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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 young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Pasteurella multocida
Flumazenil
Nephrotic syndrome

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

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3. The most common type of testicular cancer.
Seminoma
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Clostridium difficile
HBV - DTaP - Hib - IPV - PCV

4. Criteria for exudative effusion.
Ophthalmologic exam - CT - and MRI
Avascular necrosis
Spinal stenosis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

5. Name the defense mechanism:
Actinomyces israelii
50 cc/hour
Acute myelogenous leukemia (AML)
Isolation

6. CSF findings:
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Aseptic (viral) meningitis
Continuous positive airway pressure
Partial mole

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

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8. Nontender abdominal mass associated with elevated VMA and HVA.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Chronic lymphocytic leukemia (CLL)
Neuroblastoma
Neurofibromatosis 1

9. Conditions in which confidentiality must be overridden.
MCP and PIP joints; DIP joints are spared
S. aureus or S. epidermidis.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Parvovirus B19

10. Nonpainful chancre.
Glanzmann's thrombasthenia
? serum FSH
Uterine massage; if that fails - give oxytocin
1

11. The mainstay of Parkinson's therapy.
Bullous pemphigoid
Levodopa/carbidopa
50 cc/hour
Coarctation of the aorta

12. What is the immunodeficiency?

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13. The most common cause of hypertension in young women.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Hypotension and bradycardia
OCPs
Murphy's sign - seen in acute cholecystitis

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

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15. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Hashimoto's thyroiditis
Nephrotic syndrome
Administration of DDAVP ? serum osmolality and free water restriction
Threatened abortion

16. Name the organism:
Septic or anaphylactic shock
IV benzodiazepine
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Salmonella

17. The most common cause of hypertension in young men.
Excessive EtOH
Pulsus paradoxus (seen in cardiac tamponade)
Radiation
MAOIs

18. RTA associated with abnormal HCO3 - and rickets.
Weight loss and OCPs
Type II (proximal) RTA
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Lesion of 1

19. Identify key organisms causing diarrhea:
ETEC
Hypocalcemia
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
MCP and PIP joints; DIP joints are spared

20. Gout - self - mutilation - and choreoathetosis.
Neuroleptic malignant syndrome
BP > 140/90 on three separate occasions two weeks apart
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
HGPRTase deficiency)

21. Infection of small airways with epidemics in winter and spring.
Fat - female - fertile - forty - flatulent
IV hydration and loop diuretics (furosemide)
RSV bronchiolitis
Salmonella

22. Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Mallory- Weiss
Signs and symptoms of hypercalcemia
Dantrolene or bromocriptine

23. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
'Sawtooth' P waves
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Seborrheic dermatitis. Treat with antifungals
Acute myelogenous leukemia (AML)

24. Treatment of SIADH?
IV benzodiazepine
Hypoxia and hypocarbia
Fluid restriction - demeclocycline
BP > 140/90 on three separate occasions two weeks apart

25. Flat - topped papules.
Lichen planus
Number of deaths from 28 days to one year per 1000 live births
Highly sensitive for TB
Streptococcus pneumoniae

26. The most common location for an ectopic pregnancy.
Prinzmetal's angina
Osteoarthritis
Ampulla of the oviduct
Wait - surgical resection - radiation and/or androgen suppression

27. Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Exercise stress treadmill with ECG
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Toxoplasma gondii

28. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Acne vulgaris
Hypertrophic cardiomyopathy
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

29. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Fluids and antibiotics
Clostridium difficile
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7

30. The most common causes of hypercalcemia.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Malignancy and hyperparathyroidism
Bacterial meningitis
Beta- hCG; the most common cause of amenorrhea is pregnancy

31. 'Stuck - on' appearance.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Edrophonium
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Seborrheic keratosis

32. Aplastic crisis in sickle cell disease.
Actinic keratosis
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
Parvovirus B19
Treat because the disease represents an immediate threat to the child's life. Then seek a court order

33. An agent that reverses the effects of heparin.
Protamine
S. aureus
Selective IgA deficiency
CA-125 and transvaginal ultrasound

34. Medical options for endometriosis.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
OCPs - danazol - GnRH agonists
MS
Cellulitis

35. 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?
Lyme disease - Ixodes tick - doxycycline
Psoriasis
Anemia of chronic disease
? Ca2+ - ? K- - ? phosphate - ? uric acid

36. Neonatal mortality?
Elevated ICP - RBCs - xanthochromia
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Hypernatremia
Number of deaths from birth to 28 days per 1000 live births

37. Treatment for mild and severe unconjugated hyperbilirubinemia.
Anemia - thrombocytopenia - and acute renal failure
Phototherapy (mild) or exchange transfusion (severe)
Endometrial biopsy
1

38. Risk factors for pyelonephritis.
Glomerulonephritis/nephritic syndrome
Headache
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
DM - SLE - and amyloidosis

39. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Kegel exercises - estrogen - pessaries for stress incontinence
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Hypernatremia

40. Honey- crusted lesions.
Number of deaths from birth to 28 days per 1000 live births
PT
Colposcopy and endocervical curettage
Impetigo

41. Name the organism:
Pseudomonas
Suspect ankylosing spondylitis. Check HLA- B27
a - antagonists (phentolamine and phenoxybenzamine)
Incidence and prevalence

42. Tanner stage 3 in a six-year - old female.
Signs and symptoms of hypercalcemia
Broca's aphasia. Frontal lobe - left MCA distribution
Parvovirus B19
Precocious puberty

43. Treatment for neuroleptic malignant syndrome.
V/Q scan
Neisseria meningitidis
Dantrolene or bromocriptine
Osteogenesis imperfecta

44. Causes of exudative effusion.
Subdural hematoma
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Weight gain - type 2 DM - QT prolongation
Never

45. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Rate control - rhythm conversion - and anticoagulation
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
7-10 days

46. Testicular cancer associated with Beta- hCG - AFP.
Distal radius (Colles' fracture)
? protein intake - lactulose - neomycin
Choriocarcinoma
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy

47. ECG findings suggesting MI.
Hashimoto's thyroiditis
Beta- blockers - digoxin - calcium channel blockers
Kwashiorkor (protein malnutrition)
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

48. Name the organism:
Streptococcus pneumoniae
Murphy's sign - seen in acute cholecystitis
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Rate control with carotid massasge or other vagal stimulation

49. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides

50. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Retinoic acid
Mycoplasma
SIADH due to stress
Sulfonamides - antimalarial drugs - fava beans