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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. Bone is fractured in fall on outstretched hand.

2. CSF findings:
Aseptic (viral) meningitis
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Endometrial or estrogen receptor - breast cancer
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

3. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Pregnant women. Treat this group aggressively because of potential complications
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

4. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Impetigo
Small cell lung cancer (SCLC)
Hypoxia and hypocarbia

5. Treatment for Guillain - Barr
Fatigue and impending respiratory failure
Glanzmann's thrombasthenia
IVIG or plasmapheresis
Number of live births per 1000 population

6. Four characteristics of a nevus suggestive of melanoma.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Panic disorder
Asymmetry - border irregularity - color variation - large diameter
Colposcopy and endocervical curettage

7. Virchow's triad.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Neither
Iron deficiency anemia
Stasis - hypercoagulability - endothelial damage

8. Treatment for AML M3.
V/Q scan
Retinoic acid
Partial mole
Never

9. The most common causes of hypercalcemia.
? serum FSH
1
Beta- hCG; the most common cause of amenorrhea is pregnancy
Malignancy and hyperparathyroidism

10. Inspiratory arrest during palpation of the RUQ.

11. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Oral surgery
DI

12. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
Renal cell carcinoma (RCC)
Phencyclidine hydrochloride (PCP) intoxication
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

13. Sentinel loop on AXR.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Sensitivity
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Acute pancreatitis

14. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Regresses after menopause
Levodopa/carbidopa
Suspect retinoblastoma

15. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
B12 deficiency
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Higher incidence

16. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Pheochromocytoma
Pharmacologic stress test (e.g. - dobutamine echo)
Duodenal atresia
Cerebral berry aneurysms (AD PCKD)

17. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
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
Postinfectious glomerulonephritis
Dantrolene or bromocriptine
Actinic keratosis

18. When can a physician refuse to continue treating a patient on the grounds of futility?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
CML
Retrograde cystourethrogram
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

19. The most common cause of female infertility.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Pentad of TTP
Endometriosis
They can mask symptoms of hypoglycemia

20. Defect in an X- linked syndrome with mental retardation -
Hereditary spherocytosis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Lesch - Nyhan syndrome (purine salvage problem with
Amoxicillin

21. What should always be done prior to LP?
Higher incidence
Check for ? ICP; look for papilledema
Regresses after menopause
Hodgkin's lymphoma

22. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Diphenhydramine or epinephrine 1:1000
Kwashiorkor (protein malnutrition)
Parainfluenza virus type 1

23. Caf
Hypoxia and hypocarbia
Fat - female - fertile - forty - flatulent
Neurofibromatosis 1
Threatened abortion

24. Charcot's triad.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
SSRIs
IgA nephropathy (Berger's disease)
Pityriasis rosea

25. Electrolyte changes in tumor lysis syndrome.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Hypotension and bradycardia

26. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
1
Weight gain - type 2 DM - QT prolongation
Endometriosis

27. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
'Sawtooth' P waves
Neuroleptics
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Exercise stress treadmill with ECG

28. Antihypertensive for a diabetic patient with proteinuria.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
ACEI
False. Withdrawing and withholding life are the same from an ethical standpoint
Normal

29. Antidepressants associated with hypertensive crisis.
Cerebral berry aneurysms (AD PCKD)
MAOIs
Never
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

30. Why are Beta- blockers contraindicated in diabetics?
Placental abruption and placenta previa
Treat existing heart failure and replace the tricuspid valve
Oral or topical metronidazole
They can mask symptoms of hypoglycemia

31. Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Pregnant women. Treat this group aggressively because of potential complications
Amoxicillin
Phencyclidine hydrochloride (PCP) intoxication

32. ? CO - ? PCWP - ? PVR.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Septic or anaphylactic shock
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
HBV - DTaP - Hib - IPV - PCV

33. Acceptable urine output in a stable patient.
30 cc/hour
Weight gain - type 2 DM - QT prolongation
Klebsiella
Nitroprusside

34. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Transitional cell carcinoma
a - antagonists (phentolamine and phenoxybenzamine)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Wait - surgical resection - radiation and/or androgen suppression

35. The most common 1
Selective IgA deficiency
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Diamond - Blackfan anemia
Menometrorrhagia

36. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Reye's syndrome
Anemia of chronic disease
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Wait - surgical resection - radiation and/or androgen suppression

37. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Calcium oxalate
Benzodiazepines
Sarcoidosis
MCP and PIP joints; DIP joints are spared

38. Lung cancer highly related to cigarette exposure.
Hypotension and bradycardia
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
SCLC
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

39. Differential of hypervolemic hyponatremia.
Cirrhosis - CHF - nephritic syndrome
Neuroblastoma
Avascular necrosis
Abdominal ultrasound and CT

40. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
Guillain - Barr
E. coli O157:H7
O2 - analgesia - hydration - and - if severe - transfusion
Malingering

41. The most common causes of dementia.

42. Acid - base disorder in pulmonary embolism.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
HIDA scan
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Hypoxia and hypocarbia

43. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Pasteurella multocida
Immediate needle thoracostomy
Hashimoto's thyroiditis

44. The most common type of testicular cancer.
Type I (distal) RTA
Seventy percent if the stenosis is symptomatic
DI
Seminoma

45. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises - estrogen - pessaries for stress incontinence
Diphenhydramine or epinephrine 1:1000
Type II (proximal) RTA
Seventy percent if the stenosis is symptomatic

46. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Varicella zoster
Avascular necrosis
Biliary tract obstruction
Osteoarthritis

47. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Patient on dopamine antagonist
Weight loss and OCPs
Renal cell carcinoma (RCC)
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

48. A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
a - antagonists (phentolamine and phenoxybenzamine)
Duchenne muscular dystrophy

49. The mainstay of Parkinson's therapy.
Phototherapy (mild) or exchange transfusion (severe)
Third - degree heart block
Levodopa/carbidopa
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

50. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Squamous cell carcinoma
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)