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. PFT showing ? FEV1/FVC.
Continuous - painful vaginal bleeding
Restrictive pulmonary disease
Pseudomonas
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


2. What is the metabolic syndrome?
1
Coccidioidomycosis. Amphotericin B
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Kegel exercises - estrogen - pessaries for stress incontinence


3. Maternal mortality?
Type II (proximal) RTA
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Aseptic (viral) meningitis
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


4. Caf
Infection - cancer - and autoimmune disease
Hypotension and bradycardia
Neurofibromatosis 1
Number of live births per 1000 women 15-44 years of age


5. Risk factors for cholelithiasis.
Neuroleptic malignant syndrome
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Fat - female - fertile - forty - flatulent
Lyme disease - Ixodes tick - doxycycline


6. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Suspect retinoblastoma
Conversion disorder
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Dantrolene or bromocriptine


7. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


8. Red plaques with silvery- white scales and sharp margins.
Wegener's granulomatosis and Goodpasture's syndrome
Psoriasis
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
M3


9. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
Acute myelogenous leukemia (AML)
Lichen planus
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


10. How to diagnose and follow a leiomyoma.
Ultrasound
Uterine atony
Identify cause; fluid and blood repletion
Clomiphene citrate


11. Medical treatment for IBD.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
105 bacteria/mL
Dantrolene or bromocriptine
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


12. Glomerulonephritis with deafness.

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13. Iris - like target lesions.
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Erythema multiforme
Wernicke's encephalopathy due to a deficiency of thiamine


14. 'Dewdrop on a rose petal.'
Toxoplasma gondii
Neurofibromatosis 1
Prerenal
Lesions of 1


15. Identify key organisms causing diarrhea:
Treat immediately. Consent is implied in emergency situations
Klebsiella
Clostridium difficile
Chronic lymphocytic leukemia (CLL)


16. Antihypertensive for a diabetic patient with proteinuria.
ACEI
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


17. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
Ultrasound
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Paget's disease


18. May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
Asymmetry - border irregularity - color variation - large diameter
No. Parental consent is not necessary for the medical treatment of pregnant minors
Placental abruption and placenta previa


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

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20. The diagnostic test for pulmonary embolism.
Huntington's disease
V/Q scan
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Uterine atony


21. Treatment for opioid overdose.
Klebsiella
Naloxone
Kwashiorkor (protein malnutrition)
Oral or topical metronidazole


22. The most common causes of hypercalcemia.
Squamous cell carcinoma
B12 deficiency
Malignancy and hyperparathyroidism
Bullous pemphigoid


23. The 6 P's of ischemia due to peripheral vascular disease.
Bruton's X- linked agammaglobulinemia
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Panic disorder
Non - Hodgkin's lymphoma


24. Treatment for DTs.
Obstructive pulmonary disease (e.g. - asthma)
SIADH due to stress
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Benzodiazepines


25. Complication of scaphoid fracture.
Avascular necrosis
Dissociative fugue
Angina is new - is worsening - or occurs at rest
Fluids and antibiotics


26. Defect in an X- linked syndrome with mental retardation -
Pulsus paradoxus (seen in cardiac tamponade)
Lesch - Nyhan syndrome (purine salvage problem with
Isolation
Placental abruption and placenta previa


27. Therapy for polycystic ovarian syndrome.
Dissociative fugue
Pseudomonas
Weight loss and OCPs
Anemia - thrombocytopenia - and acute renal failure


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

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29. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Distal radius (Colles' fracture)
Renal cell carcinoma (RCC)
Chronic lymphocytic leukemia (CLL)
All - compartment fasciotomy for suspected compartment syndrome


30. Trauma series.
a - antagonists (phentolamine and phenoxybenzamine)
Angina - ST- segment changes on ECG - or ? BP
AP chest - AP/lateral C- spine - AP pelvis
Squamous cell carcinoma


31. Medical treatment for hepatic encephalopathy.
Neurofibromatosis 1
Edrophonium
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
? protein intake - lactulose - neomycin


32. Why are Beta- blockers contraindicated in diabetics?
Radiation
Huntington's disease
Squamous cell carcinoma
They can mask symptoms of hypoglycemia


33. Meningitis in infants. Causes? Treatment?
Nitroprusside
HBV immunoglobulin
ARDS
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


34. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Self - limited - painless vaginal bleeding
Allergic interstitial nephritis
Pheochromocytoma
Small cell lung cancer (SCLC)


35. Causes of transudative effusion.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
INH - penicillamine - hydralazine - procainamide
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Multiple myeloma


36. Name the defense mechanism:
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Isolation
Cluster headache
Guillain - Barr


37. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Clostridium difficile
Number of live births per 1000 population


38. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Lead - time bias
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Calcium oxalate
Number of deaths from birth to 28 days per 1000 live births


39. Definition of hypertension.
Pulsus paradoxus (seen in cardiac tamponade)
BP > 140/90 on three separate occasions two weeks apart
Nephrogenic diabetes insipidus (DI)
Pheochromocytoma


40. Nonpainful chancre.
Frotteurism (a paraphilia)
1
Mycoplasma
Duodenal atresia


41. Low urine specific gravity in the presence of high serum osmolality.
Guillain - Barr
Osgood - Schlatter disease
DI
Alport's syndrome


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

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43. Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Parkland formula
Hypoparathyroidism
Number of deaths per 1000 population


44. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Osteoarthritis
Cardiogenic shock
Substance abuse
Hashimoto's thyroiditis


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

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46. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma


47. Presents with a herald patch - Christmas - tree pattern.
Pulsus paradoxus (seen in cardiac tamponade)
68% - 95.5% - 99.7%
Pityriasis rosea
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism


48. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Substance abuse
Metformin


49. Mortality rate?
CF or Hirschsprung's disease
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Number of deaths per 1000 population
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


50. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Identify cause; fluid and blood repletion
Acute mania. Start a mood stabilizer (e.g. - lithium)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes