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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. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Lichen sclerosus
Beta- blockers - digoxin - calcium channel blockers
HBV - DTaP - Hib - IPV - PCV
MCP and PIP joints; DIP joints are spared

2. Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome
Colposcopy and endocervical curettage
Third - degree heart block
Klebsiella

3. Not contraindications to vaccination.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Immediate cardioversion
Hypotension - distant heart sounds - and JVD
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity

4. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

5. Infection of small airways with epidemics in winter and spring.
Precocious puberty
RSV bronchiolitis
S. aureus
Rate control - rhythm conversion - and anticoagulation

6. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Beta- blockers - Ca2+ channel blockers - TCAs
Acute mania. Start a mood stabilizer (e.g. - lithium)
Klebsiella
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

7. Extraintestinal manifestations of IBD.
Selective IgA deficiency
Crohn's disease
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Pasteurella multocida

8. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
Bruton's X- linked agammaglobulinemia
Dissociative fugue
1
Hypokalemia

9. The diagnostic test for pulmonary embolism.
Seventy percent if the stenosis is symptomatic
Substance abuse
V/Q scan
Levodopa/carbidopa

10. Chvostek's and Trousseau's signs.
68% - 95.5% - 99.7%
Hypocalcemia
Seborrheic keratosis
Basal cell carcinoma

11. A woman who was abused as a child frequently feels outside of or detached from her body.
IV benzodiazepine
Depersonalization disorder
Lead - time bias
Mycoplasma

12. Goal hemoglobin A1c for a patient with DM.
Conflict of interest
Seborrheic keratosis
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
< 7.0

13. What should always be done prior to LP?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Osgood - Schlatter disease
Mycobacterium tuberculosis
Check for ? ICP; look for papilledema

14. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Reaction formation
Murphy's sign - seen in acute cholecystitis
Osteoarthritis
Pregnant women. Treat this group aggressively because of potential complications

15. Name the organism:
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Pasteurella multocida
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

16. Honey- crusted lesions.
Neither
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Impetigo

17. In which patients do you initiate colorectal cancer screening early?
Excessive EtOH
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
Intraductal papilloma
Isolation

18. Classic ECG findings in pericarditis.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Low - voltage - diffuse ST- segment elevation
Number of deaths from birth to 28 days per 1000 live births
Conversion disorder

19. A fall in systolic BP of > 10 mmHg with inspiration.
Alopecia areata (autoimmune process)
Pulsus paradoxus (seen in cardiac tamponade)
Actinic keratosis
Wrist drop - loss of thumb abduction

20. Aplastic crisis in sickle cell disease.
Parvovirus B19
Substance abuse
Neuroleptic malignant syndrome
Excessive EtOH

21. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
ACEI
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
Consider Fitz - Hugh - Curtis syndrome

22. CSF findings:
Endometrial biopsy
Guillain - Barr
Parvovirus B19
Aseptic (viral) meningitis

23. The most common cause of Cushing's syndrome.

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24. Term for heavy bleeding during and between menstrual periods.
Distal radius (Colles' fracture)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Menometrorrhagia
OCPs - danazol - GnRH agonists

25. Iris - like target lesions.
Wait - surgical resection - radiation and/or androgen suppression
Erythema multiforme
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Signs and symptoms of hypercalcemia

26. Blood in the urethral meatus or high - riding prostate.
Contact dermatitis
Distal radius (Colles' fracture)
Bladder rupture or urethral injury
7-10 days

27. Name the organism:
Sarcoidosis
Anion gap acidosis and 1
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Streptococcus pneumoniae

28. Confusion - confabulation - ophthalmoplegia - ataxia.

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29. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
105 bacteria/mL
Prinzmetal's angina
Iron deficiency anemia
Patient on dopamine antagonist

30. Classic physical findings for endocarditis.

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31. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
105 bacteria/mL
Huntington's disease
O2 - analgesia - hydration - and - if severe - transfusion
Parkinson's disease

32. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
SCLC
Substance abuse

33. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
They can mask symptoms of hypoglycemia
Campylobacter
ACEI
False. Withdrawing and withholding life are the same from an ethical standpoint

34. Sentinel loop on AXR.
Glanzmann's thrombasthenia
Haemophilus ducreyi
Anemia - thrombocytopenia - and acute renal failure
Acute pancreatitis

35. Diagnostic test for hypertrophic cardiomyopathy.
Contact dermatitis
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
30 cc/hour
Osgood - Schlatter disease

36. Ring - enhancing brain lesion on CT with seizures
Infection - cancer - and autoimmune disease
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Radiation
Taenia solium (cysticercosis)

37. Relative risk?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
The IR of a disease in a population exposed to a particular factor
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Pharmacologic stress test (e.g. - dobutamine echo)

38. The number of true positives divided by the number of patients with the disease is _____.
Ampulla of the oviduct
Dantrolene or bromocriptine
Toxoplasma gondii
Sensitivity

39. Hematuria - flank pain - and palpable flank mass.
Diphenhydramine or epinephrine 1:1000
Sheehan's syndrome (postpartum pituitary necrosis)
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Renal cell carcinoma (RCC)

40. Indications for surgical repair of abdominal aortic aneurysm.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Dissociative fugue
The IR of a disease in a population exposed to a particular factor
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured

41. Difference between Mallory- Weiss and Boerhaave tears.
Basal cell carcinoma
Mallory- Weiss
OCP and barrier contraception
Higher prevalence

42. Administer to a symptomatic patient to diagnose myasthenia gravis.
Agranulocytosis
SIADH due to stress
Edrophonium
1

43. First - line treatment for moderate hypercalcemia.
Lobular carcinoma in situ
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
IV hydration and loop diuretics (furosemide)
TICS

44. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Fluid restriction - demeclocycline
Femoral hernia
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

45. Radiographic indications for surgery in patients with acute abdomen.
Conversion disorder
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Impetigo
? serum FSH

46. Medical options for endometriosis.
Anemia of chronic disease
Bullous pemphigoid
OCPs - danazol - GnRH agonists
Conflict of interest

47. Treatment for SVC syndrome.
Frotteurism (a paraphilia)
Radiation
Septic or anaphylactic shock
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

48. Cannon 'a' waves.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Third - degree heart block
Threatened abortion

49. Acute - phase treatment for Kawasaki disease.
Diamond - Blackfan anemia
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

50. Type of ARF in a patient with FeNa < 1%.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Infection - cancer - and autoimmune disease
Prerenal
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin