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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. Risk factors for pyelonephritis.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
ETEC
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Weight loss and OCPs

2. A patient with a history of lithium use presents with copious amounts of dilute urine.
Pityriasis rosea
Parvovirus B19
SIADH due to stress
Nephrogenic diabetes insipidus (DI)

3. Symptoms of placental abruption.
Abdominal ultrasound and CT
Emergent laparotomy to repair perforated viscus - likely stomach
Glomerulonephritis/nephritic syndrome
Continuous - painful vaginal bleeding

4. Treatment of hypovolemic shock.
Higher prevalence
Identify cause; fluid and blood repletion
Lyme disease - Ixodes tick - doxycycline
Sheehan's syndrome (postpartum pituitary necrosis)

5. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Rubella
Emergent laparotomy to repair perforated viscus - likely stomach
Endometrial biopsy
Wiskott - Aldrich syndrome

6. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Biliary tract obstruction
Central pontine myelinolysis
Endometrial biopsy
Neuroblastoma

7. What should always be done prior to LP?
? protein intake - lactulose - neomycin
Check for ? ICP; look for papilledema
Wrist drop - loss of thumb abduction
46 -XX

8. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
High TSH - low T4 - antimicrosomal antibodies
Headache
Higher prevalence

9. The most common cause of SAH.
Seminoma
Number of deaths from 28 days to one year per 1000 live births
Glanzmann's thrombasthenia
Trauma; the second most common is berry aneurysm

10. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Frotteurism (a paraphilia)
Inevitable abortion
Trauma; the second most common is berry aneurysm
Suspect retinoblastoma

11. PFT showing ? FEV1/FVC.
Coccidioidomycosis. Amphotericin B
Suspect ankylosing spondylitis. Check HLA- B27
Prerenal
Restrictive pulmonary disease

12. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Identify cause; pressors (e.g. - dobutamine)
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Reye's syndrome

13. Caf
Neurofibromatosis 1
SCLC
Fluid restriction - demeclocycline
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

14. Medical treatment for hepatic encephalopathy.
Excessive EtOH
Intussusception
Depersonalization disorder
? protein intake - lactulose - neomycin

15. Identify key organisms causing diarrhea:
Consider Fitz - Hugh - Curtis syndrome
Renal cell carcinoma (RCC)
30 cc/hour
Campylobacter

16. A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
E. coli O157:H7
Rate control with carotid massasge or other vagal stimulation
? protein intake - lactulose - neomycin

17. Name the organism:
Chronic granulomatous disease
Psoriasis
Toxoplasma gondii
Seborrheic dermatitis. Treat with antifungals

18. Treatment for neuroleptic malignant syndrome.
1
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Hypotension and bradycardia
Dantrolene or bromocriptine

19. Signs of ? ICP (Cushing's triad).
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Hypertension - bradycardia - and abnormal respirations
Benzodiazepines
Nephrogenic diabetes insipidus (DI)

20. ECG findings suggesting MI.
Malingering
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Alopecia areata (autoimmune process)

21. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Actinic keratosis
Continuous - painful vaginal bleeding
Threatened abortion
Squamous cell carcinoma

22. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Observational bias
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Alopecia areata (autoimmune process)
Bullous pemphigoid

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

24. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Isolation
Iatrogenic steroid administration. The second most common cause is Cushing's disease
a - antagonists (phentolamine and phenoxybenzamine)

25. A 49-year - old male presents with acute - onset flank pain and hematuria.
'Chocolate cysts -' powder burns
Type I (distal) RTA
Type II (proximal) RTA
Nephrolithiasis

26. Name the organism:
Sulfonamides - antimalarial drugs - fava beans
Pseudomonas
Endometrial biopsy
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy

27. Name the organism:
Haemophilus ducreyi
Frotteurism (a paraphilia)
Pityriasis versicolor
Pheochromocytoma

28. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Herpes simplex
Spinal stenosis
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
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

29. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Bruton's X- linked agammaglobulinemia
Basal cell carcinoma
a - antagonists (phentolamine and phenoxybenzamine)

30. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Polymyalgia rheumatica
Ampulla of the oviduct
Wait - surgical resection - radiation and/or androgen suppression
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

31. Describe a test that consistently gives identical results - but the results are wrong.
Normal
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
High reliability - low validity
Squamous cell carcinoma

32. Treatment for acetaminophen overdose.
N- acetylcysteine
Clomiphene citrate
Substance abuse
Iatrogenic steroid administration. The second most common cause is Cushing's disease

33. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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34. What is the metabolic syndrome?
Endometriosis
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Hyperkalemia
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states

35. The most common cause of seizures in children (2-10 years).
Infection - febrile seizures - trauma - idiopathic
1
Beta- hCG; the most common cause of amenorrhea is pregnancy
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured

36. Lung cancer associated with SIADH.
Actinic keratosis
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
B12 deficiency
Small cell lung cancer (SCLC)

37. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Calcium oxalate
Crohn's disease

38. Method of calculating fluid repletion in burn patients.
Treat immediately. Consent is implied in emergency situations
Parkland formula
Suspect ankylosing spondylitis. Check HLA- B27
Campylobacter

39. Presents with a herald patch - Christmas - tree pattern.
Confounding variable
Pityriasis rosea
Cardiogenic shock
Restrictive pulmonary disease

40. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Lead - time bias
Sensitivity
Nitroprusside

41. Risk factors for DVT.

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42. Treatment for opioid overdose.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Naloxone
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states

43. Name the organism:
M3
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
Pseudomonas
Bacillus cereus

44. Signs of neurogenic shock.
Pseudomonas
Nitroprusside
Mycoplasma
Hypotension and bradycardia

45. Acceptable urine output in a stable patient.
Mallory- Weiss
30 cc/hour
Lyme disease - Ixodes tick - doxycycline
Prerenal

46. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Selective IgA deficiency
68% - 95.5% - 99.7%
Number of deaths from birth to 28 days per 1000 live births
Biliary tract obstruction

47. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Observational bias
Hypernatremia

48. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Slipped capital femoral epiphyses. AP and frog - leg lateral view
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
INH - penicillamine - hydralazine - procainamide
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.

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
Alzheimer's and multi - infarct
Lichen planus
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

50. Identify key organisms causing diarrhea:
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Bacillus cereus
Normal
Prerenal