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. Appropriate diagnostic test?
Neisseria meningitidis
Lyme disease - Ixodes tick - doxycycline
Exercise stress treadmill with ECG
Phencyclidine hydrochloride (PCP) intoxication


2. Treatment for acetaminophen overdose.
1
Confounding variable
Trauma - alcohol withdrawal - brain tumor
N- acetylcysteine


3. Amenorrhea - bradycardia - and abnormal body image in a young female.
Diamond - Blackfan anemia
Anorexia
Absence seizures
Phencyclidine hydrochloride (PCP) intoxication


4. What is the immunodeficiency?
Normal
Chronic granulomatous disease
Intussusception
Salmonella


5. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Diphenhydramine or epinephrine 1:1000
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
1
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


6. Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis
Giardia
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Vibrio - HAV


7. CSF findings:
Type IV (distal) RTA
Patent ductus arteriosus (PDA)
Hereditary spherocytosis
Subarachnoid hemorrhage (SAH)


8. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Betamethasone or dexamethasone
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


9. Sentinel loop on AXR.
Never
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Acute pancreatitis
Neither


10. Diagnostic test for hypertrophic cardiomyopathy.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Factitious disorder (Munchausen syndrome)
Squamous cell carcinoma


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

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12. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Neuroleptic malignant syndrome
Spinal stenosis
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


13. Characteristics of 2

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14. Glomerulonephritis with hemoptysis.

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15. Why are Beta- blockers contraindicated in diabetics?
Ultrasound
Varicella zoster
Hypocalcemia
They can mask symptoms of hypoglycemia


16. Key side effects of atypical antipsychotics.
1
Substance abuse
Beta- blockers - Ca2+ channel blockers - TCAs
Weight gain - type 2 DM - QT prolongation


17. Treatment for bacterial vaginosis.
Oral or topical metronidazole
Lung - breast - skin (melanoma) - kidney - GI tract
IV benzodiazepine
Phototherapy (mild) or exchange transfusion (severe)


18. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Pharmacologic stress test (e.g. - dobutamine echo)
'Chocolate cysts -' powder burns
Membranous glomerulonephritis
Herpes simplex


19. Classic ECG finding in atrial flutter.

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20. Exophthalmos - pretibial myxedema - and ? TSH.

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21. Complication of scaphoid fracture.
Trichomonas vaginitis
Fatigue and impending respiratory failure
Avascular necrosis
Calcium oxalate


22. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Wait - surgical resection - radiation and/or androgen suppression
Hodgkin's lymphoma
Nephrotic syndrome
Seminoma


23. 'Doughy skin.'
Clostridium difficile
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Hypernatremia
Avascular necrosis


24. Acid - base disturbance commonly seen in pregnant women.
IVIG or plasmapheresis
Hypertension - bradycardia - and abnormal respirations
Respiratory alkalosis
IV penicillin or ampicillin


25. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Wait - surgical resection - radiation and/or androgen suppression
High TSH - low T4 - antimicrosomal antibodies
Conduct disorder
Reye's syndrome


26. Identify key organisms causing diarrhea:
Murphy's sign - seen in acute cholecystitis
Panic disorder
Bacillus cereus
False. Withdrawing and withholding life are the same from an ethical standpoint


27. The most common 1
Dantrolene or bromocriptine
Lung - breast - skin (melanoma) - kidney - GI tract
Inevitable abortion
Retinoic acid


28. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
105 bacteria/mL
Duchenne muscular dystrophy
Excessive EtOH
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


29. Extraintestinal manifestations of IBD.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Conversion disorder
Subarachnoid hemorrhage (SAH)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


30. Name the organism:
Spinal stenosis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Pseudomonas
Identify cause; pressors (e.g. - dobutamine)


31. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Benzodiazepines
S. aureus or S. epidermidis.
Osteogenesis imperfecta
AP chest - AP/lateral C- spine - AP pelvis


32. Confusion - confabulation - ophthalmoplegia - ataxia.

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33. Treatment for malignant hypertension.
Duodenal atresia
Nitroprusside
30 cc/hour
Sheehan's syndrome (postpartum pituitary necrosis)


34. The most likely cause of acute lower GI bleed in patients > 40 years old.
Naloxone
Metformin
Diverticulosis
Check for ? ICP; look for papilledema


35. A doctor refers a patient for an MRI at a facility he/she owns.
Hashimoto's thyroiditis
Oral surgery
Conflict of interest
Precocious puberty


36. The diagnostic test for pulmonary embolism.
V/Q scan
Higher incidence
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Hashimoto's thyroiditis


37. Risk factors for pyelonephritis.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Sheehan's syndrome (postpartum pituitary necrosis)
HBV immunoglobulin
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones


38. Virus associated with aplastic anemia in patients with sickle cell anemia.
Abdominal ultrasound and CT
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Hypoparathyroidism
Parvovirus B19


39. Name the organism:
Sheehan's syndrome (postpartum pituitary necrosis)
Neurofibromatosis 1
Sporothrix schenckii
Herpes simplex


40. Classic physical findings for endocarditis.

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41. Defect in an X- linked syndrome with mental retardation -
Higher prevalence
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Lesch - Nyhan syndrome (purine salvage problem with
Displacement


42. Name the defense mechanism:
Precocious puberty
Displacement
HBV - DTaP - Hib - IPV - PCV
Amoxicillin


43. Treatment for acute coronary syndrome.
Dantrolene or bromocriptine
Actinomyces israelii
Weight loss and OCPs
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


44. Medical options for endometriosis.
Neuroblastoma
OCPs - danazol - GnRH agonists
Lung - breast - skin (melanoma) - kidney - GI tract
Klebsiella


45. Relative risk?
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
The IR of a disease in a population exposed to a particular factor
Check for ? ICP; look for papilledema
Anticoagulation - rate control - cardioversion


46. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Selective IgA deficiency
Absence seizures
ARDS
Basal cell carcinoma


47. Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Cellulitis
Continuous - painful vaginal bleeding
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


48. Treatment for TTP.
Antipsychotics (neuroleptic malignant syndrome)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
1
CML


49. Definition of hypertension.
30 cc/hour
A patient with chest trauma who was previously stable suddenly dies
BP > 140/90 on three separate occasions two weeks apart
Respiratory alkalosis


50. The coagulation parameter affected by warfarin.
Biliary tract obstruction
PT
Hypotension and bradycardia
Chronic lymphocytic leukemia (CLL)