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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. Medical options for endometriosis.
Stasis - hypercoagulability - endothelial damage
Self - limited - painless vaginal bleeding
OCPs - danazol - GnRH agonists
TICS

2. Name the organism:
Streptococcus pneumoniae
Treat immediately. Consent is implied in emergency situations
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Malingering

3. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Small cell lung cancer (SCLC)
Elevated ICP - RBCs - xanthochromia
IV penicillin or ampicillin
Diverticulosis

4. Conditions in which confidentiality must be overridden.
Hypokalemia
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Neuroleptics
Hashimoto's thyroiditis

5. Why are Beta- blockers contraindicated in diabetics?
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Intussusception
They can mask symptoms of hypoglycemia
DM - SLE - and amyloidosis

6. Risk factors for DVT.

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7. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Diverticulosis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
AP chest - AP/lateral C- spine - AP pelvis

8. The most likely cause of acute lower GI bleed in patients > 40 years old.
Sensitivity
Diverticulosis
Usually resolves spontaneously; may require IVIG and/or corticosteroids
A patient with chest trauma who was previously stable suddenly dies

9. Name the organism:
Pasteurella multocida
Squamous cell carcinoma
Hypoxia and hypocarbia
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

10. A child has loss of red light reflex. Diagnosis?
Depersonalization disorder
Substance abuse
Neuroleptics
Suspect retinoblastoma

11. Chromosomal pattern of a complete mole.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
46 -XX
Acute pancreatitis
Pentad of TTP

12. A fall in systolic BP of > 10 mmHg with inspiration.
Streptococcus pneumoniae
Pulsus paradoxus (seen in cardiac tamponade)
Actinomyces israelii
BP > 140/90 on three separate occasions two weeks apart

13. Lung cancer associated with SIADH.
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Acute mania. Start a mood stabilizer (e.g. - lithium)
Small cell lung cancer (SCLC)
Lead - time bias

14. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Colposcopy and endocervical curettage
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Hodgkin's lymphoma

15. What is the metabolic syndrome?
Parkinson's disease
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Rate control - rhythm conversion - and anticoagulation
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination

16. First step in the management of a patient with acute GI bleed.
Establish the ABCs
Hypotension and bradycardia
Pulsus paradoxus (seen in cardiac tamponade)
Parvovirus B19

17. Identify key organisms causing diarrhea:
Pemphigus vulgaris
Legionella pneumonia
Biliary tract obstruction
Clostridium difficile

18. The most common inherited cause of hypercoagulability.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Factor V Leiden mutation
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.

19. Unopposed estrogen is contraindicated in which cancers?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Trichomonas vaginitis
Fluids and antibiotics
Endometrial or estrogen receptor - breast cancer

20. Beck's triad for cardiac tamponade.
Murphy's sign - seen in acute cholecystitis
Hypotension - distant heart sounds - and JVD
Transitional cell carcinoma
Hypocalcemia

21. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Regression
Higher prevalence
Trichomonas vaginitis

22. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Seborrheic keratosis
Septic or anaphylactic shock
Higher incidence

23. Nikolsky's sign.
Conflict of interest
Malingering
Bullous pemphigoid
Hypovolemic shock

24. Treatment for Guillain - Barr
OCPs - danazol - GnRH agonists
Septic or anaphylactic shock
IVIG or plasmapheresis
High TSH - low T4 - antimicrosomal antibodies

25. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Never
Cirrhosis - CHF - nephritic syndrome
Highly sensitive for TB

26. The most common 1
Selective IgA deficiency
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
BP > 140/90 on three separate occasions two weeks apart
Membranous glomerulonephritis

27. Treatment of SIADH?
Ophthalmologic exam - CT - and MRI
Alopecia areata (autoimmune process)
Contact dermatitis
Fluid restriction - demeclocycline

28. Identify key organisms causing diarrhea:
Colposcopy and endocervical curettage
Bacterial meningitis
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Polymyalgia rheumatica

29. Molar pregnancy containing fetal tissue.
Lung - breast - skin (melanoma) - kidney - GI tract
Partial mole
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Slipped capital femoral epiphyses. AP and frog - leg lateral view

30. Combined UMN and LMN disorder.
ALS
Prerenal
Wrist drop - loss of thumb abduction
Pseudomonas

31. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Angina - ST- segment changes on ECG - or ? BP
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

32. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
HBV immunoglobulin
Chronic lymphocytic leukemia (CLL)
Parvovirus B19

33. Medical treatment for IBD.
Fluid restriction - demeclocycline
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Pityriasis versicolor
Subdural hematoma

34. Honeycomb pattern on CXR. Diagnosis? Treatment?
Emergent laparotomy to repair perforated viscus - likely stomach
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Intraductal papilloma
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births

35. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Endometrial or estrogen receptor - breast cancer
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Kegel exercises - estrogen - pessaries for stress incontinence

36. Medical treatment for hepatic encephalopathy.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Conduct disorder
? protein intake - lactulose - neomycin
Asherman's syndrome

37. Classic ECG findings in pericarditis.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Niacin
Low - voltage - diffuse ST- segment elevation
A patient's family cannot require that a doctor withhold information from the patient

38. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Guillain - Barr
Febrile seizures (roseola infantum)
Continuous - painful vaginal bleeding
A patient's family cannot require that a doctor withhold information from the patient

39. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Kegel exercises - estrogen - pessaries for stress incontinence
Retrograde cystourethrogram
High reliability - low validity
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

40. Which healthy population is susceptible to UTIs?
INH - penicillamine - hydralazine - procainamide
Pregnant women. Treat this group aggressively because of potential complications
Intraductal papilloma
Klebsiella

41. Symptoms of placenta previa.
Inevitable abortion
High reliability - low validity
Self - limited - painless vaginal bleeding
Spinal stenosis

42. Acceptable urine output in a stable patient.
30 cc/hour
Neisseria meningitidis
Legionella pneumonia
Antipsychotics (neuroleptic malignant syndrome)

43. Pure RBC aplasia.
Inevitable abortion
IV benzodiazepine
Diamond - Blackfan anemia
Multiple myeloma

44. Glomerulonephritis with hemoptysis.

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45. Number needed to treat?
Higher prevalence
Endometriosis
1
Crohn's disease

46. Appropriate diagnostic test?
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Sensitivity
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Exercise stress treadmill with ECG

47. Radiographic indications for surgery in patients with acute abdomen.
Prerenal
Metformin
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)

48. HUS triad?
Anemia - thrombocytopenia - and acute renal failure
Bladder rupture or urethral injury
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Treat immediately. Consent is implied in emergency situations

49. Medications and viruses that ? aplastic anemia.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Dressler's syndrome: fever - pericarditis - ? ESR
High TSH - low T4 - antimicrosomal antibodies
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

50. Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
< 7.0
CA-125 and transvaginal ultrasound
IVIG or plasmapheresis