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. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Rubella
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Giardia


2. Treatment of hypovolemic shock.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Identify cause; fluid and blood repletion
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Number of live births per 1000 women 15-44 years of age


3. Confusion - confabulation - ophthalmoplegia - ataxia.

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4. The most common cause of SAH.
O2 - analgesia - hydration - and - if severe - transfusion
Pseudogout
Self - limited - painless vaginal bleeding
Trauma; the second most common is berry aneurysm


5. Three systemic diseases ? nephrotic syndrome.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Phototherapy (mild) or exchange transfusion (severe)
Toxoplasma gondii
DM - SLE - and amyloidosis


6. Signs of air embolism.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
A patient with chest trauma who was previously stable suddenly dies
< 7.0
Osgood - Schlatter disease


7. Appropriate diagnostic test?
Oral surgery
Restrictive pulmonary disease
Malignancy and hyperparathyroidism
Pharmacologic stress test (e.g. - dobutamine echo)


8. Caf
Hashimoto's thyroiditis
Beta- blockers - digoxin - calcium channel blockers
Neurofibromatosis 1
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


9. Glomerulonephritis with deafness.

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10. 'Doughy skin.'
Nephritic syndrome
Metformin
Hypernatremia
1


11. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Membranous glomerulonephritis
Fatigue and impending respiratory failure
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Phencyclidine hydrochloride (PCP) intoxication


12. CSF findings:
Campylobacter
Aseptic (viral) meningitis
Respiratory alkalosis
Regresses after menopause


13. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
IgA nephropathy (Berger's disease)
Bacillus cereus
Number of deaths from birth to 28 days per 1000 live births


14. Meningitis in neonates. Causes? Treatment?
Hypoparathyroidism
Kwashiorkor (protein malnutrition)
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Crohn's disease


15. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Trauma; the second most common is berry aneurysm
Fat - female - fertile - forty - flatulent
ALS


16. An antidiabetic agent associated with lactic acidosis.
Metformin
Signs and symptoms of hypercalcemia
Lyme disease - Ixodes tick - doxycycline
Lichen sclerosus


17. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Fluid restriction - demeclocycline
Bladder rupture or urethral injury
1
Infection - febrile seizures - trauma - idiopathic


18. Cannon 'a' waves.
Sulfonamides - antimalarial drugs - fava beans
Rett's disorder
Third - degree heart block
Uterine massage; if that fails - give oxytocin


19. The most common 1
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Selective IgA deficiency
Beta- blockers - Ca2+ channel blockers - TCAs


20. Name the organism:
RSV bronchiolitis
Streptococcus pneumoniae
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
PT


21. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
68% - 95.5% - 99.7%
Uterine atony
Herpes simplex
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


22. A patient fails to lactate after an emergency C- section with marked blood loss.

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23. Neonatal mortality?
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Threatened abortion
Number of deaths from birth to 28 days per 1000 live births
Identify cause; fluid and blood repletion


24. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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25. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Anion gap acidosis and 1
IV penicillin or ampicillin
Dantrolene or bromocriptine
Regresses after menopause


26. Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis
IVIG or plasmapheresis
Hyperkalemia
MAOIs


27. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Neuroblastoma
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Establish the ABCs


28. Risk factors for pyelonephritis.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Beta- hCG; the most common cause of amenorrhea is pregnancy
SCLC


29. Name the organism:
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Sporothrix schenckii
Respiratory alkalosis
Hashimoto's thyroiditis


30. The most frequent presentation of intracranial neoplasm.
Headache
Acute myelogenous leukemia (AML)
Weight gain - type 2 DM - QT prolongation
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


31. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
O2 - analgesia - hydration - and - if severe - transfusion
All - compartment fasciotomy for suspected compartment syndrome


32. Classic physical findings for endocarditis.

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33. The most common cause of bloody nipple discharge.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Mallory- Weiss
Clostridium difficile
Intraductal papilloma


34. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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35. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR
Radiation
Chronic lymphocytic leukemia (CLL)
Beta- blockers - digoxin - calcium channel blockers


36. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Klebsiella
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Factitious disorder (Munchausen syndrome)


37. The number of true positives divided by the number of patients with the disease is _____.
Bacillus cereus
Parkland formula
Hypotension and bradycardia
Sensitivity


38. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
HGPRTase deficiency)
CA-125 and transvaginal ultrasound
Wiskott - Aldrich syndrome


39. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
Coccidioidomycosis. Amphotericin B
Neurofibromatosis 1
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


40. Lung cancer associated with SIADH.
Hypertension - bradycardia - and abnormal respirations
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Graves' disease
Small cell lung cancer (SCLC)


41. Identify key organisms causing diarrhea:
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Substance abuse
E. coli O157:H7
Continuous - painful vaginal bleeding


42. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Taenia solium (cysticercosis)
Inevitable abortion
Nephritic syndrome
Asherman's syndrome


43. Goal hemoglobin A1c for a patient with DM.
< 7.0
Lesch - Nyhan syndrome (purine salvage problem with
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Pasteurella multocida


44. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
HIDA scan
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins
Hypoparathyroidism


45. The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR
Sporothrix schenckii
Parainfluenza virus type 1


46. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Pseudogout
IVIG or plasmapheresis
Choriocarcinoma
Bladder rupture or urethral injury


47. Acid - base disorder in pulmonary embolism.
AP chest - AP/lateral C- spine - AP pelvis
Hypoxia and hypocarbia
MAOIs
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


48. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Wegener's granulomatosis and Goodpasture's syndrome
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Salmonella


49. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Graves' disease
Edrophonium
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Pseudomonas


50. The most common location for an ectopic pregnancy.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Ampulla of the oviduct
Salmonella
Hypernatremia