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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. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Erythema multiforme
Duchenne muscular dystrophy
Emergent laparotomy to repair perforated viscus - likely stomach

2. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Hodgkin's lymphoma
Menometrorrhagia
Basal cell carcinoma
Avascular necrosis

3. Neonatal mortality?
HBV immunoglobulin
Number of deaths from birth to 28 days per 1000 live births
ARDS
Conduct disorder

4. The most common histology of bladder cancer.
Choriocarcinoma
Transitional cell carcinoma
Biliary tract obstruction
Bacterial meningitis

5. CSF findings:
30 cc/hour
Subarachnoid hemorrhage (SAH)
Asymmetry - border irregularity - color variation - large diameter
Third - degree heart block

6. Post - HBV exposure treatment.
HBV immunoglobulin
Osteogenesis imperfecta
Identify cause; fluid and blood repletion
INH - penicillamine - hydralazine - procainamide

7. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Treat immediately. Consent is implied in emergency situations
Osmotic fragility test
Highly sensitive for TB

8. A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Retrograde cystourethrogram
Hypoxia and hypocarbia
Sulfonamides - antimalarial drugs - fava beans

9. Hypercholesterolemia treatment that ? flushing and pruritus.
Niacin
Sheehan's syndrome (postpartum pituitary necrosis)
Folate deficiency
Hypokalemia

10. Medication given to accelerate fetal lung maturity.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Wernicke's encephalopathy due to a deficiency of thiamine
Septic or anaphylactic shock
Betamethasone or dexamethasone

11. How to distinguish polycythemia vera from 2
Uterine massage; if that fails - give oxytocin
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Immediate needle thoracostomy
Treat existing heart failure and replace the tricuspid valve

12. In which patients do you initiate colorectal cancer screening early?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
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
N- acetylcysteine
HBV - DTaP - Hib - IPV - PCV

13. Natural history of a leiomyoma.
Angina is new - is worsening - or occurs at rest
Continuous - painful vaginal bleeding
Regresses after menopause
Anticoagulation - rate control - cardioversion

14. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Salmonella
Broca's aphasia. Frontal lobe - left MCA distribution
O2 - analgesia - hydration - and - if severe - transfusion

15. Type of ARF in a patient with FeNa < 1%.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
A patient with chest trauma who was previously stable suddenly dies
Prerenal
Agranulocytosis

16. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Guillain - Barr
Dissociative fugue
Klebsiella
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)

17. Lung cancer highly related to cigarette exposure.
Emergent laparotomy to repair perforated viscus - likely stomach
Parkland formula
SCLC
Hypoparathyroidism

18. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Neuroleptics
Taenia solium (cysticercosis)
Seborrheic keratosis

19. Unopposed estrogen is contraindicated in which cancers?
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
HBV - DTaP - Hib - IPV - PCV
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Endometrial or estrogen receptor - breast cancer

20. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Yersinia
Duodenal atresia
Sarcoidosis
Number of live births per 1000 population

21. Hernia with highest risk of incarceration
Femoral hernia
Radiation
Conversion disorder
Normal

22. The most common location for an ectopic pregnancy.
Cardiogenic shock
ARDS
Ampulla of the oviduct
Basal cell carcinoma

23. Glomerulonephritis with deafness.

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24. Name the organism:
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Hypernatremia
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Klebsiella

25. First step in the management of a patient with acute GI bleed.
S. aureus or S. epidermidis.
Establish the ABCs
Pheochromocytoma
Fanconi's anemia

26. The first test to perform when a woman presents with amenorrhea.
Coccidioidomycosis. Amphotericin B
Beta- hCG; the most common cause of amenorrhea is pregnancy
Benzodiazepines
Endometrial biopsy

27. Cohort study
ARDS
Substance abuse
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Incidence and prevalence

28. Causes of exudative effusion.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
DI
Hypotension - distant heart sounds - and JVD
IgA nephropathy (Berger's disease)

29. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
N- acetylcysteine
Erythema multiforme

30. Complication of scaphoid fracture.
Biliary tract obstruction
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Avascular necrosis

31. Name the organism:
Diamond - Blackfan anemia
Prinzmetal's angina
Haemophilus ducreyi
Pityriasis rosea

32. Treatment for bacterial vaginosis.
The IR of a disease in a population exposed to a particular factor
Haemophilus ducreyi
Placental abruption and placenta previa
Oral or topical metronidazole

33. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Neuroleptic malignant syndrome
Non - Hodgkin's lymphoma
Renal cell carcinoma (RCC)
Edrophonium

34. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
1
Spinal stenosis
Elevated ICP - RBCs - xanthochromia
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

35. Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Folate deficiency
Pityriasis rosea
Hypernatremia

36. Indications for medical treatment of ectopic pregnancy.

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37. Findings in 3
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
HBV immunoglobulin
Asherman's syndrome

38. The 6 P's of ischemia due to peripheral vascular disease.
Frotteurism (a paraphilia)
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Fluids and antibiotics

39. Identify key organisms causing diarrhea:
Bacillus cereus
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Fatigue and impending respiratory failure
INH - penicillamine - hydralazine - procainamide

40. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Factitious disorder (Munchausen syndrome)
B12 deficiency
Wait - surgical resection - radiation and/or androgen suppression
Confounding variable

41. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Neuroleptics
Hypernatremia
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

42. AML subtype associated with DIC.
Angina is new - is worsening - or occurs at rest
Clomiphene citrate
M3
Anorexia

43. Dermatomal distribution.
Varicella zoster
Mycobacterium tuberculosis
a - antagonists (phentolamine and phenoxybenzamine)
CML

44. ? CO - ? PCWP - ? PVR.
Rate control - rhythm conversion - and anticoagulation
Lobular carcinoma in situ
Cardiogenic shock
1

45. Reynolds' pentad.

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46. Four characteristics of a nevus suggestive of melanoma.
Pseudomonas
Asymmetry - border irregularity - color variation - large diameter
Kl
Identify cause; fluid and blood repletion

47. ECG findings suggesting MI.
Oral surgery
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Nephrotic syndrome
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

48. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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49. ? CO - ? PCWP - ? PVR.
N- acetylcysteine
Observational bias
MS
Septic or anaphylactic shock

50. Identify key organisms causing diarrhea:
Factitious disorder (Munchausen syndrome)
SIADH due to stress
a - antagonists (phentolamine and phenoxybenzamine)
ETEC