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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. Signs of active ischemia during stress testing.
Fluids and antibiotics
Sensitivity
Actinomyces israelii
Angina - ST- segment changes on ECG - or ? BP

2. 'Stuck - on' appearance.
Renal cell carcinoma (RCC)
Seborrheic keratosis
Trauma - alcohol withdrawal - brain tumor
Continuous - painful vaginal bleeding

3. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
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
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
A patient's family cannot require that a doctor withhold information from the patient
S. aureus or S. epidermidis.

4. Side effects of corticosteroids.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Klebsiella

5. Identify key organisms causing diarrhea:
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Conduct disorder
Clostridium difficile

6. Causes of exudative effusion.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Menometrorrhagia
Folate deficiency

7. Virchow's triad.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Streptococcus pneumoniae
Stasis - hypercoagulability - endothelial damage
Oral surgery

8. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Fluids and antibiotics
Broca's aphasia. Frontal lobe - left MCA distribution
Seborrheic keratosis
Basal cell carcinoma

9. Fertility rate?
Number of live births per 1000 women 15-44 years of age
Kegel exercises - estrogen - pessaries for stress incontinence
Intussusception
PT

10. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Endometriosis
Iron deficiency anemia
Ultrasound

11. Trauma series.
Pseudomonas
ALS
AP chest - AP/lateral C- spine - AP pelvis
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured

12. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Phencyclidine hydrochloride (PCP) intoxication

13. Name the organism:
Haemophilus ducreyi
Reye's syndrome
Squamous cell carcinoma
They can mask symptoms of hypoglycemia

14. Signs suggesting radial nerve damage with humeral fracture.
Hodgkin's lymphoma
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Wrist drop - loss of thumb abduction
Duchenne muscular dystrophy

15. Shortest AP diameter of the pelvis.
Nephrotic syndrome
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

16. Lung cancer highly related to cigarette exposure.
OCPs
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
SCLC
Clostridium difficile

17. Treatment for opioid overdose.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Naloxone
TICS
Ulcerative colitis

18. Meningitis in infants. Causes? Treatment?
Kwashiorkor (protein malnutrition)
Parkinson's disease
Conduct disorder
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

19. The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Subdural hematoma
V/Q scan

20. First step in the management of a patient with acute GI bleed.
Establish the ABCs
Inhaled Beta- agonists and inhaled corticosteroids
Pheochromocytoma
Femoral hernia

21. Low urine specific gravity in the presence of high serum osmolality.
DI
Alzheimer's and multi - infarct
Renal cell carcinoma (RCC)
Pasteurella multocida

22. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
The IR of a disease in a population exposed to a particular factor
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Lesch - Nyhan syndrome (purine salvage problem with

23. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
Membranous glomerulonephritis
Headache
Lesch - Nyhan syndrome (purine salvage problem with

24. 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)
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Edrophonium
Hypotension - distant heart sounds - and JVD

25. CSF findings with SAH.
Choriocarcinoma
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Elevated ICP - RBCs - xanthochromia
Phencyclidine hydrochloride (PCP) intoxication

26. Not contraindications to vaccination.
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Paget's disease
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Ulcerative colitis

27. The most common causes of dementia.

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28. Medications and viruses that ? aplastic anemia.
Oral or topical metronidazole
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Klebsiella
Emergent laparotomy to repair perforated viscus - likely stomach

29. Unopposed estrogen is contraindicated in which cancers?
Immediate needle thoracostomy
Osteogenesis imperfecta
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
Endometrial or estrogen receptor - breast cancer

30. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Alopecia areata (autoimmune process)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Septic or anaphylactic shock
No. Parental consent is not necessary for the medical treatment of pregnant minors

31. Identify key organisms causing diarrhea:
Beta- hCG; the most common cause of amenorrhea is pregnancy
E. coli O157:H7
Acute pancreatitis
Identify cause; pressors (e.g. - dobutamine)

32. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Hypernatremia
Allergic interstitial nephritis
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

33. Drugs that slow AV node transmission.
Infection - febrile seizures - trauma - idiopathic
Beta- blockers - digoxin - calcium channel blockers
Squamous cell carcinoma
Diverticulosis

34. Four causes of microcytic anemia.
Placental abruption and placenta previa
RSV bronchiolitis
TICS
Abdominal ultrasound and CT

35. The mainstay of Parkinson's therapy.
O2 - analgesia - hydration - and - if severe - transfusion
Intraductal papilloma
Flumazenil
Levodopa/carbidopa

36. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Chronic granulomatous disease
Neuroleptics
Number of deaths from 28 days to one year per 1000 live births
Hodgkin's lymphoma

37. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Varicella zoster
Higher prevalence
Prinzmetal's angina

38. Prophylactic treatment for migraine.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Beta- blockers - Ca2+ channel blockers - TCAs
OCP and barrier contraception

39. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
Rett's disorder
Prinzmetal's angina
Beta- blockers - digoxin - calcium channel blockers

40. The most common cause of SAH.
Trauma; the second most common is berry aneurysm
Malignancy and hyperparathyroidism
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Factitious disorder (Munchausen syndrome)

41. CSF findings:
Aseptic (viral) meningitis
a - antagonists (phentolamine and phenoxybenzamine)
Asymmetry - border irregularity - color variation - large diameter
7-10 days

42. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Rett's disorder
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

43. Lung cancer associated with SIADH.
Identify cause; pressors (e.g. - dobutamine)
No. Parental consent is not necessary for the medical treatment of pregnant minors
SSRIs
Small cell lung cancer (SCLC)

44. The most common cause of postpartum hemorrhage.
Uterine atony
Isolation
Incidence and prevalence
Hereditary spherocytosis

45. A significant cause of morbidity in thalassemia patients. Treatment?
Check for ? ICP; look for papilledema
Factitious disorder (Munchausen syndrome)
Iron overload; use deferoxamine
Choriocarcinoma

46. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Hypoparathyroidism
Emergent laparotomy to repair perforated viscus - likely stomach
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

47. Inspiratory arrest during palpation of the RUQ.

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48. Confusion - confabulation - ophthalmoplegia - ataxia.

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49. Antibiotics with teratogenic effects.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Phototherapy (mild) or exchange transfusion (severe)
N- acetylcysteine
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

50. Electrolyte changes in tumor lysis syndrome.
Normal
Hypertrophic cardiomyopathy
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
? Ca2+ - ? K- - ? phosphate - ? uric acid