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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. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Factitious disorder (Munchausen syndrome)
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Protamine

2. Name the defense mechanism:
Regression
Never
Lyme disease - Ixodes tick - doxycycline
Higher prevalence

3. An antidiabetic agent associated with lactic acidosis.
Dantrolene or bromocriptine
Regression
Metformin
Excessive EtOH

4. Sentinel loop on AXR.
Acute pancreatitis
Angina is new - is worsening - or occurs at rest
Trauma; the second most common is berry aneurysm
S. aureus or S. epidermidis.

5. Treatment for opioid overdose.
Naloxone
AP chest - AP/lateral C- spine - AP pelvis
Panic disorder
Cerebral berry aneurysms (AD PCKD)

6. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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7. A neonate has meconium ileus.

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8. Associated with Propionibacterium acnes and changes in androgen levels.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Frotteurism (a paraphilia)
Antipsychotics (neuroleptic malignant syndrome)
Acne vulgaris

9. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Cluster headache
Emergent laparotomy to repair perforated viscus - likely stomach
Incidence and prevalence

10. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
Clostridium difficile
Bruton's X- linked agammaglobulinemia
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms

11. Name the organism:
Acute pancreatitis
Number of deaths from 28 days to one year per 1000 live births
Pasteurella multocida
Cardiogenic shock

12. The most common type of nephrolithiasis.
Calcium oxalate
CML
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Surfactant deficiency

13. 1
Retrograde cystourethrogram
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
INH - penicillamine - hydralazine - procainamide
Placental abruption and placenta previa

14. The most serious side effect of clozapine.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Establish the ABCs
Frotteurism (a paraphilia)
Agranulocytosis

15. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Angina is new - is worsening - or occurs at rest
Endometrial biopsy
Regression

16. Annual screening for women with a strong family history of ovarian cancer.
Pulsus paradoxus (seen in cardiac tamponade)
CA-125 and transvaginal ultrasound
Kwashiorkor (protein malnutrition)
30 cc/hour

17. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
105 bacteria/mL
Small cell lung cancer (SCLC)
Sarcoidosis
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

18. Characteristics of 2

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19. Appropriate diagnostic test?
Wait - surgical resection - radiation and/or androgen suppression
Pharmacologic stress test (e.g. - dobutamine echo)
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Varicella zoster

20. Honeycomb pattern on CXR. Diagnosis? Treatment?
Suspect retinoblastoma
Pharmacologic stress test (e.g. - dobutamine echo)
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

21. Treatment of SIADH?
Mallory- Weiss
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Fluid restriction - demeclocycline
Cerebral berry aneurysms (AD PCKD)

22. Blood in the urethral meatus or high - riding prostate.
Wernicke's encephalopathy due to a deficiency of thiamine
Diverticulosis
Bladder rupture or urethral injury
Wait - surgical resection - radiation and/or androgen suppression

23. Low urine specific gravity in the presence of high serum osmolality.
Conflict of interest
OCPs - danazol - GnRH agonists
DI
High TSH - low T4 - antimicrosomal antibodies

24. CSF findings:
Subarachnoid hemorrhage (SAH)
IV benzodiazepine
Phototherapy (mild) or exchange transfusion (severe)
Glanzmann's thrombasthenia

25. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Out
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Slipped capital femoral epiphyses. AP and frog - leg lateral view

26. Causes of hypoxemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Retinoic acid
Dantrolene or bromocriptine
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

27. Treatment for Guillain - Barr
Phencyclidine hydrochloride (PCP) intoxication
Out
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
IVIG or plasmapheresis

28. Auer rods on blood smear.
Ultrasound
? protein intake - lactulose - neomycin
Acute myelogenous leukemia (AML)
Alport's syndrome

29. Causes of drug - induced SLE.
INH - penicillamine - hydralazine - procainamide
Transitional cell carcinoma
Hypertrophic cardiomyopathy
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

30. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Absence seizures
Yersinia
Wait - surgical resection - radiation and/or androgen suppression

31. An agent that reverses the effects of heparin.
Endometriosis
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Chronic granulomatous disease
Protamine

32. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Asherman's syndrome
S. aureus or S. epidermidis.
Guillain - Barr
Neuroleptic malignant syndrome

33. May be seen in children who are accused of inattention in class and confused with ADHD.
Benzodiazepines
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Absence seizures

34. The mainstay of Parkinson's therapy.
Levodopa/carbidopa
Malingering
Partial mole
All - compartment fasciotomy for suspected compartment syndrome

35. Definition of hypertension.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
BP > 140/90 on three separate occasions two weeks apart
Number of deaths from birth to 28 days per 1000 live births
Niacin

36. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
SCLC
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Weight gain - type 2 DM - QT prolongation

37. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Dantrolene or bromocriptine
HIDA scan
IV penicillin or ampicillin
Transitional cell carcinoma

38. ? CO - ? PCWP - ? PVR.
ALS
Cardiogenic shock
Acne vulgaris
Contact dermatitis

39. Hematuria - flank pain - and palpable flank mass.
INH - penicillamine - hydralazine - procainamide
Renal cell carcinoma (RCC)
Intraductal papilloma
Squamous cell carcinoma

40. The most common form of glomerulonephritis.

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41. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
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
HIDA scan
Panic disorder
Beta- blockers - digoxin - calcium channel blockers

42. Drowsiness - asterixis - nausea - and a pericardial friction rub.
IV benzodiazepine
Iron overload; use deferoxamine
Uremic syndrome seen in patients with renal failure
Cluster headache

43. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Impetigo
Seventy percent if the stenosis is symptomatic
68% - 95.5% - 99.7%
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

44. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Hashimoto's thyroiditis
Hereditary spherocytosis
Squamous cell carcinoma

45. Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Dissociative fugue
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Diamond - Blackfan anemia

46. 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
Conversion disorder
Sporothrix schenckii
Isolation

47. Meningitis in infants. Causes? Treatment?
Factor V Leiden mutation
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
'Chocolate cysts -' powder burns
Beta- blockers - Ca2+ channel blockers - TCAs

48. ECG findings suggesting MI.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Angina is new - is worsening - or occurs at rest
Allergic interstitial nephritis

49. Treatment for SVC syndrome.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Vibrio - HAV
Haemophilus ducreyi
Radiation

50. Treatment for ventricular fibrillation.
Asherman's syndrome
Alport's syndrome
Cirrhosis - CHF - nephritic syndrome
Immediate cardioversion