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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 young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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2. Appropriate diagnostic test?
Menometrorrhagia
Treat immediately. Consent is implied in emergency situations
Trichomonas vaginitis
Pharmacologic stress test (e.g. - dobutamine echo)

3. Causes of hypoxemia.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Intussusception
Kl
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

4. Medication given to accelerate fetal lung maturity.
Exercise stress treadmill with ECG
Parkland formula
HGPRTase deficiency)
Betamethasone or dexamethasone

5. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Hypernatremia
? serum FSH
Panic disorder

6. True or false: Once patients sign a statement giving consent - they must continue treatment.
Lead - time bias
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
BP > 140/90 on three separate occasions two weeks apart
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

7. Gout - self - mutilation - and choreoathetosis.
HGPRTase deficiency)
Metformin
SIADH due to stress
Administration of DDAVP ? serum osmolality and free water restriction

8. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Anemia of chronic disease
Abdominal ultrasound and CT
Antipsychotics (neuroleptic malignant syndrome)
Displacement

9. Neutropenic nadir postchemotherapy.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
7-10 days
Iron overload; use deferoxamine
Administration of DDAVP ? serum osmolality and free water restriction

10. Charcot's triad.
Squamous cell carcinoma
Membranous glomerulonephritis
Confounding variable
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

11. Medications and viruses that ? aplastic anemia.
Acute pancreatitis
HBV immunoglobulin
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

12. Treatment for DTs.
Colposcopy and endocervical curettage
IV hydration and loop diuretics (furosemide)
Sporothrix schenckii
Benzodiazepines

13. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Endometrial or estrogen receptor - breast cancer
Hypocalcemia
Placental abruption and placenta previa

14. Radiographic indications for surgery in patients with acute abdomen.
Graves' disease
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Klebsiella

15. Infection of small airways with epidemics in winter and spring.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Klebsiella
RSV bronchiolitis
Anemia - thrombocytopenia - and acute renal failure

16. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Anticoagulation - rate control - cardioversion
Coccidioidomycosis. Amphotericin B
Angina is new - is worsening - or occurs at rest
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

17. The most common type of nephrolithiasis.
False. Withdrawing and withholding life are the same from an ethical standpoint
Haemophilus ducreyi
Calcium oxalate
Parkinson's disease

18. Low urine specific gravity in the presence of high serum osmolality.
Sporothrix schenckii
DI
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Weight loss and OCPs

19. Name the defense mechanism:
Displacement
Acute myelogenous leukemia (AML)
Conduct disorder
Seventy percent if the stenosis is symptomatic

20. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Calcium oxalate
Conversion disorder
Inevitable abortion

21. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Endometrial biopsy
Actinomyces israelii
Herpes simplex
Actinic keratosis

22. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Hypoxia and hypocarbia
Hypovolemic shock
Iatrogenic steroid administration. The second most common cause is Cushing's disease

23. Drugs that slow AV node transmission.
Uterine atony
Beta- blockers - digoxin - calcium channel blockers
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Spinal stenosis

24. May be seen in children who are accused of inattention in class and confused with ADHD.
Anticoagulation - rate control - cardioversion
68% - 95.5% - 99.7%
Number of live births per 1000 women 15-44 years of age
Absence seizures

25. Identify key organisms causing diarrhea:
Clostridium difficile
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Fat - female - fertile - forty - flatulent
Self - limited - painless vaginal bleeding

26. The most frequent presentation of intracranial neoplasm.
Headache
Endometrial or estrogen receptor - breast cancer
High TSH - low T4 - antimicrosomal antibodies
Observational bias

27. Bilious emesis within hours after the first feeding.
Duodenal atresia
Endometriosis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Anemia - thrombocytopenia - and acute renal failure

28. Name the organism:
Mycoplasma
Haemophilus ducreyi
Malignancy and hyperparathyroidism
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

29. Reynolds' pentad.

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30. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
ACEI
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Nephrotic syndrome

31. Name the defense mechanism:
Conversion disorder
V/Q scan
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Isolation

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

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33. What is the immunodeficiency?
< 7.0
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Osteoarthritis
Chronic granulomatous disease

34. Causes of drug - induced SLE.
IgA nephropathy (Berger's disease)
INH - penicillamine - hydralazine - procainamide
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Contact dermatitis

35. A crescent - shaped hyperdensity on CT that does not cross the midline.
Pemphigus vulgaris
Subdural hematoma
Identify cause; pressors (e.g. - dobutamine)
Alport's syndrome

36. Key side effects of atypical antipsychotics.
A patient's family cannot require that a doctor withhold information from the patient
Weight gain - type 2 DM - QT prolongation
1
Hypocalcemia

37. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Contact dermatitis
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Klebsiella

38. Identify key organisms causing diarrhea:
Pregnant women. Treat this group aggressively because of potential complications
Graves' disease
Yersinia
Bacterial meningitis

39. Appropriate diagnostic test?
Malingering
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
Campylobacter
Exercise stress treadmill with ECG

40. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Self - limited - painless vaginal bleeding
Bladder rupture or urethral injury
Pseudomonas
Osteogenesis imperfecta

41. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
M3
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis

42. Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome
Klebsiella
Bullous pemphigoid
Multiple myeloma

43. A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Malignancy and hyperparathyroidism
Treat immediately. Consent is implied in emergency situations
Infection - febrile seizures - trauma - idiopathic

44. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
46 -XX
Lichen planus
N- acetylcysteine

45. The most common cause of seizures in children (2-10 years).
Basal cell carcinoma
Aseptic (viral) meningitis
Sarcoidosis
Infection - febrile seizures - trauma - idiopathic

46. ECG findings suggesting MI.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Lesch - Nyhan syndrome (purine salvage problem with
Panic disorder

47. Beck's triad for cardiac tamponade.
Number of live births per 1000 population
Hypotension - distant heart sounds - and JVD
Duchenne muscular dystrophy
Amoxicillin

48. How to diagnose and follow a leiomyoma.
Higher incidence
Ultrasound
Lead - time bias
Conversion disorder

49. Definition of unstable angina.
Angina is new - is worsening - or occurs at rest
Allergic interstitial nephritis
Type II (proximal) RTA
Colposcopy and endocervical curettage

50. 'Doughy skin.'
SCLC
1
Hypernatremia
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)