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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. Caf
Central pontine myelinolysis
1
Neurofibromatosis 1
Conduct disorder

2. True or false: Once patients sign a statement giving consent - they must continue treatment.
Glomerulonephritis/nephritic syndrome
Type IV (distal) RTA
Third - degree heart block
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

3. 'Cradle cap.'
Amoxicillin
Alzheimer's and multi - infarct
Seborrheic dermatitis. Treat with antifungals
Ampulla of the oviduct

4. How to diagnose and follow a leiomyoma.
Hypertrophic cardiomyopathy
Ultrasound
Pheochromocytoma
Selective IgA deficiency

5. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Emergent laparotomy to repair perforated viscus - likely stomach
Partial mole
ARDS

6. Blood in the urethral meatus or high - riding prostate.
Neuroleptic malignant syndrome
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
AP chest - AP/lateral C- spine - AP pelvis
Bladder rupture or urethral injury

7. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Hypoparathyroidism
Klebsiella
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Herpes simplex

8. Treatment for benzodiazepine overdose.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Pseudogout
Angina is new - is worsening - or occurs at rest
Flumazenil

9. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Squamous cell carcinoma
Sulfonamides - antimalarial drugs - fava beans
Confounding variable

10. 'Stones - bones - groans - psychiatric overtones.'
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
HGPRTase deficiency)
Signs and symptoms of hypercalcemia
Murphy's sign - seen in acute cholecystitis

11. The most common cause of postpartum hemorrhage.
Uterine atony
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Hypoparathyroidism
Suspect retinoblastoma

12. CSF findings:
Dissociative fugue
Hyperkalemia
Colposcopy and endocervical curettage
Subarachnoid hemorrhage (SAH)

13. Signs of active ischemia during stress testing.
Streptococcus pneumoniae
Acute myelogenous leukemia (AML)
Angina - ST- segment changes on ECG - or ? BP
Factitious disorder (Munchausen syndrome)

14. Goal hemoglobin A1c for a patient with DM.
Headache
< 7.0
Pseudomonas
Agranulocytosis

15. Treatment for SVC syndrome.
Campylobacter
Radiation
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Distal radius (Colles' fracture)

16. Glomerulonephritis with hemoptysis.

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17. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
All - compartment fasciotomy for suspected compartment syndrome
Avascular necrosis
S. aureus or S. epidermidis.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

18. Evaluation of a pulsatile abdominal mass and bruit.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Squamous cell carcinoma
Infection - cancer - and autoimmune disease
Abdominal ultrasound and CT

19. Name the organism:
Amoxicillin
BP > 140/90 on three separate occasions two weeks apart
Klebsiella
Asymmetry - border irregularity - color variation - large diameter

20. Lab values suggestive of menopause.
a - antagonists (phentolamine and phenoxybenzamine)
Clomiphene citrate
? serum FSH
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

21. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Edrophonium
Legionella pneumonia
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
High reliability - low validity

22. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Oral or topical metronidazole
Metformin
Murphy's sign - seen in acute cholecystitis

23. Complication of overly rapid correction of hyponatremia.
Beta- blockers - Ca2+ channel blockers - TCAs
Central pontine myelinolysis
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Uremic syndrome seen in patients with renal failure

24. The most common cause of female infertility.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Oral surgery
Endometriosis
Out

25. Low urine specific gravity in the presence of high serum osmolality.
DI
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Trichomonas vaginitis
Number of deaths per 1000 population

26. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
Lobular carcinoma in situ
Coarctation of the aorta
Fanconi's anemia

27. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
1
Low - voltage - diffuse ST- segment elevation
Phototherapy (mild) or exchange transfusion (severe)
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

28. 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?
Out
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Excessive EtOH
Highly sensitive for TB

29. Treatment of central DI.
Glomerulonephritis/nephritic syndrome
Acute pancreatitis
Selective IgA deficiency
Administration of DDAVP ? serum osmolality and free water restriction

30. Amenorrhea - bradycardia - and abnormal body image in a young female.
Threatened abortion
Anorexia
Ampulla of the oviduct
HGPRTase deficiency)

31. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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32. Four causes of microcytic anemia.
TICS
Yersinia
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Parainfluenza virus type 1

33. Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
SSRIs
Regresses after menopause
Lesions of 1

34. 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
Seminoma
Mycoplasma
Retrograde cystourethrogram

35. Electrolyte changes in tumor lysis syndrome.
Panic disorder
Respiratory alkalosis
INH - penicillamine - hydralazine - procainamide
? Ca2+ - ? K- - ? phosphate - ? uric acid

36. The 6 P's of ischemia due to peripheral vascular disease.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Mallory- Weiss
HGPRTase deficiency)
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia

37. The most likely cause of acute lower GI bleed in patients > 40 years old.
Aseptic (viral) meningitis
Continuous positive airway pressure
Diverticulosis
Crohn's disease

38. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
? serum FSH
Hypertension - bradycardia - and abnormal respirations
Fluids and antibiotics
a - antagonists (phentolamine and phenoxybenzamine)

39. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Hypokalemia
Acute pancreatitis
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

40. Meningitis in neonates. Causes? Treatment?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Anemia - thrombocytopenia - and acute renal failure

41. Name the organism:
Pseudomonas
Type IV (distal) RTA
Reye's syndrome
Postinfectious glomerulonephritis

42. The most common cause of seizures in young adults (18-35 years).
Trauma - alcohol withdrawal - brain tumor
Non - Hodgkin's lymphoma
Rett's disorder
Number of live births per 1000 women 15-44 years of age

43. Charcot's triad.
Biliary tract obstruction
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Fluids and antibiotics
Clomiphene citrate

44. Contraceptive methods that protect against PID.
OCP and barrier contraception
M3
Squamous cell carcinoma
Diphenhydramine or epinephrine 1:1000

45. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Sulfonamides - antimalarial drugs - fava beans
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Sarcoidosis
Observational bias

46. Extraintestinal manifestations of IBD.
Trauma - alcohol withdrawal - brain tumor
Out
Diverticulosis
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1

47. Unopposed estrogen is contraindicated in which cancers?
Retrograde cystourethrogram
Endometrial or estrogen receptor - breast cancer
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

48. Infant mortality?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Seminoma
Substance abuse

49. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Ophthalmologic exam - CT - and MRI
Renal cell carcinoma (RCC)

50. The most frequent presentation of intracranial neoplasm.
Allergic interstitial nephritis
Colposcopy and endocervical curettage
Headache
Bruton's X- linked agammaglobulinemia