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. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Alzheimer's and multi - infarct
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Observational bias


2. Charcot's triad.
Neuroleptic malignant syndrome
Yersinia
Amoxicillin
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


3. Cause of neonatal RDS.
Renal cell carcinoma (RCC)
Klebsiella
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Surfactant deficiency


4. Treatment of tension pneumothorax.
Postinfectious glomerulonephritis
Immediate needle thoracostomy
Consider Fitz - Hugh - Curtis syndrome
Radiation


5. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
a - antagonists (phentolamine and phenoxybenzamine)
Fluids and antibiotics
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


6. Relative risk?
Angina is new - is worsening - or occurs at rest
The IR of a disease in a population exposed to a particular factor
Osteoarthritis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


7. Eosinophils in urine sediment.
Pseudomonas
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Allergic interstitial nephritis
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


8. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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9. Name the organism:
Streptococcus pneumoniae
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Colposcopy and endocervical curettage
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


10. Bone is fractured in fall on outstretched hand.

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11. Treatment for opioid overdose.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Naloxone
Taenia solium (cysticercosis)
Ulcerative colitis


12. Reed - Sternberg cells

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13. Lung cancer highly related to cigarette exposure.
SCLC
Ultrasound
Chronic lymphocytic leukemia (CLL)
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


14. A newborn female has continuous 'machinery murmur.'
DM - SLE - and amyloidosis
Patent ductus arteriosus (PDA)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Reye's syndrome


15. What is the immunodeficiency?

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16. Symptoms of placental abruption.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Intussusception
Continuous - painful vaginal bleeding
Actinic keratosis


17. Name the organism:
E. coli O157:H7
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Parkinson's disease
Klebsiella


18. The most common causes of dementia.

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19. T- wave flattening and U waves.
Factor V Leiden mutation
Hypokalemia
Oral or topical metronidazole
Lyme disease - Ixodes tick - doxycycline


20. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Febrile seizures (roseola infantum)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Contact dermatitis
Panic disorder


21. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Patient on dopamine antagonist
Number of deaths from 20 weeks' gestation to birth per 1000 total births
INH - penicillamine - hydralazine - procainamide


22. The most frequent presentation of intracranial neoplasm.
Headache
A patient with chest trauma who was previously stable suddenly dies
Osteoarthritis
DI


23. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Frotteurism (a paraphilia)
Suspect retinoblastoma
Hypovolemic shock


24. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
S. aureus or S. epidermidis.
Rate control - rhythm conversion - and anticoagulation
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Treat existing heart failure and replace the tricuspid valve


25. Odds ratio?
Neisseria meningitidis
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Reye's syndrome


26. ? risk of what infection with silicosis?
Mycobacterium tuberculosis
False. Withdrawing and withholding life are the same from an ethical standpoint
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
1


27. Treatment of cardiogenic shock.
Identify cause; pressors (e.g. - dobutamine)
Beta- blockers - digoxin - calcium channel blockers
False. Withdrawing and withholding life are the same from an ethical standpoint
Cirrhosis - CHF - nephritic syndrome


28. RTA associated with aldosterone defect.
Pentad of TTP
Metformin
Factor V Leiden mutation
Type IV (distal) RTA


29. Medical treatment for IBD.
Clostridium difficile
Lobular carcinoma in situ
Bacterial meningitis
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


30. Treatment of DKA.
Alport's syndrome
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Dantrolene or bromocriptine
Self - limited - painless vaginal bleeding


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

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32. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
Regresses after menopause
Immediate needle thoracostomy
Allergic interstitial nephritis


33. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Spinal stenosis
Pregnant women. Treat this group aggressively because of potential complications
Legionella pneumonia
Duchenne muscular dystrophy


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

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35. Radiographic indications for surgery in patients with acute abdomen.
Headache
Nephrolithiasis
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


36. Neutropenic nadir postchemotherapy.
7-10 days
Conflict of interest
Cerebral berry aneurysms (AD PCKD)
Salmonella


37. Acceptable urine output in a stable patient.
Reaction formation
Cerebral berry aneurysms (AD PCKD)
Lichen sclerosus
30 cc/hour


38. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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39. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Ampulla of the oviduct
Taenia solium (cysticercosis)
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Pseudogout


40. Cohort study
Incidence and prevalence
Pseudomonas
Glomerulonephritis/nephritic syndrome
Panic disorder


41. Post - HBV exposure treatment.
Pheochromocytoma
HBV immunoglobulin
Signs and symptoms of hypercalcemia
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


42. Natural history of a leiomyoma.
Regresses after menopause
Transitional cell carcinoma
MAOIs
Subarachnoid hemorrhage (SAH)


43. The most common type of testicular cancer.
Neuroblastoma
Anemia - thrombocytopenia - and acute renal failure
Seminoma
DI


44. Identify key organisms causing diarrhea:
Central pontine myelinolysis
Bacterial meningitis
E. coli O157:H7
Angina is new - is worsening - or occurs at rest


45. Glomerulonephritis with hemoptysis.

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46. Infant mortality?
Psoriasis
Aseptic (viral) meningitis
Wernicke's encephalopathy due to a deficiency of thiamine
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


47. Signs of active ischemia during stress testing.
Angina - ST- segment changes on ECG - or ? BP
Streptococcus pneumoniae
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
CML


48. Name the defense mechanism:
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Non - Hodgkin's lymphoma
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Reaction formation


49. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Neurofibromatosis 1
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Absence seizures
V/Q scan


50. What is the immunodeficiency?
Wiskott - Aldrich syndrome
Renal cell carcinoma (RCC)
Threatened abortion
N- acetylcysteine