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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. Neutropenic nadir postchemotherapy.
7-10 days
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
IV hydration and loop diuretics (furosemide)

2. The most common causes of dementia.

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3. Differential of hypervolemic hyponatremia.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Continuous - painful vaginal bleeding
Cirrhosis - CHF - nephritic syndrome
Taenia solium (cysticercosis)

4. Identify key organisms causing diarrhea:
BP > 140/90 on three separate occasions two weeks apart
Bacillus cereus
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
7-10 days

5. Epidemics such as influenza
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Higher incidence
Identify cause; fluid and blood repletion
Non - Hodgkin's lymphoma

6. CSF findings:
Parkinson's disease
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Aseptic (viral) meningitis
Multiple myeloma

7. Meningitis in neonates. Causes? Treatment?
Anticoagulation - rate control - cardioversion
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Uremic syndrome seen in patients with renal failure
Restrictive pulmonary disease

8. Treatment of anaphylactic shock.
Pulsus paradoxus (seen in cardiac tamponade)
Vibrio - HAV
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Diphenhydramine or epinephrine 1:1000

9. The mainstay of Parkinson's therapy.
CF or Hirschsprung's disease
Levodopa/carbidopa
1
Clomiphene citrate

10. Name the organism:
ARDS
Pasteurella multocida
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Fat - female - fertile - forty - flatulent

11. ECG findings suggesting MI.
Radiation
Pseudogout
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Giardia

12. Electrolyte changes in tumor lysis syndrome.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
DI
Type IV (distal) RTA
? Ca2+ - ? K- - ? phosphate - ? uric acid

13. Treatment for bacterial vaginosis.
Oral or topical metronidazole
Suspect retinoblastoma
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Folate deficiency

14. Trauma series.
Beta- hCG; the most common cause of amenorrhea is pregnancy
AP chest - AP/lateral C- spine - AP pelvis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Cerebral berry aneurysms (AD PCKD)

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

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16. Signs of active ischemia during stress testing.
Chronic granulomatous disease
Angina - ST- segment changes on ECG - or ? BP
Antipsychotics (neuroleptic malignant syndrome)
Actinic keratosis

17. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Osteoarthritis
Frotteurism (a paraphilia)
Conduct disorder

18. Method of calculating fluid repletion in burn patients.
Benzodiazepines
Sporothrix schenckii
Endometriosis
Parkland formula

19. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Hashimoto's thyroiditis
Hodgkin's lymphoma
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Murphy's sign - seen in acute cholecystitis

20. Identify key organisms causing diarrhea:
Clostridium difficile
Niacin
Inevitable abortion
Squamous cell carcinoma

21. The most common cause of postpartum hemorrhage.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Depersonalization disorder
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Uterine atony

22. Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Panic disorder
Femoral hernia
Huntington's disease

23. Infant mortality?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Elevated ICP - RBCs - xanthochromia
Nephrogenic diabetes insipidus (DI)
Pasteurella multocida

24. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Panic disorder
Rate control with carotid massasge or other vagal stimulation
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

25. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
Varicella zoster
All - compartment fasciotomy for suspected compartment syndrome
Squamous cell carcinoma

26. The most common form of nephritic syndrome.
Membranous glomerulonephritis
Type II (proximal) RTA
Wait - surgical resection - radiation and/or androgen suppression
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

27. Honey- crusted lesions.
Conversion disorder
Immediate needle thoracostomy
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Impetigo

28. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Seventy percent if the stenosis is symptomatic
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Duchenne muscular dystrophy

29. The most serious side effect of clozapine.
Central pontine myelinolysis
? serum FSH
Agranulocytosis
Wrist drop - loss of thumb abduction

30. Name the organism:
Actinomyces israelii
Phencyclidine hydrochloride (PCP) intoxication
Observational bias
Fluid restriction - demeclocycline

31. Amenorrhea - bradycardia - and abnormal body image in a young female.
Wrist drop - loss of thumb abduction
Out
Hypoxia and hypocarbia
Anorexia

32. The most common histology of bladder cancer.
Transitional cell carcinoma
Klebsiella
Wrist drop - loss of thumb abduction
Placental abruption and placenta previa

33. The most common type of nephrolithiasis.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Never
Calcium oxalate
ARDS

34. Common symptoms associated with silent MIs.
CHF - shock - and altered mental status
Crohn's disease
Lichen sclerosus
Iron deficiency anemia

35. The coagulation parameter affected by warfarin.
Hyperkalemia
PT
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

36. Identify key organisms causing diarrhea:
Legionella pneumonia
B12 deficiency
Self - limited - painless vaginal bleeding
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

37. A fall in systolic BP of > 10 mmHg with inspiration.
Hodgkin's lymphoma
Pulsus paradoxus (seen in cardiac tamponade)
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Sporothrix schenckii

38. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Protamine
Normal
Small cell lung cancer (SCLC)

39. The most common inherited hemolytic anemia.
Retinoic acid
Threatened abortion
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Hereditary spherocytosis

40. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Calcium oxalate
Antipsychotics (neuroleptic malignant syndrome)
Cluster headache
Higher prevalence

41. Side effects of corticosteroids.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Huntington's disease
Betamethasone or dexamethasone
Hypotension - distant heart sounds - and JVD

42. Albuminocytologic dissociation.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Guillain - Barr
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Choriocarcinoma

43. Caf
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
Neurofibromatosis 1
Iron deficiency anemia
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

44. Acceptable urine output in a trauma patient.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
50 cc/hour
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

45. Associated with Propionibacterium acnes and changes in androgen levels.
Pulsus paradoxus (seen in cardiac tamponade)
Phencyclidine hydrochloride (PCP) intoxication
Acne vulgaris
Fluid restriction - demeclocycline

46. Risk factors for cholelithiasis.
HIDA scan
Inevitable abortion
Fat - female - fertile - forty - flatulent
Levodopa/carbidopa

47. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Neisseria meningitidis
Observational bias
Duchenne muscular dystrophy
a - antagonists (phentolamine and phenoxybenzamine)

48. Hernia with highest risk of incarceration
Consider Fitz - Hugh - Curtis syndrome
Central pontine myelinolysis
Continuous positive airway pressure
Femoral hernia

49. 'Dewdrop on a rose petal.'
Normal
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Lesions of 1
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

50. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
< 7.0
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Iron deficiency anemia
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia