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. Perinatal mortality?

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2. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Chronic granulomatous disease
N- acetylcysteine
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Angina - ST- segment changes on ECG - or ? BP


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

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4. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Fat - female - fertile - forty - flatulent
Factor V Leiden mutation
Pseudogout
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


5. Hematuria - hypertension - and oliguria.
Alport's syndrome
Asherman's syndrome
AP chest - AP/lateral C- spine - AP pelvis
Nephritic syndrome


6. The most common cause of hypertension in young women.
OCPs
Immediate needle thoracostomy
Acute pancreatitis
Slipped capital femoral epiphyses. AP and frog - leg lateral view


7. Name the organism:
50 cc/hour
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Neisseria meningitidis


8. Identify key organisms causing diarrhea:
HIDA scan
Menometrorrhagia
HBV immunoglobulin
Giardia


9. A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
Acute mania. Start a mood stabilizer (e.g. - lithium)
Osgood - Schlatter disease
Kegel exercises - estrogen - pessaries for stress incontinence


10. Mortality rate?
Number of deaths per 1000 population
Consider Fitz - Hugh - Curtis syndrome
Treat immediately. Consent is implied in emergency situations
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


11. The most common histology of bladder cancer.
Transitional cell carcinoma
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Aseptic (viral) meningitis
Lichen planus


12. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Agranulocytosis
Sarcoidosis
30 cc/hour
Non - Hodgkin's lymphoma


13. 'Stuck - on' appearance.
Biliary tract obstruction
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Neuroblastoma
Seborrheic keratosis


14. Lab values suggestive of menopause.
Angina is new - is worsening - or occurs at rest
? serum FSH
1
Threatened abortion


15. Symptoms of placental abruption.
N- acetylcysteine
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Continuous - painful vaginal bleeding
Hyperkalemia


16. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Cluster headache
Biliary tract obstruction
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Squamous cell carcinoma


17. Medication given to accelerate fetal lung maturity.
Never
MS
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Betamethasone or dexamethasone


18. Causes of exudative effusion.
Pityriasis rosea
Endometriosis
Benzodiazepines
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis


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

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20. Electrolyte changes in tumor lysis syndrome.
Wait - surgical resection - radiation and/or androgen suppression
? Ca2+ - ? K- - ? phosphate - ? uric acid
No. Parental consent is not necessary for the medical treatment of pregnant minors
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


21. Name the organism:
Lichen planus
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Klebsiella


22. Treatment for neuroleptic malignant syndrome.
Salmonella
? Ca2+ - ? K- - ? phosphate - ? uric acid
1
Dantrolene or bromocriptine


23. A neonate has meconium ileus.

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24. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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25. Medical treatment for hepatic encephalopathy.
Clostridium difficile
Hypoxia and hypocarbia
Higher incidence
? protein intake - lactulose - neomycin


26. Identify key organisms causing diarrhea:
Wait - surgical resection - radiation and/or androgen suppression
Salmonella
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms


27. Diagnostic test for hypertrophic cardiomyopathy.
Pityriasis rosea
Actinomyces israelii
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
IV hydration and loop diuretics (furosemide)


28. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Betamethasone or dexamethasone
Rate control with carotid massasge or other vagal stimulation
Absence seizures


29. First - line pharmacotherapy for depression.
Panic disorder
Parkland formula
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
SSRIs


30. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Wait - surgical resection - radiation and/or androgen suppression
Iron overload; use deferoxamine
ARDS
Impetigo


31. Classic CXR findings for pulmonary edema.

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32. Treatment for ventricular fibrillation.
Immediate cardioversion
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Neither
Mycoplasma


33. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Herpes simplex
Uterine massage; if that fails - give oxytocin
High reliability - low validity


34. Risk factors for pyelonephritis.
Polymyalgia rheumatica
Malingering
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
S. aureus or S. epidermidis.


35. A 49-year - old male presents with acute - onset flank pain and hematuria.
Partial mole
SSRIs
DI
Nephrolithiasis


36. Honeycomb pattern on CXR. Diagnosis? Treatment?
Placental abruption and placenta previa
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Transitional cell carcinoma
Patient on dopamine antagonist


37. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Self - limited - painless vaginal bleeding
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
ALS
Pseudomonas


38. Presents with a herald patch - Christmas - tree pattern.
? serum FSH
Niacin
Pityriasis rosea
Patent ductus arteriosus (PDA)


39. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Spinal stenosis
HBV immunoglobulin
Nephrotic syndrome


40. Treatment of DKA.
OCPs
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Varicella zoster
Inevitable abortion


41. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Lead - time bias
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Diphenhydramine or epinephrine 1:1000
No. Parental consent is not necessary for the medical treatment of pregnant minors


42. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Check for ? ICP; look for papilledema
1
30 cc/hour


43. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Immediate cardioversion
Chronic lymphocytic leukemia (CLL)
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Pheochromocytoma


44. A condition associated with red 'currant - jelly' stools.
HBV - DTaP - Hib - IPV - PCV
Central pontine myelinolysis
Intussusception
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


45. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Campylobacter
Respiratory alkalosis
Ampulla of the oviduct
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


46. Characteristics of 2

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47. Annual screening for women with a strong family history of ovarian cancer.
HBV immunoglobulin
CA-125 and transvaginal ultrasound
Haemophilus ducreyi
Legionella pneumonia


48. Bilious emesis within hours after the first feeding.
Sulfonamides - antimalarial drugs - fava beans
Dantrolene or bromocriptine
MCP and PIP joints; DIP joints are spared
Duodenal atresia


49. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

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50. Signs suggesting radial nerve damage with humeral fracture.
Type II (proximal) RTA
High TSH - low T4 - antimicrosomal antibodies
Wrist drop - loss of thumb abduction
Fluids and antibiotics