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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. Symptoms of placental abruption.
ACEI
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Continuous - painful vaginal bleeding
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

2. Fetal mortality?

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3. When should a vaginal exam be performed with suspected placenta previa?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
OCPs
Never

4. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Incidence and prevalence
M3
Kegel exercises - estrogen - pessaries for stress incontinence
Diamond - Blackfan anemia

5. Amenorrhea - bradycardia - and abnormal body image in a young female.
< 7.0
Alzheimer's and multi - infarct
Actinomyces israelii
Anorexia

6. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Nephrotic syndrome
Polymyalgia rheumatica
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

7. Electrolyte changes in tumor lysis syndrome.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
? Ca2+ - ? K- - ? phosphate - ? uric acid

8. 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.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Prinzmetal's angina
Dissociative fugue
Polymyalgia rheumatica

9. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
ACEI
Nephritic syndrome
Parkinson's disease

10. PFT showing ? FEV1/FVC.
1
Fat - female - fertile - forty - flatulent
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Obstructive pulmonary disease (e.g. - asthma)

11. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
Yersinia
HBV immunoglobulin
Headache

12. Autoimmune complication occurring 2-4 weeks post - MI.

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13. The mainstay of Parkinson's therapy.
Identify cause; pressors (e.g. - dobutamine)
Levodopa/carbidopa
Allergic interstitial nephritis
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

14. Relative risk?
Weight gain - type 2 DM - QT prolongation
The IR of a disease in a population exposed to a particular factor
Flumazenil
Highly sensitive for TB

15. ECG findings suggesting MI.
Nitroprusside
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Seborrheic keratosis
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

16. Reed - Sternberg cells

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17. Unopposed estrogen is contraindicated in which cancers?
Nephrotic syndrome
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
Endometrial or estrogen receptor - breast cancer
'Chocolate cysts -' powder burns

18. CSF findings:
MS
Out
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Multiple myeloma

19. CSF findings:
Number of live births per 1000 population
Hypotension and bradycardia
Conduct disorder
Aseptic (viral) meningitis

20. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Osteogenesis imperfecta
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Coccidioidomycosis. Amphotericin B
Hypovolemic shock

21. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Avascular necrosis
Wegener's granulomatosis and Goodpasture's syndrome
Chronic lymphocytic leukemia (CLL)
Squamous cell carcinoma

22. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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23. Prophylactic treatment for migraine.
Pentad of TTP
Prevalence
Reye's syndrome
Beta- blockers - Ca2+ channel blockers - TCAs

24. Radiographic indications for surgery in patients with acute abdomen.
Diverticulosis
MAOIs
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)

25. Pure RBC aplasia.
Lichen planus
Actinic keratosis
Diamond - Blackfan anemia
Precocious puberty

26. Extraintestinal manifestations of IBD.
Squamous cell carcinoma
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Fatigue and impending respiratory failure
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

27. Lung cancer associated with SIADH.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Hypoparathyroidism
Small cell lung cancer (SCLC)
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

28. Nikolsky's sign.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Ophthalmologic exam - CT - and MRI
Dressler's syndrome: fever - pericarditis - ? ESR
Bullous pemphigoid

29. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
A patient with chest trauma who was previously stable suddenly dies
Basal cell carcinoma
Febrile seizures (roseola infantum)
Osteogenesis imperfecta

30. Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
Betamethasone or dexamethasone
Weight loss and OCPs
ARDS

31. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Pseudogout
A patient's family cannot require that a doctor withhold information from the patient
AP chest - AP/lateral C- spine - AP pelvis
SIADH due to stress

32. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Subdural hematoma
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Inevitable abortion
Trauma; the second most common is berry aneurysm

33. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Benzodiazepines
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Cellulitis
Wegener's granulomatosis and Goodpasture's syndrome

34. AML subtype associated with DIC.
Identify cause; fluid and blood repletion
Squamous cell carcinoma
M3
Calcium oxalate

35. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Rubella
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Colposcopy and endocervical curettage
Pregnant women. Treat this group aggressively because of potential complications

36. Chvostek's and Trousseau's signs.
Hypocalcemia
Salmonella
Clostridium difficile
IV penicillin or ampicillin

37. Identify key organisms causing diarrhea:
Bacterial meningitis
Endometrial or estrogen receptor - breast cancer
Rate control - rhythm conversion - and anticoagulation
Giardia

38. Definition of unstable angina.
Cardiogenic shock
Angina is new - is worsening - or occurs at rest
Beta- blockers - Ca2+ channel blockers - TCAs
HGPRTase deficiency)

39. A congenital heart disease that cause 2
Pemphigus vulgaris
Third - degree heart block
Coarctation of the aorta
Uterine massage; if that fails - give oxytocin

40. What should always be done prior to LP?
Check for ? ICP; look for papilledema
ETEC
Membranous glomerulonephritis
Rubella

41. Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome
Patent ductus arteriosus (PDA)
Hypoparathyroidism
OCPs

42. A 'blueberry muffin' rash is characteristic of what congenital infection?
Highly sensitive for TB
Pseudomonas
Kl
Rubella

43. 'Stuck - on' appearance.
Klebsiella
Check for ? ICP; look for papilledema
Seborrheic keratosis
Rate control - rhythm conversion - and anticoagulation

44. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Clomiphene citrate
Klebsiella
Fatigue and impending respiratory failure
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

45. Identify key organisms causing diarrhea:
Trauma - alcohol withdrawal - brain tumor
Campylobacter
Alport's syndrome
Acne vulgaris

46. Treatment of AF.
Never
High TSH - low T4 - antimicrosomal antibodies
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Rate control - rhythm conversion - and anticoagulation

47. Medical treatment for hepatic encephalopathy.
Pharmacologic stress test (e.g. - dobutamine echo)
Seborrheic keratosis
? protein intake - lactulose - neomycin
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate

48. HUS triad?
Reaction formation
Anemia - thrombocytopenia - and acute renal failure
False. Withdrawing and withholding life are the same from an ethical standpoint
< 7.0

49. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Pseudomonas
Vibrio - HAV
Pseudogout

50. 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)
Subarachnoid hemorrhage (SAH)
B12 deficiency
Rate control - rhythm conversion - and anticoagulation