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 patient with a history of lithium use presents with copious amounts of dilute urine.
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Oral or topical metronidazole
Nephrogenic diabetes insipidus (DI)
Duodenal atresia


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

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3. The most common cause of hypothyroidism.

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4. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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5. Reed - Sternberg cells

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6. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Lead - time bias
Taenia solium (cysticercosis)
Hypovolemic shock
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


7. The most common cause of bloody nipple discharge.
Intraductal papilloma
Alzheimer's and multi - infarct
Rate control with carotid massasge or other vagal stimulation
Treat existing heart failure and replace the tricuspid valve


8. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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9. Exophthalmos - pretibial myxedema - and ? TSH.

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10. Name the organism:
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Nephrolithiasis
Uremic syndrome seen in patients with renal failure
Pseudomonas


11. Identify key organisms causing diarrhea:
Campylobacter
Infection - febrile seizures - trauma - idiopathic
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Non - Hodgkin's lymphoma


12. Neutropenic nadir postchemotherapy.
Absence seizures
7-10 days
IV penicillin or ampicillin
Taenia solium (cysticercosis)


13. Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
Oral or topical metronidazole
Prevalence
Osgood - Schlatter disease


14. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Acute myelogenous leukemia (AML)
Frotteurism (a paraphilia)
Immediate cardioversion


15. Name the defense mechanism:
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Bullous pemphigoid
Isolation
< 7.0


16. Medical options for endometriosis.
7-10 days
Pasteurella multocida
OCPs - danazol - GnRH agonists
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


17. Laparoscopic findings in endometriosis.

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18. Virus associated with aplastic anemia in patients with sickle cell anemia.
Patient on dopamine antagonist
Parvovirus B19
Cellulitis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


19. Heinz bodies?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Psoriasis
Immediate cardioversion


20. RTA associated with aldosterone defect.
Type IV (distal) RTA
Weight gain - type 2 DM - QT prolongation
Sulfonamides - antimalarial drugs - fava beans
Regression


21. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Paget's disease
Normal
Crohn's disease
SCLC


22. The first test to perform when a woman presents with amenorrhea.
Normal
Beta- hCG; the most common cause of amenorrhea is pregnancy
Campylobacter
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


23. Name the organism:
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Varicella zoster
Betamethasone or dexamethasone
Pseudomonas


24. Classic CXR findings for pulmonary edema.

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25. Four signs and symptoms of streptococcal pharyngitis.
Coccidioidomycosis. Amphotericin B
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Number of deaths from 28 days to one year per 1000 live births
Weight gain - type 2 DM - QT prolongation


26. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Glanzmann's thrombasthenia
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Weight gain - type 2 DM - QT prolongation


27. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Stasis - hypercoagulability - endothelial damage
Glomerulonephritis/nephritic syndrome
Uterine massage; if that fails - give oxytocin
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


28. Treatment for opioid overdose.
Naloxone
AP chest - AP/lateral C- spine - AP pelvis
Diamond - Blackfan anemia
30 cc/hour


29. A fall in systolic BP of > 10 mmHg with inspiration.
Nitroprusside
Pulsus paradoxus (seen in cardiac tamponade)
Legionella pneumonia
Renal cell carcinoma (RCC)


30. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Surfactant deficiency
Pityriasis versicolor
Fluids and antibiotics


31. Acute - phase treatment for Kawasaki disease.
Observational bias
Rubella
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Highly sensitive for TB


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

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33. CSF findings with SAH.
Type IV (distal) RTA
Inhaled Beta- agonists and inhaled corticosteroids
Nephrolithiasis
Elevated ICP - RBCs - xanthochromia


34. Inspiratory arrest during palpation of the RUQ.

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35. Name the defense mechanism:
Displacement
Fatigue and impending respiratory failure
Anorexia
Paget's disease


36. Symptoms of placenta previa.
Febrile seizures (roseola infantum)
Self - limited - painless vaginal bleeding
1
Crohn's disease


37. A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
Reaction formation
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Herpes simplex


38. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Retrograde cystourethrogram
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


39. The most common location for an ectopic pregnancy.
Ampulla of the oviduct
Beta- blockers - Ca2+ channel blockers - TCAs
Prevalence
Trauma - alcohol withdrawal - brain tumor


40. Infection of small airways with epidemics in winter and spring.
Conversion disorder
Headache
Pseudogout
RSV bronchiolitis


41. Defect in an X- linked syndrome with mental retardation -
Bruton's X- linked agammaglobulinemia
Mallory- Weiss
Lesch - Nyhan syndrome (purine salvage problem with
a - antagonists (phentolamine and phenoxybenzamine)


42. Annual screening for women with a strong family history of ovarian cancer.
All - compartment fasciotomy for suspected compartment syndrome
Conflict of interest
CA-125 and transvaginal ultrasound
105 bacteria/mL


43. When can a physician refuse to continue treating a patient on the grounds of futility?
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
CF or Hirschsprung's disease
CHF - shock - and altered mental status
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


44. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Factitious disorder (Munchausen syndrome)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Graves' disease
Selective IgA deficiency


45. Peaked T waves and widened QRS.
Hyperkalemia
Hypocalcemia
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
1


46. Confusion - confabulation - ophthalmoplegia - ataxia.

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47. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Wegener's granulomatosis and Goodpasture's syndrome
Trichomonas vaginitis
Neurofibromatosis 1
Factitious disorder (Munchausen syndrome)


48. How to distinguish polycythemia vera from 2
Nephrolithiasis
They can mask symptoms of hypoglycemia
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


49. Goal hemoglobin A1c for a patient with DM.
Prerenal
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Osteoarthritis
< 7.0


50. Risk factors for pyelonephritis.
Malingering
Iron deficiency anemia
Fanconi's anemia
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones