Test your basic knowledge |

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. Nikolsky's sign.
Spinal stenosis
Check for ? ICP; look for papilledema
Osgood - Schlatter disease
Bullous pemphigoid

2. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Neuroleptic malignant syndrome
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Fatigue and impending respiratory failure

3. Describe a test that consistently gives identical results - but the results are wrong.
Nephrotic syndrome
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
High reliability - low validity
Threatened abortion

4. Identify key organisms causing diarrhea:
Parvovirus B19
1
S. aureus
Sensitivity

5. Risk factors for cholelithiasis.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Fat - female - fertile - forty - flatulent
Wiskott - Aldrich syndrome
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

6. Flat - topped papules.
Menometrorrhagia
Lichen planus
Edrophonium
Patent ductus arteriosus (PDA)

7. A patient with a history of lithium use presents with copious amounts of dilute urine.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Nephrogenic diabetes insipidus (DI)
Retrograde cystourethrogram
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots

8. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Hypoparathyroidism
Ampulla of the oviduct
RSV bronchiolitis

9. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Glanzmann's thrombasthenia
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Uterine atony

10. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Acute mania. Start a mood stabilizer (e.g. - lithium)
Cellulitis
Nitroprusside

11. Relative risk?
1
Angina - ST- segment changes on ECG - or ? BP
The IR of a disease in a population exposed to a particular factor
Wrist drop - loss of thumb abduction

12. When can a physician refuse to continue treating a patient on the grounds of futility?
Salmonella
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
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Cluster headache

13. Treatment for ventricular fibrillation.
Immediate cardioversion
Seborrheic keratosis
Bullous pemphigoid
Clostridium difficile

14. The most common cause of bloody nipple discharge.
Ophthalmologic exam - CT - and MRI
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Number of deaths from birth to 28 days per 1000 live births
Intraductal papilloma

15. 'Stones - bones - groans - psychiatric overtones.'
Malignancy and hyperparathyroidism
Signs and symptoms of hypercalcemia
Beta- hCG; the most common cause of amenorrhea is pregnancy
Abdominal ultrasound and CT

16. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Metformin
Neuroleptics

17. Evaluation of a pulsatile abdominal mass and bruit.
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
Hereditary spherocytosis
Isolation
Abdominal ultrasound and CT

18. Dermatomal distribution.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Vibrio - HAV
Varicella zoster
Uremic syndrome seen in patients with renal failure

19. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Febrile seizures (roseola infantum)
Uremic syndrome seen in patients with renal failure
Lesions of 1
Establish the ABCs

20. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
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
Lead - time bias
Retrograde cystourethrogram
Consider Fitz - Hugh - Curtis syndrome

21. Prophylactic treatment for migraine.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Beta- hCG; the most common cause of amenorrhea is pregnancy
Beta- blockers - Ca2+ channel blockers - TCAs
RCC or other erythropoietin - producing tumor; evaluate with CT scan

22. Treatment for benzodiazepine overdose.
Prerenal
Flumazenil
Asherman's syndrome
Exercise stress treadmill with ECG

23. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Third - degree heart block
Seborrheic keratosis
Hypovolemic shock
Hypokalemia

24. The most frequent presentation of intracranial neoplasm.
Sporothrix schenckii
B12 deficiency
Headache
Osteoarthritis

25. Treatment for DTs.
Emergent laparotomy to repair perforated viscus - likely stomach
Benzodiazepines
Parainfluenza virus type 1
Hypotension - distant heart sounds - and JVD

26. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Anion gap acidosis and 1
Lichen sclerosus
Amoxicillin
Intraductal papilloma

27. 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
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Phencyclidine hydrochloride (PCP) intoxication
Lung - breast - skin (melanoma) - kidney - GI tract

28. Identify key organisms causing diarrhea:
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Neurofibromatosis 1
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Patent ductus arteriosus (PDA)

29. Definition of unstable angina.
Non - Hodgkin's lymphoma
Rubella
Angina is new - is worsening - or occurs at rest
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

30. The most common type of nephrolithiasis.
Factitious disorder (Munchausen syndrome)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Asymmetry - border irregularity - color variation - large diameter
Calcium oxalate

31. The most common location for an ectopic pregnancy.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Ampulla of the oviduct
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Number of live births per 1000 population

32. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Neuroleptics
Colposcopy and endocervical curettage
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Headache

33. AML subtype associated with DIC.
Pseudomonas
Lyme disease - Ixodes tick - doxycycline
Stasis - hypercoagulability - endothelial damage
M3

34. Lung cancer highly related to cigarette exposure.
SCLC
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Highly sensitive for TB
Factor V Leiden mutation

35. Macrocytic - megaloblastic anemia with neurologic symptoms.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
B12 deficiency
Uterine massage; if that fails - give oxytocin
Vibrio - HAV

36. A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
Kwashiorkor (protein malnutrition)
Osmotic fragility test
Hashimoto's thyroiditis

37. The most common cause of SAH.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Excessive EtOH
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Trauma; the second most common is berry aneurysm

38. In which patients do you initiate colorectal cancer screening early?
Actinomyces israelii
Hodgkin's lymphoma
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
Selective IgA deficiency

39. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Weight loss and OCPs
False. Withdrawing and withholding life are the same from an ethical standpoint
Isolation
Trauma; the second most common is berry aneurysm

40. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Fatigue and impending respiratory failure
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Cellulitis
Higher incidence

41. Conditions in which confidentiality must be overridden.
< 7.0
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
IV penicillin or ampicillin
Retrograde cystourethrogram

42. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Headache
Angina is new - is worsening - or occurs at rest
Neuroleptic malignant syndrome

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

44. Treatment for neuroleptic malignant syndrome.
Giardia
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Dantrolene or bromocriptine

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)
Kl
Abdominal ultrasound and CT
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)

46. What is the immunodeficiency?
Higher prevalence
M3
Seborrheic dermatitis. Treat with antifungals
Chronic granulomatous disease

47. Case - control study
Hypotension - distant heart sounds - and JVD
Neither
Patent ductus arteriosus (PDA)
Elevated ICP - RBCs - xanthochromia

48. Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
ALS
Treat existing heart failure and replace the tricuspid valve
Reaction formation

49. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Precocious puberty
1
Crohn's disease

50. Diagnostic test for hereditary spherocytosis.
A patient's family cannot require that a doctor withhold information from the patient
Osmotic fragility test
Observational bias
O2 - analgesia - hydration - and - if severe - transfusion