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USMLE Step 2

Subjects : health-sciences, usmle-step-2

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. An active 13-year - old boy has anterior knee pain. Diagnosis?
Spinal stenosis
E. coli O157:H7
Osgood - Schlatter disease
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

2. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Emergent laparotomy to repair perforated viscus - likely stomach
Higher prevalence
IV penicillin or ampicillin

3. Chvostek's and Trousseau's signs.
Metformin
Hypocalcemia
30 cc/hour
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

4. Fertility rate?
Number of live births per 1000 women 15-44 years of age
Naloxone
Lung - breast - skin (melanoma) - kidney - GI tract
Subdural hematoma

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

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6. An agent that reverses the effects of heparin.
Kwashiorkor (protein malnutrition)
Protamine
Fluid restriction - demeclocycline
V/Q scan

7. Treatment for TTP.
Respiratory alkalosis
Parkland formula
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Inhaled Beta- agonists and inhaled corticosteroids

8. Nikolsky's sign.
Vibrio - HAV
Broca's aphasia. Frontal lobe - left MCA distribution
Conduct disorder
Bullous pemphigoid

9. Acceptable urine output in a stable patient.
Pityriasis rosea
30 cc/hour
Diphenhydramine or epinephrine 1:1000
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

10. CSF findings:
Aseptic (viral) meningitis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Rate control with carotid massasge or other vagal stimulation
Acute pancreatitis

11. Salicylate ingestion ? In What type of acid - base disorder?
Lyme disease - Ixodes tick - doxycycline
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Anion gap acidosis and 1
Pentad of TTP

12. Cold agglutinins.
Number of live births per 1000 population
Guillain - Barr
Renal cell carcinoma (RCC)
Mycoplasma

13. Acceptable urine output in a trauma patient.
50 cc/hour
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Seborrheic dermatitis. Treat with antifungals

14. Describe a test that consistently gives identical results - but the results are wrong.
Partial mole
Coarctation of the aorta
High reliability - low validity
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

15. Cannon 'a' waves.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Third - degree heart block
1
Obstructive pulmonary disease (e.g. - asthma)

16. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Low - voltage - diffuse ST- segment elevation
Cerebral berry aneurysms (AD PCKD)
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Signs and symptoms of hypercalcemia

17. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Impetigo
Mycobacterium tuberculosis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

18. Erythema migrans.
Alzheimer's and multi - infarct
Hypotension and bradycardia
Lesion of 1
Phototherapy (mild) or exchange transfusion (severe)

19. The most common cause of hypertension in young men.
Pseudogout
Phencyclidine hydrochloride (PCP) intoxication
Levodopa/carbidopa
Excessive EtOH

20. The most common causes of dementia.

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21. Treatment for SVC syndrome.
Radiation
Alport's syndrome
Pseudomonas
Anemia - thrombocytopenia - and acute renal failure

22. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Membranous glomerulonephritis
MAOIs
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Wait - surgical resection - radiation and/or androgen suppression

23. Cause of neonatal RDS.
Suspect ankylosing spondylitis. Check HLA- B27
Agranulocytosis
Surfactant deficiency
Endometriosis

24. Identify key organisms causing diarrhea:
Consider Fitz - Hugh - Curtis syndrome
? serum FSH
Salmonella
Surfactant deficiency

25. 1
Febrile seizures (roseola infantum)
Placental abruption and placenta previa
Nephritic syndrome
Ampulla of the oviduct

26. The most common location for an ectopic pregnancy.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Pityriasis versicolor
Ampulla of the oviduct
Biliary tract obstruction

27. The most common pituitary tumor. Treatment?
Agranulocytosis
They can mask symptoms of hypoglycemia
N- acetylcysteine
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

28. Dermatomal distribution.
Varicella zoster
Trichomonas vaginitis
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
The IR of a disease in a population exposed to a particular factor

29. A neonate has meconium ileus.

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30. Name the organism:
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Hypertension - bradycardia - and abnormal respirations
INH - penicillamine - hydralazine - procainamide
Pseudomonas

31. ? risk of what infection with silicosis?
Dantrolene or bromocriptine
Haemophilus ducreyi
Mycoplasma
Mycobacterium tuberculosis

32. What is the metabolic syndrome?
N- acetylcysteine
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
IV penicillin or ampicillin
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states

33. The most frequent presentation of intracranial neoplasm.
S. aureus or S. epidermidis.
Infection - febrile seizures - trauma - idiopathic
Headache
50 cc/hour

34. Blood in the urethral meatus or high - riding prostate.
Self - limited - painless vaginal bleeding
46 -XX
Factor V Leiden mutation
Bladder rupture or urethral injury

35. The mainstay of Parkinson's therapy.
Levodopa/carbidopa
False. Withdrawing and withholding life are the same from an ethical standpoint
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Sheehan's syndrome (postpartum pituitary necrosis)

36. Low urine specific gravity in the presence of high serum osmolality.
Squamous cell carcinoma
Dissociative fugue
DI
Absence seizures

37. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Fluids and antibiotics
Distal radius (Colles' fracture)
Phencyclidine hydrochloride (PCP) intoxication

38. Drugs that slow AV node transmission.
Beta- blockers - digoxin - calcium channel blockers
N- acetylcysteine
Pentad of TTP
Septic or anaphylactic shock

39. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
a - antagonists (phentolamine and phenoxybenzamine)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Conflict of interest

40. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Pemphigus vulgaris
Frotteurism (a paraphilia)
Phencyclidine hydrochloride (PCP) intoxication
Number of deaths from 28 days to one year per 1000 live births

41. Classic CXR findings for pulmonary edema.

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42. Signs of neurogenic shock.
Signs and symptoms of hypercalcemia
Hypotension and bradycardia
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Streptococcus pneumoniae

43. The diagnostic test for pulmonary embolism.
V/Q scan
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Cerebral berry aneurysms (AD PCKD)

44. Name the organism:
Neisseria meningitidis
Pulsus paradoxus (seen in cardiac tamponade)
Rett's disorder
Administration of DDAVP ? serum osmolality and free water restriction

45. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
MAOIs
Beta- blockers - Ca2+ channel blockers - TCAs
Hypotension - distant heart sounds - and JVD
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

46. Hematuria - hypertension - and oliguria.
Higher incidence
Niacin
Paget's disease
Nephritic syndrome

47. Treatment of hypovolemic shock.
Establish the ABCs
Identify cause; fluid and blood repletion
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
Salmonella

48. Treatment of tension pneumothorax.
Anemia of chronic disease
Substance abuse
Immediate needle thoracostomy
Bacillus cereus

49. The first test to perform when a woman presents with amenorrhea.
Retrograde cystourethrogram
Beta- hCG; the most common cause of amenorrhea is pregnancy
False. Withdrawing and withholding life are the same from an ethical standpoint
Duchenne muscular dystrophy

50. First - line treatment for otitis media.
Amoxicillin
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Depersonalization disorder
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.

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USMLE Step 2

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