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. 1
Higher prevalence
Cerebral berry aneurysms (AD PCKD)
Placental abruption and placenta previa
Multiple myeloma


2. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Pheochromocytoma
Kwashiorkor (protein malnutrition)
Conduct disorder
Cirrhosis - CHF - nephritic syndrome


3. Evaluation of a pulsatile abdominal mass and bruit.
Bacterial meningitis
Hypertension - bradycardia - and abnormal respirations
Abdominal ultrasound and CT
Stasis - hypercoagulability - endothelial damage


4. Treatment for malignant hypertension.
Sarcoidosis
Betamethasone or dexamethasone
Nitroprusside
Cluster headache


5. Postnatal mortality?
High TSH - low T4 - antimicrosomal antibodies
HBV immunoglobulin
Number of deaths from 28 days to one year per 1000 live births
Betamethasone or dexamethasone


6. Four signs and symptoms of streptococcal pharyngitis.
Oral surgery
Conduct disorder
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Femoral hernia


7. Four causes of microcytic anemia.
TICS
Phencyclidine hydrochloride (PCP) intoxication
CHF - shock - and altered mental status
Number of deaths per 1000 population


8. Confusion - confabulation - ophthalmoplegia - ataxia.

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9. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
Isolation
Hashimoto's thyroiditis
Protamine


10. Treatment for neuroleptic malignant syndrome.
Threatened abortion
Dantrolene or bromocriptine
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


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

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12. Lab values suggestive of menopause.
? serum FSH
Cirrhosis - CHF - nephritic syndrome
Nephrotic syndrome
Endometrial or estrogen receptor - breast cancer


13. After a minor fender bender - a man wears a neck brace and requests permanent disability.
DI
Malingering
Prerenal
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


14. A homeless child is small for his age and has peeling skin and a swollen belly.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Kwashiorkor (protein malnutrition)
Hypokalemia
Sheehan's syndrome (postpartum pituitary necrosis)


15. Three systemic diseases ? nephrotic syndrome.
CHF - shock - and altered mental status
DM - SLE - and amyloidosis
Edrophonium
Malingering


16. Gout - self - mutilation - and choreoathetosis.
Anemia - thrombocytopenia - and acute renal failure
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
HGPRTase deficiency)
Signs and symptoms of hypercalcemia


17. True or false: Once patients sign a statement giving consent - they must continue treatment.
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Uterine massage; if that fails - give oxytocin
Identify cause; pressors (e.g. - dobutamine)
Cirrhosis - CHF - nephritic syndrome


18. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
Inhaled Beta- agonists and inhaled corticosteroids
Angina is new - is worsening - or occurs at rest
Hypernatremia


19. Hematuria - flank pain - and palpable flank mass.
Renal cell carcinoma (RCC)
Spinal stenosis
SIADH due to stress
Folate deficiency


20. The number of true positives divided by the number of patients with the disease is _____.
Agranulocytosis
Lesch - Nyhan syndrome (purine salvage problem with
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Sensitivity


21. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Substance abuse
Squamous cell carcinoma
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Diverticulosis


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 _____.
Confounding variable
HGPRTase deficiency)
Treat immediately. Consent is implied in emergency situations
Lichen sclerosus


23. Bilious emesis within hours after the first feeding.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
B12 deficiency
Prinzmetal's angina
Duodenal atresia


24. Which healthy population is susceptible to UTIs?
Sensitivity
Osteoarthritis
Pregnant women. Treat this group aggressively because of potential complications
Radiation


25. AML subtype associated with DIC.
Colposcopy and endocervical curettage
M3
Oral or topical metronidazole
S. aureus


26. Treatment of hypovolemic shock.
Threatened abortion
Giardia
Identify cause; fluid and blood repletion
Impetigo


27. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Wrist drop - loss of thumb abduction
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Paget's disease
Basal cell carcinoma


28. Sensitive tests have few false negatives and are used to rule _____ a disease.
PT
Observational bias
Out
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


29. Name the organism:
Nephrotic syndrome
Toxoplasma gondii
Distal radius (Colles' fracture)
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


30. Dermatomal distribution.
Small cell lung cancer (SCLC)
IV penicillin or ampicillin
Acute mania. Start a mood stabilizer (e.g. - lithium)
Varicella zoster


31. Meningitis in neonates. Causes? Treatment?
Emergent laparotomy to repair perforated viscus - likely stomach
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


32. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Clomiphene citrate
Sensitivity
68% - 95.5% - 99.7%
Bruton's X- linked agammaglobulinemia


33. Medication used to induce ovulation.
Subarachnoid hemorrhage (SAH)
Kegel exercises - estrogen - pessaries for stress incontinence
Nephrotic syndrome
Clomiphene citrate


34. The mainstay of Parkinson's therapy.
Levodopa/carbidopa
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
MCP and PIP joints; DIP joints are spared
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


35. Appropriate diagnostic test?
Pharmacologic stress test (e.g. - dobutamine echo)
Conduct disorder
Inhaled Beta- agonists and inhaled corticosteroids
Hypertrophic cardiomyopathy


36. Perinatal mortality?

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37. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Conversion disorder
Neuroleptic malignant syndrome
Oral or topical metronidazole
Usually resolves spontaneously; may require IVIG and/or corticosteroids


38. Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
Precocious puberty
Hypotension - distant heart sounds - and JVD
Mycobacterium tuberculosis


39. Causes of transudative effusion.
Fluids and antibiotics
Parvovirus B19
Duodenal atresia
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


40. Appropriate diagnostic test?
Coarctation of the aorta
Out
Exercise stress treadmill with ECG
Hypoparathyroidism


41. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Pseudomonas
1
Alport's syndrome
V/Q scan


42. Nonpainful chancre.
Asymmetry - border irregularity - color variation - large diameter
Clomiphene citrate
1
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


43. The most common histology of bladder cancer.
Transitional cell carcinoma
Lesch - Nyhan syndrome (purine salvage problem with
OCP and barrier contraception
Cerebral berry aneurysms (AD PCKD)


44. RTA associated with abnormal HCO3 - and rickets.
Type II (proximal) RTA
Chronic lymphocytic leukemia (CLL)
CA-125 and transvaginal ultrasound
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


45. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Murphy's sign - seen in acute cholecystitis
ACEI
Inevitable abortion
Beta- hCG; the most common cause of amenorrhea is pregnancy


46. Classic causes of drug - induced hepatitis.
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
E. coli O157:H7
Niacin
Pentad of TTP


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

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48. Describe a test that consistently gives identical results - but the results are wrong.
Hodgkin's lymphoma
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
Bullous pemphigoid
High reliability - low validity


49. The most common cause of seizures in children (2-10 years).
Infection - febrile seizures - trauma - idiopathic
Lyme disease - Ixodes tick - doxycycline
Slipped capital femoral epiphyses. AP and frog - leg lateral view
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


50. A neonate has meconium ileus.

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