is pregnancy
Pityriasis versicolor
Number of deaths from 28 days to one year per 1000 live births

40. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Hodgkin's lymphoma
Anticoagulation - rate control - cardioversion
Giardia
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)

41. Symptoms of placental abruption.
AP chest - AP/lateral C- spine - AP pelvis
Seminoma
Continuous - painful vaginal bleeding
Salmonella

42. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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43. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Renal cell carcinoma (RCC)
Wernicke's encephalopathy due to a deficiency of thiamine
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
Treat immediately. Consent is implied in emergency situations

44. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Headache
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

45. Albuminocytologic dissociation.
Guillain - Barr
Renal cell carcinoma (RCC)
Basal cell carcinoma
Haemophilus ducreyi

46. Hernia with highest risk of incarceration
Impetigo
Femoral hernia
Acute myelogenous leukemia (AML)
Hypoparathyroidism

47. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
RSV bronchiolitis
Selective IgA deficiency
Basal cell carcinoma

48. CSF findings with SAH.
Anion gap acidosis and 1
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Elevated ICP - RBCs - xanthochromia
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

49. The most common form of nephritic syndrome.
Nephrogenic diabetes insipidus (DI)
Identify cause; fluid and blood repletion
Membranous glomerulonephritis
Number of deaths from 28 days to one year per 1000 live births

50. Name the organism:
Sporothrix schenckii
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Pityriasis versicolor
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies