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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. 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)
Number of deaths from 28 days to one year per 1000 live births
Parkinson's disease
Rett's disorder

2. Fetal mortality?

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3. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Haemophilus ducreyi
Legionella pneumonia

4. Antibiotics with teratogenic effects.
Dantrolene or bromocriptine
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Huntington's disease
MS

5. Name the defense mechanism:
Never
Duodenal atresia
Regression
Suspect ankylosing spondylitis. Check HLA- B27

6. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Kegel exercises - estrogen - pessaries for stress incontinence
Regression

7. Radiographic evidence of aortic disruption or dissection.
Small cell lung cancer (SCLC)
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Glomerulonephritis/nephritic syndrome
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

8. Eight surgically correctable causes of hypertension.

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9. Type of ARF in a patient with FeNa < 1%.
Sulfonamides - antimalarial drugs - fava beans
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Prerenal

10. Neonatal mortality?
Campylobacter
Chronic granulomatous disease
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Number of deaths from birth to 28 days per 1000 live births

11. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Polymyalgia rheumatica
Pheochromocytoma
Absence seizures
Fluids and antibiotics

12. Not contraindications to vaccination.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Wiskott - Aldrich syndrome
Hereditary spherocytosis
Flumazenil

13. Confusion - confabulation - ophthalmoplegia - ataxia.

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14. Vaccinations at a six- month well - child visit.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Hypotension - distant heart sounds - and JVD
Anemia of chronic disease
HBV - DTaP - Hib - IPV - PCV

15. Signs suggesting radial nerve damage with humeral fracture.
ACEI
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Wrist drop - loss of thumb abduction

16. First step in the management of a patient with acute GI bleed.
Establish the ABCs
Anticoagulation - rate control - cardioversion
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
N- acetylcysteine

17. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Nephrolithiasis
Coccidioidomycosis. Amphotericin B
Pseudomonas
Wait - surgical resection - radiation and/or androgen suppression

18. Name the organism:
Parkland formula
Klebsiella
Hypokalemia
Chronic granulomatous disease

19. Hematuria - flank pain - and palpable flank mass.
Excessive EtOH
Renal cell carcinoma (RCC)
Elevated ICP - RBCs - xanthochromia
Allergic interstitial nephritis

20. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Anorexia
Coarctation of the aorta
Hereditary spherocytosis

21. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Retinoic acid
Cellulitis

22. Identify key organisms causing diarrhea:
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Phototherapy (mild) or exchange transfusion (severe)
Yersinia
Bacillus cereus

23. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Anticoagulation - rate control - cardioversion
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Kl

24. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
V/Q scan
Hypoxia and hypocarbia
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.

25. Treatment for DTs.
Endometrial biopsy
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Benzodiazepines
B12 deficiency

26. What is the immunodeficiency?
Anion gap acidosis and 1
Wiskott - Aldrich syndrome
Trauma - alcohol withdrawal - brain tumor
Number of deaths from birth to 28 days per 1000 live births

27. Treatment of supraventricular tachycardia (SVT).
Factor V Leiden mutation
Postinfectious glomerulonephritis
MS
Rate control with carotid massasge or other vagal stimulation

28. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Immediate needle thoracostomy
Normal
Treat existing heart failure and replace the tricuspid valve
Yersinia

29. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Hypoparathyroidism
Lobular carcinoma in situ
Osteogenesis imperfecta

30. Administer to a symptomatic patient to diagnose myasthenia gravis.
Bladder rupture or urethral injury
Edrophonium
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
ARDS

31. Treatment for SVC syndrome.
Radiation
OCP and barrier contraception
Wrist drop - loss of thumb abduction
Neither

32. Caf
Hashimoto's thyroiditis
Kegel exercises - estrogen - pessaries for stress incontinence
Neurofibromatosis 1
Anemia - thrombocytopenia - and acute renal failure

33. Treatment for malignant hypertension.
1
Excessive EtOH
Parainfluenza virus type 1
Nitroprusside

34. 'Stuck - on' appearance.
Check for ? ICP; look for papilledema
E. coli O157:H7
Depersonalization disorder
Seborrheic keratosis

35. Why are Beta- blockers contraindicated in diabetics?
Huntington's disease
They can mask symptoms of hypoglycemia
HBV - DTaP - Hib - IPV - PCV
Membranous glomerulonephritis

36. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Weight loss and OCPs
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Oral surgery

37. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Hypovolemic shock
Weight gain - type 2 DM - QT prolongation
Chronic lymphocytic leukemia (CLL)
Bullous pemphigoid

38. Flat - topped papules.
DI
Lichen planus
Prinzmetal's angina
Lung - breast - skin (melanoma) - kidney - GI tract

39. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Wiskott - Aldrich syndrome
Emergent laparotomy to repair perforated viscus - likely stomach
DI
Neuroleptic malignant syndrome

40. Mortality rate?
Depersonalization disorder
Number of deaths per 1000 population
Sheehan's syndrome (postpartum pituitary necrosis)
Anemia - thrombocytopenia - and acute renal failure

41. What should always be done prior to LP?
Identify cause; pressors (e.g. - dobutamine)
Endometrial biopsy
Check for ? ICP; look for papilledema
Pulsus paradoxus (seen in cardiac tamponade)

42. 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.
Neuroleptic malignant syndrome
Reaction formation
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Guillain - Barr

43. Infant mortality?
Sarcoidosis
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Bacterial meningitis
Seborrheic keratosis

44. The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
Bullous pemphigoid
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births

45. The most common pituitary tumor. Treatment?
Anticoagulation - rate control - cardioversion
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Pityriasis rosea
Pemphigus vulgaris

46. Identify key organisms causing diarrhea:
Rate control with carotid massasge or other vagal stimulation
Bacillus cereus
Taenia solium (cysticercosis)
Menometrorrhagia

47. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
SSRIs
Calcium oxalate
Never
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.

48. Criteria for exudative effusion.
ETEC
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
B12 deficiency
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

49. Classic CXR findings for pulmonary edema.

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50. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
Cirrhosis - CHF - nephritic syndrome
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Pseudomonas