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USMLE Step 2

Subjects : health-sciences, usmle-step-2

Instructions:

Answer 50 questions in 15 minutes.
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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. 'Stuck - on' appearance.
Seborrheic keratosis
Inhaled Beta- agonists and inhaled corticosteroids
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Septic or anaphylactic shock

2. Treatment of central DI.
Administration of DDAVP ? serum osmolality and free water restriction
Inhaled Beta- agonists and inhaled corticosteroids
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Pseudomonas

3. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
RSV bronchiolitis
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Squamous cell carcinoma

4. Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Streptococcus pneumoniae
Lyme disease - Ixodes tick - doxycycline
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

5. Attributable risk?
Absence seizures
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Contact dermatitis

6. RTA associated with aldosterone defect.
Duchenne muscular dystrophy
Type IV (distal) RTA
IV benzodiazepine
OCPs

7. Medical treatment for hepatic encephalopathy.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Duchenne muscular dystrophy
? protein intake - lactulose - neomycin
Hodgkin's lymphoma

8. Signs of air embolism.
Hypokalemia
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Beta- blockers - digoxin - calcium channel blockers
A patient with chest trauma who was previously stable suddenly dies

9. Treatment of hypovolemic shock.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Identify cause; fluid and blood repletion
Prinzmetal's angina
Wernicke's encephalopathy due to a deficiency of thiamine

10. PFT showing ? FEV1/FVC.
BP > 140/90 on three separate occasions two weeks apart
S. aureus
Restrictive pulmonary disease
50 cc/hour

11. Causes of drug - induced SLE.
Identify cause; fluid and blood repletion
INH - penicillamine - hydralazine - procainamide
Actinic keratosis
RCC or other erythropoietin - producing tumor; evaluate with CT scan

12. Four signs and symptoms of streptococcal pharyngitis.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Normal
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Fever - pharyngeal erythema - tonsillar exudate - lack of cough

13. Classic causes of drug - induced hepatitis.
Flumazenil
Type IV (distal) RTA
Chronic granulomatous disease
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

14. When should a vaginal exam be performed with suspected placenta previa?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Never
Septic or anaphylactic shock

15. Mortality rate?
Coccidioidomycosis. Amphotericin B
Pseudomonas
Prinzmetal's angina
Number of deaths per 1000 population

16. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Nephritic syndrome
Wait - surgical resection - radiation and/or androgen suppression
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
Higher prevalence

17. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Regression
IV hydration and loop diuretics (furosemide)
Substance abuse
Type I (distal) RTA

18. Combined UMN and LMN disorder.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
MS
ALS
46 -XX

19. Identify key organisms causing diarrhea:
Hypertension - bradycardia - and abnormal respirations
Bacillus cereus
Self - limited - painless vaginal bleeding
Hashimoto's thyroiditis

20. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
All - compartment fasciotomy for suspected compartment syndrome
Partial mole
Wegener's granulomatosis and Goodpasture's syndrome
Emergent laparotomy to repair perforated viscus - likely stomach

21. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Incidence and prevalence
Metformin
Anion gap acidosis and 1
Slipped capital femoral epiphyses. AP and frog - leg lateral view

22. Presents with a herald patch - Christmas - tree pattern.
Betamethasone or dexamethasone
ETEC
Pityriasis rosea
Fluids and antibiotics

23. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
a - antagonists (phentolamine and phenoxybenzamine)
Anion gap acidosis and 1
E. coli O157:H7
Frotteurism (a paraphilia)

24. 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
Out
SCLC
Flumazenil

25. Hypercholesterolemia treatment that ? flushing and pruritus.
Clostridium difficile
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Niacin
Number of live births per 1000 population

26. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Pentad of TTP
Squamous cell carcinoma
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
V/Q scan

27. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Colposcopy and endocervical curettage
Nephrotic syndrome
Pityriasis versicolor

28. Complication of overly rapid correction of hyponatremia.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Betamethasone or dexamethasone
Avascular necrosis
Central pontine myelinolysis

29. Identify key organisms causing diarrhea:
Hypokalemia
Toxoplasma gondii
Low - voltage - diffuse ST- segment elevation
Clostridium difficile

30. When can a physician refuse to continue treating a patient on the grounds of futility?
Stasis - hypercoagulability - endothelial damage
Femoral hernia
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
Pityriasis rosea

31. Causes of exudative effusion.
Huntington's disease
Regression
Duodenal atresia
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

32. Cohort study
Incidence and prevalence
MCP and PIP joints; DIP joints are spared
Usually resolves spontaneously; may require IVIG and/or corticosteroids
High reliability - low validity

33. A patient presents with recent PID with RUQ pain.
Regresses after menopause
Trauma; the second most common is berry aneurysm
Factor V Leiden mutation
Consider Fitz - Hugh - Curtis syndrome

34. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Neuroleptics
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
1

35. The most common type of nephrolithiasis.
Inevitable abortion
Colposcopy and endocervical curettage
Hypertension - bradycardia - and abnormal respirations
Calcium oxalate

36. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lichen sclerosus
Lobular carcinoma in situ
Phencyclidine hydrochloride (PCP) intoxication
Acute myelogenous leukemia (AML)

37. Identify key organisms causing diarrhea:
Number of live births per 1000 women 15-44 years of age
Salmonella
Bacterial meningitis
Duchenne muscular dystrophy

38. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Consider Fitz - Hugh - Curtis syndrome
Precocious puberty
High reliability - low validity
Colposcopy and endocervical curettage

39. A fall in systolic BP of > 10 mmHg with inspiration.
Patient on dopamine antagonist
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Pulsus paradoxus (seen in cardiac tamponade)
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

40. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
CF or Hirschsprung's disease
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
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
Herpes simplex

41. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Cluster headache
Acute mania. Start a mood stabilizer (e.g. - lithium)
Usually resolves spontaneously; may require IVIG and/or corticosteroids

42. Tests to rule out shaken baby syndrome.
Ophthalmologic exam - CT - and MRI
Pheochromocytoma
No. Parental consent is not necessary for the medical treatment of pregnant minors
Restrictive pulmonary disease

43. Signs suggesting radial nerve damage with humeral fracture.
Number of live births per 1000 women 15-44 years of age
Wrist drop - loss of thumb abduction
Lesions of 1
1

44. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Anion gap acidosis and 1
Highly sensitive for TB
Diamond - Blackfan anemia
Small cell lung cancer (SCLC)

45. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Edrophonium
SIADH due to stress
Emergent laparotomy to repair perforated viscus - likely stomach
All - compartment fasciotomy for suspected compartment syndrome

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

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47. Iris - like target lesions.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Crohn's disease
Trichomonas vaginitis
Erythema multiforme

48. True or false: Once patients sign a statement giving consent - they must continue treatment.
Iron deficiency anemia
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Chronic lymphocytic leukemia (CLL)
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

49. Prophylactic treatment for migraine.
Dissociative fugue
S. aureus or S. epidermidis.
Beta- blockers - Ca2+ channel blockers - TCAs
Parkinson's disease

50. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Varicella zoster
Febrile seizures (roseola infantum)
Lung - breast - skin (melanoma) - kidney - GI tract

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USMLE Step 2

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