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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. Inspiratory arrest during palpation of the RUQ.

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2. Erythema migrans.
Emergent laparotomy to repair perforated viscus - likely stomach
Cerebral berry aneurysms (AD PCKD)
Lesion of 1
Intraductal papilloma

3. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Hypoxia and hypocarbia
Factitious disorder (Munchausen syndrome)

4. The most common causes of hypercalcemia.
Kegel exercises - estrogen - pessaries for stress incontinence
Malignancy and hyperparathyroidism
Oral or topical metronidazole
Uremic syndrome seen in patients with renal failure

5. Treatment for acute coronary syndrome.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Prinzmetal's angina
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Parvovirus B19

6. Evaluation of a pulsatile abdominal mass and bruit.
Abdominal ultrasound and CT
Check for ? ICP; look for papilledema
Asymmetry - border irregularity - color variation - large diameter
Pseudogout

7. Acceptable urine output in a trauma patient.
HBV immunoglobulin
Seborrheic keratosis
50 cc/hour
Glanzmann's thrombasthenia

8. RTA associated with aldosterone defect.
Septic or anaphylactic shock
Vibrio - HAV
Patent ductus arteriosus (PDA)
Type IV (distal) RTA

9. Caf
Excessive EtOH
Obstructive pulmonary disease (e.g. - asthma)
Neurofibromatosis 1
O2 - analgesia - hydration - and - if severe - transfusion

10. A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
Emergent laparotomy to repair perforated viscus - likely stomach
Angina is new - is worsening - or occurs at rest
Pulsus paradoxus (seen in cardiac tamponade)

11. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Anticoagulation - rate control - cardioversion
Metformin
Panic disorder

12. Epidemics such as influenza
Higher incidence
Ulcerative colitis
Malingering
Actinomyces israelii

13. A violent patient has vertical and horizontal nystagmus.
Absence seizures
Phencyclidine hydrochloride (PCP) intoxication
Pemphigus vulgaris
Cirrhosis - CHF - nephritic syndrome

14. Identify key organisms causing diarrhea:
Pentad of TTP
Colposcopy and endocervical curettage
Campylobacter
Intussusception

15. Hernia with highest risk of incarceration
Femoral hernia
30 cc/hour
Ophthalmologic exam - CT - and MRI
Acute pancreatitis

16. Appropriate diagnostic test?
Folate deficiency
Prerenal
Pityriasis versicolor
Exercise stress treadmill with ECG

17. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Membranous glomerulonephritis
O2 - analgesia - hydration - and - if severe - transfusion
Legionella pneumonia
Frotteurism (a paraphilia)

18. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Hypoxia and hypocarbia
Beta- hCG; the most common cause of amenorrhea is pregnancy
Pharmacologic stress test (e.g. - dobutamine echo)
Lobular carcinoma in situ

19. Name the organism:
Klebsiella
Guillain - Barr
OCPs - danazol - GnRH agonists
Hypertrophic cardiomyopathy

20. Attributable risk?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Patent ductus arteriosus (PDA)
ARDS
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed

21. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
1
IV penicillin or ampicillin
Conduct disorder
Highly sensitive for TB

22. Identify key organisms causing diarrhea:
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
OCPs - danazol - GnRH agonists

23. A son asks that his mother not be told about her recently discovered cancer.

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24. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Biliary tract obstruction
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Rate control - rhythm conversion - and anticoagulation
Uremic syndrome seen in patients with renal failure

25. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Observational bias
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
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
Alopecia areata (autoimmune process)

26. Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Parainfluenza virus type 1
Number of deaths from 28 days to one year per 1000 live births
Nephrolithiasis

27. Classic ECG finding in atrial flutter.

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28. Radiographic evidence of aortic disruption or dissection.
Retrograde cystourethrogram
Nephrotic syndrome
Vibrio - HAV
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

29. Blood in the urethral meatus or high - riding prostate.
Hodgkin's lymphoma
Biliary tract obstruction
Bladder rupture or urethral injury
Diamond - Blackfan anemia

30. The most common location for an ectopic pregnancy.
Factitious disorder (Munchausen syndrome)
Pentad of TTP
Low - voltage - diffuse ST- segment elevation
Ampulla of the oviduct

31. Treatment for AML M3.
Ophthalmologic exam - CT - and MRI
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Hodgkin's lymphoma
Retinoic acid

32. 'Stones - bones - groans - psychiatric overtones.'
Number of deaths from 28 days to one year per 1000 live births
Signs and symptoms of hypercalcemia
Squamous cell carcinoma
Low - voltage - diffuse ST- segment elevation

33. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Parvovirus B19
Radiation
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Mycobacterium tuberculosis

34. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
N- acetylcysteine
Hypotension - distant heart sounds - and JVD
Herpes simplex
Anemia of chronic disease

35. The most common pathogen causing croup.
Bacterial meningitis
Parainfluenza virus type 1
Acute mania. Start a mood stabilizer (e.g. - lithium)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough

36. Chvostek's and Trousseau's signs.
Nephritic syndrome
Glomerulonephritis/nephritic syndrome
Legionella pneumonia
Hypocalcemia

37. Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis
Iron overload; use deferoxamine
Seborrheic dermatitis. Treat with antifungals
OCPs - danazol - GnRH agonists

38. Odds ratio?
Mallory- Weiss
Pharmacologic stress test (e.g. - dobutamine echo)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

39. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Immediate cardioversion
PT
Observational bias
Inevitable abortion

40. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
DI
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Retinoic acid
ARDS

41. Antibiotics with teratogenic effects.
Acute myelogenous leukemia (AML)
Herpes simplex
Lyme disease - Ixodes tick - doxycycline
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

42. Which healthy population is susceptible to UTIs?
Mycoplasma
Hereditary spherocytosis
Pregnant women. Treat this group aggressively because of potential complications
Lichen sclerosus

43. Albuminocytologic dissociation.
Confounding variable
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
HGPRTase deficiency)
Guillain - Barr

44. Identify key organisms causing diarrhea:
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Clostridium difficile
Anticoagulation - rate control - cardioversion

45. Name the defense mechanism:
Pseudomonas
Displacement
Identify cause; pressors (e.g. - dobutamine)
Hypertrophic cardiomyopathy

46. Sentinel loop on AXR.
Acute pancreatitis
Beta- blockers - Ca2+ channel blockers - TCAs
Small cell lung cancer (SCLC)
Flumazenil

47. Name the defense mechanism:
Regression
PT
Membranous glomerulonephritis
Treat immediately. Consent is implied in emergency situations

48. Medical treatment for IBD.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Malignancy and hyperparathyroidism
Trauma; the second most common is berry aneurysm
ACEI

49. Name the organism:
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
High reliability - low validity
Actinomyces israelii
Pseudomonas

50. The most common cause of seizures in children (2-10 years).
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Infection - febrile seizures - trauma - idiopathic
Parkland formula
Prinzmetal's angina