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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. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Normal
Prerenal
Coccidioidomycosis. Amphotericin B

2. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

3. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Beta- blockers - Ca2+ channel blockers - TCAs
Pityriasis versicolor
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

4. RTA associated with aldosterone defect.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
E. coli O157:H7
Type IV (distal) RTA
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

5. Endocarditis prophylaxis regimens.
Substance abuse
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Oral surgery
Number of deaths per 1000 population

6. Birth rate?
Amoxicillin
Number of live births per 1000 population
Agranulocytosis
Renal cell carcinoma (RCC)

7. Identify key organisms causing diarrhea:
Wrist drop - loss of thumb abduction
Number of live births per 1000 women 15-44 years of age
S. aureus
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

8. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Consider Fitz - Hugh - Curtis syndrome
Administration of DDAVP ? serum osmolality and free water restriction
Actinic keratosis
Weight loss and OCPs

9. Describe a test that consistently gives identical results - but the results are wrong.
Identify cause; pressors (e.g. - dobutamine)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
High reliability - low validity

10. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
DM - SLE - and amyloidosis

11. Name the defense mechanism:
Calcium oxalate
Suspect ankylosing spondylitis. Check HLA- B27
Reaction formation
Alopecia areata (autoimmune process)

12. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

13. A 49-year - old male presents with acute - onset flank pain and hematuria.
Nephrolithiasis
Lead - time bias
Wegener's granulomatosis and Goodpasture's syndrome
Uterine atony

14. Complication of overly rapid correction of hyponatremia.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Prevalence
Central pontine myelinolysis
MS

15. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Suspect ankylosing spondylitis. Check HLA- B27
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

16. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Lichen planus
Hyperkalemia
Patent ductus arteriosus (PDA)

17. CSF findings:
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Bacterial meningitis
Precocious puberty
Sulfonamides - antimalarial drugs - fava beans

18. 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?
Fatigue and impending respiratory failure
Pulsus paradoxus (seen in cardiac tamponade)
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Legionella pneumonia

19. What is the immunodeficiency?
Toxoplasma gondii
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Restrictive pulmonary disease
Wiskott - Aldrich syndrome

20. Natural history of a leiomyoma.
Haemophilus ducreyi
Klebsiella
Regresses after menopause
Dissociative fugue

21. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Bacterial meningitis
Acute mania. Start a mood stabilizer (e.g. - lithium)
Mycobacterium tuberculosis
Pseudomonas

22. Reed - Sternberg cells

23. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
IV hydration and loop diuretics (furosemide)
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Highly sensitive for TB
Sensitivity

24. Identify key organisms causing diarrhea:
Erythema multiforme
A patient with chest trauma who was previously stable suddenly dies
Graves' disease
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

25. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
CF or Hirschsprung's disease
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

26. Name the organism:
Distal radius (Colles' fracture)
Klebsiella
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Beta- blockers - Ca2+ channel blockers - TCAs

27. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Cellulitis
Cerebral berry aneurysms (AD PCKD)
Glanzmann's thrombasthenia
ACEI

28. ? risk of what infection with silicosis?
Levodopa/carbidopa
Amoxicillin
Hypokalemia
Mycobacterium tuberculosis

29. Causes of exudative effusion.
Wegener's granulomatosis and Goodpasture's syndrome
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Alport's syndrome
Phencyclidine hydrochloride (PCP) intoxication

30. Risk factors for cholelithiasis.
Displacement
Fat - female - fertile - forty - flatulent
IV penicillin or ampicillin
Benzodiazepines

31. A patient presents with recent PID with RUQ pain.
Edrophonium
Consider Fitz - Hugh - Curtis syndrome
Naloxone
Nephrotic syndrome

32. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Postinfectious glomerulonephritis
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Retinoic acid
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

33. Radiographic indications for surgery in patients with acute abdomen.
Seminoma
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Reye's syndrome

34. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Neuroleptic malignant syndrome
Chronic granulomatous disease
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Beta- blockers - digoxin - calcium channel blockers

35. PFT showing ? FEV1/FVC.
Asherman's syndrome
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Restrictive pulmonary disease
Obstructive pulmonary disease (e.g. - asthma)

36. Definition of unstable angina.
Acne vulgaris
Placental abruption and placenta previa
Legionella pneumonia
Angina is new - is worsening - or occurs at rest

37. Treatment for acute coronary syndrome.
Selective IgA deficiency
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Vibrio - HAV
Frotteurism (a paraphilia)

38. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Mycobacterium tuberculosis
Pheochromocytoma
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Cluster headache

39. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Basal cell carcinoma
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Hyperkalemia
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

40. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Precocious puberty
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Diamond - Blackfan anemia

41. Differential of hypervolemic hyponatremia.
Hypocalcemia
Anemia - thrombocytopenia - and acute renal failure
Cirrhosis - CHF - nephritic syndrome
Sporothrix schenckii

42. The most common inherited hemolytic anemia.
Beta- blockers - Ca2+ channel blockers - TCAs
Conduct disorder
Nephrotic syndrome
Hereditary spherocytosis

43. Meningitis in infants. Causes? Treatment?
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Emergent laparotomy to repair perforated viscus - likely stomach
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
CF or Hirschsprung's disease

44. A 'blueberry muffin' rash is characteristic of what congenital infection?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Highly sensitive for TB
Rubella
CHF - shock - and altered mental status

45. Gout - self - mutilation - and choreoathetosis.
Avascular necrosis
Naloxone
TICS
HGPRTase deficiency)

46. Treatment for malignant hypertension.
Calcium oxalate
Nitroprusside
Basal cell carcinoma
Avascular necrosis

47. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
MCP and PIP joints; DIP joints are spared
Wegener's granulomatosis and Goodpasture's syndrome
Restrictive pulmonary disease

48. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Duchenne muscular dystrophy
Giardia
Sarcoidosis
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

49. Name the organism:
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Protamine
Vibrio - HAV
Pasteurella multocida

50. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Intussusception
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Emergent laparotomy to repair perforated viscus - likely stomach
Wait - surgical resection - radiation and/or androgen suppression