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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. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Agranulocytosis
Huntington's disease
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

2. Treatment for Guillain - Barr
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Postinfectious glomerulonephritis
IVIG or plasmapheresis
Broca's aphasia. Frontal lobe - left MCA distribution

3. Macrocytic - megaloblastic anemia without neurologic symptoms.
Chronic granulomatous disease
Confounding variable
Varicella zoster
Folate deficiency

4. Key side effects of atypical antipsychotics.
Ultrasound
Type I (distal) RTA
Weight gain - type 2 DM - QT prolongation
Administration of DDAVP ? serum osmolality and free water restriction

5. Treatment of cardiogenic shock.
? serum FSH
Frotteurism (a paraphilia)
Identify cause; pressors (e.g. - dobutamine)
Iatrogenic steroid administration. The second most common cause is Cushing's disease

6. 1
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Rett's disorder
Placental abruption and placenta previa
Acute myelogenous leukemia (AML)

7. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
1
Malingering
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

8. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
Establish the ABCs
Higher prevalence
Anion gap acidosis and 1

9. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Allergic interstitial nephritis
Panic disorder
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

10. The diagnostic test for pulmonary embolism.
Nitroprusside
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
V/Q scan
Giardia

11. A doctor refers a patient for an MRI at a facility he/she owns.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Conflict of interest
Pityriasis rosea
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs

12. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Suspect ankylosing spondylitis. Check HLA- B27
Trauma - alcohol withdrawal - brain tumor
CHF - shock - and altered mental status
Dissociative fugue

13. Classic CXR findings for pulmonary edema.

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14. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Bacterial meningitis
MS
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Continuous positive airway pressure

15. A condition associated with red 'currant - jelly' stools.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Higher prevalence
Number of deaths from birth to 28 days per 1000 live births
Intussusception

16. 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)
Immediate needle thoracostomy
Parainfluenza virus type 1
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

17. May be seen in children who are accused of inattention in class and confused with ADHD.
68% - 95.5% - 99.7%
Wernicke's encephalopathy due to a deficiency of thiamine
Cerebral berry aneurysms (AD PCKD)
Absence seizures

18. Complication of scaphoid fracture.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Avascular necrosis
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Hyperkalemia

19. Treatment of tension pneumothorax.
Immediate needle thoracostomy
Alport's syndrome
Observational bias
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity

20. Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
Ophthalmologic exam - CT - and MRI
Higher prevalence
Pseudomonas

21. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Hypernatremia
Polymyalgia rheumatica
Stasis - hypercoagulability - endothelial damage
Retrograde cystourethrogram

22. Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Haemophilus ducreyi
Duchenne muscular dystrophy
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

23. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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24. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Neuroleptics
Metformin
Iron overload; use deferoxamine
Regresses after menopause

25. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Haemophilus ducreyi
Elevated ICP - RBCs - xanthochromia
Postinfectious glomerulonephritis
Normal

26. Lab values suggestive of menopause.
Amoxicillin
Trichomonas vaginitis
Intussusception
? serum FSH

27. The 6 P's of ischemia due to peripheral vascular disease.
Neisseria meningitidis
Anion gap acidosis and 1
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Third - degree heart block

28. Epidemics such as influenza
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Higher incidence
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
< 7.0

29. Gout - self - mutilation - and choreoathetosis.
HGPRTase deficiency)
Suspect ankylosing spondylitis. Check HLA- B27
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

30. Treatment for opioid overdose.
Observational bias
Bullous pemphigoid
Agranulocytosis
Naloxone

31. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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32. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Calcium oxalate
Pheochromocytoma
Pseudomonas

33. Evaluation of a pulsatile abdominal mass and bruit.
1
Abdominal ultrasound and CT
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
They can mask symptoms of hypoglycemia

34. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Higher incidence
Panic disorder
Identify cause; pressors (e.g. - dobutamine)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

35. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
Intraductal papilloma
Nephrolithiasis
MAOIs

36. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Parvovirus B19
Impetigo
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
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

37. Hematuria - flank pain - and palpable flank mass.
? serum FSH
Renal cell carcinoma (RCC)
SCLC
ALS

38. Three systemic diseases ? nephrotic syndrome.
Inhaled Beta- agonists and inhaled corticosteroids
Campylobacter
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
DM - SLE - and amyloidosis

39. Treatment for acute coronary syndrome.
Cluster headache
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Respiratory alkalosis

40. Antihypertensive for a diabetic patient with proteinuria.
Mycobacterium tuberculosis
Wait - surgical resection - radiation and/or androgen suppression
ACEI
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

41. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
IV hydration and loop diuretics (furosemide)
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Stasis - hypercoagulability - endothelial damage
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)

42. Treatment for ventricular fibrillation.
IVIG or plasmapheresis
Immediate cardioversion
Postinfectious glomerulonephritis
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia

43. Classic ECG findings in pericarditis.
Coarctation of the aorta
Low - voltage - diffuse ST- segment elevation
Rubella
Lesion of 1

44. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Fatigue and impending respiratory failure
High reliability - low validity
Incidence and prevalence

45. Acid - base disorder in pulmonary embolism.
Hypoxia and hypocarbia
Lung - breast - skin (melanoma) - kidney - GI tract
Alzheimer's and multi - infarct
Lichen planus

46. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Type II (proximal) RTA
Prevalence

47. Aplastic crisis in sickle cell disease.
Parvovirus B19
Ulcerative colitis
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Suspect ankylosing spondylitis. Check HLA- B27

48. Differential of hypervolemic hyponatremia.
Cirrhosis - CHF - nephritic syndrome
Pityriasis versicolor
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Osmotic fragility test

49. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
Respiratory alkalosis
Iron overload; use deferoxamine
Pseudomonas

50. Medication used to induce ovulation.
Erythema multiforme
Clomiphene citrate
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Sarcoidosis