USMLE Step 2 Rapid Review Exam Questions With Verified Answers

"Sawtooth" P waves - Answer Classic ECG finding in atrial flutter. Angina is new, is worsening, or occurs at rest - Answer Definition of unstable angina. ACEI - Answer Antihypertensive for a diabetic patient with proteinuria. Hypotension, distant heart sounds, and JVD - Answer Beck's triad for cardiac tamponade. β-blockers, digoxin, calcium channel blockers - Answer Drugs that slow AV node transmission. Niacin - Answer Hypercholesterolemia treatment that → flushing and pruritus. Anticoagulation, rate control, cardioversion - Answer Treatment for atrial fibrillation. Immediate cardioversion - Answer Treatment for ventricular fibrillation. Dressler's syndrome: fever, pericarditis, ↑ ESR - Answer Autoimmune complication occurring 2-4 weeks post-MI. Treat existing heart failure and replace the tricuspid valve - Answer IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment? Echocardiogram (showing thickened left ventricular wall and outflow obstruction) - Answer Diagnostic test for hypertrophic cardiomyopathy. Pulsus paradoxus (seen in cardiac tamponade) - Answer A fall in systolic BP of > 10 mmHg with inspiration. Low-voltage, diffuse ST-segment elevation - Answer Classic ECG findings in pericarditis. BP > 140/90 on three separate occasions two weeks apart - Answer Definition of hypertension. Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism - Answer Eight surgically correctable causes of hypertension. Abdominal ultrasound and CT - Answer Evaluation of a pulsatile abdominal mass and bruit. > 5.5 cm, rapidly enlarging, symptomatic, or ruptured - Answer Indications for surgical repair of abdominal aortic aneurysm. Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin - Answer Treatment for acute coronary syndrome. Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states - Answer What is the metabolic syndrome? Exercise stress treadmill with ECG - Answer Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate. Pharmacologic stress test (e.g., dobutamine echo) - Answer Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina. Angina, ST-segment changes on ECG, or ↓ BP - Answer Signs of active ischemia during stress testing. ST-segment elevation (depression means ischemia), flattened T waves, and Q waves - Answer ECG findings suggesting MI. Prinzmetal's angina - Answer A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal. CHF, shock, and altered mental status - Answer Common symptoms associated with silent MIs. V/Q scan - Answer The diagnostic test for pulmonary embolism. Protamine - Answer An agent that reverses the effects of heparin. PT - Answer The coagulation parameter affected by warfarin. Hypertrophic cardiomyopathy - Answer A young patient with a family history of sudden death collapses and dies while exercising. Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after - Answer Endocarditis prophylaxis regimens. Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia - Answer The 6 P's of ischemia due to peripheral vascular disease. Stasis, hypercoagulability, endothelial damage - Answer Virchow's triad. OCPs - Answer The most common cause of hypertension in young women. Excessive EtOH - Answer The most common cause of hypertension in young men. Seborrheic keratosis - Answer "Stuck-on" appearance. Psoriasis - Answer Red plaques with silvery-white scales and sharp margins. Basal cell carcinoma - Answer The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias. Impetigo - Answer Honey-crusted lesions. Cellulitis - Answer A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity. Pemphigus vulgaris - Answer + Nikolsky's sign. Bullous pemphigoid - Answer - Nikolsky's sign. Acanthosis nigricans. Check fasting blood sugar to rule out diabetes - Answer A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck. Varicella zoster - Answer Dermatomal distribution. Lichen planus - Answer Flat-topped papules. Erythema multiforme - Answer Iris-like target lesions. Contact dermatitis - Answer A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry. Pityriasis rosea - Answer Presents with a herald patch, Christmas-tree pattern. Alopecia areata (autoimmune process) - Answer A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs. Pityriasis versicolor - Answer Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance. Asymmetry, border irregularity, color variation, large diameter - Answer Four characteristics of a nevus suggestive of melanoma. Actinic keratosis - Answer Premalignant lesion from sun exposure that can → squamous cell carcinoma. Lesions of 1° varicella - Answer "Dewdrop on a rose petal." Seborrheic dermatitis. Treat with antifungals - Answer "Cradle cap." Acne vulgaris - Answer Associated with Propionibacterium acnes and changes in androgen levels. Herpes simplex - Answer A painful, recurrent vesicular eruption of mucocutaneous surfaces. Lichen sclerosus - Answer Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women. Squamous cell carcinoma - Answer Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer. Hashimoto's thyroiditis - Answer The most common cause of hypothyroidism. High TSH, low T4, antimicrosomal antibodies - Answer Lab findings in Hashimoto's thyroiditis. Graves' disease - Answer Exophthalmos, pretibial myxedema, and ↓ TSH. Iatrogenic steroid administration. The second most common cause is Cushing's disease - Answer The most common cause of Cushing's syndrome. Hypoparathyroidism - Answer A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. Signs and symptoms of hypercalcemia - Answer "Stones, bones, groans, psychiatric overtones." 1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) - Answer A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis. Pheochromocytoma - Answer A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic. α-antagonists (phentolamine and phenoxybenzamine) - Answer Should α- or β-antagonists be used first in treating pheochromocytoma? Nephrogenic diabetes insipidus (DI) - Answer A patient with a history of lithium use presents with copious amounts of dilute urine. Administration of DDAVP ↓ serum osmolality and free water restriction - Answer Treatment of central DI. SIADH due to stress - Answer A postoperative patient with significant pain presents with hyponatremia and normal volume status. Metformin - Answer An antidiabetic agent associated with lactic acidosis. 1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids - Answer A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment? < 7.0 - Answer Goal hemoglobin A1c for a patient with DM. Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+) - Answer Treatment of DKA. They can mask symptoms of hypoglycemia - Answer Why are β-blockers contraindicated in diabetics? Observational bias - Answer Bias introduced into a study when a clinician is aware of the patient's treatment type. Lead-time bias - Answer Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death. Confounding variable - Answer If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____. Sensitivity - Answer The number of true positives divided by the number of patients with the disease is _____. Out - Answer Sensitive tests have few false negatives and are used to rule _____ a disease. Highly sensitive for TB - Answer PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific? Higher prevalence - Answer Chronic diseases such as SLE—higher prevalence or incidence? Higher incidence - Answer Epidemics such as influenza—higher prevalence or incidence? Prevalence - Answer Cross-sectional survey—incidence or prevalence? Incidence and prevalence - Answer Cohort study—incidence or prevalence? Neither - Answer Case-control study—incidence or prevalence? High reliability, low validity - Answer Describe a test that consistently gives identical results, but the results are wrong. 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 - Answer Difference between a cohort and a case-control study. The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed - Answer Attributable risk? The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed - Answer Relative risk? The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed - Answer Odds ratio? 1 ÷ (rate in untreated group − rate in treated group) - Answer Number needed to treat? 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 - Answer In which patients do you initiate colorectal cancer screening early? Prostate cancer is the most common cancer in men, but lung cancer causes more deaths - Answer The most common cancer in men and the most common cause of death from cancer in men. 68%, 95.5%, 99.7% - Answer The percentage of cases within one SD of the mean? Two SDs? Three SDs? Number of live births per 1000 population - Answer Birth rate? Number of live births per 1000 women 15-44 years of age - Answer Fertility rate? Number of deaths per 1000 population - Answer Mortality rate? Number of deaths from birth to 28 days per 1000 live births - Answer Neonatal mortality? Number of deaths from 28 days to one year per 1000 live births - Answer Postnatal mortality? Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality) - Answer Infant mortality? Number of deaths from 20 weeks' gestation to birth per 1000 total births - Answer Fetal mortality? Number of deaths from 20 weeks' gestation to one month of life per 1000 total births - Answer Perinatal mortality? Number of deaths during pregnancy to 90 days postpartum per 100,000 live births - Answer Maternal mortality? False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity - Answer True or false: Once patients sign a statement giving consent, they must continue treatment. No. Parental consent is not necessary for the medical treatment of pregnant minors - Answer A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed? Conflict of interest - Answer A doctor refers a patient for an MRI at a facility he/she owns. The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs) - Answer Involuntary psychiatric hospitalization can be undertaken for which three reasons? False. Withdrawing and withholding life are the same from an ethical standpoint - Answer True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care. When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care - Answer When can a physician refuse to continue treating a patient on the grounds of futility? Treat immediately. Consent is implied in emergency situations - Answer An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present. Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse - Answer Conditions in which confidentiality must be overridden. When treatment noncompliance represents a serious danger to public health (e.g., active TB) - Answer Involuntary commitment or isolation for medical treatment may be undertaken for what reason? Treat because the disease represents an immediate threat to the child's life. Then seek a court order - Answer A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds. A patient's family cannot require that a doctor withhold information from the patient - Answer A son asks that his mother not be told about her recently discovered cancer. Emergent laparotomy to repair perforated viscus, likely stomach - Answer Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?