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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. Test to rule out urethral injury.
Septic or anaphylactic shock
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Retrograde cystourethrogram
Agranulocytosis

2. Cold agglutinins.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Regresses after menopause
Mycoplasma

3. Identify key organisms causing diarrhea:
CHF - shock - and altered mental status
? protein intake - lactulose - neomycin
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Yersinia

4. Epidemics such as influenza
Higher incidence
Rate control - rhythm conversion - and anticoagulation
Huntington's disease
Administration of DDAVP ? serum osmolality and free water restriction

5. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Osmotic fragility test
Subdural hematoma
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

6. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Conduct disorder
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
30 cc/hour

7. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Beta- blockers - Ca2+ channel blockers - TCAs
SCLC
Endometriosis

8. How to distinguish polycythemia vera from 2
Uremic syndrome seen in patients with renal failure
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Pityriasis versicolor

9. Name the organism:
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Establish the ABCs
Neisseria meningitidis
'Sawtooth' P waves

10. Laparoscopic findings in endometriosis.

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11. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Neuroleptic malignant syndrome
Chronic lymphocytic leukemia (CLL)
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Highly sensitive for TB

12. CSF findings:
Surfactant deficiency
Aseptic (viral) meningitis
Septic or anaphylactic shock
Conduct disorder

13. The most common histology of bladder cancer.
Transitional cell carcinoma
Cirrhosis - CHF - nephritic syndrome
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Erythema multiforme

14. Three systemic diseases ? nephrotic syndrome.
Ophthalmologic exam - CT - and MRI
DM - SLE - and amyloidosis
Diamond - Blackfan anemia
Out

15. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
Cardiogenic shock
Diverticulosis
Slipped capital femoral epiphyses. AP and frog - leg lateral view

16. The most common form of nephritic syndrome.
Membranous glomerulonephritis
Antipsychotics (neuroleptic malignant syndrome)
Ophthalmologic exam - CT - and MRI
Alzheimer's and multi - infarct

17. Name the organism:
Clomiphene citrate
Klebsiella
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
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

18. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Suspect ankylosing spondylitis. Check HLA- B27
Diamond - Blackfan anemia
Endometrial biopsy
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

19. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Endometrial biopsy
Neisseria meningitidis
Hyperkalemia
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.

20. Ring - enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Dantrolene or bromocriptine
CA-125 and transvaginal ultrasound
Uterine atony

21. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
E. coli O157:H7
Nephrotic syndrome
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

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

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23. Presents with a herald patch - Christmas - tree pattern.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Pityriasis rosea
? protein intake - lactulose - neomycin
Conflict of interest

24. Name the organism:
Campylobacter
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Pseudomonas
Exercise stress treadmill with ECG

25. A 'blueberry muffin' rash is characteristic of what congenital infection?
Higher prevalence
Rubella
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
ETEC

26. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Fluids and antibiotics
Confounding variable
SCLC
Klebsiella

27. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Radiation
Agranulocytosis

28. Classic CXR findings for pulmonary edema.

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29. Macrocytic - megaloblastic anemia without neurologic symptoms.
IgA nephropathy (Berger's disease)
Folate deficiency
Bruton's X- linked agammaglobulinemia
Lichen sclerosus

30. Tanner stage 3 in a six-year - old female.
OCPs
Precocious puberty
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

31. First step in the management of a patient with acute GI bleed.
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
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
CML
Establish the ABCs

32. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
Broca's aphasia. Frontal lobe - left MCA distribution
Erythema multiforme
Huntington's disease

33. Nonpainful chancre.
Neuroleptic malignant syndrome
1
Reaction formation
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

34. The most common cause of seizures in young adults (18-35 years).
Phototherapy (mild) or exchange transfusion (severe)
Trauma - alcohol withdrawal - brain tumor
AP chest - AP/lateral C- spine - AP pelvis
RCC or other erythropoietin - producing tumor; evaluate with CT scan

35. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Confounding variable
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
50 cc/hour

36. The most common cause of postpartum hemorrhage.
Flumazenil
Seventy percent if the stenosis is symptomatic
Uterine atony
Parvovirus B19

37. Describe a test that consistently gives identical results - but the results are wrong.
IVIG or plasmapheresis
High reliability - low validity
Seventy percent if the stenosis is symptomatic
Endometrial biopsy

38. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Type IV (distal) RTA
Duodenal atresia
Broca's aphasia. Frontal lobe - left MCA distribution
Febrile seizures (roseola infantum)

39. A patient presents with recent PID with RUQ pain.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Consider Fitz - Hugh - Curtis syndrome
MS
Nephrogenic diabetes insipidus (DI)

40. Treatment for malignant hypertension.
Nitroprusside
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Conduct disorder
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

41. A neonate has meconium ileus.

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42. Maternal mortality?
Isolation
Anemia of chronic disease
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Retinoic acid

43. Vaccinations at a six- month well - child visit.
Allergic interstitial nephritis
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
HBV - DTaP - Hib - IPV - PCV
BP > 140/90 on three separate occasions two weeks apart

44. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Polymyalgia rheumatica
Postinfectious glomerulonephritis
Lobular carcinoma in situ
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

45. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
ETEC
Coccidioidomycosis. Amphotericin B
Asherman's syndrome
Retinoic acid

46. A 49-year - old male presents with acute - onset flank pain and hematuria.
Continuous positive airway pressure
Nephrolithiasis
Malignancy and hyperparathyroidism
Anorexia

47. Definition of unstable angina.
Prinzmetal's angina
Uremic syndrome seen in patients with renal failure
HIDA scan
Angina is new - is worsening - or occurs at rest

48. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Immediate cardioversion
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
The IR of a disease in a population exposed to a particular factor
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

49. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Acne vulgaris
SIADH due to stress
Regression
Klebsiella

50. CSF findings:
MS
Wrist drop - loss of thumb abduction
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Conversion disorder