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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. Symptoms of placental abruption.
Continuous - painful vaginal bleeding
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Number of live births per 1000 population
7-10 days

2. Treatment of anaphylactic shock.
Iron overload; use deferoxamine
Identify cause; pressors (e.g. - dobutamine)
Dissociative fugue
Diphenhydramine or epinephrine 1:1000

3. Blood in the urethral meatus or high - riding prostate.
Bladder rupture or urethral injury
Suspect ankylosing spondylitis. Check HLA- B27
MCP and PIP joints; DIP joints are spared
Taenia solium (cysticercosis)

4. Causes of hypoxemia.
Self - limited - painless vaginal bleeding
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Lichen sclerosus
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

5. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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6. Flat - topped papules.
Lichen planus
Placental abruption and placenta previa
Signs and symptoms of hypercalcemia
Acute mania. Start a mood stabilizer (e.g. - lithium)

7. + Nikolsky's sign.
Angina - ST- segment changes on ECG - or ? BP
Pemphigus vulgaris
Frotteurism (a paraphilia)
Neuroleptics

8. Case - control study
Neither
Septic or anaphylactic shock
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Kwashiorkor (protein malnutrition)

9. The first test to perform when a woman presents with amenorrhea.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Self - limited - painless vaginal bleeding
Taenia solium (cysticercosis)
Parkinson's disease

10. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Legionella pneumonia
Trichomonas vaginitis
Check for ? ICP; look for papilledema

11. What is the metabolic syndrome?
Salmonella
Basal cell carcinoma
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Betamethasone or dexamethasone

12. Peaked T waves and widened QRS.
Higher prevalence
Prinzmetal's angina
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Hyperkalemia

13. Antibiotics with teratogenic effects.
Betamethasone or dexamethasone
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
V/Q scan
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

14. The three most common causes of fever of unknown origin (FUO).
Menometrorrhagia
Infection - cancer - and autoimmune disease
Acne vulgaris
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

15. The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
Mycoplasma
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Fat - female - fertile - forty - flatulent

16. First - line pharmacotherapy for depression.
SSRIs
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Angina - ST- segment changes on ECG - or ? BP
'Chocolate cysts -' powder burns

17. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Anemia - thrombocytopenia - and acute renal failure
Beta- blockers - Ca2+ channel blockers - TCAs
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Actinic keratosis

18. Infection of small airways with epidemics in winter and spring.
Metformin
RSV bronchiolitis
Neuroleptic malignant syndrome
Dantrolene or bromocriptine

19. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
105 bacteria/mL
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Type I (distal) RTA
Restrictive pulmonary disease

20. Virchow's triad.
Mycoplasma
Stasis - hypercoagulability - endothelial damage
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Third - degree heart block

21. Name the defense mechanism:
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Reaction formation
Bacterial meningitis
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

22. Why are Beta- blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
Parkland formula
Salmonella
Membranous glomerulonephritis

23. Iris - like target lesions.
Erythema multiforme
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Displacement

24. Heinz bodies?
Subarachnoid hemorrhage (SAH)
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Anorexia
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy

25. Unopposed estrogen is contraindicated in which cancers?
Cluster headache
Endometrial or estrogen receptor - breast cancer
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Hyperkalemia

26. Method of calculating fluid repletion in burn patients.
Check for ? ICP; look for papilledema
Bacterial meningitis
Parkland formula
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity

27. Treatment for TTP.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Pheochromocytoma
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Folate deficiency

28. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Seborrheic dermatitis. Treat with antifungals
Neurofibromatosis 1
30 cc/hour
Alopecia areata (autoimmune process)

29. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Lyme disease - Ixodes tick - doxycycline
Dissociative fugue
Subarachnoid hemorrhage (SAH)

30. Name the organism:
1
Antipsychotics (neuroleptic malignant syndrome)
Hypertrophic cardiomyopathy
Salmonella

31. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Endometrial or estrogen receptor - breast cancer
Squamous cell carcinoma
Lichen planus
Bladder rupture or urethral injury

32. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
Nephrogenic diabetes insipidus (DI)
Non - Hodgkin's lymphoma
RCC or other erythropoietin - producing tumor; evaluate with CT scan

33. Exophthalmos - pretibial myxedema - and ? TSH.

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34. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
S. aureus or S. epidermidis.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Bruton's X- linked agammaglobulinemia

35. Infant mortality?
Murphy's sign - seen in acute cholecystitis
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

36. Treatment for bacterial vaginosis.
HBV immunoglobulin
O2 - analgesia - hydration - and - if severe - transfusion
Parainfluenza virus type 1
Oral or topical metronidazole

37. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Confounding variable
S. aureus or S. epidermidis.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

38. A patient presents with recent PID with RUQ pain.
Endometrial or estrogen receptor - breast cancer
Consider Fitz - Hugh - Curtis syndrome
Higher prevalence
AP chest - AP/lateral C- spine - AP pelvis

39. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Fluids and antibiotics
Choriocarcinoma
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

40. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Number of deaths per 1000 population
Lead - time bias
Diverticulosis
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

41. The diagnostic test for pulmonary embolism.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
CA-125 and transvaginal ultrasound
V/Q scan
Intraductal papilloma

42. 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.
Huntington's disease
Polymyalgia rheumatica
Klebsiella
Consider Fitz - Hugh - Curtis syndrome

43. Caf
Anemia - thrombocytopenia - and acute renal failure
Neurofibromatosis 1
SCLC
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

44. Erythema migrans.
Mallory- Weiss
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
SCLC
Lesion of 1

45. A violent patient has vertical and horizontal nystagmus.
Ulcerative colitis
Highly sensitive for TB
Phencyclidine hydrochloride (PCP) intoxication
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

46. The most likely cause of acute lower GI bleed in patients > 40 years old.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Diverticulosis
Coarctation of the aorta
Hyperkalemia

47. The most common type of nephrolithiasis.
Immediate cardioversion
Number of deaths per 1000 population
Calcium oxalate
Seminoma

48. Findings in 3
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Cardiogenic shock
MAOIs
Neither

49. A condition associated with red 'currant - jelly' stools.
Reye's syndrome
Regression
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Intussusception

50. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Squamous cell carcinoma
Cirrhosis - CHF - nephritic syndrome
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
MS