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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. Virchow's triad.
They can mask symptoms of hypoglycemia
DM - SLE - and amyloidosis
Stasis - hypercoagulability - endothelial damage
Colposcopy and endocervical curettage

2. Name the organism:
Wernicke's encephalopathy due to a deficiency of thiamine
Type IV (distal) RTA
Multiple myeloma
Salmonella

3. Tests to rule out shaken baby syndrome.
Ophthalmologic exam - CT - and MRI
Threatened abortion
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs

4. Relative risk?
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Intussusception
All - compartment fasciotomy for suspected compartment syndrome
The IR of a disease in a population exposed to a particular factor

5. Nonpainful chancre.
Nephrotic syndrome
MAOIs
1
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

6. Name the organism:
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
? Ca2+ - ? K- - ? phosphate - ? uric acid
Selective IgA deficiency
Toxoplasma gondii

7. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Metformin
Duodenal atresia
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

8. Name the organism:
Nitroprusside
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Coccidioidomycosis. Amphotericin B
Streptococcus pneumoniae

9. Sentinel loop on AXR.
Acute pancreatitis
Wernicke's encephalopathy due to a deficiency of thiamine
Depersonalization disorder
PT

10. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Osteogenesis imperfecta
CML
Hyperkalemia
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

11. Inflammatory disease of the colon with ? risk of colon cancer.
Pemphigus vulgaris
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Ulcerative colitis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

12. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Seborrheic keratosis
HGPRTase deficiency)
Dissociative fugue
Acute myelogenous leukemia (AML)

13. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Immediate needle thoracostomy
Hypertrophic cardiomyopathy
Pseudogout
Treat immediately. Consent is implied in emergency situations

14. Lab values suggestive of menopause.
Asherman's syndrome
Administration of DDAVP ? serum osmolality and free water restriction
? serum FSH
Kl

15. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Nitroprusside
Klebsiella
Fatigue and impending respiratory failure
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction

16. Combined UMN and LMN disorder.
Patent ductus arteriosus (PDA)
ALS
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Sensitivity

17. First step in the management of a patient with acute GI bleed.
Glanzmann's thrombasthenia
Establish the ABCs
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
MCP and PIP joints; DIP joints are spared

18. Name the organism:
Neither
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
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
Pseudomonas

19. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Ampulla of the oviduct
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Edrophonium
Emergent laparotomy to repair perforated viscus - likely stomach

20. Identify key organisms causing diarrhea:
S. aureus
Asymmetry - border irregularity - color variation - large diameter
Bacillus cereus
Fanconi's anemia

21. HUS triad?
Anemia - thrombocytopenia - and acute renal failure
'Sawtooth' P waves
Weight loss and OCPs
DM - SLE - and amyloidosis

22. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Hypertrophic cardiomyopathy
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Beta- hCG; the most common cause of amenorrhea is pregnancy
Nephrotic syndrome

23. Differential of hypervolemic hyponatremia.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Cirrhosis - CHF - nephritic syndrome
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Consider Fitz - Hugh - Curtis syndrome

24. Criteria for exudative effusion.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Protamine
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
The IR of a disease in a population exposed to a particular factor

25. The most serious side effect of clozapine.
Betamethasone or dexamethasone
Agranulocytosis
Beta- blockers - digoxin - calcium channel blockers
Factitious disorder (Munchausen syndrome)

26. Treatment for acetaminophen overdose.
N- acetylcysteine
Clomiphene citrate
Ultrasound
Stasis - hypercoagulability - endothelial damage

27. The most common cause of hypothyroidism.

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28. Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis
Parainfluenza virus type 1
DM - SLE - and amyloidosis
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

29. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Ulcerative colitis
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
ETEC
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

30. Chromosomal pattern of a complete mole.
Squamous cell carcinoma
Anticoagulation - rate control - cardioversion
46 -XX
Pregnant women. Treat this group aggressively because of potential complications

31. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Acute mania. Start a mood stabilizer (e.g. - lithium)
Hashimoto's thyroiditis
Spinal stenosis
Renal cell carcinoma (RCC)

32. The most common causes of hypercalcemia.
Membranous glomerulonephritis
Suspect retinoblastoma
Mycobacterium tuberculosis
Malignancy and hyperparathyroidism

33. The most common cause of SAH.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Check for ? ICP; look for papilledema
Trichomonas vaginitis
Trauma; the second most common is berry aneurysm

34. CSF findings:
MS
Self - limited - painless vaginal bleeding
Lobular carcinoma in situ
IV benzodiazepine

35. Annual screening for women with a strong family history of ovarian cancer.
Membranous glomerulonephritis
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
46 -XX
CA-125 and transvaginal ultrasound

36. A neonate has meconium ileus.

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37. Treatment for Guillain - Barr
IVIG or plasmapheresis
Wait - surgical resection - radiation and/or androgen suppression
MAOIs
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate

38. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
SCLC
Acne vulgaris
Wernicke's encephalopathy due to a deficiency of thiamine
Treat existing heart failure and replace the tricuspid valve

39. A congenital heart disease that cause 2
Klebsiella
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
? protein intake - lactulose - neomycin
Coarctation of the aorta

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

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41. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
IV penicillin or ampicillin
Pseudogout
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity

42. Classic ECG findings in pericarditis.
SIADH due to stress
Acute myelogenous leukemia (AML)
Higher incidence
Low - voltage - diffuse ST- segment elevation

43. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Self - limited - painless vaginal bleeding
1
Non - Hodgkin's lymphoma

44. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
SSRIs
Surfactant deficiency
HBV immunoglobulin

45. Medications and viruses that ? aplastic anemia.
Calcium oxalate
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Depersonalization disorder
Klebsiella

46. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Substance abuse
Normal
Lesch - Nyhan syndrome (purine salvage problem with
A patient with chest trauma who was previously stable suddenly dies

47. Supportive treatment for ARDS.
Continuous positive airway pressure
Edrophonium
Lesch - Nyhan syndrome (purine salvage problem with
Actinomyces israelii

48. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Panic disorder
Immediate needle thoracostomy
Hypocalcemia
Conduct disorder

49. Ring - enhancing brain lesion on CT with seizures
Osgood - Schlatter disease
Infection - cancer - and autoimmune disease
Immediate needle thoracostomy
Taenia solium (cysticercosis)

50. Autoimmune complication occurring 2-4 weeks post - MI.

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USMLE Step 2

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