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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. Identify key organisms causing diarrhea:
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Streptococcus pneumoniae
Prinzmetal's angina
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

2. Treatment for benzodiazepine overdose.
Flumazenil
Mallory- Weiss
IVIG or plasmapheresis
Suspect retinoblastoma

3. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Radiation
Reaction formation
Pharmacologic stress test (e.g. - dobutamine echo)

4. Name the organism:
RSV bronchiolitis
Toxoplasma gondii
Out
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

5. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Number of live births per 1000 population
All - compartment fasciotomy for suspected compartment syndrome
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Osteogenesis imperfecta

6. The most common cause of SAH.
Haemophilus ducreyi
Pasteurella multocida
Trauma; the second most common is berry aneurysm
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

7. Identify key organisms causing diarrhea:
ETEC
V/Q scan
Duodenal atresia
Higher incidence

8. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
IV penicillin or ampicillin
High reliability - low validity

9. 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?
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Lyme disease - Ixodes tick - doxycycline
Hypertension - bradycardia - and abnormal respirations
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

10. Inspiratory arrest during palpation of the RUQ.

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11. Testicular cancer associated with Beta- hCG - AFP.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
AP chest - AP/lateral C- spine - AP pelvis
Hereditary spherocytosis
Choriocarcinoma

12. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Bullous pemphigoid
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Frotteurism (a paraphilia)

13. Radiographic evidence of aortic disruption or dissection.
Headache
1
Fluids and antibiotics
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

14. Treatment of hypovolemic shock.
Wegener's granulomatosis and Goodpasture's syndrome
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Hyperkalemia
Identify cause; fluid and blood repletion

15. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Clostridium difficile
Seborrheic dermatitis. Treat with antifungals

16. Nonpainful chancre.
1
< 7.0
Erythema multiforme
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs

17. First - line treatment for moderate hypercalcemia.
Multiple myeloma
IV hydration and loop diuretics (furosemide)
Substance abuse
Never

18. Treatment of central DI.
Calcium oxalate
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Osmotic fragility test
Administration of DDAVP ? serum osmolality and free water restriction

19. The coagulation parameter affected by warfarin.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
PT
Psoriasis
Weight gain - type 2 DM - QT prolongation

20. Treatment for neuroleptic malignant syndrome.
Identify cause; fluid and blood repletion
Dantrolene or bromocriptine
O2 - analgesia - hydration - and - if severe - transfusion
Sporothrix schenckii

21. Treatment for atrial fibrillation.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Anticoagulation - rate control - cardioversion
Never

22. The most common 1
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Administration of DDAVP ? serum osmolality and free water restriction
Lung - breast - skin (melanoma) - kidney - GI tract
They can mask symptoms of hypoglycemia

23. An active 13-year - old boy has anterior knee pain. Diagnosis?
Sheehan's syndrome (postpartum pituitary necrosis)
Spinal stenosis
Threatened abortion
Osgood - Schlatter disease

24. Fertility rate?
Herpes simplex
Neuroleptic malignant syndrome
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Number of live births per 1000 women 15-44 years of age

25. Treatment of AF.
Rate control - rhythm conversion - and anticoagulation
Hyperkalemia
Excessive EtOH
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma

26. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Bacillus cereus
HIDA scan
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

27. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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28. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Trauma - alcohol withdrawal - brain tumor
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Kl
Endometrial biopsy

29. Key side effects of atypical antipsychotics.
? protein intake - lactulose - neomycin
Parainfluenza virus type 1
Weight gain - type 2 DM - QT prolongation
Lesch - Nyhan syndrome (purine salvage problem with

30. Associated with Propionibacterium acnes and changes in androgen levels.
Precocious puberty
Acne vulgaris
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Huntington's disease

31. Blood in the urethral meatus or high - riding prostate.
Betamethasone or dexamethasone
Higher incidence
Parkland formula
Bladder rupture or urethral injury

32. Aplastic crisis in sickle cell disease.
Parvovirus B19
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first - degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
Multiple myeloma
Substance abuse

33. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Substance abuse
The IR of a disease in a population exposed to a particular factor

34. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA- B27
Angina - ST- segment changes on ECG - or ? BP
MS
Dressler's syndrome: fever - pericarditis - ? ESR

35. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Klebsiella
Kl
Hypocalcemia
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

36. Eosinophils in urine sediment.
Allergic interstitial nephritis
IV benzodiazepine
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Iatrogenic steroid administration. The second most common cause is Cushing's disease

37. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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38. Joints in the hand affected in rheumatoid arthritis.
Neurofibromatosis 1
MCP and PIP joints; DIP joints are spared
Sarcoidosis
Acne vulgaris

39. Molar pregnancy containing fetal tissue.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Benzodiazepines
DM - SLE - and amyloidosis
Partial mole

40. 'Stones - bones - groans - psychiatric overtones.'
Signs and symptoms of hypercalcemia
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Depersonalization disorder
Lichen sclerosus

41. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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42. Causes of hypoxemia.
Pseudomonas
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Depersonalization disorder
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

43. Virchow's triad.
Substance abuse
High reliability - low validity
Duodenal atresia
Stasis - hypercoagulability - endothelial damage

44. Meningitis in neonates. Causes? Treatment?
a - antagonists (phentolamine and phenoxybenzamine)
Pheochromocytoma
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

45. The diagnostic test for pulmonary embolism.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
MCP and PIP joints; DIP joints are spared
V/Q scan

46. Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
50 cc/hour
Klebsiella
Hypoxia and hypocarbia

47. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Phototherapy (mild) or exchange transfusion (severe)
Coccidioidomycosis. Amphotericin B
Aseptic (viral) meningitis
Anemia of chronic disease

48. Dermatomal distribution.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
False. Withdrawing and withholding life are the same from an ethical standpoint
Varicella zoster
Seminoma

49. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Endometrial biopsy
Biliary tract obstruction
Metformin
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

50. Vaccinations at a six- month well - child visit.
HBV - DTaP - Hib - IPV - PCV
High reliability - low validity
Nephrolithiasis
Sarcoidosis

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