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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. Causes of hypoxemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
S. aureus or S. epidermidis.
Small cell lung cancer (SCLC)
Pregnant women. Treat this group aggressively because of potential complications

2. Which healthy population is susceptible to UTIs?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Pregnant women. Treat this group aggressively because of potential complications
HBV immunoglobulin

3. RTA associated with abnormal HCO3 - and rickets.
Avascular necrosis
Type II (proximal) RTA
Threatened abortion
Hypotension - distant heart sounds - and JVD

4. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Neurofibromatosis 1
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Anemia - thrombocytopenia - and acute renal failure
Endometrial or estrogen receptor - breast cancer

5. Infection of small airways with epidemics in winter and spring.
Sporothrix schenckii
Ophthalmologic exam - CT - and MRI
Iron overload; use deferoxamine
RSV bronchiolitis

6. When should a vaginal exam be performed with suspected placenta previa?
ALS
Never
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Fluids and antibiotics

7. Flat - topped papules.
'Chocolate cysts -' powder burns
Exercise stress treadmill with ECG
Confounding variable
Lichen planus

8. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Wait - surgical resection - radiation and/or androgen suppression
7-10 days
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Patient on dopamine antagonist

9. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Parvovirus B19
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Conduct disorder
Coccidioidomycosis. Amphotericin B

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

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11. The 6 P's of ischemia due to peripheral vascular disease.
68% - 95.5% - 99.7%
1
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Endometriosis

12. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
HBV - DTaP - Hib - IPV - PCV
Substance abuse
DM - SLE - and amyloidosis
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births

13. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Fat - female - fertile - forty - flatulent
Radiation
? serum FSH

14. The most common 1
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Selective IgA deficiency
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Anemia of chronic disease

15. The most common form of nephritic syndrome.
Diphenhydramine or epinephrine 1:1000
Fatigue and impending respiratory failure
Membranous glomerulonephritis
Factor V Leiden mutation

16. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Confounding variable
Neuroleptic malignant syndrome
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Asherman's syndrome

17. Name the defense mechanism:
Regression
Fanconi's anemia
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Mycobacterium tuberculosis

18. Diagnostic test for hereditary spherocytosis.
Prinzmetal's angina
? Ca2+ - ? K- - ? phosphate - ? uric acid
Osmotic fragility test
High TSH - low T4 - antimicrosomal antibodies

19. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Confounding variable
Broca's aphasia. Frontal lobe - left MCA distribution
Intraductal papilloma
Postinfectious glomerulonephritis

20. A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Pseudomonas
Observational bias

21. The mainstay of Parkinson's therapy.
Angina - ST- segment changes on ECG - or ? BP
Parkinson's disease
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Levodopa/carbidopa

22. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Multiple myeloma
Uremic syndrome seen in patients with renal failure
Hypokalemia
Pseudogout

23. Medical options for endometriosis.
Impetigo
OCPs - danazol - GnRH agonists
Renal cell carcinoma (RCC)
Neisseria meningitidis

24. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Consider Fitz - Hugh - Curtis syndrome
Trichomonas vaginitis
Reaction formation
Pseudomonas

25. PFT showing ? FEV1/FVC.
IVIG or plasmapheresis
Treat immediately. Consent is implied in emergency situations
Restrictive pulmonary disease
Uterine massage; if that fails - give oxytocin

26. Treatment of DKA.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Weight gain - type 2 DM - QT prolongation
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia

27. Tanner stage 3 in a six-year - old female.
ACEI
Neuroleptics
Precocious puberty
Uterine massage; if that fails - give oxytocin

28. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
DI
Broca's aphasia. Frontal lobe - left MCA distribution
Squamous cell carcinoma
MS

29. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Anion gap acidosis and 1
Oral surgery
Wrist drop - loss of thumb abduction
No. Parental consent is not necessary for the medical treatment of pregnant minors

30. Identify key organisms causing diarrhea:
1
Cluster headache
Vibrio - HAV
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

31. The most common type of testicular cancer.
Consider Fitz - Hugh - Curtis syndrome
AP chest - AP/lateral C- spine - AP pelvis
Anemia - thrombocytopenia - and acute renal failure
Seminoma

32. Nonpainful chancre.
Iron deficiency anemia
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
1
Parkinson's disease

33. Glomerulonephritis with hemoptysis.

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34. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Lung - breast - skin (melanoma) - kidney - GI tract
Iron deficiency anemia
Intussusception
Nephrotic syndrome

35. Presents with a herald patch - Christmas - tree pattern.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Pityriasis rosea

36. Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe)
Restrictive pulmonary disease
Conflict of interest
Pseudomonas

37. Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Pregnant women. Treat this group aggressively because of potential complications
Surfactant deficiency

38. How to distinguish polycythemia vera from 2
Klebsiella
Conflict of interest
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Bruton's X- linked agammaglobulinemia

39. Low urine specific gravity in the presence of high serum osmolality.
Seventy percent if the stenosis is symptomatic
Rate control with carotid massasge or other vagal stimulation
DI
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

40. Nontender abdominal mass associated with elevated VMA and HVA.
30 cc/hour
Membranous glomerulonephritis
Prevalence
Neuroblastoma

41. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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42. Albuminocytologic dissociation.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Hypertension - bradycardia - and abnormal respirations
Guillain - Barr

43. First step in the management of a patient with acute GI bleed.
Establish the ABCs
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Higher prevalence
S. aureus or S. epidermidis.

44. Hernia with highest risk of incarceration
Hypertension - bradycardia - and abnormal respirations
Femoral hernia
Edrophonium
Osmotic fragility test

45. PFT showing ? FEV1/FVC.
Obstructive pulmonary disease (e.g. - asthma)
Acute mania. Start a mood stabilizer (e.g. - lithium)
Levodopa/carbidopa
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

46. Four signs and symptoms of streptococcal pharyngitis.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Parainfluenza virus type 1
Bruton's X- linked agammaglobulinemia
Lead - time bias

47. In which patients do you initiate colorectal cancer screening early?
Sporothrix schenckii
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
Identify cause; pressors (e.g. - dobutamine)
Malingering

48. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Beta- blockers - digoxin - calcium channel blockers
Neurofibromatosis 1
Hypocalcemia

49. A young patient with a family history of sudden death collapses and dies while exercising.
IV benzodiazepine
Ophthalmologic exam - CT - and MRI
Osgood - Schlatter disease
Hypertrophic cardiomyopathy

50. Antihypertensive for a diabetic patient with proteinuria.
HGPRTase deficiency)
ACEI
S. aureus or S. epidermidis.
Non - Hodgkin's lymphoma