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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. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
BP > 140/90 on three separate occasions two weeks apart
105 bacteria/mL

2. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Huntington's disease
Chronic lymphocytic leukemia (CLL)
Type I (distal) RTA
Ophthalmologic exam - CT - and MRI

3. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Pulsus paradoxus (seen in cardiac tamponade)
Lyme disease - Ixodes tick - doxycycline
105 bacteria/mL

4. Infant mortality?
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Iatrogenic steroid administration. The second most common cause is Cushing's disease

5. ? CO - ? PCWP - ? PVR.
N- acetylcysteine
Highly sensitive for TB
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Septic or anaphylactic shock

6. Treatment for benzodiazepine overdose.
Flumazenil
Continuous positive airway pressure
Alport's syndrome
Fanconi's anemia

7. The most common cause of hypothyroidism.

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8. Treatment for bacterial vaginosis.
Oral or topical metronidazole
A patient's family cannot require that a doctor withhold information from the patient
Osteoarthritis
Niacin

9. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Sarcoidosis
Rubella
Nephritic syndrome
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

10. A condition associated with red 'currant - jelly' stools.
Anemia of chronic disease
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Seminoma
Intussusception

11. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Threatened abortion
INH - penicillamine - hydralazine - procainamide
Bruton's X- linked agammaglobulinemia
Calcium oxalate

12. Name the organism:
Streptococcus pneumoniae
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
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
MS

13. First - line treatment for moderate hypercalcemia.
Crohn's disease
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Patent ductus arteriosus (PDA)
IV hydration and loop diuretics (furosemide)

14. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Pseudogout
Fatigue and impending respiratory failure
Wegener's granulomatosis and Goodpasture's syndrome
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

15. Four characteristics of a nevus suggestive of melanoma.
Asymmetry - border irregularity - color variation - large diameter
Calcium oxalate
Diphenhydramine or epinephrine 1:1000
Number of deaths per 1000 population

16. Vaccinations at a six- month well - child visit.
Varicella zoster
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
HBV - DTaP - Hib - IPV - PCV
Number of deaths from 20 weeks' gestation to birth per 1000 total births

17. Signs of ? ICP (Cushing's triad).
M3
Normal
Hypertension - bradycardia - and abnormal respirations
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

18. The most common cause of Cushing's syndrome.

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19. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Ultrasound
Levodopa/carbidopa
Cluster headache

20. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
SSRIs
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Identify cause; fluid and blood repletion

21. Red plaques with silvery- white scales and sharp margins.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Amoxicillin
Type I (distal) RTA
Psoriasis

22. Causes of transudative effusion.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
'Chocolate cysts -' powder burns
Parkland formula
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

23. Natural history of a leiomyoma.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Regresses after menopause
A patient's family cannot require that a doctor withhold information from the patient
Broca's aphasia. Frontal lobe - left MCA distribution

24. Treatment of SIADH?
Impetigo
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Fluid restriction - demeclocycline
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

25. Sentinel loop on AXR.
Beta- blockers - Ca2+ channel blockers - TCAs
Dissociative fugue
TICS
Acute pancreatitis

26. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
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
Cirrhosis - CHF - nephritic syndrome
ARDS
S. aureus

27. Blood in the urethral meatus or high - riding prostate.
Exercise stress treadmill with ECG
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Bladder rupture or urethral injury
Infection - febrile seizures - trauma - idiopathic

28. Treatment of tension pneumothorax.
Aseptic (viral) meningitis
Hypernatremia
Immediate needle thoracostomy
Mycoplasma

29. What is the immunodeficiency?
Anemia - thrombocytopenia - and acute renal failure
Endometriosis
V/Q scan
Chronic granulomatous disease

30. Signs of active ischemia during stress testing.
Angina - ST- segment changes on ECG - or ? BP
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
M3
Number of deaths from birth to 28 days per 1000 live births

31. CSF findings with SAH.
Clomiphene citrate
Elevated ICP - RBCs - xanthochromia
Haemophilus ducreyi
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

32. The most common cause of postpartum hemorrhage.
Erythema multiforme
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Uterine atony

33. Lung cancer associated with SIADH.
Pasteurella multocida
Rate control with carotid massasge or other vagal stimulation
Neisseria meningitidis
Small cell lung cancer (SCLC)

34. Charcot's triad.
Hypertension - bradycardia - and abnormal respirations
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
They can mask symptoms of hypoglycemia
Immediate cardioversion

35. Treatment for acute coronary syndrome.
Pulsus paradoxus (seen in cardiac tamponade)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Lichen planus
Lobular carcinoma in situ

36. Virchow's triad.
Stasis - hypercoagulability - endothelial damage
Higher incidence
Basal cell carcinoma
Inhaled Beta- agonists and inhaled corticosteroids

37. Causes of drug - induced SLE.
Acute mania. Start a mood stabilizer (e.g. - lithium)
INH - penicillamine - hydralazine - procainamide
Type II (proximal) RTA
Lichen sclerosus

38. Treatment for malignant hypertension.
a - antagonists (phentolamine and phenoxybenzamine)
Immediate cardioversion
Nitroprusside
High TSH - low T4 - antimicrosomal antibodies

39. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
30 cc/hour
Number of live births per 1000 women 15-44 years of age
No. Parental consent is not necessary for the medical treatment of pregnant minors
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

40. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Subarachnoid hemorrhage (SAH)
Endometrial biopsy
M3
Anemia of chronic disease

41. Name the organism:
Calcium oxalate
Number of deaths from 28 days to one year per 1000 live births
Pseudomonas
Conduct disorder

42. Radiographic indications for surgery in patients with acute abdomen.
Inevitable abortion
Hodgkin's lymphoma
Ampulla of the oviduct
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)

43. Signs of neurogenic shock.
Hypotension and bradycardia
Salmonella
Fluid restriction - demeclocycline
Hypovolemic shock

44. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
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
Angina - ST- segment changes on ECG - or ? BP
Pheochromocytoma
Bladder rupture or urethral injury

45. Flat - topped papules.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
SIADH due to stress
Uremic syndrome seen in patients with renal failure
Lichen planus

46. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Flumazenil
Continuous - painful vaginal bleeding
CF or Hirschsprung's disease
Antipsychotics (neuroleptic malignant syndrome)

47. A young patient with a family history of sudden death collapses and dies while exercising.
Hypotension and bradycardia
Diamond - Blackfan anemia
Hypertrophic cardiomyopathy
Antipsychotics (neuroleptic malignant syndrome)

48. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
MCP and PIP joints; DIP joints are spared
Frotteurism (a paraphilia)
Basal cell carcinoma

49. Annual screening for women with a strong family history of ovarian cancer.
False. Withdrawing and withholding life are the same from an ethical standpoint
CA-125 and transvaginal ultrasound
Broca's aphasia. Frontal lobe - left MCA distribution
Choriocarcinoma

50. Treatment for postpartum hemorrhage.
Absence seizures
Giardia
Higher incidence
Uterine massage; if that fails - give oxytocin