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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. Antihypertensive for a diabetic patient with proteinuria.
Dissociative fugue
ACEI
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Seventy percent if the stenosis is symptomatic

2. Red plaques with silvery- white scales and sharp margins.
Psoriasis
Trauma; the second most common is berry aneurysm
Clomiphene citrate
Biliary tract obstruction

3. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Beta- blockers - digoxin - calcium channel blockers
Check for ? ICP; look for papilledema
Lead - time bias
Hypertension - bradycardia - and abnormal respirations

4. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
? serum FSH
Haemophilus ducreyi
Alopecia areata (autoimmune process)

5. Attributable risk?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Identify cause; fluid and blood repletion
Betamethasone or dexamethasone

6. First - line medication for status epilepticus.
Asherman's syndrome
'Sawtooth' P waves
IV benzodiazepine
Membranous glomerulonephritis

7. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
No. Parental consent is not necessary for the medical treatment of pregnant minors
Nephritic syndrome
Allergic interstitial nephritis

8. The most common histology of bladder cancer.
IV hydration and loop diuretics (furosemide)
Type IV (distal) RTA
Transitional cell carcinoma
Neuroblastoma

9. Key side effects of atypical antipsychotics.
Type II (proximal) RTA
Weight gain - type 2 DM - QT prolongation
Lesch - Nyhan syndrome (purine salvage problem with
Fluid restriction - demeclocycline

10. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Malingering
Sarcoidosis
Infection - cancer - and autoimmune disease
Clomiphene citrate

11. Joints in the hand affected in rheumatoid arthritis.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Hashimoto's thyroiditis
MCP and PIP joints; DIP joints are spared

12. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Distal radius (Colles' fracture)
False. Withdrawing and withholding life are the same from an ethical standpoint
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Sarcoidosis

13. Common symptoms associated with silent MIs.
CHF - shock - and altered mental status
Obstructive pulmonary disease (e.g. - asthma)
Third - degree heart block
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

14. Medication used to induce ovulation.
Continuous positive airway pressure
ACEI
Clomiphene citrate
Central pontine myelinolysis

15. Nonpainful chancre.
Isolation
1
Consider Fitz - Hugh - Curtis syndrome
Immediate needle thoracostomy

16. Case - control study
Osmotic fragility test
Hypoxia and hypocarbia
Highly sensitive for TB
Neither

17. Risk factors for cholelithiasis.
ETEC
Spinal stenosis
Nephrolithiasis
Fat - female - fertile - forty - flatulent

18. Reed - Sternberg cells

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19. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Amoxicillin
< 7.0
Excessive EtOH
ARDS

20. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Seventy percent if the stenosis is symptomatic
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Ophthalmologic exam - CT - and MRI

21. Classic physical findings for endocarditis.

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22. ? risk of what infection with silicosis?
Pulsus paradoxus (seen in cardiac tamponade)
Mycobacterium tuberculosis
Number of deaths per 1000 population
Cluster headache

23. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Wiskott - Aldrich syndrome
Cluster headache
Trichomonas vaginitis
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

24. First - line pharmacotherapy for depression.
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
DI
Exercise stress treadmill with ECG
SSRIs

25. Medication given to accelerate fetal lung maturity.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Protamine
Betamethasone or dexamethasone
Hypovolemic shock

26. A significant cause of morbidity in thalassemia patients. Treatment?
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Febrile seizures (roseola infantum)
Iron overload; use deferoxamine
Endometrial or estrogen receptor - breast cancer

27. Name the organism:
Inhaled Beta- agonists and inhaled corticosteroids
Aseptic (viral) meningitis
Neuroleptic malignant syndrome
Klebsiella

28. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Treat immediately. Consent is implied in emergency situations
Subarachnoid hemorrhage (SAH)
a - antagonists (phentolamine and phenoxybenzamine)
Huntington's disease

29. Beck's triad for cardiac tamponade.
Osteogenesis imperfecta
Anorexia
Prevalence
Hypotension - distant heart sounds - and JVD

30. What should always be done prior to LP?
Check for ? ICP; look for papilledema
Number of live births per 1000 population
Prinzmetal's angina
Toxoplasma gondii

31. Virchow's triad.
Asymmetry - border irregularity - color variation - large diameter
Stasis - hypercoagulability - endothelial damage
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Cluster headache

32. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
105 bacteria/mL
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Hypokalemia
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

33. 'Stuck - on' appearance.
Abdominal ultrasound and CT
Seborrheic keratosis
IV hydration and loop diuretics (furosemide)
Type I (distal) RTA

34. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Pseudomonas
Endometrial or estrogen receptor - breast cancer
Trichomonas vaginitis

35. Identify key organisms causing diarrhea:
Diamond - Blackfan anemia
Protamine
Agranulocytosis
Campylobacter

36. Identify key organisms causing diarrhea:
Bacillus cereus
Clostridium difficile
Squamous cell carcinoma
Prerenal

37. Testicular cancer associated with Beta- hCG - AFP.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Choriocarcinoma
Bacterial meningitis
Neither

38. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Actinic keratosis
HBV immunoglobulin
Neuroleptic malignant syndrome
Depersonalization disorder

39. ECG findings suggesting MI.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

40. Complication of overly rapid correction of hyponatremia.
Retinoic acid
Central pontine myelinolysis
Weight loss and OCPs
Endometriosis

41. Goal hemoglobin A1c for a patient with DM.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Naloxone
Duchenne muscular dystrophy
< 7.0

42. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Endometrial or estrogen receptor - breast cancer
Legionella pneumonia
No. Parental consent is not necessary for the medical treatment of pregnant minors
Neuroleptics

43. Inflammatory disease of the colon with ? risk of colon cancer.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Check for ? ICP; look for papilledema
Ulcerative colitis

44. How to diagnose and follow a leiomyoma.
E. coli O157:H7
Ultrasound
Broca's aphasia. Frontal lobe - left MCA distribution
The IR of a disease in a population exposed to a particular factor

45. 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?
Folate deficiency
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Legionella pneumonia
Ampulla of the oviduct

46. A child has loss of red light reflex. Diagnosis?
Rate control - rhythm conversion - and anticoagulation
Giardia
Suspect retinoblastoma
Partial mole

47. Dermatomal distribution.
1
Varicella zoster
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Respiratory alkalosis

48. What % lesion is an indication for carotid endarterectomy?
Identify cause; fluid and blood repletion
Seventy percent if the stenosis is symptomatic
Check for ? ICP; look for papilledema
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

49. What is the immunodeficiency?
Wiskott - Aldrich syndrome
S. aureus or S. epidermidis.
Neither
Parkinson's disease

50. Supportive treatment for ARDS.
Varicella zoster
Continuous positive airway pressure
Regresses after menopause
Campylobacter