USMLE STEP 2 COMPREHENSIVE EXAM UPDATED
QUESTIONS AND ANSWERS GRADED A+
✔✔Hereditary spherocytosis - ✔✔The most common inherited hemolytic anemia.
✔✔Osmotic fragility test - ✔✔Diagnostic test for hereditary spherocytosis.
✔✔Diamond-Blackfan anemia - ✔✔Pure RBC aplasia.
✔✔Fanconi's anemia - ✔✔Anemia associated with absent radii and thumbs, diffuse
hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.
✔✔Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis,
parvovirus B19, EBV - ✔✔Medications and viruses that → aplastic anemia.
✔✔Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal
O2 saturation and low erythropoietin levels - ✔✔How to distinguish polycythemia vera
from 2° polycythemia.
✔✔Pentad of TTP—"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction,
Neurologic abnormalities - ✔✔Thrombotic thrombocytopenic purpura (TTP) pentad?
✔✔Anemia, thrombocytopenia, and acute renal failure - ✔✔HUS triad?
✔✔Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs -
✔✔Treatment for TTP.
✔✔Usually resolves spontaneously; may require IVIG and/or corticosteroids -
✔✔Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
✔✔Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit
are ↓. - ✔✔Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen,
platelets, and hematocrit.
✔✔Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX
supplements - ✔✔An eight-year-old boy presents with hemarthrosis and ↑ PTT with
normal PT and bleeding time. Diagnosis? Treatment?
✔✔von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate - ✔✔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?
,✔✔Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray
of the skull and long bones - ✔✔A 60-year-old African-American male presents with
bone pain. Workup for multiple myeloma might reveal?
✔✔Hodgkin's lymphoma - ✔✔Reed-Sternberg cells
✔✔Non-Hodgkin's lymphoma - ✔✔A 10-year-old boy presents with fever, weight loss,
and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
✔✔Anemia of chronic disease - ✔✔Microcytic anemia with ↓ serum iron, ↓ total iron-
binding capacity (TIBC), and normal or ↑ ferritin.
✔✔Iron deficiency anemia - ✔✔Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑
TIBC.
✔✔Chronic lymphocytic leukemia (CLL) - ✔✔An 80-year-old man presents with fatigue,
lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
✔✔Blast crisis (fever, bone pain, splenomegaly, pancytopenia) - ✔✔A late, life-
threatening complication of chronic myelogenous leukemia (CML).
✔✔Acute myelogenous leukemia (AML) - ✔✔Auer rods on blood smear.
✔✔M3 - ✔✔AML subtype associated with DIC.
✔✔↓ Ca2+ , ↑ K− , ↑ phosphate, ↑ uric acid - ✔✔Electrolyte changes in tumor lysis
syndrome.
✔✔Retinoic acid - ✔✔Treatment for AML M3.
✔✔CML - ✔✔A 50-year-old male presents with early satiety, splenomegaly, and
bleeding. Cytogenetics show t(9,22). Diagnosis?
✔✔Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
- ✔✔Heinz bodies?
✔✔Glanzmann's thrombasthenia - ✔✔An autosomal-recessive disorder with a defect in
the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
✔✔Parvovirus B19 - ✔✔Virus associated with aplastic anemia in patients with sickle cell
anemia.
, ✔✔O2, analgesia, hydration, and, if severe, transfusion - ✔✔A 25-year-old African-
American male with sickle cell anemia has sudden onset of bone pain. Management of
pain crisis?
✔✔Iron overload; use deferoxamine - ✔✔A significant cause of morbidity in thalassemia
patients. Treatment?
✔✔Infection, cancer, and autoimmune disease - ✔✔The three most common causes of
fever of unknown origin (FUO).
✔✔Fever, pharyngeal erythema, tonsillar exudate, lack of cough - ✔✔Four signs and
symptoms of streptococcal pharyngitis.
✔✔Postinfectious glomerulonephritis - ✔✔A nonsuppurative complication of
streptococcal infection that is not altered by treatment of 1° infection.
✔✔Encapsulated organisms--pneumococcus, meningococcus, Haemophilus influenzae,
Klebsiella - ✔✔Asplenic patients are particularly susceptible to these organisms.
✔✔105 bacteria/mL - ✔✔The number of bacterial culture on a clean-catch specimen to
diagnose a UTI.
✔✔Pregnant women. Treat this group aggressively because of potential complications -
✔✔Which healthy population is susceptible to UTIs?
✔✔Coccidioidomycosis. Amphotericin B - ✔✔A patient from California or Arizona
presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
✔✔1° syphilis - ✔✔Nonpainful chancre.
✔✔Rubella - ✔✔A "blueberry muffin" rash is characteristic of what congenital infection?
✔✔Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin - ✔✔Meningitis
in neonates. Causes? Treatment?
✔✔Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and
vancomycin - ✔✔Meningitis in infants. Causes? Treatment?
✔✔Check for ↑ ICP; look for papilledema - ✔✔What should always be done prior to LP?
✔✔Bacterial meningitis - ✔✔CSF findings: ■ Low glucose, PMN predominance
QUESTIONS AND ANSWERS GRADED A+
✔✔Hereditary spherocytosis - ✔✔The most common inherited hemolytic anemia.
✔✔Osmotic fragility test - ✔✔Diagnostic test for hereditary spherocytosis.
✔✔Diamond-Blackfan anemia - ✔✔Pure RBC aplasia.
✔✔Fanconi's anemia - ✔✔Anemia associated with absent radii and thumbs, diffuse
hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.
✔✔Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis,
parvovirus B19, EBV - ✔✔Medications and viruses that → aplastic anemia.
✔✔Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal
O2 saturation and low erythropoietin levels - ✔✔How to distinguish polycythemia vera
from 2° polycythemia.
✔✔Pentad of TTP—"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction,
Neurologic abnormalities - ✔✔Thrombotic thrombocytopenic purpura (TTP) pentad?
✔✔Anemia, thrombocytopenia, and acute renal failure - ✔✔HUS triad?
✔✔Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs -
✔✔Treatment for TTP.
✔✔Usually resolves spontaneously; may require IVIG and/or corticosteroids -
✔✔Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
✔✔Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit
are ↓. - ✔✔Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen,
platelets, and hematocrit.
✔✔Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX
supplements - ✔✔An eight-year-old boy presents with hemarthrosis and ↑ PTT with
normal PT and bleeding time. Diagnosis? Treatment?
✔✔von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate - ✔✔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?
,✔✔Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray
of the skull and long bones - ✔✔A 60-year-old African-American male presents with
bone pain. Workup for multiple myeloma might reveal?
✔✔Hodgkin's lymphoma - ✔✔Reed-Sternberg cells
✔✔Non-Hodgkin's lymphoma - ✔✔A 10-year-old boy presents with fever, weight loss,
and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
✔✔Anemia of chronic disease - ✔✔Microcytic anemia with ↓ serum iron, ↓ total iron-
binding capacity (TIBC), and normal or ↑ ferritin.
✔✔Iron deficiency anemia - ✔✔Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑
TIBC.
✔✔Chronic lymphocytic leukemia (CLL) - ✔✔An 80-year-old man presents with fatigue,
lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
✔✔Blast crisis (fever, bone pain, splenomegaly, pancytopenia) - ✔✔A late, life-
threatening complication of chronic myelogenous leukemia (CML).
✔✔Acute myelogenous leukemia (AML) - ✔✔Auer rods on blood smear.
✔✔M3 - ✔✔AML subtype associated with DIC.
✔✔↓ Ca2+ , ↑ K− , ↑ phosphate, ↑ uric acid - ✔✔Electrolyte changes in tumor lysis
syndrome.
✔✔Retinoic acid - ✔✔Treatment for AML M3.
✔✔CML - ✔✔A 50-year-old male presents with early satiety, splenomegaly, and
bleeding. Cytogenetics show t(9,22). Diagnosis?
✔✔Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
- ✔✔Heinz bodies?
✔✔Glanzmann's thrombasthenia - ✔✔An autosomal-recessive disorder with a defect in
the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
✔✔Parvovirus B19 - ✔✔Virus associated with aplastic anemia in patients with sickle cell
anemia.
, ✔✔O2, analgesia, hydration, and, if severe, transfusion - ✔✔A 25-year-old African-
American male with sickle cell anemia has sudden onset of bone pain. Management of
pain crisis?
✔✔Iron overload; use deferoxamine - ✔✔A significant cause of morbidity in thalassemia
patients. Treatment?
✔✔Infection, cancer, and autoimmune disease - ✔✔The three most common causes of
fever of unknown origin (FUO).
✔✔Fever, pharyngeal erythema, tonsillar exudate, lack of cough - ✔✔Four signs and
symptoms of streptococcal pharyngitis.
✔✔Postinfectious glomerulonephritis - ✔✔A nonsuppurative complication of
streptococcal infection that is not altered by treatment of 1° infection.
✔✔Encapsulated organisms--pneumococcus, meningococcus, Haemophilus influenzae,
Klebsiella - ✔✔Asplenic patients are particularly susceptible to these organisms.
✔✔105 bacteria/mL - ✔✔The number of bacterial culture on a clean-catch specimen to
diagnose a UTI.
✔✔Pregnant women. Treat this group aggressively because of potential complications -
✔✔Which healthy population is susceptible to UTIs?
✔✔Coccidioidomycosis. Amphotericin B - ✔✔A patient from California or Arizona
presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
✔✔1° syphilis - ✔✔Nonpainful chancre.
✔✔Rubella - ✔✔A "blueberry muffin" rash is characteristic of what congenital infection?
✔✔Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin - ✔✔Meningitis
in neonates. Causes? Treatment?
✔✔Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and
vancomycin - ✔✔Meningitis in infants. Causes? Treatment?
✔✔Check for ↑ ICP; look for papilledema - ✔✔What should always be done prior to LP?
✔✔Bacterial meningitis - ✔✔CSF findings: ■ Low glucose, PMN predominance
