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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. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

2. CSF findings:
Protamine
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Aseptic (viral) meningitis
Normal

3. Lung cancer associated with SIADH.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Small cell lung cancer (SCLC)
Contact dermatitis
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states

4. The most common causes of hypercalcemia.
Conflict of interest
Neuroleptic malignant syndrome
Pulsus paradoxus (seen in cardiac tamponade)
Malignancy and hyperparathyroidism

5. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Rett's disorder
Yersinia
V/Q scan
Coccidioidomycosis. Amphotericin B

6. The three most common causes of fever of unknown origin (FUO).
Infection - cancer - and autoimmune disease
CA-125 and transvaginal ultrasound
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Choriocarcinoma

7. Identify key organisms causing diarrhea:
Yersinia
Varicella zoster
Wernicke's encephalopathy due to a deficiency of thiamine
Pasteurella multocida

8. Complication of scaphoid fracture.
Avascular necrosis
Cardiogenic shock
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Dissociative fugue

9. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Conflict of interest
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Acute pancreatitis

10. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Beta- blockers - Ca2+ channel blockers - TCAs
Postinfectious glomerulonephritis
Intraductal papilloma
Duodenal atresia

11. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
Stasis - hypercoagulability - endothelial damage
Oral surgery
Inevitable abortion

12. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Dressler's syndrome: fever - pericarditis - ? ESR
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Signs and symptoms of hypercalcemia
Obstructive pulmonary disease (e.g. - asthma)

13. Number needed to treat?
Obstructive pulmonary disease (e.g. - asthma)
1
Contact dermatitis
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

14. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Hypernatremia
Cluster headache
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels

15. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Osgood - Schlatter disease
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

16. The most common inherited hemolytic anemia.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Hereditary spherocytosis
Bullous pemphigoid
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

17. Name the organism:
Haemophilus ducreyi
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
BP > 140/90 on three separate occasions two weeks apart
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

18. 'Stones - bones - groans - psychiatric overtones.'
B12 deficiency
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Signs and symptoms of hypercalcemia
Esophageal atresia with distal TEF (85%). Unable to pass NG tube

19. 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.
Polymyalgia rheumatica
Type I (distal) RTA
Pemphigus vulgaris
Headache

20. Treatment of cardiogenic shock.
Identify cause; pressors (e.g. - dobutamine)
Pseudogout
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Pityriasis versicolor

21. Key side effects of atypical antipsychotics.
Colposcopy and endocervical curettage
Nephritic syndrome
Intraductal papilloma
Weight gain - type 2 DM - QT prolongation

22. Aplastic crisis in sickle cell disease.
Parvovirus B19
Oral or topical metronidazole
Nitroprusside
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

23. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
CA-125 and transvaginal ultrasound
Hypovolemic shock
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Inevitable abortion

24. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Lead - time bias
Biliary tract obstruction
Clostridium difficile
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

25. First - line treatment for moderate hypercalcemia.
Alport's syndrome
IV hydration and loop diuretics (furosemide)
S. aureus or S. epidermidis.
Ultrasound

26. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Bullous pemphigoid
Type II (proximal) RTA
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

27. CSF findings with SAH.
Absence seizures
Contact dermatitis
Elevated ICP - RBCs - xanthochromia
Higher prevalence

28. The most common cause of seizures in young adults (18-35 years).
Pseudomonas
Number of live births per 1000 population
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Trauma - alcohol withdrawal - brain tumor

29. AML subtype associated with DIC.
M3
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Clomiphene citrate

30. Cross - sectional survey
Acute pancreatitis
Prevalence
Dressler's syndrome: fever - pericarditis - ? ESR
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)

31. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Nitroprusside
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Continuous - painful vaginal bleeding
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)

32. Fertility rate?
Number of live births per 1000 women 15-44 years of age
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Allergic interstitial nephritis
Giardia

33. Honeycomb pattern on CXR. Diagnosis? Treatment?
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Ulcerative colitis
Amoxicillin

34. Relative risk?
The IR of a disease in a population exposed to a particular factor
S. aureus or S. epidermidis.
Choriocarcinoma
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

35. Identify key organisms causing diarrhea:
Conflict of interest
Seborrheic keratosis
Pseudomonas
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

36. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Trauma; the second most common is berry aneurysm
Obstructive pulmonary disease (e.g. - asthma)
Radiation
HIDA scan

37. Name the defense mechanism:
Reaction formation
Rett's disorder
Fanconi's anemia
Febrile seizures (roseola infantum)

38. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Pheochromocytoma
Identify cause; fluid and blood repletion
Observational bias

39. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

40. Trauma series.
Isolation
Herpes simplex
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
AP chest - AP/lateral C- spine - AP pelvis

41. The 6 P's of ischemia due to peripheral vascular disease.
Inhaled Beta- agonists and inhaled corticosteroids
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
HIDA scan

42. Treatment for postpartum hemorrhage.
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Kl
Uterine massage; if that fails - give oxytocin
'Sawtooth' P waves

43. Nikolsky's sign.
Number of live births per 1000 women 15-44 years of age
Hereditary spherocytosis
Pemphigus vulgaris
Bullous pemphigoid

44. Risk factors for DVT.

45. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Factor V Leiden mutation
Confounding variable
Pregnant women. Treat this group aggressively because of potential complications

46. An agent that reverses the effects of heparin.
S. aureus or S. epidermidis.
Infection - febrile seizures - trauma - idiopathic
Pharmacologic stress test (e.g. - dobutamine echo)
Protamine

47. The most common cause of postpartum hemorrhage.
Beta- blockers - Ca2+ channel blockers - TCAs
Uterine atony
Agranulocytosis
Malignancy and hyperparathyroidism

48. Infant mortality?
Hereditary spherocytosis
Dantrolene or bromocriptine
Amoxicillin
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

49. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

50. Symptoms of placental abruption.
Placental abruption and placenta previa
Continuous - painful vaginal bleeding
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Sheehan's syndrome (postpartum pituitary necrosis)