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. Therapy for polycystic ovarian syndrome.
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Bacterial meningitis
Partial mole
Weight loss and OCPs


2. CSF findings:
Bacterial meningitis
PT
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Bullous pemphigoid


3. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Chronic granulomatous disease
Pulsus paradoxus (seen in cardiac tamponade)
Seborrheic dermatitis. Treat with antifungals
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction


4. CSF findings:
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
MS
A patient with chest trauma who was previously stable suddenly dies
Immediate needle thoracostomy


5. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Conversion disorder
Seborrheic keratosis


6. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
OCPs
Exercise stress treadmill with ECG
No. Parental consent is not necessary for the medical treatment of pregnant minors
Restrictive pulmonary disease


7. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Glomerulonephritis/nephritic syndrome
Subarachnoid hemorrhage (SAH)
Osteogenesis imperfecta
Immediate needle thoracostomy


8. The most common cause of hypertension in young women.
OCPs
Seborrheic keratosis
Number of deaths from birth to 28 days per 1000 live births
Beta- blockers - digoxin - calcium channel blockers


9. The most common 1
Niacin
Selective IgA deficiency
Nephrolithiasis
Bacillus cereus


10. Treatment of septic shock.
1
Fluids and antibiotics
Intraductal papilloma
OCPs


11. Name the organism:
Pasteurella multocida
B12 deficiency
a - antagonists (phentolamine and phenoxybenzamine)
Allergic interstitial nephritis


12. Eight surgically correctable causes of hypertension.

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13. A homeless child is small for his age and has peeling skin and a swollen belly.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Regresses after menopause
Partial mole
Kwashiorkor (protein malnutrition)


14. Epidemics such as influenza
Hypovolemic shock
Ophthalmologic exam - CT - and MRI
Mycoplasma
Higher incidence


15. Treatment for postpartum hemorrhage.
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Uterine massage; if that fails - give oxytocin
N- acetylcysteine
ETEC


16. A fall in systolic BP of > 10 mmHg with inspiration.
Sporothrix schenckii
ALS
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Pulsus paradoxus (seen in cardiac tamponade)


17. Antidepressants associated with hypertensive crisis.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
MAOIs
Infection - febrile seizures - trauma - idiopathic
Threatened abortion


18. Causes of transudative effusion.
Ophthalmologic exam - CT - and MRI
O2 - analgesia - hydration - and - if severe - transfusion
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


19. Endocarditis prophylaxis regimens.
Patent ductus arteriosus (PDA)
Oral surgery
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Asherman's syndrome


20. Treatment of supraventricular tachycardia (SVT).
Bullous pemphigoid
Precocious puberty
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
Rate control with carotid massasge or other vagal stimulation


21. Signs of neurogenic shock.
Hypotension and bradycardia
Antipsychotics (neuroleptic malignant syndrome)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Neurofibromatosis 1


22. Cohort study
BP > 140/90 on three separate occasions two weeks apart
Vibrio - HAV
Pasteurella multocida
Incidence and prevalence


23. Appropriate diagnostic test?
A patient's family cannot require that a doctor withhold information from the patient
Pharmacologic stress test (e.g. - dobutamine echo)
Kegel exercises - estrogen - pessaries for stress incontinence
Metformin


24. Medications and viruses that ? aplastic anemia.
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Lichen planus
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


25. A crescent - shaped hyperdensity on CT that does not cross the midline.
Lyme disease - Ixodes tick - doxycycline
Subdural hematoma
Diverticulosis
Treat immediately. Consent is implied in emergency situations


26. Treatment for benzodiazepine overdose.
IV benzodiazepine
Renal cell carcinoma (RCC)
INH - penicillamine - hydralazine - procainamide
Flumazenil


27. Electrolyte changes in tumor lysis syndrome.
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
? Ca2+ - ? K- - ? phosphate - ? uric acid
Reaction formation
MAOIs


28. Meningitis in infants. Causes? Treatment?
Suspect retinoblastoma
Treat immediately. Consent is implied in emergency situations
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Uterine atony


29. Treatment for Guillain - Barr
Angina - ST- segment changes on ECG - or ? BP
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Nephrotic syndrome
IVIG or plasmapheresis


30. Confusion - confabulation - ophthalmoplegia - ataxia.

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31. Treatment of AF.
Squamous cell carcinoma
Rate control - rhythm conversion - and anticoagulation
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
46 -XX


32. Associated with Propionibacterium acnes and changes in androgen levels.
Cellulitis
High TSH - low T4 - antimicrosomal antibodies
Acne vulgaris
Highly sensitive for TB


33. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Niacin
Neuroleptic malignant syndrome
Rate control with carotid massasge or other vagal stimulation
Pityriasis versicolor


34. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Cellulitis
Treat existing heart failure and replace the tricuspid valve
Emergent laparotomy to repair perforated viscus - likely stomach
Postinfectious glomerulonephritis


35. CSF findings with SAH.
Dantrolene or bromocriptine
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Elevated ICP - RBCs - xanthochromia
CA-125 and transvaginal ultrasound


36. Fetal mortality?

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37. A neonate has meconium ileus.

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38. RTA associated with aldosterone defect.
Membranous glomerulonephritis
Type IV (distal) RTA
Suspect retinoblastoma
Neisseria meningitidis


39. Signs suggesting radial nerve damage with humeral fracture.
TICS
Parvovirus B19
Wrist drop - loss of thumb abduction
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


40. Antibiotics with teratogenic effects.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Varicella zoster
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Rubella


41. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Cellulitis
1
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Nephritic syndrome


42. The most common cause of hypothyroidism.

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43. The most frequent presentation of intracranial neoplasm.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Headache
Coarctation of the aorta


44. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conversion disorder
Pityriasis versicolor
Lichen sclerosus
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births


45. Identify key organisms causing diarrhea:
Precocious puberty
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Bacillus cereus
Broca's aphasia. Frontal lobe - left MCA distribution


46. The most common 1
Nephrotic syndrome
Multiple myeloma
Paget's disease
Patent ductus arteriosus (PDA)


47. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Nephrotic syndrome
Panic disorder
Amoxicillin
Normal


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

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49. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Antipsychotics (neuroleptic malignant syndrome)
Emergent laparotomy to repair perforated viscus - likely stomach
Fluids and antibiotics
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


50. Name the organism:
AP chest - AP/lateral C- spine - AP pelvis
Toxoplasma gondii
Lobular carcinoma in situ
Out