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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.
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. Albuminocytologic dissociation.
Spinal stenosis
Kegel exercises - estrogen - pessaries for stress incontinence
Guillain - Barr
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms

2. Ring - enhancing brain lesion on CT with seizures
Beta- blockers - digoxin - calcium channel blockers
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
SSRIs
Taenia solium (cysticercosis)

3. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
IV benzodiazepine
Number of live births per 1000 women 15-44 years of age
Duchenne muscular dystrophy
Cellulitis

4. The most common 1
Treat immediately. Consent is implied in emergency situations
Basal cell carcinoma
Multiple myeloma
Kwashiorkor (protein malnutrition)

5. Antihypertensive for a diabetic patient with proteinuria.
Rubella
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Immediate cardioversion
ACEI

6. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Hypovolemic shock
Infection - cancer - and autoimmune disease
Oral surgery

7. 'Doughy skin.'
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
IV hydration and loop diuretics (furosemide)
Angina is new - is worsening - or occurs at rest
Hypernatremia

8. A congenital heart disease that cause 2
? protein intake - lactulose - neomycin
Vibrio - HAV
Subarachnoid hemorrhage (SAH)
Coarctation of the aorta

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

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10. Treatment of central DI.
Septic or anaphylactic shock
Administration of DDAVP ? serum osmolality and free water restriction
Endometrial or estrogen receptor - breast cancer
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states

11. Honey- crusted lesions.
Impetigo
Hyperkalemia
Crohn's disease
Intussusception

12. Name the organism:
E. coli O157:H7
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Sporothrix schenckii
Mycoplasma

13. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Osgood - Schlatter disease
Wernicke's encephalopathy due to a deficiency of thiamine
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Nephrotic syndrome

14. Trauma series.
S. aureus
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
AP chest - AP/lateral C- spine - AP pelvis
Nephrotic syndrome

15. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
Pseudomonas
1
Osteogenesis imperfecta

16. Treatment for ventricular fibrillation.
Rett's disorder
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Psoriasis
Immediate cardioversion

17. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Niacin
Retrograde cystourethrogram
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

18. Name the organism:
Klebsiella
Parvovirus B19
OCPs
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)

19. First step in the management of a patient with acute GI bleed.
Lichen sclerosus
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Establish the ABCs
The IR of a disease in a population exposed to a particular factor

20. A 'blueberry muffin' rash is characteristic of what congenital infection?
Signs and symptoms of hypercalcemia
Lichen planus
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Rubella

21. Describe a test that consistently gives identical results - but the results are wrong.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
High reliability - low validity
SSRIs
Infection - cancer - and autoimmune disease

22. Nikolsky's sign.
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Nephrolithiasis
Bullous pemphigoid
Femoral hernia

23. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Respiratory alkalosis
Elevated ICP - RBCs - xanthochromia
Contact dermatitis
Levodopa/carbidopa

24. Medical options for endometriosis.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
OCPs - danazol - GnRH agonists
AP chest - AP/lateral C- spine - AP pelvis
Nephrotic syndrome

25. 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
No. Parental consent is not necessary for the medical treatment of pregnant minors
SCLC
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies

26. Meningitis in infants. Causes? Treatment?
Ulcerative colitis
Neisseria meningitidis
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

27. The most common cause of female infertility.
Hodgkin's lymphoma
Cerebral berry aneurysms (AD PCKD)
Non - Hodgkin's lymphoma
Endometriosis

28. Identify key organisms causing diarrhea:
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Salmonella
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Weight gain - type 2 DM - QT prolongation

29. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Polymyalgia rheumatica
Postinfectious glomerulonephritis
S. aureus or S. epidermidis.

30. Name the organism:
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Klebsiella
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

31. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
DM - SLE - and amyloidosis
Squamous cell carcinoma
1
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

32. Flat - topped papules.
Substance abuse
68% - 95.5% - 99.7%
Lichen planus
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

33. 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?
Weight loss and OCPs
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Biliary tract obstruction
Highly sensitive for TB

34. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Excessive EtOH
Neuroleptic malignant syndrome
CHF - shock - and altered mental status
Ulcerative colitis

35. Treatment of DKA.
68% - 95.5% - 99.7%
Signs and symptoms of hypercalcemia
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Psoriasis

36. Acid - base disorder in pulmonary embolism.
Hypoxia and hypocarbia
46 -XX
Regresses after menopause
Hypernatremia

37. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Biliary tract obstruction
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Erythema multiforme
Conflict of interest

38. Natural history of a leiomyoma.
Regresses after menopause
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Coarctation of the aorta
Factor V Leiden mutation

39. The most serious side effect of clozapine.
Huntington's disease
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Agranulocytosis

40. A fall in systolic BP of > 10 mmHg with inspiration.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Pulsus paradoxus (seen in cardiac tamponade)
Immediate needle thoracostomy
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

41. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Elevated ICP - RBCs - xanthochromia
Salmonella
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

42. Extraintestinal manifestations of IBD.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Paget's disease
Metformin
Headache

43. Birth rate?
False. Withdrawing and withholding life are the same from an ethical standpoint
Endometrial biopsy
Number of live births per 1000 population
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations

44. Goal hemoglobin A1c for a patient with DM.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
< 7.0
Glanzmann's thrombasthenia
Substance abuse

45. Name the defense mechanism:
Headache
Treat existing heart failure and replace the tricuspid valve
50 cc/hour
Reaction formation

46. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Aseptic (viral) meningitis
Hypertrophic cardiomyopathy
Sulfonamides - antimalarial drugs - fava beans
Wegener's granulomatosis and Goodpasture's syndrome

47. Administer to a symptomatic patient to diagnose myasthenia gravis.
Malingering
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Pseudomonas
Edrophonium

48. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Excessive EtOH
DM - SLE - and amyloidosis
Parkinson's disease

49. Treatment for acetaminophen overdose.
Varicella zoster
Continuous - painful vaginal bleeding
E. coli O157:H7
N- acetylcysteine

50. Name the defense mechanism:
Hashimoto's thyroiditis
Angina - ST- segment changes on ECG - or ? BP
Displacement
Pityriasis versicolor

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USMLE Step 2

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