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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. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Spinal stenosis
Panic disorder
Sarcoidosis

2. Treatment for acute coronary syndrome.
Pasteurella multocida
Intussusception
Lead - time bias
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

3. Treatment for ventricular fibrillation.
Parkinson's disease
Sarcoidosis
Immediate cardioversion
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

4. Treatment for postpartum hemorrhage.
CML
Uterine massage; if that fails - give oxytocin
Dissociative fugue
Acute pancreatitis

5. Testicular cancer associated with Beta- hCG - AFP.
Sulfonamides - antimalarial drugs - fava beans
Choriocarcinoma
Hashimoto's thyroiditis
DM - SLE - and amyloidosis

6. First - line treatment for otitis media.
Amoxicillin
Rate control - rhythm conversion - and anticoagulation
Nephrotic syndrome
Sporothrix schenckii

7. Unopposed estrogen is contraindicated in which cancers?
HIDA scan
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Transitional cell carcinoma
Endometrial or estrogen receptor - breast cancer

8. 'Cradle cap.'
False. Withdrawing and withholding life are the same from an ethical standpoint
Retinoic acid
Lesion of 1
Seborrheic dermatitis. Treat with antifungals

9. Number needed to treat?
1
Suspect ankylosing spondylitis. Check HLA- B27
Pheochromocytoma
Suspect retinoblastoma

10. Tanner stage 3 in a six-year - old female.
Endometrial or estrogen receptor - breast cancer
1
Neuroleptic malignant syndrome
Precocious puberty

11. Four causes of microcytic anemia.
Alport's syndrome
Endometriosis
TICS
Hashimoto's thyroiditis

12. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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13. Presents with a herald patch - Christmas - tree pattern.
Pityriasis rosea
Anticoagulation - rate control - cardioversion
Neither
Ulcerative colitis

14. Hematuria - flank pain - and palpable flank mass.
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Substance abuse
Confounding variable
Renal cell carcinoma (RCC)

15. Method of calculating fluid repletion in burn patients.
Parkland formula
Higher prevalence
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Neurofibromatosis 1

16. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Type II (proximal) RTA
Retinoic acid
CML
Trauma; the second most common is berry aneurysm

17. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Threatened abortion
A patient with chest trauma who was previously stable suddenly dies
Lyme disease - Ixodes tick - doxycycline
Renal cell carcinoma (RCC)

18. The most common inherited cause of hypercoagulability.
Continuous - painful vaginal bleeding
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Factor V Leiden mutation
Iatrogenic steroid administration. The second most common cause is Cushing's disease

19. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
CHF - shock - and altered mental status
Beta- blockers - digoxin - calcium channel blockers
Phototherapy (mild) or exchange transfusion (severe)

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

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21. Signs of air embolism.
Non - Hodgkin's lymphoma
Trauma; the second most common is berry aneurysm
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
A patient with chest trauma who was previously stable suddenly dies

22. Post - HBV exposure treatment.
Subdural hematoma
All - compartment fasciotomy for suspected compartment syndrome
Graves' disease
HBV immunoglobulin

23. A patient presents with recent PID with RUQ pain.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Consider Fitz - Hugh - Curtis syndrome
Hodgkin's lymphoma
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms

24. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Cluster headache
Legionella pneumonia
CF or Hirschsprung's disease
Ulcerative colitis

25. First - line medication for status epilepticus.
a - antagonists (phentolamine and phenoxybenzamine)
Acute mania. Start a mood stabilizer (e.g. - lithium)
IV benzodiazepine
Colposcopy and endocervical curettage

26. Treatment of central DI.
Administration of DDAVP ? serum osmolality and free water restriction
DI
Seminoma
Polymyalgia rheumatica

27. Symptoms of placenta previa.
Self - limited - painless vaginal bleeding
MCP and PIP joints; DIP joints are spared
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Type IV (distal) RTA

28. Rigidity and stiffness with resting tremor and masked facies.

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29. Neonatal mortality?
Avascular necrosis
False. Withdrawing and withholding life are the same from an ethical standpoint
Number of deaths from birth to 28 days per 1000 live births
High TSH - low T4 - antimicrosomal antibodies

30. Sentinel loop on AXR.
Graves' disease
Wrist drop - loss of thumb abduction
Normal
Acute pancreatitis

31. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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32. Signs suggesting radial nerve damage with humeral fracture.
Pharmacologic stress test (e.g. - dobutamine echo)
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Wrist drop - loss of thumb abduction
Naloxone

33. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
1
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

34. Shortest AP diameter of the pelvis.
Central pontine myelinolysis
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
105 bacteria/mL
IV penicillin or ampicillin

35. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Retrograde cystourethrogram
Niacin
Erythema multiforme
Cluster headache

36. What % lesion is an indication for carotid endarterectomy?
OCPs - danazol - GnRH agonists
Pseudomonas
Coccidioidomycosis. Amphotericin B
Seventy percent if the stenosis is symptomatic

37. Salicylate ingestion ? In What type of acid - base disorder?
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Anion gap acidosis and 1
IVIG or plasmapheresis
Pseudogout

38. Name the defense mechanism:
Reaction formation
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Number of deaths per 1000 population
M3

39. Causes of drug - induced SLE.
Trauma; the second most common is berry aneurysm
Type II (proximal) RTA
INH - penicillamine - hydralazine - procainamide
Rate control - rhythm conversion - and anticoagulation

40. Name the organism:
CA-125 and transvaginal ultrasound
Subarachnoid hemorrhage (SAH)
OCP and barrier contraception
Salmonella

41. Peaked T waves and widened QRS.
Identify cause; pressors (e.g. - dobutamine)
Hyperkalemia
Nephrotic syndrome
Hypertrophic cardiomyopathy

42. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Coccidioidomycosis. Amphotericin B
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
Anemia - thrombocytopenia - and acute renal failure

43. Identify key organisms causing diarrhea:
Lichen planus
ETEC
Panic disorder
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1

44. CSF findings:
Bacterial meningitis
They can mask symptoms of hypoglycemia
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

45. Symptoms of placental abruption.
Number of live births per 1000 women 15-44 years of age
Flumazenil
Fluids and antibiotics
Continuous - painful vaginal bleeding

46. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
High reliability - low validity
Trichomonas vaginitis
CML
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

47. What should always be done prior to LP?
Highly sensitive for TB
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Hypocalcemia
Check for ? ICP; look for papilledema

48. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Hypokalemia
Number of live births per 1000 population
Endometrial biopsy
Surfactant deficiency

49. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Multiple myeloma
ALS
Amoxicillin

50. The most common location for an ectopic pregnancy.
Klebsiella
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Flumazenil
Ampulla of the oviduct