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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 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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2. Treatment for ventricular fibrillation.
Immediate cardioversion
Retinoic acid
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Beta- blockers - Ca2+ channel blockers - TCAs

3. Hypercholesterolemia treatment that ? flushing and pruritus.
Niacin
Kwashiorkor (protein malnutrition)
OCPs
Displacement

4. A patient fails to lactate after an emergency C- section with marked blood loss.

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5. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Infection - cancer - and autoimmune disease
Mycoplasma
Chronic granulomatous disease

6. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
IVIG or plasmapheresis
Lichen planus
Giardia

7. Treatment for acetaminophen overdose.
Osteoarthritis
Fanconi's anemia
Flumazenil
N- acetylcysteine

8. Radiographic indications for surgery in patients with acute abdomen.
Pseudomonas
HIDA scan
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
DM - SLE - and amyloidosis

9. RTA associated with aldosterone defect.
Seventy percent if the stenosis is symptomatic
Type IV (distal) RTA
Iron overload; use deferoxamine
Acute pancreatitis

10. Treatment of supraventricular tachycardia (SVT).
Contact dermatitis
Rate control with carotid massasge or other vagal stimulation
Neuroblastoma
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline

11. Cause of neonatal RDS.
Surfactant deficiency
Elevated ICP - RBCs - xanthochromia
Continuous positive airway pressure
Uremic syndrome seen in patients with renal failure

12. Bone is fractured in fall on outstretched hand.

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13. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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14. 'Cradle cap.'
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Low - voltage - diffuse ST- segment elevation
Septic or anaphylactic shock
Seborrheic dermatitis. Treat with antifungals

15. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Sheehan's syndrome (postpartum pituitary necrosis)
Prevalence
All - compartment fasciotomy for suspected compartment syndrome
Treat existing heart failure and replace the tricuspid valve

16. Pure RBC aplasia.
Cardiogenic shock
Diamond - Blackfan anemia
Aseptic (viral) meningitis
Exercise stress treadmill with ECG

17. Treatment for mild - persistent asthma.
Asherman's syndrome
Squamous cell carcinoma
Inhaled Beta- agonists and inhaled corticosteroids
Higher prevalence

18. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
HIDA scan
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Elevated ICP - RBCs - xanthochromia

19. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Spinal stenosis
Wegener's granulomatosis and Goodpasture's syndrome
Osteoarthritis
Murphy's sign - seen in acute cholecystitis

20. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Treat immediately. Consent is implied in emergency situations
MAOIs
Endometrial or estrogen receptor - breast cancer

21. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Multiple myeloma
Coccidioidomycosis. Amphotericin B
Pulsus paradoxus (seen in cardiac tamponade)
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella

22. Meningitis in infants. Causes? Treatment?
Immediate needle thoracostomy
Fluids and antibiotics
Hypocalcemia
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

23. A newborn female has continuous 'machinery murmur.'
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Type IV (distal) RTA
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Patent ductus arteriosus (PDA)

24. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
Pentad of TTP
Hypocalcemia
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

25. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Neuroblastoma
1
INH - penicillamine - hydralazine - procainamide

26. Name the defense mechanism:
Trauma; the second most common is berry aneurysm
Folate deficiency
Reaction formation
Anticoagulation - rate control - cardioversion

27. An active 13-year - old boy has anterior knee pain. Diagnosis?
Never
OCPs - danazol - GnRH agonists
Osgood - Schlatter disease
Mycobacterium tuberculosis

28. Treatment of SIADH?
Fluid restriction - demeclocycline
Clomiphene citrate
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Glomerulonephritis/nephritic syndrome

29. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Crohn's disease
Lead - time bias
Factitious disorder (Munchausen syndrome)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

30. A patient with a history of lithium use presents with copious amounts of dilute urine.
Rett's disorder
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Nephrogenic diabetes insipidus (DI)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

31. Nonpainful chancre.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Inevitable abortion
Weight gain - type 2 DM - QT prolongation
1

32. RTA associated with abnormal HCO3 - and rickets.
Legionella pneumonia
Phencyclidine hydrochloride (PCP) intoxication
Type II (proximal) RTA
1

33. When should a vaginal exam be performed with suspected placenta previa?
Alopecia areata (autoimmune process)
Alport's syndrome
Never
Endometrial biopsy

34. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Chronic granulomatous disease
Cluster headache
Trauma - alcohol withdrawal - brain tumor
Pregnant women. Treat this group aggressively because of potential complications

35. The most common type of testicular cancer.
Coarctation of the aorta
Respiratory alkalosis
Radiation
Seminoma

36. Medication to avoid in patients with a history of alcohol withdrawal seizures.
OCP and barrier contraception
Endometrial biopsy
Neuroleptics
? serum FSH

37. The most common cause of hypertension in young men.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Excessive EtOH
Fluids and antibiotics
7-10 days

38. Treatment of cardiogenic shock.
IV hydration and loop diuretics (furosemide)
HBV immunoglobulin
Identify cause; pressors (e.g. - dobutamine)
'Sawtooth' P waves

39. Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
Febrile seizures (roseola infantum)
Graves' disease
Never

40. Postnatal mortality?
Dissociative fugue
Depersonalization disorder
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Number of deaths from 28 days to one year per 1000 live births

41. Cross - sectional survey
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Patient on dopamine antagonist
Lichen planus
Prevalence

42. Drowsiness - asterixis - nausea - and a pericardial friction rub.
SSRIs
Yersinia
Uremic syndrome seen in patients with renal failure
Rate control with carotid massasge or other vagal stimulation

43. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Prevalence
Bacillus cereus
Acute myelogenous leukemia (AML)
Actinic keratosis

44. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Low - voltage - diffuse ST- segment elevation
Mallory- Weiss
Threatened abortion
Parvovirus B19

45. Treatment for neuroleptic malignant syndrome.
Septic or anaphylactic shock
Dantrolene or bromocriptine
Klebsiella
Third - degree heart block

46. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Confounding variable
Guillain - Barr
Type I (distal) RTA
Neurofibromatosis 1

47. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
All - compartment fasciotomy for suspected compartment syndrome
Lesions of 1
OCPs
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

48. Name the defense mechanism:
Parvovirus B19
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Nephrolithiasis
Displacement

49. Acute - phase treatment for Kawasaki disease.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Anemia - thrombocytopenia - and acute renal failure
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Usually resolves spontaneously; may require IVIG and/or corticosteroids

50. 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?
Lead - time bias
'Chocolate cysts -' powder burns
Distal radius (Colles' fracture)
Lyme disease - Ixodes tick - doxycycline