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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. Criteria for exudative effusion.
Sheehan's syndrome (postpartum pituitary necrosis)
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Uterine atony
Stasis - endothelial injury and hypercoagulability (Virchow's triad)

2. A violent patient has vertical and horizontal nystagmus.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Alport's syndrome
Phencyclidine hydrochloride (PCP) intoxication

3. Hernia with highest risk of incarceration
IV penicillin or ampicillin
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Number of live births per 1000 women 15-44 years of age
Femoral hernia

4. Virus associated with aplastic anemia in patients with sickle cell anemia.
Conduct disorder
Prerenal
Small cell lung cancer (SCLC)
Parvovirus B19

5. Name the defense mechanism:
Obstructive pulmonary disease (e.g. - asthma)
Alopecia areata (autoimmune process)
Regression
Angina - ST- segment changes on ECG - or ? BP

6. A woman who was abused as a child frequently feels outside of or detached from her body.
Phencyclidine hydrochloride (PCP) intoxication
Depersonalization disorder
Mallory- Weiss
Klebsiella

7. Bilious emesis within hours after the first feeding.
Psoriasis
Number of deaths from birth to 28 days per 1000 live births
Duodenal atresia
M3

8. PFT showing ? FEV1/FVC.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
1
Restrictive pulmonary disease

9. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
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
Actinic keratosis
Identify cause; pressors (e.g. - dobutamine)

10. ? CO - ? PCWP - ? PVR.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Cardiogenic shock
Cerebral berry aneurysms (AD PCKD)
Neurofibromatosis 1

11. Method of calculating fluid repletion in burn patients.
Trauma - alcohol withdrawal - brain tumor
Neisseria meningitidis
Normal
Parkland formula

12. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
Headache
Partial mole
Mallory- Weiss

13. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Nephrotic syndrome
Obstructive pulmonary disease (e.g. - asthma)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Iron deficiency anemia

14. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
Acute mania. Start a mood stabilizer (e.g. - lithium)
Mallory- Weiss
Acne vulgaris

15. Treatment for acute coronary syndrome.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Endometrial biopsy
Depersonalization disorder
Wait - surgical resection - radiation and/or androgen suppression

16. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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17. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
Polymyalgia rheumatica
Acute myelogenous leukemia (AML)
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies

18. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Sarcoidosis
Agranulocytosis
Contact dermatitis
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

19. Name the defense mechanism:
Rett's disorder
? serum FSH
Beta- blockers - Ca2+ channel blockers - TCAs
Displacement

20. Chromosomal pattern of a complete mole.
Threatened abortion
Pseudomonas
46 -XX
Mycobacterium tuberculosis

21. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
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
? serum FSH
Inevitable abortion
Polymyalgia rheumatica

22. 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?
Legionella pneumonia
Pemphigus vulgaris
OCP and barrier contraception
Glomerulonephritis/nephritic syndrome

23. Identify key organisms causing diarrhea:
Placental abruption and placenta previa
Fatigue and impending respiratory failure
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Bacillus cereus

24. Treatment for DTs.
Pseudomonas
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Benzodiazepines
Contact dermatitis

25. Tanner stage 3 in a six-year - old female.
Conduct disorder
Inhaled Beta- agonists and inhaled corticosteroids
Phencyclidine hydrochloride (PCP) intoxication
Precocious puberty

26. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Graves' disease
Reaction formation
Flumazenil

27. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Clostridium difficile
Nephrotic syndrome
Wiskott - Aldrich syndrome
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

28. Case - control study
Neither
Pseudomonas
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

29. Prophylactic treatment for migraine.
Campylobacter
Hypoparathyroidism
Neither
Beta- blockers - Ca2+ channel blockers - TCAs

30. Cross - sectional survey
Mycoplasma
Prevalence
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Naloxone

31. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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32. HUS triad?
Anemia - thrombocytopenia - and acute renal failure
Nephrogenic diabetes insipidus (DI)
DI
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

33. Identify key organisms causing diarrhea:
ETEC
Osmotic fragility test
Hyperkalemia
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

34. Acute - phase treatment for Kawasaki disease.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Neurofibromatosis 1
All - compartment fasciotomy for suspected compartment syndrome
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

35. Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
OCPs - danazol - GnRH agonists
Substance abuse
A patient with chest trauma who was previously stable suddenly dies

36. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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37. Causes of exudative effusion.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Inhaled Beta- agonists and inhaled corticosteroids
Basal cell carcinoma
Vibrio - HAV

38. Lab findings in Hashimoto's thyroiditis.
High TSH - low T4 - antimicrosomal antibodies
Sarcoidosis
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Lesch - Nyhan syndrome (purine salvage problem with

39. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
IV penicillin or ampicillin
Frotteurism (a paraphilia)
M3
Seborrheic dermatitis. Treat with antifungals

40. Trauma series.
Obstructive pulmonary disease (e.g. - asthma)
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
AP chest - AP/lateral C- spine - AP pelvis
Hypertrophic cardiomyopathy

41. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Kl
Femoral hernia

42. Classic causes of drug - induced hepatitis.
Agranulocytosis
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
Intussusception
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

43. Acceptable urine output in a trauma patient.
Hypotension - distant heart sounds - and JVD
Substance abuse
50 cc/hour
Impetigo

44. Annual screening for women with a strong family history of ovarian cancer.
Confounding variable
CA-125 and transvaginal ultrasound
Partial mole
Normal

45. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Weight gain - type 2 DM - QT prolongation
Toxoplasma gondii

46. Difference between Mallory- Weiss and Boerhaave tears.
Fanconi's anemia
All - compartment fasciotomy for suspected compartment syndrome
Self - limited - painless vaginal bleeding
Mallory- Weiss

47. Birth rate?
S. aureus
Administration of DDAVP ? serum osmolality and free water restriction
Streptococcus pneumoniae
Number of live births per 1000 population

48. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Coarctation of the aorta
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Bladder rupture or urethral injury
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

49. CSF findings with SAH.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Herpes simplex
Pemphigus vulgaris
Elevated ICP - RBCs - xanthochromia

50. A patient with a history of lithium use presents with copious amounts of dilute urine.
Flumazenil
Pseudogout
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Nephrogenic diabetes insipidus (DI)