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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. Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
HIDA scan
Lichen sclerosus
They can mask symptoms of hypoglycemia

2. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Dissociative fugue
DM - SLE - and amyloidosis
Wrist drop - loss of thumb abduction
The IR of a disease in a population exposed to a particular factor

3. 'Stones - bones - groans - psychiatric overtones.'
ACEI
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Signs and symptoms of hypercalcemia
Postinfectious glomerulonephritis

4. A 'blueberry muffin' rash is characteristic of what congenital infection?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
OCP and barrier contraception
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Rubella

5. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Uterine atony
Respiratory alkalosis
Streptococcus pneumoniae
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.

6. What is the immunodeficiency?
Wiskott - Aldrich syndrome
Pentad of TTP
OCP and barrier contraception
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

7. Peaked T waves and widened QRS.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Prerenal
ARDS
Hyperkalemia

8. Treatment of tension pneumothorax.
Weight gain - type 2 DM - QT prolongation
Toxoplasma gondii
Trichomonas vaginitis
Immediate needle thoracostomy

9. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Inevitable abortion
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Pharmacologic stress test (e.g. - dobutamine echo)

10. Signs suggesting radial nerve damage with humeral fracture.
DM - SLE - and amyloidosis
IgA nephropathy (Berger's disease)
Wrist drop - loss of thumb abduction
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

11. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Glomerulonephritis/nephritic syndrome
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Immediate needle thoracostomy

12. Classic ultrasound and gross appearance of complete hydatidiform mole.

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13. Identify key organisms causing diarrhea:
Clostridium difficile
Partial mole
Prevalence
CHF - shock - and altered mental status

14. Cause of neonatal RDS.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Surfactant deficiency
Actinic keratosis
Squamous cell carcinoma

15. Neonatal mortality?
Diverticulosis
Beta- blockers - digoxin - calcium channel blockers
Number of deaths from birth to 28 days per 1000 live births
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

16. Sentinel loop on AXR.
Identify cause; pressors (e.g. - dobutamine)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Agranulocytosis
Acute pancreatitis

17. Lab values suggestive of menopause.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
? serum FSH
Pityriasis rosea

18. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Reye's syndrome
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Cellulitis
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

19. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
IV hydration and loop diuretics (furosemide)
Alopecia areata (autoimmune process)
Nephrolithiasis
O2 - analgesia - hydration - and - if severe - transfusion

20. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Identify cause; pressors (e.g. - dobutamine)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

21. Reynolds' pentad.

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22. Treatment for TTP.
Pheochromocytoma
HGPRTase deficiency)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Iron deficiency anemia

23. Post - HBV exposure treatment.
HBV immunoglobulin
Nephritic syndrome
Dressler's syndrome: fever - pericarditis - ? ESR
1

24. Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Absence seizures
Klebsiella

25. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Broca's aphasia. Frontal lobe - left MCA distribution

26. An active 13-year - old boy has anterior knee pain. Diagnosis?
Choriocarcinoma
Osgood - Schlatter disease
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
High reliability - low validity

27. Acid - base disorder in pulmonary embolism.
ALS
Guillain - Barr
Never
Hypoxia and hypocarbia

28. In which patients do you initiate colorectal cancer screening early?
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
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Type II (proximal) RTA
Protamine

29. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
IV hydration and loop diuretics (furosemide)
Trichomonas vaginitis
Treat existing heart failure and replace the tricuspid valve

30. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Headache
Establish the ABCs
MS

31. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Spinal stenosis

32. Nontender abdominal mass associated with elevated VMA and HVA.
? serum FSH
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Neuroblastoma

33. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Sheehan's syndrome (postpartum pituitary necrosis)

34. Virchow's triad.
Stasis - hypercoagulability - endothelial damage
Hypotension - distant heart sounds - and JVD
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Abdominal ultrasound and CT

35. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
CML
Pheochromocytoma
ARDS
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

36. Pure RBC aplasia.
Kl
Isolation
DI
Diamond - Blackfan anemia

37. The most common 1
Osteoarthritis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Multiple myeloma

38. Treatment for SVC syndrome.
Abdominal ultrasound and CT
CML
Radiation
Bacterial meningitis

39. Treatment for postpartum hemorrhage.
Regresses after menopause
Uterine massage; if that fails - give oxytocin
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Slipped capital femoral epiphyses. AP and frog - leg lateral view

40. Contraceptive methods that protect against PID.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Endometrial biopsy
OCP and barrier contraception

41. 'Stuck - on' appearance.
Endometriosis
Seborrheic keratosis
Diverticulosis
Anion gap acidosis and 1

42. Risk factors for pyelonephritis.
INH - penicillamine - hydralazine - procainamide
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Dissociative fugue
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

43. Number needed to treat?
1
Fluid restriction - demeclocycline
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

44. Method of calculating fluid repletion in burn patients.
Osteogenesis imperfecta
Choriocarcinoma
Parkland formula
Oral or topical metronidazole

45. Risk factors for DVT.

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46. A violent patient has vertical and horizontal nystagmus.
High TSH - low T4 - antimicrosomal antibodies
Phencyclidine hydrochloride (PCP) intoxication
MAOIs
Obstructive pulmonary disease (e.g. - asthma)

47. Honey- crusted lesions.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
The IR of a disease in a population exposed to a particular factor
Murphy's sign - seen in acute cholecystitis
Impetigo

48. A child has loss of red light reflex. Diagnosis?
46 -XX
Intussusception
Osgood - Schlatter disease
Suspect retinoblastoma

49. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
TICS
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

50. Radiographic indications for surgery in patients with acute abdomen.
Substance abuse
Oral or topical metronidazole
Hereditary spherocytosis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)