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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 patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
Hypoparathyroidism
Factor V Leiden mutation
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

2. Definition of hypertension.
Suspect ankylosing spondylitis. Check HLA- B27
BP > 140/90 on three separate occasions two weeks apart
Inhaled Beta- agonists and inhaled corticosteroids
OCPs - danazol - GnRH agonists

3. Reynolds' pentad.

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4. Tanner stage 3 in a six-year - old female.
Precocious puberty
TICS
Continuous - painful vaginal bleeding
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

5. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Non - Hodgkin's lymphoma
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
HBV - DTaP - Hib - IPV - PCV
Osteoarthritis

6. The most common cause of bloody nipple discharge.
Subarachnoid hemorrhage (SAH)
Klebsiella
Non - Hodgkin's lymphoma
Intraductal papilloma

7. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Metformin
RSV bronchiolitis
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

8. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Sarcoidosis
Lyme disease - Ixodes tick - doxycycline
Self - limited - painless vaginal bleeding
Factitious disorder (Munchausen syndrome)

9. Attributable risk?
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Type IV (distal) RTA
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed

10. Identify key organisms causing diarrhea:
50 cc/hour
Pasteurella multocida
Third - degree heart block
Giardia

11. 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?

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12. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Self - limited - painless vaginal bleeding
Slipped capital femoral epiphyses. AP and frog - leg lateral view

13. Cohort study
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Incidence and prevalence
Acne vulgaris
Squamous cell carcinoma

14. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Salmonella
Colposcopy and endocervical curettage
Non - Hodgkin's lymphoma
Type II (proximal) RTA

15. What % lesion is an indication for carotid endarterectomy?
V/Q scan
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Seventy percent if the stenosis is symptomatic
Hashimoto's thyroiditis

16. Acute - phase treatment for Kawasaki disease.
Observational bias
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
HBV immunoglobulin
Seventy percent if the stenosis is symptomatic

17. 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
TICS
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

18. The three most common causes of fever of unknown origin (FUO).
Third - degree heart block
Nephrolithiasis
Pulsus paradoxus (seen in cardiac tamponade)
Infection - cancer - and autoimmune disease

19. Name the organism:
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Sporothrix schenckii
High TSH - low T4 - antimicrosomal antibodies
Never

20. Indications for surgical repair of abdominal aortic aneurysm.
Lung - breast - skin (melanoma) - kidney - GI tract
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Anion gap acidosis and 1
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured

21. Auer rods on blood smear.
Administration of DDAVP ? serum osmolality and free water restriction
Acute myelogenous leukemia (AML)
Lichen planus
Broca's aphasia. Frontal lobe - left MCA distribution

22. What should always be done prior to LP?
Calcium oxalate
Confounding variable
Small cell lung cancer (SCLC)
Check for ? ICP; look for papilledema

23. Acceptable urine output in a trauma patient.
Crohn's disease
Polymyalgia rheumatica
50 cc/hour
Kegel exercises - estrogen - pessaries for stress incontinence

24. AML subtype associated with DIC.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
MCP and PIP joints; DIP joints are spared
M3
Salmonella

25. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Polymyalgia rheumatica
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Alport's syndrome

26. Eosinophils in urine sediment.
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Allergic interstitial nephritis
Treat existing heart failure and replace the tricuspid valve
O2 - analgesia - hydration - and - if severe - transfusion

27. Trauma series.
AP chest - AP/lateral C- spine - AP pelvis
Normal
Hypocalcemia
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin

28. The most common 1
Multiple myeloma
Radiation
Psoriasis
Guillain - Barr

29. May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
DI
Taenia solium (cysticercosis)
Patient on dopamine antagonist

30. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Giardia
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Duchenne muscular dystrophy

31. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Radiation
Number of deaths from 28 days to one year per 1000 live births
Beta- hCG; the most common cause of amenorrhea is pregnancy
Inevitable abortion

32. Name the organism:
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Treat immediately. Consent is implied in emergency situations
Salmonella
Osgood - Schlatter disease

33. Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
1
PT
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis

34. Treatment for acetaminophen overdose.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Exercise stress treadmill with ECG
Wegener's granulomatosis and Goodpasture's syndrome
N- acetylcysteine

35. ? CO - ? PCWP - ? PVR.
Retinoic acid
Septic or anaphylactic shock
Osgood - Schlatter disease
Pulsus paradoxus (seen in cardiac tamponade)

36. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
1
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
No. Parental consent is not necessary for the medical treatment of pregnant minors
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

37. Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP
Weight loss and OCPs
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Fluids and antibiotics

38. Causes of drug - induced SLE.
The IR of a disease in a population exposed to a particular factor
CA-125 and transvaginal ultrasound
INH - penicillamine - hydralazine - procainamide
False. Withdrawing and withholding life are the same from an ethical standpoint

39. Nikolsky's sign.
Bullous pemphigoid
Inevitable abortion
Reaction formation
Yersinia

40. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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41. 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)
Continuous positive airway pressure
DM - SLE - and amyloidosis
Weight gain - type 2 DM - QT prolongation

42. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
Kl
Panic disorder
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

43. The most serious side effect of clozapine.
Agranulocytosis
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Subarachnoid hemorrhage (SAH)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV

44. The most common cause of postpartum hemorrhage.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Uterine atony
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Kegel exercises - estrogen - pessaries for stress incontinence

45. Difference between Mallory- Weiss and Boerhaave tears.
Lesion of 1
MCP and PIP joints; DIP joints are spared
Mallory- Weiss
Central pontine myelinolysis

46. Side effects of corticosteroids.
OCPs - danazol - GnRH agonists
Mycoplasma
Rate control - rhythm conversion - and anticoagulation
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies

47. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Panic disorder
Sarcoidosis
Isolation

48. Differential of hypervolemic hyponatremia.
Cirrhosis - CHF - nephritic syndrome
Higher prevalence
Lead - time bias
Seborrheic dermatitis. Treat with antifungals

49. Name the organism:
Erythema multiforme
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
A patient with chest trauma who was previously stable suddenly dies
Pasteurella multocida

50. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
SSRIs
Pulsus paradoxus (seen in cardiac tamponade)
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms