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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 postoperative patient with significant pain presents with hyponatremia and normal volume status.
Depersonalization disorder
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
SIADH due to stress
Phototherapy (mild) or exchange transfusion (severe)

2. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Alopecia areata (autoimmune process)
Lyme disease - Ixodes tick - doxycycline
S. aureus or S. epidermidis.
Reye's syndrome

3. Type of ARF in a patient with FeNa < 1%.
Lesion of 1
Prerenal
Selective IgA deficiency
Hypotension - distant heart sounds - and JVD

4. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Ampulla of the oviduct
Lead - time bias
Parvovirus B19

5. Bone is fractured in fall on outstretched hand.

6. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Sarcoidosis
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
B12 deficiency

7. AML subtype associated with DIC.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Nitroprusside
HBV immunoglobulin
M3

8. Medical options for endometriosis.
MAOIs
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
OCPs - danazol - GnRH agonists
Actinic keratosis

9. Virchow's triad.
Lesions of 1
Stasis - hypercoagulability - endothelial damage
Salmonella
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

10. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Impetigo
Immediate cardioversion
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Beta- blockers - digoxin - calcium channel blockers

11. RTA associated with aldosterone defect.
Colposcopy and endocervical curettage
Taenia solium (cysticercosis)
Depersonalization disorder
Type IV (distal) RTA

12. The most common cause of seizures in children (2-10 years).
Taenia solium (cysticercosis)
Infection - febrile seizures - trauma - idiopathic
Cirrhosis - CHF - nephritic syndrome
PT

13. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

14. Name the organism:
Guillain - Barr
S. aureus
Sporothrix schenckii
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)

15. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Infection - febrile seizures - trauma - idiopathic
Never
HBV - DTaP - Hib - IPV - PCV
Biliary tract obstruction

16. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
The IR of a disease in a population exposed to a particular factor
Edrophonium
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)

17. The most common location for an ectopic pregnancy.
Ampulla of the oviduct
Malingering
Continuous - painful vaginal bleeding
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

18. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Distal radius (Colles' fracture)
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Toxoplasma gondii

19. CSF findings:
Nitroprusside
Aseptic (viral) meningitis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Dressler's syndrome: fever - pericarditis - ? ESR

20. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Legionella pneumonia
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Menometrorrhagia
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

21. Name the organism:
50 cc/hour
Placental abruption and placenta previa
Pseudomonas
Dressler's syndrome: fever - pericarditis - ? ESR

22. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma
Benzodiazepines
Anion gap acidosis and 1
Number of live births per 1000 women 15-44 years of age

23. Acute - phase treatment for Kawasaki disease.
IV penicillin or ampicillin
Pseudogout
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
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

24. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Confounding variable
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

25. When should a vaginal exam be performed with suspected placenta previa?
Hashimoto's thyroiditis
Actinic keratosis
Never
Ophthalmologic exam - CT - and MRI

26. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Higher prevalence
Confounding variable
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Headache

27. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Seventy percent if the stenosis is symptomatic
Hypovolemic shock
Rate control - rhythm conversion - and anticoagulation

28. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Frotteurism (a paraphilia)
Pheochromocytoma

29. Antidepressants associated with hypertensive crisis.
MAOIs
Guillain - Barr
Diphenhydramine or epinephrine 1:1000
Fluid restriction - demeclocycline

30. Name the defense mechanism:
IVIG or plasmapheresis
Dantrolene or bromocriptine
Regression
Normal

31. Ring - enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Neuroleptic malignant syndrome
IgA nephropathy (Berger's disease)
Normal

32. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Streptococcus pneumoniae
Febrile seizures (roseola infantum)
Niacin
Fatigue and impending respiratory failure

33. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
IV benzodiazepine
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Yersinia
Emergent laparotomy to repair perforated viscus - likely stomach

34. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Absence seizures
Angina is new - is worsening - or occurs at rest
Lobular carcinoma in situ
Low - voltage - diffuse ST- segment elevation

35. CSF findings:
Bacterial meningitis
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Uterine massage; if that fails - give oxytocin
Renal cell carcinoma (RCC)

36. Cohort study
Sarcoidosis
Incidence and prevalence
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Subarachnoid hemorrhage (SAH)

37. Reynolds' pentad.

38. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Dantrolene or bromocriptine
Duchenne muscular dystrophy
Alopecia areata (autoimmune process)
Nephrolithiasis

39. Macrocytic - megaloblastic anemia without neurologic symptoms.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Folate deficiency
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

40. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Alport's syndrome
Reye's syndrome
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

41. Conditions in which confidentiality must be overridden.
Squamous cell carcinoma
Nephrotic syndrome
Weight gain - type 2 DM - QT prolongation
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

42. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Basal cell carcinoma
Frotteurism (a paraphilia)

43. Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
'Chocolate cysts -' powder burns
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Depersonalization disorder

44. Identify key organisms causing diarrhea:
CF or Hirschsprung's disease
Pseudomonas
Oral surgery
E. coli O157:H7

45. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
IVIG or plasmapheresis
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)

46. Albuminocytologic dissociation.
Guillain - Barr
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Wiskott - Aldrich syndrome

47. Medical treatment for hepatic encephalopathy.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
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
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
? protein intake - lactulose - neomycin

48. Indications for medical treatment of ectopic pregnancy.

49. Molar pregnancy containing fetal tissue.
Partial mole
Beta- blockers - digoxin - calcium channel blockers
O2 - analgesia - hydration - and - if severe - transfusion
Number of deaths per 1000 population

50. The most common histology of bladder cancer.
Rate control with carotid massasge or other vagal stimulation
Transitional cell carcinoma
E. coli O157:H7
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones