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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. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Pseudomonas
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care

2. Autoimmune complication occurring 2-4 weeks post - MI.

3. Combined UMN and LMN disorder.
Emergent laparotomy to repair perforated viscus - likely stomach
Trauma - alcohol withdrawal - brain tumor
CHF - shock - and altered mental status
ALS

4. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
DI
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
? protein intake - lactulose - neomycin
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)

5. The most common type of nephrolithiasis.
Angina - ST- segment changes on ECG - or ? BP
Uterine atony
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Calcium oxalate

6. When should a vaginal exam be performed with suspected placenta previa?
Betamethasone or dexamethasone
Never
Neurofibromatosis 1
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism

7. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

8. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Dissociative fugue
Lesion of 1
Never

9. Classic ECG findings in pericarditis.
Parainfluenza virus type 1
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Neurofibromatosis 1
Low - voltage - diffuse ST- segment elevation

10. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Acute mania. Start a mood stabilizer (e.g. - lithium)
They can mask symptoms of hypoglycemia
Higher prevalence

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

12. Dermatomal distribution.
Varicella zoster
Trauma; the second most common is berry aneurysm
Biliary tract obstruction
Beta- hCG; the most common cause of amenorrhea is pregnancy

13. Causes of drug - induced SLE.
Legionella pneumonia
INH - penicillamine - hydralazine - procainamide
Clostridium difficile
Never

14. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

15. Treatment for postpartum hemorrhage.
Lesion of 1
Nephrolithiasis
Uterine massage; if that fails - give oxytocin
Aseptic (viral) meningitis

16. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

17. The most common form of nephritic syndrome.
Membranous glomerulonephritis
Febrile seizures (roseola infantum)
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Wait - surgical resection - radiation and/or androgen suppression

18. Common symptoms associated with silent MIs.
Hypokalemia
Huntington's disease
CF or Hirschsprung's disease
CHF - shock - and altered mental status

19. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Substance abuse
Inevitable abortion
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Edrophonium

20. Eight surgically correctable causes of hypertension.

21. Electrolyte changes in tumor lysis syndrome.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Oral surgery
Elevated ICP - RBCs - xanthochromia
Bladder rupture or urethral injury

22. Characteristics of 2

23. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Beta- blockers - Ca2+ channel blockers - TCAs

24. Cross - sectional survey
Bullous pemphigoid
Membranous glomerulonephritis
Frotteurism (a paraphilia)
Prevalence

25. Acceptable urine output in a stable patient.
30 cc/hour
Never
Immediate cardioversion
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate

26. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Amoxicillin
Iron deficiency anemia

27. 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
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Hypoparathyroidism
Rubella

28. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead - time bias
Anticoagulation - rate control - cardioversion
Parkinson's disease
68% - 95.5% - 99.7%

29. Honey- crusted lesions.
Betamethasone or dexamethasone
Diverticulosis
Impetigo
Erythema multiforme

30. The most common cancer in men and the most common cause of death from cancer in men.
Varicella zoster
Low - voltage - diffuse ST- segment elevation
Iron deficiency anemia
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

31. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Emergent laparotomy to repair perforated viscus - likely stomach
Basal cell carcinoma
Contact dermatitis
Weight gain - type 2 DM - QT prolongation

32. Nonpainful chancre.
Fanconi's anemia
1
Selective IgA deficiency
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

33. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Pityriasis versicolor
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Biliary tract obstruction
Trichomonas vaginitis

34. Name the organism:
Radiation
Pseudomonas
B12 deficiency
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

35. Treatment for benzodiazepine overdose.
Dissociative fugue
Flumazenil
30 cc/hour
Bacillus cereus

36. Tanner stage 3 in a six-year - old female.
Uremic syndrome seen in patients with renal failure
Wernicke's encephalopathy due to a deficiency of thiamine
Precocious puberty
S. aureus or S. epidermidis.

37. Meningitis in infants. Causes? Treatment?
Precocious puberty
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Partial mole

38. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Intraductal papilloma
Type I (distal) RTA
Murphy's sign - seen in acute cholecystitis
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia

39. Sentinel loop on AXR.
Trauma; the second most common is berry aneurysm
Acute pancreatitis
Regression
Alzheimer's and multi - infarct

40. The most common 1
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Self - limited - painless vaginal bleeding
Multiple myeloma

41. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Beta- blockers - Ca2+ channel blockers - TCAs
Squamous cell carcinoma
Neither
Lesch - Nyhan syndrome (purine salvage problem with

42. Treatment of supraventricular tachycardia (SVT).
Neither
Rate control with carotid massasge or other vagal stimulation
Klebsiella
Dantrolene or bromocriptine

43. A fall in systolic BP of > 10 mmHg with inspiration.
Fat - female - fertile - forty - flatulent
Pulsus paradoxus (seen in cardiac tamponade)
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Pregnant women. Treat this group aggressively because of potential complications

44. The most common cause of hypothyroidism.

45. Radiographic indications for surgery in patients with acute abdomen.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Agranulocytosis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Lesch - Nyhan syndrome (purine salvage problem with

46. The most common cause of seizures in children (2-10 years).
Infection - febrile seizures - trauma - idiopathic
Membranous glomerulonephritis
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
IV penicillin or ampicillin

47. 'Doughy skin.'
Asherman's syndrome
Hypernatremia
Squamous cell carcinoma
Cirrhosis - CHF - nephritic syndrome

48. Medications and viruses that ? aplastic anemia.
Broca's aphasia. Frontal lobe - left MCA distribution
Squamous cell carcinoma
HBV immunoglobulin
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

49. Rigidity and stiffness with resting tremor and masked facies.

50. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
OCPs
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Amoxicillin