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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. First step in the management of a patient with acute GI bleed.
Beta- blockers - Ca2+ channel blockers - TCAs
Murphy's sign - seen in acute cholecystitis
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Establish the ABCs

2. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Acute myelogenous leukemia (AML)
Iron deficiency anemia
Weight loss and OCPs

3. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
V/Q scan
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Contact dermatitis
Malingering

4. The most common type of testicular cancer.
Bruton's X- linked agammaglobulinemia
Seminoma
Conversion disorder
Toxoplasma gondii

5. First - line treatment for moderate hypercalcemia.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
IV hydration and loop diuretics (furosemide)
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Hypotension - distant heart sounds - and JVD

6. 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.
HIDA scan
Establish the ABCs
Beta- blockers - Ca2+ channel blockers - TCAs
Polymyalgia rheumatica

7. A patient presents with recent PID with RUQ pain.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Consider Fitz - Hugh - Curtis syndrome
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

8. The most common cause of seizures in children (2-10 years).
INH - penicillamine - hydralazine - procainamide
Cardiogenic shock
Infection - febrile seizures - trauma - idiopathic
SCLC

9. Tanner stage 3 in a six-year - old female.
Precocious puberty
OCPs - danazol - GnRH agonists
Endometrial biopsy
Infection - febrile seizures - trauma - idiopathic

10. Treatment of hypovolemic shock.
Duchenne muscular dystrophy
Identify cause; fluid and blood repletion
Inevitable abortion
Levodopa/carbidopa

11. Combined UMN and LMN disorder.
Hypertension - bradycardia - and abnormal respirations
Erythema multiforme
ALS
Naloxone

12. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Type IV (distal) RTA
Seborrheic dermatitis. Treat with antifungals
Renal cell carcinoma (RCC)
Cellulitis

13. Three systemic diseases ? nephrotic syndrome.
Allergic interstitial nephritis
Neuroleptics
DM - SLE - and amyloidosis
Endometrial or estrogen receptor - breast cancer

14. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Trauma; the second most common is berry aneurysm
Sarcoidosis
Neuroleptics
Signs and symptoms of hypercalcemia

15. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Allergic interstitial nephritis
Hypovolemic shock
Immediate cardioversion
Usually resolves spontaneously; may require IVIG and/or corticosteroids

16. The most common 1
Multiple myeloma
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Sensitivity
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

17. Neutropenic nadir postchemotherapy.
INH - penicillamine - hydralazine - procainamide
7-10 days
Wrist drop - loss of thumb abduction
Postinfectious glomerulonephritis

18. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
105 bacteria/mL
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Glomerulonephritis/nephritic syndrome

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

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20. Identify key organisms causing diarrhea:
Incidence and prevalence
Campylobacter
ALS
Edrophonium

21. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Neuroleptics
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Frotteurism (a paraphilia)

22. CSF findings:
Cirrhosis - CHF - nephritic syndrome
Obstructive pulmonary disease (e.g. - asthma)
MS
Acute myelogenous leukemia (AML)

23. The 6 P's of ischemia due to peripheral vascular disease.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Alopecia areata (autoimmune process)
46 -XX

24. The most common cause of Cushing's syndrome.

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25. Hypercholesterolemia treatment that ? flushing and pruritus.
Niacin
Murphy's sign - seen in acute cholecystitis
Biliary tract obstruction
Pemphigus vulgaris

26. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Observational bias
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Prerenal
HBV - DTaP - Hib - IPV - PCV

27. Attributable risk?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Restrictive pulmonary disease
Giardia
Diphenhydramine or epinephrine 1:1000

28. Mortality rate?
Number of deaths per 1000 population
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Hypoxia and hypocarbia
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

29. The most common inherited hemolytic anemia.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Hereditary spherocytosis
Lesion of 1
MCP and PIP joints; DIP joints are spared

30. Charcot's triad.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Cellulitis
IV hydration and loop diuretics (furosemide)
Anion gap acidosis and 1

31. Difference between a cohort and a case - control study.
Fluid restriction - demeclocycline
Endometrial or estrogen receptor - breast cancer
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
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

32. Term for heavy bleeding during and between menstrual periods.
50 cc/hour
B12 deficiency
Squamous cell carcinoma
Menometrorrhagia

33. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
IV penicillin or ampicillin
CF or Hirschsprung's disease
Hereditary spherocytosis

34. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Angina is new - is worsening - or occurs at rest
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Nephrotic syndrome

35. Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe)
50 cc/hour
Placental abruption and placenta previa
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

36. Conditions in which confidentiality must be overridden.
Pregnant women. Treat this group aggressively because of potential complications
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Suspect retinoblastoma
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

37. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Treat immediately. Consent is implied in emergency situations
No. Parental consent is not necessary for the medical treatment of pregnant minors
Squamous cell carcinoma
Suspect ankylosing spondylitis. Check HLA- B27

38. Acute - phase treatment for Kawasaki disease.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
S. aureus or S. epidermidis.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

39. Describe a test that consistently gives identical results - but the results are wrong.
Hereditary spherocytosis
Diphenhydramine or epinephrine 1:1000
High reliability - low validity
OCP and barrier contraception

40. Relative risk?
The IR of a disease in a population exposed to a particular factor
Lichen planus
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
Anemia of chronic disease

41. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Ulcerative colitis
DM - SLE - and amyloidosis
High TSH - low T4 - antimicrosomal antibodies
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)

42. Identify key organisms causing diarrhea:
E. coli O157:H7
Number of deaths from birth to 28 days per 1000 live births
Ampulla of the oviduct
Ultrasound

43. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
SCLC
1
HIDA scan

44. The most common cause of postpartum hemorrhage.
Uterine atony
Femoral hernia
Campylobacter
Phencyclidine hydrochloride (PCP) intoxication

45. Antihypertensive for a diabetic patient with proteinuria.
ACEI
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

46. Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Conflict of interest
Acute mania. Start a mood stabilizer (e.g. - lithium)
Observational bias

47. Name the defense mechanism:
Bladder rupture or urethral injury
Never
Isolation
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

48. Autoimmune complication occurring 2-4 weeks post - MI.

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49. The three most common causes of fever of unknown origin (FUO).
Regression
Infection - cancer - and autoimmune disease
30 cc/hour
Angina is new - is worsening - or occurs at rest

50. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Self - limited - painless vaginal bleeding
Oral surgery
Immediate needle thoracostomy