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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. Classic physical findings for endocarditis.

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2. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
105 bacteria/mL
Lead - time bias
Exercise stress treadmill with ECG

3. Aplastic crisis in sickle cell disease.
E. coli O157:H7
Squamous cell carcinoma
Parvovirus B19
Bullous pemphigoid

4. Difference between a cohort and a case - control study.
Ophthalmologic exam - CT - and MRI
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
Phototherapy (mild) or exchange transfusion (severe)
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

5. Tests to rule out shaken baby syndrome.
Precocious puberty
Ophthalmologic exam - CT - and MRI
SCLC
Observational bias

6. Name the organism:
Neither
? protein intake - lactulose - neomycin
IV penicillin or ampicillin
Pasteurella multocida

7. T- wave flattening and U waves.
Hypokalemia
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Subarachnoid hemorrhage (SAH)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

8. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Varicella zoster
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

9. Treatment for neuroleptic malignant syndrome.
Rate control with carotid massasge or other vagal stimulation
Dantrolene or bromocriptine
The IR of a disease in a population exposed to a particular factor
Seborrheic keratosis

10. Goal hemoglobin A1c for a patient with DM.
< 7.0
Infection - cancer - and autoimmune disease
50 cc/hour
Displacement

11. Medical treatment for IBD.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Higher prevalence
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Third - degree heart block

12. The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
Pseudomonas
Number of deaths per 1000 population
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

13. Pure RBC aplasia.
Protamine
Actinic keratosis
Partial mole
Diamond - Blackfan anemia

14. Ring - enhancing brain lesion on CT with seizures
Excessive EtOH
Taenia solium (cysticercosis)
MS
Continuous positive airway pressure

15. Maternal mortality?
Out
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Avascular necrosis
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births

16. Treatment of cardiogenic shock.
Osmotic fragility test
Identify cause; pressors (e.g. - dobutamine)
'Chocolate cysts -' powder burns
Panic disorder

17. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Guillain - Barr
Wiskott - Aldrich syndrome
Levodopa/carbidopa
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

18. Relative risk?
Colposcopy and endocervical curettage
The IR of a disease in a population exposed to a particular factor
Aseptic (viral) meningitis
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'

19. Beck's triad for cardiac tamponade.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Actinic keratosis
Lichen planus
Hypotension - distant heart sounds - and JVD

20. Chvostek's and Trousseau's signs.
CML
Pityriasis versicolor
Hypocalcemia
Rett's disorder

21. Treatment for acute coronary syndrome.
Graves' disease
Acute myelogenous leukemia (AML)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Iron overload; use deferoxamine

22. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
IV hydration and loop diuretics (furosemide)
Beta- blockers - digoxin - calcium channel blockers
S. aureus
Dissociative fugue

23. Treatment of AF.
Rate control - rhythm conversion - and anticoagulation
Continuous positive airway pressure
Dressler's syndrome: fever - pericarditis - ? ESR
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

24. Identify key organisms causing diarrhea:
Hypertension - bradycardia - and abnormal respirations
Clostridium difficile
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

25. The three most common causes of fever of unknown origin (FUO).
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Infection - cancer - and autoimmune disease
Inhaled Beta- agonists and inhaled corticosteroids
INH - penicillamine - hydralazine - procainamide

26. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Retinoic acid
The IR of a disease in a population exposed to a particular factor
Anorexia

27. Not contraindications to vaccination.
Cellulitis
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Factitious disorder (Munchausen syndrome)
Chronic lymphocytic leukemia (CLL)

28. Classic CXR findings for pulmonary edema.

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29. CSF findings:
Subarachnoid hemorrhage (SAH)
Obstructive pulmonary disease (e.g. - asthma)
Elevated ICP - RBCs - xanthochromia
Seminoma

30. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
'Chocolate cysts -' powder burns
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
SIADH due to stress
a - antagonists (phentolamine and phenoxybenzamine)

31. Findings in 3
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Emergent laparotomy to repair perforated viscus - likely stomach
Campylobacter

32. Symptoms of placenta previa.
Headache
Self - limited - painless vaginal bleeding
SCLC
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

33. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Polymyalgia rheumatica
Pityriasis rosea
Suspect retinoblastoma

34. Treatment for AML M3.
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
Retinoic acid
DM - SLE - and amyloidosis
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms

35. Supportive treatment for ARDS.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Stasis - hypercoagulability - endothelial damage
Lesch - Nyhan syndrome (purine salvage problem with
Continuous positive airway pressure

36. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Panic disorder
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Squamous cell carcinoma
Nephrotic syndrome

37. Infant mortality?
Alzheimer's and multi - infarct
Weight loss and OCPs
Uterine massage; if that fails - give oxytocin
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

38. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Hyperkalemia
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Emergent laparotomy to repair perforated viscus - likely stomach
Panic disorder

39. Dermatomal distribution.
Beta- blockers - Ca2+ channel blockers - TCAs
Mallory- Weiss
Mycobacterium tuberculosis
Varicella zoster

40. Associated with Propionibacterium acnes and changes in androgen levels.
Pseudogout
Neither
Inhaled Beta- agonists and inhaled corticosteroids
Acne vulgaris

41. Name the organism:
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Klebsiella
Dressler's syndrome: fever - pericarditis - ? ESR
Malignancy and hyperparathyroidism

42. Vaccinations at a six- month well - child visit.
Trauma - alcohol withdrawal - brain tumor
Klebsiella
Exercise stress treadmill with ECG
HBV - DTaP - Hib - IPV - PCV

43. Risk factors for cholelithiasis.
Alopecia areata (autoimmune process)
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Suspect ankylosing spondylitis. Check HLA- B27
Fat - female - fertile - forty - flatulent

44. Glomerulonephritis with hemoptysis.

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45. HUS triad?
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Parvovirus B19
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Anemia - thrombocytopenia - and acute renal failure

46. Causes of exudative effusion.
Acute mania. Start a mood stabilizer (e.g. - lithium)
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Hypovolemic shock
Patient on dopamine antagonist

47. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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48. Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP
Hypernatremia
1
< 7.0

49. 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
Small cell lung cancer (SCLC)
Parvovirus B19
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

50. Name the organism:
Weight gain - type 2 DM - QT prolongation
Pasteurella multocida
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Klebsiella