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. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Renal cell carcinoma (RCC)
Campylobacter
Nephrotic syndrome
? serum FSH


2. Extraintestinal manifestations of IBD.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Seminoma
Neisseria meningitidis


3. Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor - breast cancer
Pseudomonas
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Partial mole


4. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Hypovolemic shock
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Haemophilus ducreyi


5. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Stasis - hypercoagulability - endothelial damage
Mycobacterium tuberculosis
Beta- blockers - digoxin - calcium channel blockers
Hypoparathyroidism


6. Epidemics such as influenza
Sulfonamides - antimalarial drugs - fava beans
Neurofibromatosis 1
Varicella zoster
Higher incidence


7. The coagulation parameter affected by warfarin.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
PT
Lesions of 1
CF or Hirschsprung's disease


8. Classic ECG finding in atrial flutter.

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9. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Betamethasone or dexamethasone
Niacin
Hypoxia and hypocarbia


10. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Pseudogout
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Absence seizures
OCPs


11. Glomerulonephritis with deafness.

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12. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Chronic granulomatous disease
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Self - limited - painless vaginal bleeding
Basal cell carcinoma


13. The most common cause of postpartum hemorrhage.
Uterine atony
Displacement
OCPs - danazol - GnRH agonists
Pseudomonas


14. The most common causes of dementia.

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15. Medication used to induce ovulation.
Emergent laparotomy to repair perforated viscus - likely stomach
Clomiphene citrate
Anemia of chronic disease
Hypotension and bradycardia


16. A neonate has meconium ileus.

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17. Pure RBC aplasia.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Diamond - Blackfan anemia
Multiple myeloma
Bruton's X- linked agammaglobulinemia


18. Differential of hypervolemic hyponatremia.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
No. Parental consent is not necessary for the medical treatment of pregnant minors
Hypocalcemia
Cirrhosis - CHF - nephritic syndrome


19. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Exercise stress treadmill with ECG
Pharmacologic stress test (e.g. - dobutamine echo)


20. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Intraductal papilloma
Rett's disorder
Uremic syndrome seen in patients with renal failure
Chronic granulomatous disease


21. Name the defense mechanism:
Lead - time bias
Displacement
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Type II (proximal) RTA


22. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Fatigue and impending respiratory failure
Uterine atony
Malignancy and hyperparathyroidism
Confounding variable


23. 1
Placental abruption and placenta previa
DM - SLE - and amyloidosis
Amoxicillin
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


24. 'Cradle cap.'
Hypocalcemia
Continuous positive airway pressure
Normal
Seborrheic dermatitis. Treat with antifungals


25. Name the defense mechanism:
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
Fanconi's anemia
Pregnant women. Treat this group aggressively because of potential complications
Regression


26. The first test to perform when a woman presents with amenorrhea.
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Choriocarcinoma
Beta- hCG; the most common cause of amenorrhea is pregnancy


27. Chvostek's and Trousseau's signs.
Hypocalcemia
Seminoma
Ulcerative colitis
Weight gain - type 2 DM - QT prolongation


28. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Parvovirus B19
68% - 95.5% - 99.7%
a - antagonists (phentolamine and phenoxybenzamine)
RSV bronchiolitis


29. Medical treatment for hepatic encephalopathy.
? protein intake - lactulose - neomycin
Sporothrix schenckii
Benzodiazepines
Pregnant women. Treat this group aggressively because of potential complications


30. A 49-year - old male presents with acute - onset flank pain and hematuria.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Displacement
Taenia solium (cysticercosis)
Nephrolithiasis


31. Caf
105 bacteria/mL
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Neurofibromatosis 1
Alzheimer's and multi - infarct


32. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Pemphigus vulgaris
Oral or topical metronidazole
1


33. Nikolsky's sign.
Asherman's syndrome
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Bullous pemphigoid
SSRIs


34. Identify key organisms causing diarrhea:
Headache
E. coli O157:H7
Higher incidence
Parkinson's disease


35. First - line medication for status epilepticus.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
IV benzodiazepine
Angina is new - is worsening - or occurs at rest
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


36. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Phencyclidine hydrochloride (PCP) intoxication
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Distal radius (Colles' fracture)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


37. Peaked T waves and widened QRS.
Acne vulgaris
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Hyperkalemia
Nephritic syndrome


38. Name the organism:
Erythema multiforme
Hyperkalemia
Calcium oxalate
Klebsiella


39. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
A patient's family cannot require that a doctor withhold information from the patient
Inhaled Beta- agonists and inhaled corticosteroids
Confounding variable
Slipped capital femoral epiphyses. AP and frog - leg lateral view


40. Side effects of corticosteroids.
Subarachnoid hemorrhage (SAH)
Murphy's sign - seen in acute cholecystitis
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
O2 - analgesia - hydration - and - if severe - transfusion


41. Acid - base disorder in pulmonary embolism.
Immediate cardioversion
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Hypoxia and hypocarbia
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


42. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
SCLC
Broca's aphasia. Frontal lobe - left MCA distribution
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Frotteurism (a paraphilia)


43. A patient presents with recent PID with RUQ pain.
Self - limited - painless vaginal bleeding
Consider Fitz - Hugh - Curtis syndrome
Bruton's X- linked agammaglobulinemia
TICS


44. Classic physical findings for endocarditis.

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45. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
Beta- blockers - Ca2+ channel blockers - TCAs
Avascular necrosis
Wernicke's encephalopathy due to a deficiency of thiamine


46. Lung cancer highly related to cigarette exposure.
Ophthalmologic exam - CT - and MRI
Regresses after menopause
SCLC
Prinzmetal's angina


47. PFT showing ? FEV1/FVC.
Cerebral berry aneurysms (AD PCKD)
Mycobacterium tuberculosis
Hypertension - bradycardia - and abnormal respirations
Obstructive pulmonary disease (e.g. - asthma)


48. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Cardiogenic shock
Conversion disorder
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


49. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Lesions of 1
Neuroleptics
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Coccidioidomycosis. Amphotericin B


50. A condition associated with red 'currant - jelly' stools.
Kl
Intussusception
Check for ? ICP; look for papilledema
Weight gain - type 2 DM - QT prolongation