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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. An antidiabetic agent associated with lactic acidosis.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Metformin
1
B12 deficiency

2. Name the defense mechanism:
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Small cell lung cancer (SCLC)
50 cc/hour
Regression

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?
Broca's aphasia. Frontal lobe - left MCA distribution
Weight loss and OCPs
Dissociative fugue
Normal

4. Treatment of septic shock.
Fluids and antibiotics
OCP and barrier contraception
Klebsiella
Number of deaths per 1000 population

5. The three most common causes of fever of unknown origin (FUO).
Inevitable abortion
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Infection - cancer - and autoimmune 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

6. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Dressler's syndrome: fever - pericarditis - ? ESR
Lichen sclerosus
Malingering
Glanzmann's thrombasthenia

7. Bone is fractured in fall on outstretched hand.

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8. Treatment for Guillain - Barr
Rate control with carotid massasge or other vagal stimulation
Bruton's X- linked agammaglobulinemia
? Ca2+ - ? K- - ? phosphate - ? uric acid
IVIG or plasmapheresis

9. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Seborrheic keratosis
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Contact dermatitis
a - antagonists (phentolamine and phenoxybenzamine)

10. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Sarcoidosis
Actinic keratosis
Bladder rupture or urethral injury

11. Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
Squamous cell carcinoma
Campylobacter
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

12. Treatment of anaphylactic shock.
50 cc/hour
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Cellulitis
Diphenhydramine or epinephrine 1:1000

13. Eight surgically correctable causes of hypertension.

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14. Testicular cancer associated with Beta- hCG - AFP.
Neuroblastoma
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Choriocarcinoma
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels

15. 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
Angina - ST- segment changes on ECG - or ? BP
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

16. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Patient on dopamine antagonist
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

17. Name the organism:
Hypovolemic shock
Seminoma
Beta- hCG; the most common cause of amenorrhea is pregnancy
Neisseria meningitidis

18. Odds ratio?
Osteogenesis imperfecta
1
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
SCLC

19. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Type IV (distal) RTA
Fatigue and impending respiratory failure
Hypoxia and hypocarbia
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

20. Perinatal mortality?

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21. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus - likely stomach
Hashimoto's thyroiditis
Klebsiella
Angina - ST- segment changes on ECG - or ? BP

22. First - line medication for status epilepticus.
Clomiphene citrate
IV benzodiazepine
Establish the ABCs
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction

23. The most common 1
Osgood - Schlatter disease
Agranulocytosis
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Lung - breast - skin (melanoma) - kidney - GI tract

24. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Mycoplasma
Squamous cell carcinoma
Number of live births per 1000 women 15-44 years of age
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

25. Acid - base disturbance commonly seen in pregnant women.
Hypoxia and hypocarbia
Respiratory alkalosis
Lyme disease - Ixodes tick - doxycycline
Sensitivity

26. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Suspect ankylosing spondylitis. Check HLA- B27
SIADH due to stress
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

27. Type of ARF in a patient with FeNa < 1%.
Prerenal
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
OCPs - danazol - GnRH agonists
Depersonalization disorder

28. CSF findings:
MS
Panic disorder
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Normal

29. Identify key organisms causing diarrhea:
Amoxicillin
Hypertension - bradycardia - and abnormal respirations
Vibrio - HAV
ETEC

30. When should a vaginal exam be performed with suspected placenta previa?
Parvovirus B19
Oral surgery
Never
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

31. Causes of transudative effusion.
Check for ? ICP; look for papilledema
Lung - breast - skin (melanoma) - kidney - GI tract
Prerenal
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

32. Causes of hypoxemia.
Distal radius (Colles' fracture)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

33. Neutropenic nadir postchemotherapy.
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
7-10 days
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
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

34. Definition of unstable angina.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Angina is new - is worsening - or occurs at rest
Endometriosis
Restrictive pulmonary disease

35. Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Levodopa/carbidopa
68% - 95.5% - 99.7%

36. Indications for surgical repair of abdominal aortic aneurysm.
Angina - ST- segment changes on ECG - or ? BP
Pharmacologic stress test (e.g. - dobutamine echo)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Niacin

37. 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.
Precocious puberty
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Trauma - alcohol withdrawal - brain tumor

38. Chromosomal pattern of a complete mole.
46 -XX
Neuroleptics
? Ca2+ - ? K- - ? phosphate - ? uric acid
Weight loss and OCPs

39. The most common pathogen causing croup.
Beta- blockers - digoxin - calcium channel blockers
Streptococcus pneumoniae
Parainfluenza virus type 1
Giardia

40. Treatment for malignant hypertension.
Actinomyces israelii
Colposcopy and endocervical curettage
Nitroprusside
Femoral hernia

41. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Choriocarcinoma
False. Withdrawing and withholding life are the same from an ethical standpoint
Hypotension - distant heart sounds - and JVD
Betamethasone or dexamethasone

42. Identify key organisms causing diarrhea:
They can mask symptoms of hypoglycemia
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Giardia
Hypoxia and hypocarbia

43. CSF findings with SAH.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Hashimoto's thyroiditis
Elevated ICP - RBCs - xanthochromia
AP chest - AP/lateral C- spine - AP pelvis

44. Symptoms of placental abruption.
Toxoplasma gondii
Continuous - painful vaginal bleeding
S. aureus or S. epidermidis.
Distal radius (Colles' fracture)

45. The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Continuous - painful vaginal bleeding
Neither
Malingering

46. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Anticoagulation - rate control - cardioversion
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Observational bias
Pasteurella multocida

47. Causes of exudative effusion.
Contact dermatitis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Hodgkin's lymphoma
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

48. Administer to a symptomatic patient to diagnose myasthenia gravis.
Chronic lymphocytic leukemia (CLL)
B12 deficiency
Edrophonium
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

49. Epidemics such as influenza
Higher incidence
Infection - cancer - and autoimmune disease
Hashimoto's thyroiditis
Neurofibromatosis 1

50. A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
Malignancy and hyperparathyroidism
Glanzmann's thrombasthenia
Parkinson's disease