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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. Eosinophils in urine sediment.
False. Withdrawing and withholding life are the same from an ethical standpoint
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
Allergic interstitial nephritis
Polymyalgia rheumatica

2. Treatment of central DI.
Pseudomonas
Dissociative fugue
Administration of DDAVP ? serum osmolality and free water restriction
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

3. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Reye's syndrome
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

4. The three most common causes of fever of unknown origin (FUO).
Membranous glomerulonephritis
IgA nephropathy (Berger's disease)
Infection - cancer - and autoimmune disease
Isolation

5. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
IV hydration and loop diuretics (furosemide)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Suspect retinoblastoma
Administration of DDAVP ? serum osmolality and free water restriction

6. When can a physician refuse to continue treating a patient on the grounds of futility?
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
Angina is new - is worsening - or occurs at rest
Rate control - rhythm conversion - and anticoagulation
Lesch - Nyhan syndrome (purine salvage problem with

7. A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
Murphy's sign - seen in acute cholecystitis
Consider Fitz - Hugh - Curtis syndrome
Self - limited - painless vaginal bleeding

8. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
a - antagonists (phentolamine and phenoxybenzamine)
Anemia of chronic disease
Fatigue and impending respiratory failure

9. The most common organism in burn - related infections.
Acute pancreatitis
Cellulitis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Pseudomonas

10. Presence of red cell casts in urine sediment.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Streptococcus pneumoniae
Aseptic (viral) meningitis
Glomerulonephritis/nephritic syndrome

11. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Salmonella
Seborrheic dermatitis. Treat with antifungals
Lichen planus
Alopecia areata (autoimmune process)

12. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Small cell lung cancer (SCLC)
Anemia of chronic disease
Parkland formula
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

13. Treatment for Guillain - Barr
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
IVIG or plasmapheresis
Wernicke's encephalopathy due to a deficiency of thiamine
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms

14. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Neurofibromatosis 1
Patent ductus arteriosus (PDA)
CML
Type IV (distal) RTA

15. First - line medication for status epilepticus.
IV benzodiazepine
Hypoparathyroidism
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Nephritic syndrome

16. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
Partial mole
Fluids and antibiotics
Lyme disease - Ixodes tick - doxycycline
Salmonella

17. Describe a test that consistently gives identical results - but the results are wrong.
Observational bias
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
High reliability - low validity
Varicella zoster

18. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
M3
Biliary tract obstruction
Lesions of 1
Duchenne muscular dystrophy

19. Glomerulonephritis with hemoptysis.

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20. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Highly sensitive for TB
Pseudogout
Nitroprusside
Phencyclidine hydrochloride (PCP) intoxication

21. Identify key organisms causing diarrhea:
Elevated ICP - RBCs - xanthochromia
False. Withdrawing and withholding life are the same from an ethical standpoint
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

22. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
68% - 95.5% - 99.7%
Iron overload; use deferoxamine
Substance abuse
All - compartment fasciotomy for suspected compartment syndrome

23. Cold agglutinins.
Pregnant women. Treat this group aggressively because of potential complications
Graves' disease
Mycoplasma
IV benzodiazepine

24. Annual screening for women with a strong family history of ovarian cancer.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
CA-125 and transvaginal ultrasound
ALS
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

25. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
V/Q scan
Rate control with carotid massasge or other vagal stimulation
a - antagonists (phentolamine and phenoxybenzamine)
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

26. Cannon 'a' waves.
Third - degree heart block
Diphenhydramine or epinephrine 1:1000
Salmonella
Nephrotic syndrome

27. AML subtype associated with DIC.
M3
OCPs - danazol - GnRH agonists
Anemia - thrombocytopenia - and acute renal failure
Colposcopy and endocervical curettage

28. Treatment of hypovolemic shock.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Depersonalization disorder
Identify cause; fluid and blood repletion
Exercise stress treadmill with ECG

29. Testicular cancer associated with Beta- hCG - AFP.
Seborrheic keratosis
OCPs - danazol - GnRH agonists
DM - SLE - and amyloidosis
Choriocarcinoma

30. Which healthy population is susceptible to UTIs?
Surfactant deficiency
Spinal stenosis
Mallory- Weiss
Pregnant women. Treat this group aggressively because of potential complications

31. CSF findings:
S. aureus
Bacterial meningitis
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Type I (distal) RTA

32. Treatment for postpartum hemorrhage.
Establish the ABCs
Uterine massage; if that fails - give oxytocin
Alopecia areata (autoimmune process)
Rate control - rhythm conversion - and anticoagulation

33. Peaked T waves and widened QRS.
High reliability - low validity
Hyperkalemia
Diverticulosis
Third - degree heart block

34. Epidemics such as influenza
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
Patent ductus arteriosus (PDA)
Giardia
Higher incidence

35. A woman who was abused as a child frequently feels outside of or detached from her body.
Number of deaths from birth to 28 days per 1000 live births
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
Aseptic (viral) meningitis
Depersonalization disorder

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

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37. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
Uremic syndrome seen in patients with renal failure
IgA nephropathy (Berger's disease)
Acute mania. Start a mood stabilizer (e.g. - lithium)

38. Name the defense mechanism:
Isolation
Number of deaths from 28 days to one year per 1000 live births
Pemphigus vulgaris
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

39. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Malingering
Lesion of 1
Phencyclidine hydrochloride (PCP) intoxication
Type I (distal) RTA

40. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Nitroprusside
O2 - analgesia - hydration - and - if severe - transfusion
Number of deaths from birth to 28 days per 1000 live births
Cellulitis

41. A fall in systolic BP of > 10 mmHg with inspiration.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
HBV immunoglobulin
Subarachnoid hemorrhage (SAH)
Pulsus paradoxus (seen in cardiac tamponade)

42. Shortest AP diameter of the pelvis.
Hypoparathyroidism
Sheehan's syndrome (postpartum pituitary necrosis)
Signs and symptoms of hypercalcemia
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

43. Treatment for benzodiazepine overdose.
Asherman's syndrome
Partial mole
Flumazenil
False. Withdrawing and withholding life are the same from an ethical standpoint

44. Inflammatory disease of the colon with ? risk of colon cancer.
Biliary tract obstruction
Beta- blockers - Ca2+ channel blockers - TCAs
Ulcerative colitis
Spinal stenosis

45. Defect in an X- linked syndrome with mental retardation -
Seborrheic keratosis
Lesch - Nyhan syndrome (purine salvage problem with
Campylobacter
Infection - cancer - and autoimmune disease

46. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Amoxicillin
Pityriasis rosea
Observational bias
Beta- hCG; the most common cause of amenorrhea is pregnancy

47. Rigidity and stiffness with resting tremor and masked facies.

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48. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Reaction formation
Cardiogenic shock

49. Classic ECG finding in atrial flutter.

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50. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Beta- blockers - Ca2+ channel blockers - TCAs
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Pseudomonas

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USMLE Step 2

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