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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. Classic physical findings for endocarditis.

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2. Identify key organisms causing diarrhea:
E. coli O157:H7
Stasis - hypercoagulability - endothelial damage
MCP and PIP joints; DIP joints are spared
Pseudomonas

3. Inflammatory disease of the colon with ? risk of colon cancer.
SIADH due to stress
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Observational bias
Ulcerative colitis

4. When can a physician refuse to continue treating a patient on the grounds of futility?
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
Infection - febrile seizures - trauma - idiopathic
Beta- hCG; the most common cause of amenorrhea is pregnancy
Uremic syndrome seen in patients with renal failure

5. Classic causes of drug - induced hepatitis.
Abdominal ultrasound and CT
Anemia of chronic disease
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

6. Antihypertensive for a diabetic patient with proteinuria.
ACEI
Observational bias
Protamine
Hypoparathyroidism

7. Acid - base disorder in pulmonary embolism.
Hypoxia and hypocarbia
Kwashiorkor (protein malnutrition)
Colposcopy and endocervical curettage
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

8. Name the organism:
Pseudomonas
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
E. coli O157:H7
Ampulla of the oviduct

9. The most common cause of seizures in children (2-10 years).
Glanzmann's thrombasthenia
Exercise stress treadmill with ECG
Infection - febrile seizures - trauma - idiopathic
a - antagonists (phentolamine and phenoxybenzamine)

10. The most common cause of female infertility.
Threatened abortion
Respiratory alkalosis
Hypertrophic cardiomyopathy
Endometriosis

11. Name the organism:
IgA nephropathy (Berger's disease)
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Actinomyces israelii
Lichen planus

12. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Contact dermatitis
Incidence and prevalence
Osteoarthritis

13. Risk factors for cholelithiasis.
Treat immediately. Consent is implied in emergency situations
Iron deficiency anemia
Beta- hCG; the most common cause of amenorrhea is pregnancy
Fat - female - fertile - forty - flatulent

14. + Nikolsky's sign.
Protamine
Pemphigus vulgaris
Respiratory alkalosis
Psoriasis

15. Rigidity and stiffness with resting tremor and masked facies.

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16. Supportive treatment for ARDS.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Continuous positive airway pressure
ACEI
Hypernatremia

17. Glomerulonephritis with deafness.

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18. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Signs and symptoms of hypercalcemia
Giardia
HIDA scan

19. Treatment for acute coronary syndrome.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Mycoplasma
Confounding variable
Acute myelogenous leukemia (AML)

20. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Neurofibromatosis 1
Frotteurism (a paraphilia)
Surfactant deficiency

21. What % lesion is an indication for carotid endarterectomy?
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Seventy percent if the stenosis is symptomatic
Sheehan's syndrome (postpartum pituitary necrosis)
Retrograde cystourethrogram

22. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
N- acetylcysteine
ARDS
Asymmetry - border irregularity - color variation - large diameter
Asherman's syndrome

23. Molar pregnancy containing fetal tissue.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Partial mole
Bacillus cereus
Selective IgA deficiency

24. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
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
68% - 95.5% - 99.7%
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

25. Aplastic crisis in sickle cell disease.
Lesions of 1
Parvovirus B19
Parainfluenza virus type 1
Polymyalgia rheumatica

26. Identify key organisms causing diarrhea:
Surfactant deficiency
Chronic lymphocytic leukemia (CLL)
Yersinia
Treat immediately. Consent is implied in emergency situations

27. Classic ECG finding in atrial flutter.

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28. Acute - phase treatment for Kawasaki disease.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Lichen planus
Number of deaths from 20 weeks' gestation to birth per 1000 total births
? serum FSH

29. The most common cause of postpartum hemorrhage.
Ulcerative colitis
Continuous positive airway pressure
Wrist drop - loss of thumb abduction
Uterine atony

30. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Trauma; the second most common is berry aneurysm
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

31. Blood in the urethral meatus or high - riding prostate.
Coarctation of the aorta
Hypotension - distant heart sounds - and JVD
Bladder rupture or urethral injury
Patient on dopamine antagonist

32. Natural history of a leiomyoma.
Regresses after menopause
Elevated ICP - RBCs - xanthochromia
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Continuous - painful vaginal bleeding

33. Acid - base disturbance commonly seen in pregnant women.
Neisseria meningitidis
Treat immediately. Consent is implied in emergency situations
Respiratory alkalosis
Panic disorder

34. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Beta- blockers - digoxin - calcium channel blockers
Streptococcus pneumoniae
Pharmacologic stress test (e.g. - dobutamine echo)

35. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
105 bacteria/mL
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Osteogenesis imperfecta
Oral surgery

36. Iris - like target lesions.
Cirrhosis - CHF - nephritic syndrome
Giardia
Erythema multiforme
Number of deaths from 28 days to one year per 1000 live births

37. Treatment of septic shock.
Fluids and antibiotics
Anemia of chronic disease
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Parkinson's disease

38. Neonatal mortality?
Number of live births per 1000 women 15-44 years of age
'Chocolate cysts -' powder burns
Number of deaths from birth to 28 days per 1000 live births
ALS

39. Honeycomb pattern on CXR. Diagnosis? Treatment?
Toxoplasma gondii
Osmotic fragility test
Patent ductus arteriosus (PDA)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

40. Dermatomal distribution.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Fat - female - fertile - forty - flatulent
Hypoparathyroidism
Varicella zoster

41. The 6 P's of ischemia due to peripheral vascular disease.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Headache
Pentad of TTP

42. 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?
Pentad of TTP
Nitroprusside
Highly sensitive for TB
Continuous - painful vaginal bleeding

43. Acceptable urine output in a trauma patient.
Actinomyces israelii
50 cc/hour
Phototherapy (mild) or exchange transfusion (severe)
Kwashiorkor (protein malnutrition)

44. Signs of air embolism.
DM - SLE - and amyloidosis
A patient with chest trauma who was previously stable suddenly dies
Kl
Asymmetry - border irregularity - color variation - large diameter

45. Treatment for opioid overdose.
Duodenal atresia
Naloxone
INH - penicillamine - hydralazine - procainamide
Hypertrophic cardiomyopathy

46. Test to rule out urethral injury.
Conflict of interest
Retrograde cystourethrogram
Clomiphene citrate
Uterine massage; if that fails - give oxytocin

47. Identify key organisms causing diarrhea:
S. aureus
CF or Hirschsprung's disease
Broca's aphasia. Frontal lobe - left MCA distribution
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate

48. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Excessive EtOH
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Rate control - rhythm conversion - and anticoagulation

49. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Mycobacterium tuberculosis
Anemia of chronic disease
Uterine massage; if that fails - give oxytocin
Pseudomonas

50. The diagnostic test for pulmonary embolism.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
V/Q scan
Pseudomonas