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. Aplastic crisis in sickle cell disease.
Sheehan's syndrome (postpartum pituitary necrosis)
Bladder rupture or urethral injury
Parvovirus B19
Retinoic acid


2. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Actinic keratosis
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Erythema multiforme


3. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Nephrotic syndrome
Membranous glomerulonephritis
Dissociative fugue


4. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
Beta- hCG; the most common cause of amenorrhea is pregnancy
Hypotension - distant heart sounds - and JVD
Out


5. 'Doughy skin.'
1
Anemia of chronic disease
A patient with chest trauma who was previously stable suddenly dies
Hypernatremia


6. Honeycomb pattern on CXR. Diagnosis? Treatment?
Acute pancreatitis
V/Q scan
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Avascular necrosis


7. Nikolsky's sign.
Patient on dopamine antagonist
Distal radius (Colles' fracture)
Bullous pemphigoid
Pentad of TTP


8. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Uremic syndrome seen in patients with renal failure
SIADH due to stress
Murphy's sign - seen in acute cholecystitis


9. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
All - compartment fasciotomy for suspected compartment syndrome
Trichomonas vaginitis
Naloxone
Chronic lymphocytic leukemia (CLL)


10. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Pasteurella multocida
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
Calcium oxalate


11. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
Pharmacologic stress test (e.g. - dobutamine echo)
CF or Hirschsprung's disease
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma


12. RTA associated with aldosterone defect.
High reliability - low validity
Sheehan's syndrome (postpartum pituitary necrosis)
Type IV (distal) RTA
Dissociative fugue


13. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Uterine atony
SIADH due to stress
CA-125 and transvaginal ultrasound
Giardia


14. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Aseptic (viral) meningitis
MCP and PIP joints; DIP joints are spared
Hypoparathyroidism


15. Goal hemoglobin A1c for a patient with DM.
Malingering
ETEC
< 7.0
Septic or anaphylactic shock


16. Classic physical findings for endocarditis.

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17. Lung cancer highly related to cigarette exposure.
MCP and PIP joints; DIP joints are spared
Non - Hodgkin's lymphoma
Phencyclidine hydrochloride (PCP) intoxication
SCLC


18. Inspiratory arrest during palpation of the RUQ.

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19. Unopposed estrogen is contraindicated in which cancers?
Number of deaths from 28 days to one year per 1000 live births
HIDA scan
Endometrial or estrogen receptor - breast cancer
Substance abuse


20. Macrocytic - megaloblastic anemia with neurologic symptoms.
Mallory- Weiss
Pityriasis rosea
Hyperkalemia
B12 deficiency


21. The most common location for an ectopic pregnancy.
Conflict of interest
Sheehan's syndrome (postpartum pituitary necrosis)
Ampulla of the oviduct
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


22. Identify key organisms causing diarrhea:
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Yersinia
Treat existing heart failure and replace the tricuspid valve


23. Gout - self - mutilation - and choreoathetosis.
Abdominal ultrasound and CT
Anticoagulation - rate control - cardioversion
Ultrasound
HGPRTase deficiency)


24. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Acute myelogenous leukemia (AML)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
IV hydration and loop diuretics (furosemide)
Lichen sclerosus


25. RTA associated with abnormal HCO3 - and rickets.
Higher prevalence
Type II (proximal) RTA
Inevitable abortion
Varicella zoster


26. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
1
Nephrotic syndrome
68% - 95.5% - 99.7%


27. Identify key organisms causing diarrhea:
IV hydration and loop diuretics (furosemide)
Selective IgA deficiency
Incidence and prevalence
ETEC


28. Which healthy population is susceptible to UTIs?
Conduct disorder
Pregnant women. Treat this group aggressively because of potential complications
Isolation
Placental abruption and placenta previa


29. Case - control study
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Neither
Factor V Leiden mutation
Wrist drop - loss of thumb abduction


30. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Hodgkin's lymphoma
Diverticulosis
Lung - breast - skin (melanoma) - kidney - GI tract
Threatened abortion


31. Chronic diseases such as SLE
Klebsiella
Higher prevalence
Consider Fitz - Hugh - Curtis syndrome
Obstructive pulmonary disease (e.g. - asthma)


32. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
OCPs - danazol - GnRH agonists
Nephrolithiasis


33. Signs of ? ICP (Cushing's triad).
Klebsiella
Hypertension - bradycardia - and abnormal respirations
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Treat immediately. Consent is implied in emergency situations


34. The most common inherited cause of hypercoagulability.
Retrograde cystourethrogram
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Factor V Leiden mutation
Oral surgery


35. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
RSV bronchiolitis
S. aureus
Biliary tract obstruction
Dantrolene or bromocriptine


36. First - line treatment for moderate hypercalcemia.
Pseudomonas
IV hydration and loop diuretics (furosemide)
Dantrolene or bromocriptine
Oral or topical metronidazole


37. Eight surgically correctable causes of hypertension.

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38. Caf
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Continuous positive airway pressure
Neurofibromatosis 1
Hypovolemic shock


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

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40. Treatment of septic shock.
Trauma; the second most common is berry aneurysm
Coccidioidomycosis. Amphotericin B
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Fluids and antibiotics


41. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Angina - ST- segment changes on ECG - or ? BP
Postinfectious glomerulonephritis
Cluster headache
Taenia solium (cysticercosis)


42. Method of calculating fluid repletion in burn patients.
Angina - ST- segment changes on ECG - or ? BP
Suspect retinoblastoma
Parkland formula
Precocious puberty


43. Perinatal mortality?

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44. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Conflict of interest
Sulfonamides - antimalarial drugs - fava beans
Fanconi's anemia
SIADH due to stress


45. Name the organism:
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Pseudomonas
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
1


46. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Fatigue and impending respiratory failure
Aseptic (viral) meningitis
Neuroleptics
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


47. Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
OCPs
Nephrolithiasis
Continuous positive airway pressure


48. CSF findings with SAH.
Elevated ICP - RBCs - xanthochromia
Osteogenesis imperfecta
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Hyperkalemia


49. Key side effects of atypical antipsychotics.
Colposcopy and endocervical curettage
Angina is new - is worsening - or occurs at rest
Weight gain - type 2 DM - QT prolongation
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


50. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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