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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. The most serious side effect of clozapine.
Partial mole
Alzheimer's and multi - infarct
Sporothrix schenckii
Agranulocytosis

2. Treatment for malignant hypertension.
Nitroprusside
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Hypoparathyroidism
Multiple myeloma

3. Findings in 3
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Patent ductus arteriosus (PDA)

4. First - line medication for status epilepticus.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
IV benzodiazepine
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Pulsus paradoxus (seen in cardiac tamponade)

5. A congenital heart disease that cause 2
Pseudogout
Consider Fitz - Hugh - Curtis syndrome
Coarctation of the aorta
Distal radius (Colles' fracture)

6. A woman who was abused as a child frequently feels outside of or detached from her body.
OCPs - danazol - GnRH agonists
Depersonalization disorder
Wernicke's encephalopathy due to a deficiency of thiamine
Taenia solium (cysticercosis)

7. Endocarditis prophylaxis regimens.
Infection - febrile seizures - trauma - idiopathic
Oral surgery
1
HGPRTase deficiency)

8. Causes of transudative effusion.
Immediate cardioversion
Observational bias
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

9. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
7-10 days
Renal cell carcinoma (RCC)
Emergent laparotomy to repair perforated viscus - likely stomach
Giardia

10. 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
Confounding variable
Pseudomonas
N- acetylcysteine

11. Classic causes of drug - induced hepatitis.
Duodenal atresia
Excessive EtOH
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
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

12. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Pityriasis versicolor
Distal radius (Colles' fracture)
Cardiogenic shock
Duodenal atresia

13. Name the organism:
Squamous cell carcinoma
Alport's syndrome
Pasteurella multocida
Hypotension - distant heart sounds - and JVD

14. Infection of small airways with epidemics in winter and spring.
False. Withdrawing and withholding life are the same from an ethical standpoint
RSV bronchiolitis
Never
Femoral hernia

15. The most common causes of hypercalcemia.
Betamethasone or dexamethasone
OCPs
Alport's syndrome
Malignancy and hyperparathyroidism

16. Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
CF or Hirschsprung's disease
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Lobular carcinoma in situ

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

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18. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Inhaled Beta- agonists and inhaled corticosteroids
Broca's aphasia. Frontal lobe - left MCA distribution
Out

19. Diagnostic test for hypertrophic cardiomyopathy.
Patient on dopamine antagonist
Neurofibromatosis 1
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Distal radius (Colles' fracture)

20. Treatment of septic shock.
Cardiogenic shock
Fluids and antibiotics
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
TICS

21. First - line treatment for moderate hypercalcemia.
V/Q scan
Neuroleptic malignant syndrome
Sarcoidosis
IV hydration and loop diuretics (furosemide)

22. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fat - female - fertile - forty - flatulent
Fatigue and impending respiratory failure
Mallory- Weiss
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction

23. Associated with Propionibacterium acnes and changes in androgen levels.
Pulsus paradoxus (seen in cardiac tamponade)
Acne vulgaris
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Nitroprusside

24. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Salmonella
68% - 95.5% - 99.7%
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
? protein intake - lactulose - neomycin

25. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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26. Erythema migrans.
Lesion of 1
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Inhaled Beta- agonists and inhaled corticosteroids
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

27. A patient with a history of lithium use presents with copious amounts of dilute urine.
Anticoagulation - rate control - cardioversion
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Nephrogenic diabetes insipidus (DI)
OCP and barrier contraception

28. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
Coarctation of the aorta
Salmonella
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels

29. Administer to a symptomatic patient to diagnose myasthenia gravis.
30 cc/hour
Edrophonium
Signs and symptoms of hypercalcemia
Type I (distal) RTA

30. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
< 7.0
Alopecia areata (autoimmune process)
Normal
Suspect ankylosing spondylitis. Check HLA- B27

31. RTA associated with abnormal HCO3 - and rickets.
Absence seizures
Type II (proximal) RTA
Parkland formula
Number of live births per 1000 women 15-44 years of age

32. Blood in the urethral meatus or high - riding prostate.
Conversion disorder
Angina is new - is worsening - or occurs at rest
Bladder rupture or urethral injury
Number of deaths per 1000 population

33. Treatment of anaphylactic shock.
Parainfluenza virus type 1
Vibrio - HAV
Diphenhydramine or epinephrine 1:1000
Bullous pemphigoid

34. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
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
Spinal stenosis
Basal cell carcinoma
HBV immunoglobulin

35. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Erythema multiforme
Betamethasone or dexamethasone
Headache
Sulfonamides - antimalarial drugs - fava beans

36. Glomerulonephritis with hemoptysis.

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37. Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Lesion of 1
Lobular carcinoma in situ
Substance abuse

38. Medical options for endometriosis.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Asherman's syndrome
OCPs - danazol - GnRH agonists
1

39. Conditions in which confidentiality must be overridden.
Frotteurism (a paraphilia)
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Pseudomonas
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

40. 'Dewdrop on a rose petal.'
Obstructive pulmonary disease (e.g. - asthma)
Lesions of 1
Angina is new - is worsening - or occurs at rest
Osteoarthritis

41. 'Stones - bones - groans - psychiatric overtones.'
Weight gain - type 2 DM - QT prolongation
Giardia
Sporothrix schenckii
Signs and symptoms of hypercalcemia

42. Name the organism:
Normal
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Klebsiella
Cerebral berry aneurysms (AD PCKD)

43. Treatment of DKA.
Osteogenesis imperfecta
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Wait - surgical resection - radiation and/or androgen suppression
OCPs - danazol - GnRH agonists

44. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Oral surgery
Nephrolithiasis
IV penicillin or ampicillin
CHF - shock - and altered mental status

45. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
High TSH - low T4 - antimicrosomal antibodies
Substance abuse
ALS
Lesch - Nyhan syndrome (purine salvage problem with

46. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
ETEC
Actinomyces israelii
SCLC

47. Perinatal mortality?

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48. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Biliary tract obstruction
Iron deficiency anemia
Psoriasis

49. Three systemic diseases ? nephrotic syndrome.
DM - SLE - and amyloidosis
Panic disorder
Choriocarcinoma
E. coli O157:H7

50. Treatment for Guillain - Barr
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
MCP and PIP joints; DIP joints are spared
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
IVIG or plasmapheresis