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USMLE Step 2

Subjects : health-sciences, usmle-step-2

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Type of ARF in a patient with FeNa < 1%.
Uterine massage; if that fails - give oxytocin
Prerenal
Phencyclidine hydrochloride (PCP) intoxication
Excessive EtOH

2. Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis
They can mask symptoms of hypoglycemia
Subdural hematoma
Nephrotic syndrome

3. The most serious side effect of clozapine.
Edrophonium
Avascular necrosis
Agranulocytosis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

4. Macrocytic - megaloblastic anemia with neurologic symptoms.
Conduct disorder
B12 deficiency
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
Out

5. The most common inherited cause of hypercoagulability.
Femoral hernia
Factor V Leiden mutation
Spinal stenosis
Number of live births per 1000 population

6. Four signs and symptoms of streptococcal pharyngitis.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Fatigue and impending respiratory failure

7. A crescent - shaped hyperdensity on CT that does not cross the midline.
Number of live births per 1000 women 15-44 years of age
Oral surgery
Cellulitis
Subdural hematoma

8. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA- B27
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
Impetigo
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

9. HUS triad?
Uterine atony
Selective IgA deficiency
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Anemia - thrombocytopenia - and acute renal failure

10. First - line medication for status epilepticus.
IV benzodiazepine
Haemophilus ducreyi
Fluid restriction - demeclocycline
Trichomonas vaginitis

11. Identify key organisms causing diarrhea:
Actinic keratosis
Trauma; the second most common is berry aneurysm
ETEC
Lead - time bias

12. The number of true positives divided by the number of patients with the disease is _____.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Duchenne muscular dystrophy
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Sensitivity

13. How to diagnose and follow a leiomyoma.
Endometrial or estrogen receptor - breast cancer
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Ultrasound

14. When can a physician refuse to continue treating a patient on the grounds of futility?
Yersinia
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
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
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)

15. Classic CXR findings for pulmonary edema.

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16. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Coccidioidomycosis. Amphotericin B
Chronic lymphocytic leukemia (CLL)
Anorexia
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

17. A patient fails to lactate after an emergency C- section with marked blood loss.

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18. The most common cause of female infertility.
Pharmacologic stress test (e.g. - dobutamine echo)
Pregnant women. Treat this group aggressively because of potential complications
Stasis - hypercoagulability - endothelial damage
Endometriosis

19. Test to rule out urethral injury.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
S. aureus
Retrograde cystourethrogram
Parainfluenza virus type 1

20. Key side effects of atypical antipsychotics.
MS
Weight gain - type 2 DM - QT prolongation
Rate control with carotid massasge or other vagal stimulation
ARDS

21. Treatment for ventricular fibrillation.
Oral surgery
Immediate cardioversion
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Seborrheic dermatitis. Treat with antifungals

22. Term for heavy bleeding during and between menstrual periods.
Type II (proximal) RTA
Menometrorrhagia
Prerenal
S. aureus

23. The most common form of glomerulonephritis.

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24. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Nephrotic syndrome
Pseudogout
Acute pancreatitis

25. Joints in the hand affected in rheumatoid arthritis.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
MCP and PIP joints; DIP joints are spared
Duodenal atresia
Herpes simplex

26. Criteria for exudative effusion.
Avascular necrosis
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Neuroleptics
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

27. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Neuroleptic malignant syndrome
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

28. Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
Number of live births per 1000 women 15-44 years of age
HBV - DTaP - Hib - IPV - PCV
Hypoparathyroidism

29. Antihypertensive for a diabetic patient with proteinuria.
Glanzmann's thrombasthenia
Ophthalmologic exam - CT - and MRI
Septic or anaphylactic shock
ACEI

30. Tanner stage 3 in a six-year - old female.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Precocious puberty
MS
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

31. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
68% - 95.5% - 99.7%
Angina - ST- segment changes on ECG - or ? BP
Bruton's X- linked agammaglobulinemia

32. A 49-year - old male presents with acute - onset flank pain and hematuria.
Obstructive pulmonary disease (e.g. - asthma)
Nephrolithiasis
CHF - shock - and altered mental status
Hypertension - bradycardia - and abnormal respirations

33. Name the organism:
Herpes simplex
Crohn's disease
Neisseria meningitidis
Taenia solium (cysticercosis)

34. RTA associated with aldosterone defect.
Pseudomonas
Clostridium difficile
Type IV (distal) RTA
Antipsychotics (neuroleptic malignant syndrome)

35. Endocarditis prophylaxis regimens.
ALS
ETEC
Oral surgery
Nephritic syndrome

36. Presents with a herald patch - Christmas - tree pattern.
O2 - analgesia - hydration - and - if severe - transfusion
Malignancy and hyperparathyroidism
Yersinia
Pityriasis rosea

37. Medication used to induce ovulation.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Clomiphene citrate
Sensitivity
Intraductal papilloma

38. Treatment for Guillain - Barr
Avascular necrosis
Wrist drop - loss of thumb abduction
IVIG or plasmapheresis
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

39. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
Partial mole
Treat existing heart failure and replace the tricuspid valve
Parkland formula

40. Virus associated with aplastic anemia in patients with sickle cell anemia.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Patient on dopamine antagonist
Excessive EtOH
Parvovirus B19

41. Treatment of DKA.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Klebsiella
Crohn's disease

42. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Rett's disorder
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Cerebral berry aneurysms (AD PCKD)
Confounding variable

43. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Septic or anaphylactic shock
Streptococcus pneumoniae
CML
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

44. Identify key organisms causing diarrhea:
Biliary tract obstruction
Campylobacter
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Mallory- Weiss

45. An antidiabetic agent associated with lactic acidosis.
Lichen planus
Continuous - painful vaginal bleeding
Metformin
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)

46. Medications and viruses that ? aplastic anemia.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Contact dermatitis
Number of deaths from 28 days to one year per 1000 live births

47. + Nikolsky's sign.
Protamine
Hypovolemic shock
Pemphigus vulgaris
Rubella

48. Low urine specific gravity in the presence of high serum osmolality.
Streptococcus pneumoniae
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
DI
Endometriosis

49. Antidepressants associated with hypertensive crisis.
MAOIs
< 7.0
Incidence and prevalence
Streptococcus pneumoniae

50. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Parvovirus B19
Lobular carcinoma in situ
Chronic lymphocytic leukemia (CLL)
Klebsiella

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USMLE Step 2

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