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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. Risk factors for DVT.

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2. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Lesions of 1
Oral or topical metronidazole
Femoral hernia
Polymyalgia rheumatica

3. Name the organism:
Pharmacologic stress test (e.g. - dobutamine echo)
Wiskott - Aldrich syndrome
Nephritic syndrome
Neisseria meningitidis

4. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Reye's syndrome
IV hydration and loop diuretics (furosemide)
Subdural hematoma
a - antagonists (phentolamine and phenoxybenzamine)

5. 'Cradle cap.'
Bruton's X- linked agammaglobulinemia
Usually resolves spontaneously; may require IVIG and/or corticosteroids
BP > 140/90 on three separate occasions two weeks apart
Seborrheic dermatitis. Treat with antifungals

6. Macrocytic - megaloblastic anemia with neurologic symptoms.
B12 deficiency
IgA nephropathy (Berger's disease)
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
Restrictive pulmonary disease

7. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Alopecia areata (autoimmune process)
Prerenal
Stasis - hypercoagulability - endothelial damage

8. Appropriate diagnostic test?
ACEI
50 cc/hour
Exercise stress treadmill with ECG
Duchenne muscular dystrophy

9. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Angina is new - is worsening - or occurs at rest
Chronic lymphocytic leukemia (CLL)
105 bacteria/mL
Identify cause; fluid and blood repletion

10. CSF findings:
Depersonalization disorder
Bacterial meningitis
? protein intake - lactulose - neomycin
Identify cause; pressors (e.g. - dobutamine)

11. Identify key organisms causing diarrhea:
Varicella zoster
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Hyperkalemia

12. Charcot's triad.
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
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Bacillus cereus
Choriocarcinoma

13. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
Cerebral berry aneurysms (AD PCKD)
Actinic keratosis
Placental abruption and placenta previa

14. A late - life - threatening complication of chronic myelogenous leukemia (CML).
V/Q scan
Conduct disorder
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

15. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
MAOIs
Allergic interstitial nephritis
Sensitivity
Sarcoidosis

16. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
MS
Parvovirus B19
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Avascular necrosis

17. PFT showing ? FEV1/FVC.
Guillain - Barr
Restrictive pulmonary disease
Lesion of 1
Basal cell carcinoma

18. 1
Nephrotic syndrome
Absence seizures
Placental abruption and placenta previa
SSRIs

19. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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20. Eosinophils in urine sediment.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Fluids and antibiotics
Allergic interstitial nephritis
Pasteurella multocida

21. Attributable risk?
High reliability - low validity
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Acute myelogenous leukemia (AML)

22. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Squamous cell carcinoma
Acute pancreatitis

23. Natural history of a leiomyoma.
Nephrolithiasis
Regresses after menopause
Guillain - Barr
Signs and symptoms of hypercalcemia

24. Classic ECG findings in pericarditis.
Colposcopy and endocervical curettage
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Low - voltage - diffuse ST- segment elevation
105 bacteria/mL

25. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Menometrorrhagia
Huntington's disease
Hypertrophic cardiomyopathy

26. A fall in systolic BP of > 10 mmHg with inspiration.
Flumazenil
Pulsus paradoxus (seen in cardiac tamponade)
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Levodopa/carbidopa

27. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Pheochromocytoma
Fat - female - fertile - forty - flatulent
Patient on dopamine antagonist
Nephrotic syndrome

28. Acceptable urine output in a trauma patient.
50 cc/hour
Ultrasound
Trauma; the second most common is berry aneurysm
Protamine

29. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Glomerulonephritis/nephritic syndrome
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Conversion disorder

30. Side effects of corticosteroids.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
BP > 140/90 on three separate occasions two weeks apart
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

31. Endocarditis prophylaxis regimens.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Oral surgery
Osmotic fragility test
Sulfonamides - antimalarial drugs - fava beans

32. Complication of scaphoid fracture.
E. coli O157:H7
Avascular necrosis
Hypoxia and hypocarbia
Obstructive pulmonary disease (e.g. - asthma)

33. Name the defense mechanism:
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Reaction formation
Highly sensitive for TB
Suspect retinoblastoma

34. Four signs and symptoms of streptococcal pharyngitis.
False. Withdrawing and withholding life are the same from an ethical standpoint
Precocious puberty
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Coccidioidomycosis. Amphotericin B

35. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
Vibrio - HAV
Hypertrophic cardiomyopathy
Neither

36. The most common histology of bladder cancer.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Kegel exercises - estrogen - pessaries for stress incontinence
Transitional cell carcinoma
1

37. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Intraductal papilloma
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
Emergent laparotomy to repair perforated viscus - likely stomach
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.

38. Diagnostic test for hypertrophic cardiomyopathy.
Varicella zoster
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Continuous positive airway pressure
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

39. Name the defense mechanism:
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Hypertrophic cardiomyopathy
Taenia solium (cysticercosis)
Displacement

40. Definition of hypertension.
Dissociative fugue
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
BP > 140/90 on three separate occasions two weeks apart
Elevated ICP - RBCs - xanthochromia

41. Name the organism:
Salmonella
Headache
Pseudogout
Phencyclidine hydrochloride (PCP) intoxication

42. Bilious emesis within hours after the first feeding.
Duodenal atresia
Highly sensitive for TB
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Number of deaths from 28 days to one year per 1000 live births

43. Chromosomal pattern of a complete mole.
Pentad of TTP
46 -XX
Hyperkalemia
Establish the ABCs

44. Name the organism:
Pseudomonas
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Niacin

45. Perinatal mortality?

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46. Name the defense mechanism:
Trauma - alcohol withdrawal - brain tumor
Slipped capital femoral epiphyses. AP and frog - leg lateral view
ACEI
Isolation

47. Name the organism:
Pasteurella multocida
Prinzmetal's angina
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Anion gap acidosis and 1

48. What is the metabolic syndrome?
AP chest - AP/lateral C- spine - AP pelvis
Hereditary spherocytosis
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Bacillus cereus

49. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
False. Withdrawing and withholding life are the same from an ethical standpoint

50. First - line treatment for moderate hypercalcemia.
Renal cell carcinoma (RCC)
Klebsiella
IV hydration and loop diuretics (furosemide)
Abdominal ultrasound and CT