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 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Avascular necrosis
Wiskott - Aldrich syndrome
No. Parental consent is not necessary for the medical treatment of pregnant minors
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


2. Complication of scaphoid fracture.
Clomiphene citrate
Pseudomonas
Clostridium difficile
Avascular necrosis


3. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Angina is new - is worsening - or occurs at rest
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
68% - 95.5% - 99.7%


4. Nikolsky's sign.
Pityriasis rosea
Huntington's disease
Bullous pemphigoid
1


5. Fetal mortality?

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6. Post - HBV exposure treatment.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Administration of DDAVP ? serum osmolality and free water restriction
HBV immunoglobulin
Osteogenesis imperfecta


7. Difference between a cohort and a case - control study.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Selective IgA deficiency
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


8. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Hypoxia and hypocarbia
Bullous pemphigoid
Spinal stenosis
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


9. Inspiratory arrest during palpation of the RUQ.

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10. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Lead - time bias
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


11. Hernia with highest risk of incarceration
Femoral hernia
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
BP > 140/90 on three separate occasions two weeks apart
Duchenne muscular dystrophy


12. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
A patient with chest trauma who was previously stable suddenly dies
68% - 95.5% - 99.7%
Type I (distal) RTA
Slipped capital femoral epiphyses. AP and frog - leg lateral view


13. ? risk of what infection with silicosis?
Mycobacterium tuberculosis
< 7.0
68% - 95.5% - 99.7%
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


14. Appropriate diagnostic test?
Duchenne muscular dystrophy
Substance abuse
Pharmacologic stress test (e.g. - dobutamine echo)
Allergic interstitial nephritis


15. Presents with a herald patch - Christmas - tree pattern.
Angina is new - is worsening - or occurs at rest
Radiation
Pityriasis rosea
Duodenal atresia


16. Fertility rate?
Septic or anaphylactic shock
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Restrictive pulmonary disease
Number of live births per 1000 women 15-44 years of age


17. Amenorrhea - bradycardia - and abnormal body image in a young female.
Taenia solium (cysticercosis)
Retinoic acid
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Anorexia


18. Rigidity and stiffness with resting tremor and masked facies.

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19. Eight surgically correctable causes of hypertension.

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20. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Toxoplasma gondii
Number of deaths from birth to 28 days per 1000 live births
105 bacteria/mL


21. Name the organism:
7-10 days
Huntington's disease
O2 - analgesia - hydration - and - if severe - transfusion
Salmonella


22. The most common histology of bladder cancer.
Transitional cell carcinoma
Hodgkin's lymphoma
A patient with chest trauma who was previously stable suddenly dies
Seminoma


23. Honey- crusted lesions.
Type IV (distal) RTA
Isolation
Retrograde cystourethrogram
Impetigo


24. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
IV benzodiazepine
Alopecia areata (autoimmune process)
Anorexia


25. A patient presents with recent PID with RUQ pain.
Consider Fitz - Hugh - Curtis syndrome
OCPs - danazol - GnRH agonists
Sensitivity
Neither


26. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Third - degree heart block
Biliary tract obstruction
Parkland formula
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


27. A congenital heart disease that cause 2
Central pontine myelinolysis
Coarctation of the aorta
Reaction formation
No. Parental consent is not necessary for the medical treatment of pregnant minors


28. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Parainfluenza virus type 1
AP chest - AP/lateral C- spine - AP pelvis


29. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
Iron overload; use deferoxamine
Regresses after menopause
Seventy percent if the stenosis is symptomatic


30. Classic ultrasound and gross appearance of complete hydatidiform mole.

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31. Combined UMN and LMN disorder.
MAOIs
ALS
Sulfonamides - antimalarial drugs - fava beans
V/Q scan


32. Treatment for benzodiazepine overdose.
Crohn's disease
Flumazenil
IgA nephropathy (Berger's disease)
Administration of DDAVP ? serum osmolality and free water restriction


33. Differential of hypervolemic hyponatremia.
30 cc/hour
Cirrhosis - CHF - nephritic syndrome
Higher prevalence
Parvovirus B19


34. Case - control study
Third - degree heart block
Anemia of chronic disease
Neither
Regression


35. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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36. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
'Sawtooth' P waves
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


37. 'Stuck - on' appearance.
Seborrheic keratosis
Endometriosis
CML
Retinoic acid


38. Goal hemoglobin A1c for a patient with DM.
< 7.0
Salmonella
Uterine massage; if that fails - give oxytocin
Establish the ABCs


39. Name the organism:
Hypotension and bradycardia
Anemia - thrombocytopenia - and acute renal failure
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Klebsiella


40. The most common cause of hypertension in young women.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Renal cell carcinoma (RCC)
OCPs
Number of deaths from birth to 28 days per 1000 live births


41. Conditions in which confidentiality must be overridden.
Regresses after menopause
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
1
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births


42. Treatment for TTP.
Emergent laparotomy to repair perforated viscus - likely stomach
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


43. Eosinophils in urine sediment.
Lesch - Nyhan syndrome (purine salvage problem with
Number of live births per 1000 population
Allergic interstitial nephritis
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


44. Signs suggesting radial nerve damage with humeral fracture.
Conduct disorder
Wrist drop - loss of thumb abduction
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Salmonella


45. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Confounding variable
Hypoparathyroidism
Normal
Number of live births per 1000 women 15-44 years of age


46. Identify key organisms causing diarrhea:
Low - voltage - diffuse ST- segment elevation
Campylobacter
Broca's aphasia. Frontal lobe - left MCA distribution
Partial mole


47. Electrolyte changes in tumor lysis syndrome.
Phototherapy (mild) or exchange transfusion (severe)
Angina - ST- segment changes on ECG - or ? BP
Slipped capital femoral epiphyses. AP and frog - leg lateral view
? Ca2+ - ? K- - ? phosphate - ? uric acid


48. Name the organism:
Diamond - Blackfan anemia
Neisseria meningitidis
DI
Anemia of chronic disease


49. Difference between Mallory- Weiss and Boerhaave tears.
Bullous pemphigoid
Mallory- Weiss
Factitious disorder (Munchausen syndrome)
Neurofibromatosis 1


50. Name the organism:
1
Hodgkin's lymphoma
Klebsiella
Central pontine myelinolysis