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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. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Self - limited - painless vaginal bleeding
Absence seizures
Murphy's sign - seen in acute cholecystitis
Slipped capital femoral epiphyses. AP and frog - leg lateral view

2. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1

3. Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
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
Wait - surgical resection - radiation and/or androgen suppression
? Ca2+ - ? K- - ? phosphate - ? uric acid

4. Infection of small airways with epidemics in winter and spring.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Nephritic syndrome
RSV bronchiolitis

5. Classic causes of drug - induced hepatitis.
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
HIDA scan
Membranous glomerulonephritis
Prinzmetal's angina

6. Identify key organisms causing diarrhea:
Lichen sclerosus
Clostridium difficile
Self - limited - painless vaginal bleeding
Hypertension - bradycardia - and abnormal respirations

7. Name the organism:
Panic disorder
Neisseria meningitidis
IV benzodiazepine
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'

8. A doctor refers a patient for an MRI at a facility he/she owns.
Dissociative fugue
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Conflict of interest

9. Complication of scaphoid fracture.
Iron deficiency anemia
Sulfonamides - antimalarial drugs - fava beans
Endometriosis
Avascular necrosis

10. Treatment for mild and severe unconjugated hyperbilirubinemia.
Out
Phototherapy (mild) or exchange transfusion (severe)
Lesions of 1
Hereditary spherocytosis

11. Vaccinations at a six- month well - child visit.
Sulfonamides - antimalarial drugs - fava beans
HBV - DTaP - Hib - IPV - PCV
Toxoplasma gondii
Membranous glomerulonephritis

12. Treatment for ventricular fibrillation.
Broca's aphasia. Frontal lobe - left MCA distribution
Emergent laparotomy to repair perforated viscus - likely stomach
? serum FSH
Immediate cardioversion

13. Appropriate diagnostic test?
Exercise stress treadmill with ECG
Continuous - painful vaginal bleeding
Kl
PT

14. Unopposed estrogen is contraindicated in which cancers?
Distal radius (Colles' fracture)
S. aureus
Type I (distal) RTA
Endometrial or estrogen receptor - breast cancer

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

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16. The diagnostic test for pulmonary embolism.
Number of live births per 1000 women 15-44 years of age
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
V/Q scan

17. Radiographic evidence of aortic disruption or dissection.
Fatigue and impending respiratory failure
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Endometriosis
Agranulocytosis

18. Sentinel loop on AXR.
Prevalence
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Reaction formation
Acute pancreatitis

19. Name the defense mechanism:
Bacillus cereus
Regression
Displacement
Frotteurism (a paraphilia)

20. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Neurofibromatosis 1
ARDS
HBV immunoglobulin
Stasis - endothelial injury and hypercoagulability (Virchow's triad)

21. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Pseudomonas
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Iron deficiency anemia

22. Name the organism:
Prevalence
Actinomyces israelii
Salmonella
RSV bronchiolitis

23. Hernia with highest risk of incarceration
'Chocolate cysts -' powder burns
Klebsiella
Femoral hernia
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

24. Four characteristics of a nevus suggestive of melanoma.
Asymmetry - border irregularity - color variation - large diameter
Giardia
Murphy's sign - seen in acute cholecystitis
Prevalence

25. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Rate control - rhythm conversion - and anticoagulation
Duchenne muscular dystrophy
Hypokalemia
IV hydration and loop diuretics (furosemide)

26. The most common form of nephritic syndrome.
Wait - surgical resection - radiation and/or androgen suppression
Neisseria meningitidis
Conversion disorder
Membranous glomerulonephritis

27. A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Paget's disease
Iron overload; use deferoxamine
Seminoma

28. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Herpes simplex
Postinfectious glomerulonephritis
Lead - time bias
Wernicke's encephalopathy due to a deficiency of thiamine

29. A newborn female has continuous 'machinery murmur.'
Patent ductus arteriosus (PDA)
Frotteurism (a paraphilia)
INH - penicillamine - hydralazine - procainamide
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination

30. Name the organism:
Ophthalmologic exam - CT - and MRI
Conduct disorder
Klebsiella
S. aureus or S. epidermidis.

31. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Dissociative fugue
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Hypovolemic shock

32. Identify key organisms causing diarrhea:
Bacillus cereus
AP chest - AP/lateral C- spine - AP pelvis
Hypoxia and hypocarbia
Clomiphene citrate

33. First - line pharmacotherapy for depression.
SSRIs
Impetigo
SIADH due to stress
Wiskott - Aldrich syndrome

34. A son asks that his mother not be told about her recently discovered cancer.

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35. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Normal
Reaction formation
Panic disorder
Fatigue and impending respiratory failure

36. Fetal mortality?

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37. In which patients do you initiate colorectal cancer screening early?
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Naloxone
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
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

38. Gout - self - mutilation - and choreoathetosis.
1
HGPRTase deficiency)
Higher incidence
Duchenne muscular dystrophy

39. The most likely cause of acute lower GI bleed in patients > 40 years old.
Seventy percent if the stenosis is symptomatic
Mycoplasma
Diverticulosis
Subdural hematoma

40. Four causes of microcytic anemia.
50 cc/hour
Clostridium difficile
TICS
Actinomyces israelii

41. A congenital heart disease that cause 2
Iron deficiency anemia
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Coarctation of the aorta
Precocious puberty

42. Findings in 3
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Conflict of interest
CF or Hirschsprung's disease
Isolation

43. May be seen in children who are accused of inattention in class and confused with ADHD.
Acute myelogenous leukemia (AML)
Absence seizures
Legionella pneumonia
Isolation

44. Honey- crusted lesions.
Impetigo
Intraductal papilloma
Salmonella
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)

45. Identify key organisms causing diarrhea:
Vibrio - HAV
Glomerulonephritis/nephritic syndrome
Nephrotic syndrome
ETEC

46. Radiographic indications for surgery in patients with acute abdomen.
Number of live births per 1000 population
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
They can mask symptoms of hypoglycemia
Trauma; the second most common is berry aneurysm

47. Presence of red cell casts in urine sediment.
Mycobacterium tuberculosis
Glomerulonephritis/nephritic syndrome
Betamethasone or dexamethasone
Precocious puberty

48. Meningitis in infants. Causes? Treatment?
Neuroleptics
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Factor V Leiden mutation
Pentad of TTP

49. Acute - phase treatment for Kawasaki disease.
Wrist drop - loss of thumb abduction
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Lung - breast - skin (melanoma) - kidney - GI tract
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies

50. Asplenic patients are particularly susceptible to these organisms.
Signs and symptoms of hypercalcemia
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Biliary tract obstruction
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies