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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. Gout - self - mutilation - and choreoathetosis.
HGPRTase deficiency)
50 cc/hour
RSV bronchiolitis
Excessive EtOH

2. RTA associated with aldosterone defect.
Type IV (distal) RTA
Suspect retinoblastoma
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate

3. Case - control study
CF or Hirschsprung's disease
Asherman's syndrome
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Neither

4. What is the immunodeficiency?
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Chronic granulomatous disease
Headache
Multiple myeloma

5. The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Regresses after menopause
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Impetigo

6. 'Stuck - on' appearance.
Seborrheic keratosis
Folate deficiency
Pseudomonas
S. aureus or S. epidermidis.

7. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Beta- blockers - Ca2+ channel blockers - TCAs
Osteoarthritis
Allergic interstitial nephritis

8. Definition of hypertension.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Conversion disorder
BP > 140/90 on three separate occasions two weeks apart
Pheochromocytoma

9. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Abdominal ultrasound and CT
IV penicillin or ampicillin
'Sawtooth' P waves
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

10. ? CO - ? PCWP - ? PVR.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Naloxone
Endometriosis
Cardiogenic shock

11. Cross - sectional survey
Prevalence
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Weight gain - type 2 DM - QT prolongation
Anticoagulation - rate control - cardioversion

12. Lung cancer associated with SIADH.
Varicella zoster
Contact dermatitis
Small cell lung cancer (SCLC)
Subarachnoid hemorrhage (SAH)

13. Identify key organisms causing diarrhea:
Lung - breast - skin (melanoma) - kidney - GI tract
Giardia
Treat immediately. Consent is implied in emergency situations
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

14. Name the defense mechanism:
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Colposcopy and endocervical curettage
Antipsychotics (neuroleptic malignant syndrome)
Reaction formation

15. The most common type of testicular cancer.
Seminoma
Absence seizures
Asymmetry - border irregularity - color variation - large diameter
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

16. The most common cause of Cushing's syndrome.

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17. Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
IV benzodiazepine
Legionella pneumonia
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

18. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Kwashiorkor (protein malnutrition)
ARDS
Identify cause; fluid and blood repletion

19. Identify key organisms causing diarrhea:
Yersinia
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Oral or topical metronidazole
Nephrolithiasis

20. Symptoms of placental abruption.
AP chest - AP/lateral C- spine - AP pelvis
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Continuous - painful vaginal bleeding
N- acetylcysteine

21. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
No. Parental consent is not necessary for the medical treatment of pregnant minors
OCPs
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

22. Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Anemia - thrombocytopenia - and acute renal failure
Ampulla of the oviduct
Treat existing heart failure and replace the tricuspid valve

23. Sensitive tests have few false negatives and are used to rule _____ a disease.
Administration of DDAVP ? serum osmolality and free water restriction
Fluids and antibiotics
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Out

24. The most common location for an ectopic pregnancy.
Membranous glomerulonephritis
Infection - febrile seizures - trauma - idiopathic
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Ampulla of the oviduct

25. How to distinguish polycythemia vera from 2
Bullous pemphigoid
Uterine atony
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Hereditary spherocytosis

26. A congenital heart disease that cause 2
MCP and PIP joints; DIP joints are spared
ETEC
Coarctation of the aorta
Nephrotic syndrome

27. Signs of neurogenic shock.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Hypotension and bradycardia
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia

28. Neonatal mortality?
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Number of deaths from birth to 28 days per 1000 live births
Erythema multiforme
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

29. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Osmotic fragility test
Radiation
Hypoparathyroidism
Weight gain - type 2 DM - QT prolongation

30. Causes of exudative effusion.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Kl
Neisseria meningitidis

31. Treatment for mild and severe unconjugated hyperbilirubinemia.
Guillain - Barr
Phototherapy (mild) or exchange transfusion (severe)
Anticoagulation - rate control - cardioversion
Usually resolves spontaneously; may require IVIG and/or corticosteroids

32. Glomerulonephritis with deafness.

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33. Treatment of DKA.
ARDS
1
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births

34. T- wave flattening and U waves.
1
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Suspect retinoblastoma
Hypokalemia

35. Contraceptive methods that protect against PID.
Restrictive pulmonary disease
Kwashiorkor (protein malnutrition)
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
OCP and barrier contraception

36. Honeycomb pattern on CXR. Diagnosis? Treatment?
Restrictive pulmonary disease
Nephrolithiasis
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

37. Hematuria - flank pain - and palpable flank mass.
Asymmetry - border irregularity - color variation - large diameter
Renal cell carcinoma (RCC)
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Kegel exercises - estrogen - pessaries for stress incontinence

38. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Acne vulgaris
Metformin
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

39. Virus associated with aplastic anemia in patients with sickle cell anemia.
INH - penicillamine - hydralazine - procainamide
Fatigue and impending respiratory failure
Actinomyces israelii
Parvovirus B19

40. The most common causes of dementia.

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41. CSF findings:
Incidence and prevalence
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Subarachnoid hemorrhage (SAH)
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

42. Identify key organisms causing diarrhea:
Spinal stenosis
Campylobacter
Nephrolithiasis
Bruton's X- linked agammaglobulinemia

43. 'Doughy skin.'
Hypernatremia
Ulcerative colitis
Allergic interstitial nephritis
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

44. Causes of hypoxemia.
SSRIs
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Guillain - Barr

45. The most serious side effect of clozapine.
Threatened abortion
Agranulocytosis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Transitional cell carcinoma

46. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Incidence and prevalence
Nephrotic syndrome
Hashimoto's thyroiditis
Mycoplasma

47. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Panic disorder
Never
Pseudomonas

48. Blood in the urethral meatus or high - riding prostate.
Inevitable abortion
Bladder rupture or urethral injury
Diamond - Blackfan anemia
Salmonella

49. Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
Agranulocytosis
Nephrogenic diabetes insipidus (DI)
Hypertrophic cardiomyopathy

50. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Selective IgA deficiency
Treat existing heart failure and replace the tricuspid valve
? protein intake - lactulose - neomycin