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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. 'Dewdrop on a rose petal.'
Lesions of 1
Higher prevalence
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Exercise stress treadmill with ECG

2. CSF findings with SAH.
Elevated ICP - RBCs - xanthochromia
Broca's aphasia. Frontal lobe - left MCA distribution
Actinomyces israelii
Radiation

3. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Ulcerative colitis
Biliary tract obstruction
Lichen planus
Number of deaths from 28 days to one year per 1000 live births

4. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
They can mask symptoms of hypoglycemia
Pseudomonas
Varicella zoster

5. + Nikolsky's sign.
Pemphigus vulgaris
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
Continuous positive airway pressure
Contact dermatitis

6. Signs of air embolism.
Conflict of interest
Pregnant women. Treat this group aggressively because of potential complications
Lung - breast - skin (melanoma) - kidney - GI tract
A patient with chest trauma who was previously stable suddenly dies

7. Inflammatory disease of the colon with ? risk of colon cancer.
Ulcerative colitis
a - antagonists (phentolamine and phenoxybenzamine)
Intraductal papilloma
Allergic interstitial nephritis

8. Albuminocytologic dissociation.
Avascular necrosis
OCPs
Guillain - Barr
Bacterial meningitis

9. Characteristics of 2

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10. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Cerebral berry aneurysms (AD PCKD)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
? Ca2+ - ? K- - ? phosphate - ? uric acid

11. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Chronic lymphocytic leukemia (CLL)
Continuous positive airway pressure
Transitional cell carcinoma
Factitious disorder (Munchausen syndrome)

12. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Kegel exercises - estrogen - pessaries for stress incontinence
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Exercise stress treadmill with ECG

13. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Hypoparathyroidism
INH - penicillamine - hydralazine - procainamide
HGPRTase deficiency)

14. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Coccidioidomycosis. Amphotericin B
Lyme disease - Ixodes tick - doxycycline
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

15. Tanner stage 3 in a six-year - old female.
Placental abruption and placenta previa
Rate control with carotid massasge or other vagal stimulation
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Precocious puberty

16. 1
Placental abruption and placenta previa
Nephrolithiasis
Intraductal papilloma
Coarctation of the aorta

17. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
Intussusception
Neisseria meningitidis
Threatened abortion

18. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Out
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Absence seizures
1

19. Appropriate diagnostic test?
Pharmacologic stress test (e.g. - dobutamine echo)
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Continuous - painful vaginal bleeding
IV benzodiazepine

20. Name the organism:
Sporothrix schenckii
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
ETEC

21. A fall in systolic BP of > 10 mmHg with inspiration.
1
Pulsus paradoxus (seen in cardiac tamponade)
Niacin
Antipsychotics (neuroleptic malignant syndrome)

22. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
HBV - DTaP - Hib - IPV - PCV
Rate control with carotid massasge or other vagal stimulation
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)

23. Treatment of central DI.
Administration of DDAVP ? serum osmolality and free water restriction
Angina - ST- segment changes on ECG - or ? BP
Type IV (distal) RTA
ETEC

24. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Herpes simplex
Diphenhydramine or epinephrine 1:1000
Cardiogenic shock
Central pontine myelinolysis

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

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26. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Neurofibromatosis 1
Pulsus paradoxus (seen in cardiac tamponade)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Iron overload; use deferoxamine

27. A doctor refers a patient for an MRI at a facility he/she owns.
Selective IgA deficiency
Conflict of interest
Pseudomonas
7-10 days

28. Definition of unstable angina.
Intraductal papilloma
Bruton's X- linked agammaglobulinemia
Pheochromocytoma
Angina is new - is worsening - or occurs at rest

29. Acid - base disturbance commonly seen in pregnant women.
Impetigo
Respiratory alkalosis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
IVIG or plasmapheresis

30. Classic ECG findings in pericarditis.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Dantrolene or bromocriptine
Frotteurism (a paraphilia)
Low - voltage - diffuse ST- segment elevation

31. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
CML
Never
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

32. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Endometrial or estrogen receptor - breast cancer
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Patient on dopamine antagonist
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)

33. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Malignancy and hyperparathyroidism
Retinoic acid
Parkinson's disease

34. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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35. An antidiabetic agent associated with lactic acidosis.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Metformin
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

36. Signs of active ischemia during stress testing.
Ultrasound
Patent ductus arteriosus (PDA)
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Angina - ST- segment changes on ECG - or ? BP

37. Treatment for acute coronary syndrome.
Treat existing heart failure and replace the tricuspid valve
False. Withdrawing and withholding life are the same from an ethical standpoint
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Mycobacterium tuberculosis

38. A 49-year - old male presents with acute - onset flank pain and hematuria.
Low - voltage - diffuse ST- segment elevation
Fluids and antibiotics
Nephrolithiasis
Nephrotic syndrome

39. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Cirrhosis - CHF - nephritic syndrome
Suspect retinoblastoma
Absence seizures
Antipsychotics (neuroleptic malignant syndrome)

40. Sensitive tests have few false negatives and are used to rule _____ a disease.
OCPs - danazol - GnRH agonists
Hodgkin's lymphoma
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
Out

41. Test to rule out urethral injury.
Chronic lymphocytic leukemia (CLL)
MS
Retrograde cystourethrogram
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination

42. Birth rate?
Infection - cancer - and autoimmune disease
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Number of live births per 1000 population
Ulcerative colitis

43. The most common inherited hemolytic anemia.
Hereditary spherocytosis
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
Guillain - Barr
Consider Fitz - Hugh - Curtis syndrome

44. Nonpainful chancre.
1
Trichomonas vaginitis
Lead - time bias
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

45. Hematuria - flank pain - and palpable flank mass.
ARDS
Renal cell carcinoma (RCC)
Bruton's X- linked agammaglobulinemia
Anemia of chronic disease

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?
Pseudomonas
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Seborrheic keratosis
Normal

47. Post - HBV exposure treatment.
Respiratory alkalosis
HBV immunoglobulin
MCP and PIP joints; DIP joints are spared
Parkinson's disease

48. What should always be done prior to LP?
Check for ? ICP; look for papilledema
Never
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Pseudomonas

49. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Postinfectious glomerulonephritis
Neuroblastoma
Actinomyces israelii
Contact dermatitis

50. The most common 1
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Multiple myeloma
Fanconi's anemia
Distal radius (Colles' fracture)