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. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Transitional cell carcinoma
Cluster headache
Contact dermatitis
A patient with chest trauma who was previously stable suddenly dies


2. Name the defense mechanism:
? Ca2+ - ? K- - ? phosphate - ? uric acid
Isolation
Kwashiorkor (protein malnutrition)
A patient's family cannot require that a doctor withhold information from the patient


3. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
Metformin
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Duchenne muscular dystrophy


4. First - line medication for status epilepticus.
IV benzodiazepine
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'
Actinomyces israelii


5. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Diphenhydramine or epinephrine 1:1000
Mallory- Weiss
Osteogenesis imperfecta
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


6. Treatment of cardiogenic shock.
50 cc/hour
Suspect retinoblastoma
Identify cause; pressors (e.g. - dobutamine)
SCLC


7. Presents with a herald patch - Christmas - tree pattern.
Lyme disease - Ixodes tick - doxycycline
Parkinson's disease
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Pityriasis rosea


8. Treatment for ventricular fibrillation.
Wernicke's encephalopathy due to a deficiency of thiamine
Immediate cardioversion
Asherman's syndrome
Toxoplasma gondii


9. Name the organism:
Klebsiella
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
Trauma; the second most common is berry aneurysm
Small cell lung cancer (SCLC)


10. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Hypotension - distant heart sounds - and JVD
Cardiogenic shock
Pheochromocytoma
ALS


11. Medications and viruses that ? aplastic anemia.
Naloxone
Elevated ICP - RBCs - xanthochromia
Membranous glomerulonephritis
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


12. Name the organism:
Pityriasis rosea
Pasteurella multocida
Weight gain - type 2 DM - QT prolongation
No. Parental consent is not necessary for the medical treatment of pregnant minors


13. Vaccinations at a six- month well - child visit.
Regression
HBV - DTaP - Hib - IPV - PCV
Neuroleptics
MS


14. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Beta- blockers - Ca2+ channel blockers - TCAs
Suspect ankylosing spondylitis. Check HLA- B27
Aseptic (viral) meningitis
Menometrorrhagia


15. + Nikolsky's sign.
Prerenal
Pemphigus vulgaris
50 cc/hour
Infection - cancer - and autoimmune disease


16. Treatment for neuroleptic malignant syndrome.
Emergent laparotomy to repair perforated viscus - likely stomach
Dantrolene or bromocriptine
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


17. A doctor refers a patient for an MRI at a facility he/she owns.
Malingering
Sheehan's syndrome (postpartum pituitary necrosis)
Conflict of interest
Asymmetry - border irregularity - color variation - large diameter


18. Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
a - antagonists (phentolamine and phenoxybenzamine)
Treat existing heart failure and replace the tricuspid valve
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


19. Difference between a cohort and a case - control study.
Anemia of chronic disease
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR
Regression
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


20. A patient with a history of lithium use presents with copious amounts of dilute urine.
Hypernatremia
Surfactant deficiency
Nephrogenic diabetes insipidus (DI)
Fluid restriction - demeclocycline


21. Blood in the urethral meatus or high - riding prostate.
Prinzmetal's angina
Obstructive pulmonary disease (e.g. - asthma)
Consider Fitz - Hugh - Curtis syndrome
Bladder rupture or urethral injury


22. 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.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
N- acetylcysteine
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


23. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


24. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Sarcoidosis
Folate deficiency
Angina - ST- segment changes on ECG - or ? BP
Sulfonamides - antimalarial drugs - fava beans


25. Classic CXR findings for pulmonary edema.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


27. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
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
Hypernatremia
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


28. Key side effects of atypical antipsychotics.
Avascular necrosis
Calcium oxalate
Weight gain - type 2 DM - QT prolongation
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


29. Four characteristics of a nevus suggestive of melanoma.
Continuous positive airway pressure
Asymmetry - border irregularity - color variation - large diameter
Polymyalgia rheumatica
Protamine


30. Causes of exudative effusion.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Avascular necrosis
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Sulfonamides - antimalarial drugs - fava beans


31. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
OCPs - danazol - GnRH agonists
Wrist drop - loss of thumb abduction
Pseudomonas


32. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Placental abruption and placenta previa
Contact dermatitis
Pityriasis versicolor
Surfactant deficiency


33. Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Patient on dopamine antagonist


34. Attributable risk?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Mycoplasma
Phencyclidine hydrochloride (PCP) intoxication


35. Red plaques with silvery- white scales and sharp margins.
Confounding variable
1
Parkinson's disease
Psoriasis


36. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Squamous cell carcinoma
Sulfonamides - antimalarial drugs - fava beans
Factitious disorder (Munchausen syndrome)
Frotteurism (a paraphilia)


37. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


38. Cohort study
Crohn's disease
DM - SLE - and amyloidosis
Incidence and prevalence
Selective IgA deficiency


39. Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Immediate cardioversion
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


40. 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
50 cc/hour
Higher incidence
Coccidioidomycosis. Amphotericin B


41. Symptoms of placental abruption.
Treat existing heart failure and replace the tricuspid valve
Continuous - painful vaginal bleeding
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Vibrio - HAV


42. A significant cause of morbidity in thalassemia patients. Treatment?
? serum FSH
7-10 days
Iron overload; use deferoxamine
Malignancy and hyperparathyroidism


43. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Uterine massage; if that fails - give oxytocin
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Emergent laparotomy to repair perforated viscus - likely stomach


44. The most common causes of hypercalcemia.
Conflict of interest
Malignancy and hyperparathyroidism
Basal cell carcinoma
Conversion disorder


45. Defect in an X- linked syndrome with mental retardation -
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Anorexia
Parainfluenza virus type 1
Lesch - Nyhan syndrome (purine salvage problem with


46. Meningitis in infants. Causes? Treatment?
RSV bronchiolitis
Dantrolene or bromocriptine
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Levodopa/carbidopa


47. The most common cause of hypertension in young women.
OCPs
Excessive EtOH
Displacement
Taenia solium (cysticercosis)


48. True or false: Once patients sign a statement giving consent - they must continue treatment.
Hypoxia and hypocarbia
Dantrolene or bromocriptine
Mycoplasma
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. Inspiratory arrest during palpation of the RUQ.

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


50. The number of true positives divided by the number of patients with the disease is _____.
Calcium oxalate
Sensitivity
Normal
Pentad of TTP