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USMLE Step 2

Subjects : health-sciences, usmle-step-2

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Why are Beta- blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
Pseudomonas
Type I (distal) RTA
Absence seizures

2. Annual screening for women with a strong family history of ovarian cancer.
Wrist drop - loss of thumb abduction
CA-125 and transvaginal ultrasound
Seminoma
IV benzodiazepine

3. What is the immunodeficiency?

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4. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Anemia of chronic disease
CF or Hirschsprung's disease
Prevalence
Slipped capital femoral epiphyses. AP and frog - leg lateral view

5. The most common histology of bladder cancer.
Transitional cell carcinoma
SIADH due to stress
Niacin
Febrile seizures (roseola infantum)

6. The most common cause of bloody nipple discharge.
Cluster headache
Displacement
Respiratory alkalosis
Intraductal papilloma

7. The diagnostic test for pulmonary embolism.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
V/Q scan

8. The most common inherited hemolytic anemia.
Cluster headache
Hereditary spherocytosis
Diamond - Blackfan anemia
Seventy percent if the stenosis is symptomatic

9. What is the immunodeficiency?
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
IV benzodiazepine
Chronic granulomatous disease

10. ? CO - ? PCWP - ? PVR.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Weight loss and OCPs
Hypovolemic shock
Cardiogenic shock

11. Treatment of supraventricular tachycardia (SVT).
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Campylobacter
Rate control with carotid massasge or other vagal stimulation
S. aureus or S. epidermidis.

12. What should always be done prior to LP?
Check for ? ICP; look for papilledema
A patient with chest trauma who was previously stable suddenly dies
Biliary tract obstruction
Guillain - Barr

13. When should a vaginal exam be performed with suspected placenta previa?
Rate control with carotid massasge or other vagal stimulation
Identify cause; pressors (e.g. - dobutamine)
Never
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

14. 'Dewdrop on a rose petal.'
Klebsiella
Impetigo
Lesions of 1
Restrictive pulmonary disease

15. The most common cause of postpartum hemorrhage.
High TSH - low T4 - antimicrosomal antibodies
Uterine atony
Alzheimer's and multi - infarct
Amoxicillin

16. Medications and viruses that ? aplastic anemia.
Rate control - rhythm conversion - and anticoagulation
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
BP > 140/90 on three separate occasions two weeks apart
Immediate needle thoracostomy

17. Infection of small airways with epidemics in winter and spring.
Pregnant women. Treat this group aggressively because of potential complications
50 cc/hour
Postinfectious glomerulonephritis
RSV bronchiolitis

18. Causes of hypoxemia.
Seventy percent if the stenosis is symptomatic
Regresses after menopause
Hypokalemia
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

19. A homeless child is small for his age and has peeling skin and a swollen belly.
Pseudomonas
Psoriasis
? protein intake - lactulose - neomycin
Kwashiorkor (protein malnutrition)

20. Acid - base disorder in pulmonary embolism.
Substance abuse
Hypoxia and hypocarbia
Yersinia
Duodenal atresia

21. Joints in the hand affected in rheumatoid arthritis.
Higher incidence
Number of deaths from 20 weeks' gestation to birth per 1000 total births
MCP and PIP joints; DIP joints are spared
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction

22. Eosinophils in urine sediment.
Allergic interstitial nephritis
Agranulocytosis
Fluid restriction - demeclocycline
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

23. Honey- crusted lesions.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Coarctation of the aorta
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Impetigo

24. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
CHF - shock - and altered mental status
Factitious disorder (Munchausen syndrome)
O2 - analgesia - hydration - and - if severe - transfusion
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

25. 'Cradle cap.'
Hypokalemia
Seborrheic dermatitis. Treat with antifungals
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Placental abruption and placenta previa

26. First - line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide)
Femoral hernia
Mallory- Weiss
Fluids and antibiotics

27. Name the defense mechanism:
Self - limited - painless vaginal bleeding
Treat immediately. Consent is implied in emergency situations
Seventy percent if the stenosis is symptomatic
Displacement

28. Key side effects of atypical antipsychotics.
Febrile seizures (roseola infantum)
Weight gain - type 2 DM - QT prolongation
Nephrolithiasis
Exercise stress treadmill with ECG

29. Treatment for acute coronary syndrome.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
OCPs - danazol - GnRH agonists
Uterine atony
Clostridium difficile

30. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Salmonella
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

31. A congenital heart disease that cause 2
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Glanzmann's thrombasthenia
Coarctation of the aorta
Septic or anaphylactic shock

32. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
105 bacteria/mL
Hypoparathyroidism
Levodopa/carbidopa
Postinfectious glomerulonephritis

33. Virchow's triad.
1
Lyme disease - Ixodes tick - doxycycline
Stasis - hypercoagulability - endothelial damage
Lesion of 1

34. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Malingering
Legionella pneumonia
Diphenhydramine or epinephrine 1:1000
1

35. First - line medication for status epilepticus.
Out
IV benzodiazepine
High TSH - low T4 - antimicrosomal antibodies
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

36. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Bacillus cereus
Klebsiella
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
SIADH due to stress

37. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
Number of deaths per 1000 population
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
Small cell lung cancer (SCLC)

38. ? CO - ? PCWP - ? PVR.
Septic or anaphylactic shock
Pseudomonas
Depersonalization disorder
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

39. A patient fails to lactate after an emergency C- section with marked blood loss.

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40. Therapy for polycystic ovarian syndrome.
Prinzmetal's angina
AP chest - AP/lateral C- spine - AP pelvis
Weight loss and OCPs
HGPRTase deficiency)

41. Identify key organisms causing diarrhea:
Acute mania. Start a mood stabilizer (e.g. - lithium)
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Yersinia

42. A woman who was abused as a child frequently feels outside of or detached from her body.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Establish the ABCs
Elevated ICP - RBCs - xanthochromia
Depersonalization disorder

43. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Contact dermatitis
Lichen sclerosus
Niacin

44. Side effects of corticosteroids.
Radiation
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Sensitivity
Dissociative fugue

45. The coagulation parameter affected by warfarin.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Nephrotic syndrome
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
PT

46. Goal hemoglobin A1c for a patient with DM.
Guillain - Barr
Lichen planus
TICS
< 7.0

47. Four signs and symptoms of streptococcal pharyngitis.
Broca's aphasia. Frontal lobe - left MCA distribution
Treat existing heart failure and replace the tricuspid valve
Consider Fitz - Hugh - Curtis syndrome
Fever - pharyngeal erythema - tonsillar exudate - lack of cough

48. The most common type of nephrolithiasis.
Calcium oxalate
ALS
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Duodenal atresia

49. Antidepressants associated with hypertensive crisis.
? serum FSH
ARDS
Signs and symptoms of hypercalcemia
MAOIs

50. A doctor refers a patient for an MRI at a facility he/she owns.
Treat immediately. Consent is implied in emergency situations
Type II (proximal) RTA
Spinal stenosis
Conflict of interest

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