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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. Red plaques with silvery- white scales and sharp margins.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Pseudogout
Psoriasis
Continuous - painful vaginal bleeding

2. 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)
Prerenal
? protein intake - lactulose - neomycin
Highly sensitive for TB

3. Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Pasteurella multocida
Nephrolithiasis
Metformin

4. Reynolds' pentad.

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5. Appropriate diagnostic test?
7-10 days
Pharmacologic stress test (e.g. - dobutamine echo)
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Conduct disorder

6. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Observational bias
Rubella
Osteoarthritis
Pityriasis rosea

7. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Campylobacter
Highly sensitive for TB
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

8. Treatment of supraventricular tachycardia (SVT).
Spinal stenosis
Rate control with carotid massasge or other vagal stimulation
Hypotension - distant heart sounds - and JVD
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

9. The three most common causes of fever of unknown origin (FUO).
Infection - cancer - and autoimmune disease
Parkland formula
Central pontine myelinolysis
Number of deaths from birth to 28 days per 1000 live births

10. First - line medication for status epilepticus.
Haemophilus ducreyi
IV benzodiazepine
Antipsychotics (neuroleptic malignant syndrome)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

11. Acceptable urine output in a stable patient.
Kegel exercises - estrogen - pessaries for stress incontinence
30 cc/hour
Seborrheic dermatitis. Treat with antifungals
Signs and symptoms of hypercalcemia

12. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
a - antagonists (phentolamine and phenoxybenzamine)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1

13. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Incidence and prevalence
1
Self - limited - painless vaginal bleeding
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

14. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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15. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
OCPs
Parkland formula
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction

16. Cause of neonatal RDS.
Regression
Excessive EtOH
Ulcerative colitis
Surfactant deficiency

17. Diagnostic test for hereditary spherocytosis.
Wait - surgical resection - radiation and/or androgen suppression
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Osmotic fragility test

18. The most common form of nephritic syndrome.
Nitroprusside
Membranous glomerulonephritis
PT
Hereditary spherocytosis

19. Eight surgically correctable causes of hypertension.

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20. Flat - topped papules.
Number of deaths from birth to 28 days per 1000 live births
105 bacteria/mL
IVIG or plasmapheresis
Lichen planus

21. When can a physician refuse to continue treating a patient on the grounds of futility?
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Klebsiella
Slipped capital femoral epiphyses. AP and frog - leg lateral view
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

22. Amenorrhea - bradycardia - and abnormal body image in a young female.
Anorexia
Lead - time bias
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Out

23. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Hereditary spherocytosis
ETEC
ARDS

24. A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Lobular carcinoma in situ
Pasteurella multocida

25. Treatment for opioid overdose.
INH - penicillamine - hydralazine - procainamide
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Diverticulosis
Naloxone

26. Supportive treatment for ARDS.
Rate control with carotid massasge or other vagal stimulation
Kwashiorkor (protein malnutrition)
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Continuous positive airway pressure

27. The first test to perform when a woman presents with amenorrhea.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Placental abruption and placenta previa
Nephrolithiasis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order

28. A young patient with a family history of sudden death collapses and dies while exercising.
Partial mole
Anemia of chronic disease
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Hypertrophic cardiomyopathy

29. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Depersonalization disorder
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Rett's disorder

30. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Trichomonas vaginitis
Betamethasone or dexamethasone
Low - voltage - diffuse ST- segment elevation
Coccidioidomycosis. Amphotericin B

31. Medications and viruses that ? aplastic anemia.
Duchenne muscular dystrophy
Neuroleptic malignant syndrome
Inevitable abortion
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

32. Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Fever - pharyngeal erythema - tonsillar exudate - lack of cough

33. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
a - antagonists (phentolamine and phenoxybenzamine)
Postinfectious glomerulonephritis
O2 - analgesia - hydration - and - if severe - transfusion
Out

34. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Cellulitis
Femoral hernia
Inhaled Beta- agonists and inhaled corticosteroids

35. Asplenic patients are particularly susceptible to these organisms.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Cerebral berry aneurysms (AD PCKD)
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

36. Medication given to accelerate fetal lung maturity.
Uremic syndrome seen in patients with renal failure
Betamethasone or dexamethasone
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Precocious puberty

37. Not contraindications to vaccination.
Oral surgery
Suspect retinoblastoma
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Campylobacter

38. Definition of hypertension.
Salmonella
Acute pancreatitis
PT
BP > 140/90 on three separate occasions two weeks apart

39. The most common cause of hypertension in young women.
Actinic keratosis
OCPs
50 cc/hour
False. Withdrawing and withholding life are the same from an ethical standpoint

40. The most likely cause of acute lower GI bleed in patients > 40 years old.
Osgood - Schlatter disease
Biliary tract obstruction
Diverticulosis
Hypertrophic cardiomyopathy

41. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Parvovirus B19
Lobular carcinoma in situ
Parkland formula
Rett's disorder

42. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Partial mole
Chronic lymphocytic leukemia (CLL)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Sarcoidosis

43. In which patients do you initiate colorectal cancer screening early?
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
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
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
O2 - analgesia - hydration - and - if severe - transfusion

44. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Basal cell carcinoma
Hypernatremia
Precocious puberty

45. Medication used to induce ovulation.
Clomiphene citrate
Seborrheic keratosis
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Beta- blockers - digoxin - calcium channel blockers

46. 'Stones - bones - groans - psychiatric overtones.'
Administration of DDAVP ? serum osmolality and free water restriction
Exercise stress treadmill with ECG
Signs and symptoms of hypercalcemia
Nephrotic syndrome

47. Chvostek's and Trousseau's signs.
Hypocalcemia
Inevitable abortion
Number of deaths from birth to 28 days per 1000 live births
BP > 140/90 on three separate occasions two weeks apart

48. Acceptable urine output in a trauma patient.
50 cc/hour
MS
Hashimoto's thyroiditis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

49. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Levodopa/carbidopa
Substance abuse
Pheochromocytoma
Isolation

50. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Graves' disease
Flumazenil
ARDS
ALS