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 history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
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
Anion gap acidosis and 1
Endometrial biopsy
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


2. The most common cause of female infertility.
Anemia - thrombocytopenia - and acute renal failure
Endometriosis
Salmonella
Broca's aphasia. Frontal lobe - left MCA distribution


3. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Naloxone
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms


4. Treatment for ventricular fibrillation.
Isolation
Immediate cardioversion
IV hydration and loop diuretics (furosemide)
Colposcopy and endocervical curettage


5. Peaked T waves and widened QRS.
Anorexia
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Hyperkalemia


6. Classic ECG findings in pericarditis.
Uremic syndrome seen in patients with renal failure
Low - voltage - diffuse ST- segment elevation
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Erythema multiforme


7. RTA associated with abnormal HCO3 - and rickets.
IV benzodiazepine
Out
Wrist drop - loss of thumb abduction
Type II (proximal) RTA


8. PFT showing ? FEV1/FVC.
Obstructive pulmonary disease (e.g. - asthma)
Contact dermatitis
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
1


9. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Hashimoto's thyroiditis
Protamine
Actinic keratosis
Ampulla of the oviduct


10. Trauma series.
AP chest - AP/lateral C- spine - AP pelvis
Hereditary spherocytosis
Nephrotic syndrome
Osteogenesis imperfecta


11. A son asks that his mother not be told about her recently discovered cancer.

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12. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Number of live births per 1000 women 15-44 years of age
Inevitable abortion
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


13. First - line medication for status epilepticus.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Selective IgA deficiency
IV benzodiazepine
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'


14. Treatment of supraventricular tachycardia (SVT).
Varicella zoster
'Chocolate cysts -' powder burns
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Rate control with carotid massasge or other vagal stimulation


15. Annual screening for women with a strong family history of ovarian cancer.
Haemophilus ducreyi
Pasteurella multocida
CA-125 and transvaginal ultrasound
Bacillus cereus


16. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Lichen sclerosus
Conduct disorder
Conversion disorder


17. A newborn female has continuous 'machinery murmur.'
Calcium oxalate
Patent ductus arteriosus (PDA)
No. Parental consent is not necessary for the medical treatment of pregnant minors
Hypernatremia


18. Side effects of corticosteroids.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Phencyclidine hydrochloride (PCP) intoxication
Reye's syndrome
Conduct disorder


19. Supportive treatment for ARDS.
Continuous positive airway pressure
Dantrolene or bromocriptine
Rate control - rhythm conversion - and anticoagulation
Anticoagulation - rate control - cardioversion


20. Eosinophils in urine sediment.
Acne vulgaris
Allergic interstitial nephritis
Klebsiella
Nephritic syndrome


21. The most common inherited hemolytic anemia.
Coccidioidomycosis. Amphotericin B
Fluids and antibiotics
Nephritic syndrome
Hereditary spherocytosis


22. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Alopecia areata (autoimmune process)
Squamous cell carcinoma
CHF - shock - and altered mental status


23. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
a - antagonists (phentolamine and phenoxybenzamine)
Hashimoto's thyroiditis
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Osgood - Schlatter disease


24. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conversion disorder
Bladder rupture or urethral injury
Ampulla of the oviduct
Immediate needle thoracostomy


25. Treatment of tension pneumothorax.
Immediate needle thoracostomy
Graves' disease
Pulsus paradoxus (seen in cardiac tamponade)
Identify cause; pressors (e.g. - dobutamine)


26. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
PT
Pseudogout
MCP and PIP joints; DIP joints are spared
Erythema multiforme


27. True or false: Once patients sign a statement giving consent - they must continue treatment.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Coarctation of the aorta
CF or Hirschsprung's disease
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


28. Identify key organisms causing diarrhea:
Hypocalcemia
Bruton's X- linked agammaglobulinemia
50 cc/hour
Bacillus cereus


29. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Immediate cardioversion
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
50 cc/hour
Diamond - Blackfan anemia


30. ? CO - ? PCWP - ? PVR.
Endometrial biopsy
Septic or anaphylactic shock
Isolation
INH - penicillamine - hydralazine - procainamide


31. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
IV hydration and loop diuretics (furosemide)
B12 deficiency
Sporothrix schenckii


32. First - line pharmacotherapy for depression.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
SSRIs
Pseudomonas
Acute mania. Start a mood stabilizer (e.g. - lithium)


33. Natural history of a leiomyoma.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Kwashiorkor (protein malnutrition)
Regresses after menopause
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


34. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Hypokalemia
Placental abruption and placenta previa
Taenia solium (cysticercosis)
105 bacteria/mL


35. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
CF or Hirschsprung's disease
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Suspect ankylosing spondylitis. Check HLA- B27
Pasteurella multocida


36. The diagnostic test for pulmonary embolism.
Regresses after menopause
1
Endometrial or estrogen receptor - breast cancer
V/Q scan


37. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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38. Identify key organisms causing diarrhea:
Trichomonas vaginitis
ETEC
Third - degree heart block
Self - limited - painless vaginal bleeding


39. Tests to rule out shaken baby syndrome.
50 cc/hour
Ophthalmologic exam - CT - and MRI
Haemophilus ducreyi
Rate control with carotid massasge or other vagal stimulation


40. Classic ECG finding in atrial flutter.

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41. Lung cancer highly related to cigarette exposure.
Immediate cardioversion
SCLC
Type I (distal) RTA
A patient with chest trauma who was previously stable suddenly dies


42. The most common cause of Cushing's syndrome.

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43. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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44. Case - control study
Hypertrophic cardiomyopathy
Pharmacologic stress test (e.g. - dobutamine echo)
Neither
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


45. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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46. The mainstay of Parkinson's therapy.
E. coli O157:H7
Trauma; the second most common is berry aneurysm
Levodopa/carbidopa
Spinal stenosis


47. Identify key organisms causing diarrhea:
7-10 days
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Trauma; the second most common is berry aneurysm
Campylobacter


48. Meningitis in infants. Causes? Treatment?
Hypotension and bradycardia
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Intraductal papilloma


49. Signs of ? ICP (Cushing's triad).
Oral surgery
Hypertension - bradycardia - and abnormal respirations
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


50. What is the immunodeficiency?
Iron overload; use deferoxamine
Pseudomonas
Phototherapy (mild) or exchange transfusion (severe)
Wiskott - Aldrich syndrome