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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. Four signs and symptoms of streptococcal pharyngitis.
CHF - shock - and altered mental status
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
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
SCLC

2. Name the organism:
Toxoplasma gondii
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
IV hydration and loop diuretics (furosemide)
Self - limited - painless vaginal bleeding

3. Common symptoms associated with silent MIs.
Lichen sclerosus
CHF - shock - and altered mental status
Hyperkalemia
High TSH - low T4 - antimicrosomal antibodies

4. The most common cause of female infertility.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Acute pancreatitis
Endometriosis
Sheehan's syndrome (postpartum pituitary necrosis)

5. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Factitious disorder (Munchausen syndrome)
Inevitable abortion
Asymmetry - border irregularity - color variation - large diameter

6. Chronic diseases such as SLE
Higher prevalence
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
ACEI
Mycoplasma

7. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
? serum FSH
Uterine massage; if that fails - give oxytocin
Incidence and prevalence
Polymyalgia rheumatica

8. Therapy for polycystic ovarian syndrome.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Weight loss and OCPs
Alzheimer's and multi - infarct
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

9. Causes of drug - induced SLE.
Lead - time bias
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Membranous glomerulonephritis
INH - penicillamine - hydralazine - procainamide

10. Bone is fractured in fall on outstretched hand.

11. Medications and viruses that ? aplastic anemia.
Number of deaths from birth to 28 days per 1000 live births
50 cc/hour
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

12. A 49-year - old male presents with acute - onset flank pain and hematuria.
Restrictive pulmonary disease
Giardia
Nephrolithiasis
They can mask symptoms of hypoglycemia

13. Eosinophils in urine sediment.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Allergic interstitial nephritis
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Renal cell carcinoma (RCC)

14. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Huntington's disease
Reaction formation
Type I (distal) RTA
Abdominal ultrasound and CT

15. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
Acute pancreatitis
Asherman's syndrome
Rett's disorder

16. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Cerebral berry aneurysms (AD PCKD)
Vibrio - HAV
Pasteurella multocida

17. Charcot's triad.
Never
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Lesion of 1
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

18. Laparoscopic findings in endometriosis.

19. The most common location for an ectopic pregnancy.
Pseudomonas
Broca's aphasia. Frontal lobe - left MCA distribution
Ampulla of the oviduct
Immediate needle thoracostomy

20. Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
1
Pemphigus vulgaris

21. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

22. Goal hemoglobin A1c for a patient with DM.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Kwashiorkor (protein malnutrition)
Exercise stress treadmill with ECG
< 7.0

23. Breast malignancy presenting as itching - burning - and erosion of the nipple.

24. Radiographic indications for surgery in patients with acute abdomen.
Hodgkin's lymphoma
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Number of deaths from 28 days to one year per 1000 live births
Immediate cardioversion

25. Thrombotic thrombocytopenic purpura (TTP) pentad?
Continuous - painful vaginal bleeding
Pentad of TTP
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Kegel exercises - estrogen - pessaries for stress incontinence

26. The most common form of glomerulonephritis.

27. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Toxoplasma gondii
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Hyperkalemia
Murphy's sign - seen in acute cholecystitis

28. Auer rods on blood smear.
Avascular necrosis
Acute myelogenous leukemia (AML)
Cerebral berry aneurysms (AD PCKD)
Osgood - Schlatter disease

29. A doctor refers a patient for an MRI at a facility he/she owns.
< 7.0
Conflict of interest
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Exercise stress treadmill with ECG

30. Virchow's triad.
Stasis - hypercoagulability - endothelial damage
Erythema multiforme
V/Q scan
Squamous cell carcinoma

31. Three systemic diseases ? nephrotic syndrome.
Biliary tract obstruction
DM - SLE - and amyloidosis
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Basal cell carcinoma

32. Low urine specific gravity in the presence of high serum osmolality.
Administration of DDAVP ? serum osmolality and free water restriction
DI
Pentad of TTP
MAOIs

33. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Mycobacterium tuberculosis
Uremic syndrome seen in patients with renal failure
Excessive EtOH
Broca's aphasia. Frontal lobe - left MCA distribution

34. In which patients do you initiate colorectal cancer screening early?
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
Intraductal papilloma
Amoxicillin
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

35. Extraintestinal manifestations of IBD.
S. aureus or S. epidermidis.
Avascular necrosis
Beta- blockers - Ca2+ channel blockers - TCAs
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1

36. Appropriate diagnostic test?
Pregnant women. Treat this group aggressively because of potential complications
Exercise stress treadmill with ECG
Neuroleptic malignant syndrome
Number of live births per 1000 population

37. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Alopecia areata (autoimmune process)
Chronic lymphocytic leukemia (CLL)
Hashimoto's thyroiditis
Multiple myeloma

38. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Factitious disorder (Munchausen syndrome)
Multiple myeloma
Acute myelogenous leukemia (AML)

39. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

40. The most common cause of seizures in children (2-10 years).
Psoriasis
Infection - febrile seizures - trauma - idiopathic
Intussusception
Iron overload; use deferoxamine

41. Hypercholesterolemia treatment that ? flushing and pruritus.
IV hydration and loop diuretics (furosemide)
Sarcoidosis
Niacin
Usually resolves spontaneously; may require IVIG and/or corticosteroids

42. Fertility rate?
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Number of live births per 1000 women 15-44 years of age
MS
Third - degree heart block

43. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Absence seizures
Prerenal
False. Withdrawing and withholding life are the same from an ethical standpoint

44. How to diagnose and follow a leiomyoma.
Alopecia areata (autoimmune process)
Pharmacologic stress test (e.g. - dobutamine echo)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Ultrasound

45. Birth rate?
Number of live births per 1000 population
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Transitional cell carcinoma
Folate deficiency

46. A violent patient has vertical and horizontal nystagmus.
Diphenhydramine or epinephrine 1:1000
Acute myelogenous leukemia (AML)
Salmonella
Phencyclidine hydrochloride (PCP) intoxication

47. Supportive treatment for ARDS.
Beta- blockers - digoxin - calcium channel blockers
Continuous positive airway pressure
ALS
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

48. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Multiple myeloma
Osteogenesis imperfecta
Biliary tract obstruction
Angina is new - is worsening - or occurs at rest

49. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Self - limited - painless vaginal bleeding
Weight loss and OCPs
Bullous pemphigoid

50. When can a physician refuse to continue treating a patient on the grounds of futility?
Obstructive pulmonary disease (e.g. - asthma)
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
Beta- hCG; the most common cause of amenorrhea is pregnancy
Placental abruption and placenta previa