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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. Medication used to induce ovulation.
Conversion disorder
Clomiphene citrate
Asymmetry - border irregularity - color variation - large diameter
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots

2. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
a - antagonists (phentolamine and phenoxybenzamine)
Agranulocytosis
Hereditary spherocytosis

3. The most common cause of hypertension in young women.
OCPs
Weight gain - type 2 DM - QT prolongation
N- acetylcysteine
Infection - febrile seizures - trauma - idiopathic

4. The most common pathogen causing croup.
Factor V Leiden mutation
Parainfluenza virus type 1
Pentad of TTP
Placental abruption and placenta previa

5. The most common inherited hemolytic anemia.
Klebsiella
Hereditary spherocytosis
Highly sensitive for TB
Never

6. A condition associated with red 'currant - jelly' stools.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Intussusception
Herpes simplex
A patient's family cannot require that a doctor withhold information from the patient

7. The most common cause of female infertility.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Endometriosis
Phencyclidine hydrochloride (PCP) intoxication
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

8. Glomerulonephritis with deafness.

9. Cross - sectional survey
Dissociative fugue
Prevalence
Ultrasound
Hypotension and bradycardia

10. First - line treatment for moderate hypercalcemia.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Alzheimer's and multi - infarct
IV hydration and loop diuretics (furosemide)
Clomiphene citrate

11. Signs of neurogenic shock.
Mycoplasma
Reaction formation
Hypotension and bradycardia
IVIG or plasmapheresis

12. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Elevated ICP - RBCs - xanthochromia
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Membranous glomerulonephritis
Signs and symptoms of hypercalcemia

13. Amenorrhea - bradycardia - and abnormal body image in a young female.
Postinfectious glomerulonephritis
Self - limited - painless vaginal bleeding
Alport's syndrome
Anorexia

14. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Niacin
Normal
Type I (distal) RTA

15. Treatment for malignant hypertension.
Hypertension - bradycardia - and abnormal respirations
Nitroprusside
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Trichomonas vaginitis

16. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
Wiskott - Aldrich syndrome
IgA nephropathy (Berger's disease)
Giardia

17. Name the organism:
Pseudomonas
DI
Seventy percent if the stenosis is symptomatic
Treat existing heart failure and replace the tricuspid valve

18. Endocarditis prophylaxis regimens.
Oral surgery
SCLC
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Lichen planus

19. Classic causes of drug - induced hepatitis.
B12 deficiency
CA-125 and transvaginal ultrasound
ETEC
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

20. 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?

21. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Ultrasound
Seminoma
Psoriasis

22. Classic ECG finding in atrial flutter.

23. The most common type of testicular cancer.
Bacterial meningitis
Osmotic fragility test
Seminoma
Pulsus paradoxus (seen in cardiac tamponade)

24. CSF findings:
Ampulla of the oviduct
ARDS
Aseptic (viral) meningitis
Murphy's sign - seen in acute cholecystitis

25. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
30 cc/hour
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

26. Medical treatment for IBD.
O2 - analgesia - hydration - and - if severe - transfusion
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Immediate needle thoracostomy
Frotteurism (a paraphilia)

27. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Anticoagulation - rate control - cardioversion
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Trauma - alcohol withdrawal - brain tumor
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

28. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Precocious puberty
1
OCP and barrier contraception
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)

29. Name the organism:
Streptococcus pneumoniae
Isolation
Folate deficiency
Suspect retinoblastoma

30. Identify key organisms causing diarrhea:
Hyperkalemia
OCPs - danazol - GnRH agonists
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

31. Risk factors for pyelonephritis.
IV penicillin or ampicillin
Phototherapy (mild) or exchange transfusion (severe)
Bruton's X- linked agammaglobulinemia
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones

32. A son asks that his mother not be told about her recently discovered cancer.

33. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Broca's aphasia. Frontal lobe - left MCA distribution
Conversion disorder
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

34. RTA associated with aldosterone defect.
Cirrhosis - CHF - nephritic syndrome
Precocious puberty
Type IV (distal) RTA
MAOIs

35. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
CML
IV hydration and loop diuretics (furosemide)
Pharmacologic stress test (e.g. - dobutamine echo)
Betamethasone or dexamethasone

36. Symptoms of placenta previa.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Excessive EtOH
Self - limited - painless vaginal bleeding
SIADH due to stress

37. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
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
Glomerulonephritis/nephritic syndrome
Pasteurella multocida
Nephrotic syndrome

38. Confusion - confabulation - ophthalmoplegia - ataxia.

39. PFT showing ? FEV1/FVC.
Trichomonas vaginitis
ACEI
HBV - DTaP - Hib - IPV - PCV
Obstructive pulmonary disease (e.g. - asthma)

40. Evaluation of a pulsatile abdominal mass and bruit.
Contact dermatitis
SIADH due to stress
Abdominal ultrasound and CT
Uremic syndrome seen in patients with renal failure

41. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Intraductal papilloma
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Headache

42. Treatment for acetaminophen overdose.
N- acetylcysteine
DM - SLE - and amyloidosis
Rate control with carotid massasge or other vagal stimulation
Polymyalgia rheumatica

43. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Actinic keratosis
Iron deficiency anemia
Paget's disease

44. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Giardia
INH - penicillamine - hydralazine - procainamide
Salmonella

45. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Edrophonium
Membranous glomerulonephritis
Nephrotic syndrome
Higher prevalence

46. Identify key organisms causing diarrhea:
E. coli O157:H7
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
CF or Hirschsprung's disease
Taenia solium (cysticercosis)

47. Nonpainful chancre.
Spinal stenosis
1
Oral or topical metronidazole
Parkland formula

48. Treatment of septic shock.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Fluids and antibiotics
Transitional cell carcinoma
Prevalence

49. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Conflict of interest
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Lobular carcinoma in situ

50. Goal hemoglobin A1c for a patient with DM.
< 7.0
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Nephrotic syndrome
Neuroleptic malignant syndrome