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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. Hematuria - flank pain - and palpable flank mass.
Renal cell carcinoma (RCC)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Continuous positive airway pressure

2. First step in the management of a patient with acute GI bleed.
OCPs
Establish the ABCs
MAOIs
Ampulla of the oviduct

3. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Iron deficiency anemia
Alopecia areata (autoimmune process)
Anion gap acidosis and 1

4. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Kwashiorkor (protein malnutrition)
Subarachnoid hemorrhage (SAH)
Conduct disorder
Legionella pneumonia

5. Shortest AP diameter of the pelvis.
Hypotension - distant heart sounds - and JVD
Rett's disorder
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
O2 - analgesia - hydration - and - if severe - transfusion

6. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
HBV - DTaP - Hib - IPV - PCV
All - compartment fasciotomy for suspected compartment syndrome
Uterine massage; if that fails - give oxytocin
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

7. Causes of exudative effusion.
Bladder rupture or urethral injury
Low - voltage - diffuse ST- segment elevation
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Parvovirus B19

8. Identify key organisms causing diarrhea:
Hypovolemic shock
Trichomonas vaginitis
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Wiskott - Aldrich syndrome

9. First - line treatment for moderate hypercalcemia.
Number of live births per 1000 population
Betamethasone or dexamethasone
IV hydration and loop diuretics (furosemide)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs

10. Treatment for bacterial vaginosis.
Oral or topical metronidazole
Actinic keratosis
'Sawtooth' P waves
Clostridium difficile

11. A young patient with a family history of sudden death collapses and dies while exercising.
Hypotension and bradycardia
CA-125 and transvaginal ultrasound
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Hypertrophic cardiomyopathy

12. Chvostek's and Trousseau's signs.
Campylobacter
Ulcerative colitis
Hypocalcemia
Biliary tract obstruction

13. Characteristics of 2

14. Hypercholesterolemia treatment that ? flushing and pruritus.
Fluids and antibiotics
Niacin
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Herpes simplex

15. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Campylobacter

16. Treatment for ventricular fibrillation.
Postinfectious glomerulonephritis
Immediate cardioversion
Angina is new - is worsening - or occurs at rest
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis

17. Administer to a symptomatic patient to diagnose myasthenia gravis.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Broca's aphasia. Frontal lobe - left MCA distribution
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Edrophonium

18. Birth rate?
Kwashiorkor (protein malnutrition)
'Chocolate cysts -' powder burns
Number of live births per 1000 population
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots

19. The most common pathogen causing croup.
MCP and PIP joints; DIP joints are spared
Renal cell carcinoma (RCC)
Low - voltage - diffuse ST- segment elevation
Parainfluenza virus type 1

20. Prophylactic treatment for migraine.
Third - degree heart block
46 -XX
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Beta- blockers - Ca2+ channel blockers - TCAs

21. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Malingering
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
PT
Nephrogenic diabetes insipidus (DI)

22. Medical treatment for hepatic encephalopathy.
Renal cell carcinoma (RCC)
? protein intake - lactulose - neomycin
Abdominal ultrasound and CT
The IR of a disease in a population exposed to a particular factor

23. Inspiratory arrest during palpation of the RUQ.

24. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead - time bias
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Patient on dopamine antagonist
Third - degree heart block

25. The diagnostic test for pulmonary embolism.
Bacterial meningitis
1
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
V/Q scan

26. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
Non - Hodgkin's lymphoma
Self - limited - painless vaginal bleeding
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

27. A violent patient has vertical and horizontal nystagmus.
Renal cell carcinoma (RCC)
Phencyclidine hydrochloride (PCP) intoxication
Restrictive pulmonary disease
Fanconi's anemia

28. Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Hereditary spherocytosis
Membranous glomerulonephritis
Cerebral berry aneurysms (AD PCKD)

29. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Malingering
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Cluster headache

30. Evaluation of a pulsatile abdominal mass and bruit.
Abdominal ultrasound and CT
Radiation
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
High reliability - low validity

31. Name the defense mechanism:
Subarachnoid hemorrhage (SAH)
Isolation
Broca's aphasia. Frontal lobe - left MCA distribution
Obstructive pulmonary disease (e.g. - asthma)

32. Salicylate ingestion ? In What type of acid - base disorder?
M3
Folate deficiency
Weight loss and OCPs
Anion gap acidosis and 1

33. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Seminoma
Pemphigus vulgaris
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

34. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
IVIG or plasmapheresis
O2 - analgesia - hydration - and - if severe - transfusion
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

35. Treatment for acute coronary syndrome.
Surfactant deficiency
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

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

37. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
Seborrheic dermatitis. Treat with antifungals
Suspect retinoblastoma
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births

38. Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Actinic keratosis
Trauma; the second most common is berry aneurysm
1

39. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

40. Diagnostic test for hypertrophic cardiomyopathy.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Oral surgery
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

41. Signs of active ischemia during stress testing.
Cellulitis
Angina - ST- segment changes on ECG - or ? BP
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Parkinson's disease

42. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

43. Relative risk?
Lesch - Nyhan syndrome (purine salvage problem with
Wiskott - Aldrich syndrome
The IR of a disease in a population exposed to a particular factor
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

44. Name the organism:
Pulsus paradoxus (seen in cardiac tamponade)
Pseudomonas
Higher prevalence
Flumazenil

45. Why are Beta- blockers contraindicated in diabetics?
Depersonalization disorder
DI
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
They can mask symptoms of hypoglycemia

46. Epidemics such as influenza
Betamethasone or dexamethasone
Higher incidence
Pheochromocytoma
Intraductal papilloma

47. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Menometrorrhagia
Pheochromocytoma
Duchenne muscular dystrophy

48. A patient presents with recent PID with RUQ pain.
Endometriosis
Hypernatremia
Allergic interstitial nephritis
Consider Fitz - Hugh - Curtis syndrome

49. Pure RBC aplasia.
Pseudomonas
Diamond - Blackfan anemia
Lichen sclerosus
Respiratory alkalosis

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