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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. Name the organism:
Abdominal ultrasound and CT
TICS
Seborrheic keratosis
Actinomyces israelii

2. When can a physician refuse to continue treating a patient on the grounds of futility?
SIADH due to stress
Alport's syndrome
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
Bladder rupture or urethral injury

3. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Iron overload; use deferoxamine
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Patient on dopamine antagonist
Phencyclidine hydrochloride (PCP) intoxication

4. Infection of small airways with epidemics in winter and spring.
Lyme disease - Ixodes tick - doxycycline
RSV bronchiolitis
Glomerulonephritis/nephritic syndrome
Elevated ICP - RBCs - xanthochromia

5. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Nitroprusside
Alzheimer's and multi - infarct
Stasis - hypercoagulability - endothelial damage
Squamous cell carcinoma

6. Hematuria - flank pain - and palpable flank mass.
Excessive EtOH
Renal cell carcinoma (RCC)
Bladder rupture or urethral injury
Small cell lung cancer (SCLC)

7. Causes of transudative effusion.
Neisseria meningitidis
? protein intake - lactulose - neomycin
Bacillus cereus
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

8. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Small cell lung cancer (SCLC)
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Beta- blockers - Ca2+ channel blockers - TCAs
Actinic keratosis

9. Identify key organisms causing diarrhea:
Yersinia
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Partial mole
Bacillus cereus

10. Postnatal mortality?
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
Number of deaths from 28 days to one year per 1000 live births
OCPs - danazol - GnRH agonists
ETEC

11. Cohort study
Postinfectious glomerulonephritis
Incidence and prevalence
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Erythema multiforme

12. Perinatal mortality?

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13. The most common causes of dementia.

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14. 'Stuck - on' appearance.
Seborrheic keratosis
Prevalence
Glanzmann's thrombasthenia
Lesions of 1

15. Causes of hypoxemia.
ALS
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Parkland formula
Immediate cardioversion

16. The coagulation parameter affected by warfarin.
Radiation
Vibrio - HAV
PT
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs

17. Eosinophils in urine sediment.
False. Withdrawing and withholding life are the same from an ethical standpoint
Oral surgery
Allergic interstitial nephritis
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

18. Tanner stage 3 in a six-year - old female.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Chronic lymphocytic leukemia (CLL)
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Precocious puberty

19. Signs of neurogenic shock.
Beta- blockers - Ca2+ channel blockers - TCAs
Benzodiazepines
Endometrial or estrogen receptor - breast cancer
Hypotension and bradycardia

20. Tests to rule out shaken baby syndrome.
Ophthalmologic exam - CT - and MRI
7-10 days
Elevated ICP - RBCs - xanthochromia
ALS

21. When should a vaginal exam be performed with suspected placenta previa?
Beta- blockers - Ca2+ channel blockers - TCAs
< 7.0
Never
Mallory- Weiss

22. CSF findings:
Administration of DDAVP ? serum osmolality and free water restriction
Bacterial meningitis
Basal cell carcinoma
Nephrotic syndrome

23. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Third - degree heart block
TICS
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)

24. The most common 1
Type IV (distal) RTA
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Multiple myeloma
HBV - DTaP - Hib - IPV - PCV

25. Test to rule out urethral injury.
Asymmetry - border irregularity - color variation - large diameter
Retrograde cystourethrogram
Hypertrophic cardiomyopathy
Consider Fitz - Hugh - Curtis syndrome

26. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Multiple myeloma
Colposcopy and endocervical curettage
ACEI
Exercise stress treadmill with ECG

27. Treatment for DTs.
Bladder rupture or urethral injury
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Benzodiazepines
Conduct disorder

28. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Duchenne muscular dystrophy
Aseptic (viral) meningitis
Avascular necrosis
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

29. First - line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide)
Lead - time bias
Spinal stenosis
Regresses after menopause

30. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
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
Out
Lobular carcinoma in situ
Avascular necrosis

31. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Paget's disease
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Check for ? ICP; look for papilledema
Factitious disorder (Munchausen syndrome)

32. How to distinguish polycythemia vera from 2
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Panic disorder
Fatigue and impending respiratory failure
Low - voltage - diffuse ST- segment elevation

33. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Parvovirus B19
a - antagonists (phentolamine and phenoxybenzamine)
Higher prevalence
Neisseria meningitidis

34. Vaccinations at a six- month well - child visit.
Nephrogenic diabetes insipidus (DI)
Endometriosis
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
HBV - DTaP - Hib - IPV - PCV

35. Name the defense mechanism:
Headache
Regression
Naloxone
TICS

36. Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Hereditary spherocytosis
Multiple myeloma
Basal cell carcinoma

37. Low urine specific gravity in the presence of high serum osmolality.
Paget's disease
Incidence and prevalence
DI
Type I (distal) RTA

38. Symptoms of placenta previa.
Benzodiazepines
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
1
Self - limited - painless vaginal bleeding

39. Number needed to treat?
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
1
Avascular necrosis
Anemia of chronic disease

40. Cold agglutinins.
Mycoplasma
Excessive EtOH
Metformin
Inevitable abortion

41. Presence of red cell casts in urine sediment.
Coarctation of the aorta
Glomerulonephritis/nephritic syndrome
Administration of DDAVP ? serum osmolality and free water restriction
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots

42. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Signs and symptoms of hypercalcemia
Third - degree heart block
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Salmonella

43. Conditions in which confidentiality must be overridden.
Colposcopy and endocervical curettage
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Rate control with carotid massasge or other vagal stimulation
Factor V Leiden mutation

44. Treatment for postpartum hemorrhage.
Aseptic (viral) meningitis
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
High TSH - low T4 - antimicrosomal antibodies
Uterine massage; if that fails - give oxytocin

45. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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46. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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47. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
Hypotension and bradycardia
Allergic interstitial nephritis
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

48. The 6 P's of ischemia due to peripheral vascular disease.
Beta- blockers - Ca2+ channel blockers - TCAs
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Anion gap acidosis and 1
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

49. Difference between Mallory- Weiss and Boerhaave tears.
Multiple myeloma
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Substance abuse
Mallory- Weiss

50. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Never
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
a - antagonists (phentolamine and phenoxybenzamine)