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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. The most common cause of bloody nipple discharge.
Intraductal papilloma
Iron deficiency anemia
Normal
O2 - analgesia - hydration - and - if severe - transfusion

2. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Varicella zoster
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Hodgkin's lymphoma
ARDS

3. Antihypertensive for a diabetic patient with proteinuria.
30 cc/hour
Femoral hernia
ACEI
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing

4. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Depersonalization disorder
Calcium oxalate
Alzheimer's and multi - infarct
Nephrotic syndrome

5. In which patients do you initiate colorectal cancer screening early?
Choriocarcinoma
Asherman's syndrome
BP > 140/90 on three separate occasions two weeks apart
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

6. 'Cradle cap.'
Legionella pneumonia
Seborrheic dermatitis. Treat with antifungals
Naloxone
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

7. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Acute myelogenous leukemia (AML)
Phencyclidine hydrochloride (PCP) intoxication
Emergent laparotomy to repair perforated viscus - likely stomach

8. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
DM - SLE - and amyloidosis
Immediate needle thoracostomy
No. Parental consent is not necessary for the medical treatment of pregnant minors
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

9. Inspiratory arrest during palpation of the RUQ.

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10. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Self - limited - painless vaginal bleeding
Parvovirus B19
Lichen planus
Osteoarthritis

11. Medical options for endometriosis.
Pseudomonas
HBV immunoglobulin
OCPs - danazol - GnRH agonists
S. aureus

12. Which healthy population is susceptible to UTIs?
Anemia of chronic disease
Pregnant women. Treat this group aggressively because of potential complications
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Basal cell carcinoma

13. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
ALS
Squamous cell carcinoma
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Cerebral berry aneurysms (AD PCKD)

14. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Patent ductus arteriosus (PDA)
Kl
Treat existing heart failure and replace the tricuspid valve
'Chocolate cysts -' powder burns

15. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Haemophilus ducreyi
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Rett's disorder

16. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Weight loss and OCPs
Trichomonas vaginitis
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

17. Name the defense mechanism:
S. aureus or S. epidermidis.
50 cc/hour
Flumazenil
Displacement

18. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Panic disorder
Alopecia areata (autoimmune process)
O2 - analgesia - hydration - and - if severe - transfusion
Infection - cancer - and autoimmune disease

19. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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20. The most common inherited cause of hypercoagulability.
Conversion disorder
Continuous positive airway pressure
Factor V Leiden mutation
Cirrhosis - CHF - nephritic syndrome

21. Caf
Neurofibromatosis 1
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Klebsiella
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

22. Identify key organisms causing diarrhea:
Metformin
Naloxone
S. aureus
Endometriosis

23. Symptoms of placental abruption.
Isolation
Continuous - painful vaginal bleeding
Abdominal ultrasound and CT
Intussusception

24. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
Wiskott - Aldrich syndrome
Abdominal ultrasound and CT
Postinfectious glomerulonephritis

25. Combined UMN and LMN disorder.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
ALS
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Paget's disease

26. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Rubella
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Fanconi's anemia
Febrile seizures (roseola infantum)

27. Treatment for acute coronary syndrome.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Hypoparathyroidism
Osmotic fragility test

28. Chromosomal pattern of a complete mole.
46 -XX
Absence seizures
Broca's aphasia. Frontal lobe - left MCA distribution
1

29. Joints in the hand affected in rheumatoid arthritis.
Higher incidence
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Diverticulosis
MCP and PIP joints; DIP joints are spared

30. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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31. Evaluation of a pulsatile abdominal mass and bruit.
Glomerulonephritis/nephritic syndrome
Duodenal atresia
Abdominal ultrasound and CT
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

32. Antibiotics with teratogenic effects.
HBV immunoglobulin
Type II (proximal) RTA
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Taenia solium (cysticercosis)

33. Classic ECG finding in atrial flutter.

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34. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
They can mask symptoms of hypoglycemia
Frotteurism (a paraphilia)
Trichomonas vaginitis
Giardia

35. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Taenia solium (cysticercosis)
Type II (proximal) RTA

36. Presence of red cell casts in urine sediment.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Glomerulonephritis/nephritic syndrome
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

37. PFT showing ? FEV1/FVC.
Fluids and antibiotics
Restrictive pulmonary disease
Cluster headache
N- acetylcysteine

38. PFT showing ? FEV1/FVC.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Obstructive pulmonary disease (e.g. - asthma)
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
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

39. Medical treatment for IBD.
Cardiogenic shock
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
False. Withdrawing and withholding life are the same from an ethical standpoint
Legionella pneumonia

40. Signs of air embolism.
Taenia solium (cysticercosis)
A patient with chest trauma who was previously stable suddenly dies
IV hydration and loop diuretics (furosemide)
Salmonella

41. The most common pituitary tumor. Treatment?
Diverticulosis
Number of deaths from 20 weeks' gestation to birth per 1000 total births
S. aureus
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

42. Epidemics such as influenza
Pityriasis rosea
Higher incidence
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
Bacterial meningitis

43. Chronic diseases such as SLE
Acute myelogenous leukemia (AML)
Higher prevalence
V/Q scan
Wegener's granulomatosis and Goodpasture's syndrome

44. Flat - topped papules.
CF or Hirschsprung's disease
Malignancy and hyperparathyroidism
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Lichen planus

45. Risk factors for cholelithiasis.
IV benzodiazepine
Patient on dopamine antagonist
1
Fat - female - fertile - forty - flatulent

46. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Basal cell carcinoma
Abdominal ultrasound and CT
Placental abruption and placenta previa

47. Key side effects of atypical antipsychotics.
Malingering
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
B12 deficiency
Weight gain - type 2 DM - QT prolongation

48. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Conflict of interest
Sulfonamides - antimalarial drugs - fava beans
Dissociative fugue
Oral or topical metronidazole

49. Name the defense mechanism:
Infection - cancer - and autoimmune disease
Regression
DM - SLE - and amyloidosis
Renal cell carcinoma (RCC)

50. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Number of live births per 1000 women 15-44 years of age
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Sulfonamides - antimalarial drugs - fava beans
Frotteurism (a paraphilia)