Test your basic knowledge |

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. Difference between Mallory- Weiss and Boerhaave tears.
Out
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Mallory- Weiss

2. AML subtype associated with DIC.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Elevated ICP - RBCs - xanthochromia
M3
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

3. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Asymmetry - border irregularity - color variation - large diameter
Calcium oxalate
Threatened abortion
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones

4. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Biliary tract obstruction
Kl
Pseudomonas
M3

5. Treatment for ventricular fibrillation.
Immediate cardioversion
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Retrograde cystourethrogram
SCLC

6. Causes of hypoxemia.
Transitional cell carcinoma
Sheehan's syndrome (postpartum pituitary necrosis)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Nephrogenic diabetes insipidus (DI)

7. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Pseudogout
46 -XX
Edrophonium
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

8. Treatment for malignant hypertension.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Nitroprusside
Conduct disorder

9. Diagnostic test for hereditary spherocytosis.
50 cc/hour
Broca's aphasia. Frontal lobe - left MCA distribution
Protamine
Osmotic fragility test

10. Symptoms of placental abruption.
Continuous - painful vaginal bleeding
Fluid restriction - demeclocycline
Alzheimer's and multi - infarct
Anion gap acidosis and 1

11. The most common cause of postpartum hemorrhage.
Uterine atony
46 -XX
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
1

12. When can a physician refuse to continue treating a patient on the grounds of futility?
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
N- acetylcysteine
Yersinia
Alport's syndrome

13. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
O2 - analgesia - hydration - and - if severe - transfusion
Cerebral berry aneurysms (AD PCKD)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Squamous cell carcinoma

14. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Fluids and antibiotics
ARDS
Uremic syndrome seen in patients with renal failure
Neuroleptic malignant syndrome

15. 1
Betamethasone or dexamethasone
Varicella zoster
Acute pancreatitis
Placental abruption and placenta previa

16. Blood in the urethral meatus or high - riding prostate.
Wiskott - Aldrich syndrome
Multiple myeloma
Bladder rupture or urethral injury
Self - limited - painless vaginal bleeding

17. Treatment for atrial fibrillation.
Factor V Leiden mutation
Hereditary spherocytosis
Anticoagulation - rate control - cardioversion
High TSH - low T4 - antimicrosomal antibodies

18. Sentinel loop on AXR.
Nephrolithiasis
Acute pancreatitis
Agranulocytosis
Levodopa/carbidopa

19. Name the organism:
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Haemophilus ducreyi
Pulsus paradoxus (seen in cardiac tamponade)

20. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
S. aureus
Ulcerative colitis
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Endometriosis

21. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
CHF - shock - and altered mental status
Beta- blockers - digoxin - calcium channel blockers

22. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
Sulfonamides - antimalarial drugs - fava beans
Diphenhydramine or epinephrine 1:1000
Weight loss and OCPs

23. Name the defense mechanism:
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Reaction formation
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

24. An antidiabetic agent associated with lactic acidosis.
Metformin
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Mycobacterium tuberculosis
Patent ductus arteriosus (PDA)

25. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Number of live births per 1000 population
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Chronic lymphocytic leukemia (CLL)
Crohn's disease

26. The most common cause of hypertension in young men.
Hypotension - distant heart sounds - and JVD
Excessive EtOH
Identify cause; pressors (e.g. - dobutamine)
Hashimoto's thyroiditis

27. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Flumazenil
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Frotteurism (a paraphilia)
Lesion of 1

28. Identify key organisms causing diarrhea:
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Emergent laparotomy to repair perforated viscus - likely stomach
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Normal

29. Treatment for Guillain - Barr
? Ca2+ - ? K- - ? phosphate - ? uric acid
Intussusception
IVIG or plasmapheresis
1

30. The most common cause of hypothyroidism.

31. Identify key organisms causing diarrhea:
Neuroleptics
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Giardia
Kwashiorkor (protein malnutrition)

32. What is the immunodeficiency?

33. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
N- acetylcysteine
Exercise stress treadmill with ECG
1

34. Acid - base disturbance commonly seen in pregnant women.
Naloxone
Trauma; the second most common is berry aneurysm
Respiratory alkalosis
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)

35. Testicular cancer associated with Beta- hCG - AFP.
Phototherapy (mild) or exchange transfusion (severe)
Choriocarcinoma
Anemia - thrombocytopenia - and acute renal failure
Chronic granulomatous disease

36. Thrombotic thrombocytopenic purpura (TTP) pentad?
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Choriocarcinoma
Pentad of TTP
Chronic granulomatous disease

37. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Infection - febrile seizures - trauma - idiopathic
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Number of live births per 1000 population
Acute mania. Start a mood stabilizer (e.g. - lithium)

38. The most common cancer in men and the most common cause of death from cancer in men.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Confounding variable
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

39. PFT showing ? FEV1/FVC.
O2 - analgesia - hydration - and - if severe - transfusion
Restrictive pulmonary disease
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Pharmacologic stress test (e.g. - dobutamine echo)

40. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Iron overload; use deferoxamine
A patient with chest trauma who was previously stable suddenly dies
Seminoma
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

41. What is the immunodeficiency?
Actinic keratosis
Acute myelogenous leukemia (AML)
Chronic granulomatous disease
Infection - cancer - and autoimmune disease

42. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
Inevitable abortion
Rate control with carotid massasge or other vagal stimulation
HGPRTase deficiency)

43. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Lichen sclerosus
Hypovolemic shock
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Iron deficiency anemia

44. Goal hemoglobin A1c for a patient with DM.
Low - voltage - diffuse ST- segment elevation
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Calcium oxalate
< 7.0

45. In which patients do you initiate colorectal cancer screening early?
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
Retrograde cystourethrogram
IVIG or plasmapheresis
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

46. Defect in an X- linked syndrome with mental retardation -
Rate control with carotid massasge or other vagal stimulation
Bullous pemphigoid
Lesch - Nyhan syndrome (purine salvage problem with
Murphy's sign - seen in acute cholecystitis

47. Name the organism:
Streptococcus pneumoniae
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Allergic interstitial nephritis
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

48. The most common form of glomerulonephritis.

49. Definition of unstable angina.
Angina is new - is worsening - or occurs at rest
'Sawtooth' P waves
Elevated ICP - RBCs - xanthochromia
Vibrio - HAV

50. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Hypotension - distant heart sounds - and JVD
Endometrial or estrogen receptor - breast cancer
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
MCP and PIP joints; DIP joints are spared