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. Medical options for endometriosis.
Intussusception
OCPs - danazol - GnRH agonists
Pulsus paradoxus (seen in cardiac tamponade)
Hypokalemia


2. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
Prinzmetal's angina
Hypernatremia
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


3. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Central pontine myelinolysis
Erythema multiforme
Dissociative fugue
30 cc/hour


4. Honeycomb pattern on CXR. Diagnosis? Treatment?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Regresses after menopause
Identify cause; fluid and blood repletion


5. Antidepressants associated with hypertensive crisis.
Vibrio - HAV
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
MAOIs
S. aureus or S. epidermidis.


6. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Continuous positive airway pressure
High reliability - low validity
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


7. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Number of deaths from 20 weeks' gestation to birth per 1000 total births
ALS
Colposcopy and endocervical curettage


8. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Contact dermatitis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
? Ca2+ - ? K- - ? phosphate - ? uric acid


9. Neonatal mortality?
Ulcerative colitis
Angina - ST- segment changes on ECG - or ? BP
Number of deaths from birth to 28 days per 1000 live births
Establish the ABCs


10. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Pharmacologic stress test (e.g. - dobutamine echo)
Coarctation of the aorta
Headache


11. Epidemics such as influenza
Amoxicillin
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Angina - ST- segment changes on ECG - or ? BP
Higher incidence


12. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Central pontine myelinolysis
Endometriosis
Pseudomonas
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


13. AML subtype associated with DIC.
Bladder rupture or urethral injury
M3
Hypotension - distant heart sounds - and JVD
Iron deficiency anemia


14. Heinz bodies?
Impetigo
SCLC
Parkinson's disease
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


15. 'Doughy skin.'
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Normal
Cluster headache
Hypernatremia


16. Name the defense mechanism:
Displacement
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Bacillus cereus
1


17. A neonate has meconium ileus.

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18. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Elevated ICP - RBCs - xanthochromia
'Sawtooth' P waves
Lyme disease - Ixodes tick - doxycycline


19. CSF findings:
Signs and symptoms of hypercalcemia
Aseptic (viral) meningitis
The IR of a disease in a population exposed to a particular factor
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


20. Medical treatment for hepatic encephalopathy.
? protein intake - lactulose - neomycin
Confounding variable
Subdural hematoma
DM - SLE - and amyloidosis


21. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Displacement
Administration of DDAVP ? serum osmolality and free water restriction
Inhaled Beta- agonists and inhaled corticosteroids
Treat existing heart failure and replace the tricuspid valve


22. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Patient on dopamine antagonist
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
1
Radiation


23. Test to rule out urethral injury.
< 7.0
Retrograde cystourethrogram
Continuous - painful vaginal bleeding
OCP and barrier contraception


24. Laparoscopic findings in endometriosis.

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25. Meningitis in neonates. Causes? Treatment?
S. aureus
Hypovolemic shock
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


26. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Anticoagulation - rate control - cardioversion
Isolation
ALS
Postinfectious glomerulonephritis


27. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Pheochromocytoma
? Ca2+ - ? K- - ? phosphate - ? uric acid
Hypotension and bradycardia
Hodgkin's lymphoma


28. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Pseudogout
Agranulocytosis
Substance abuse
False. Withdrawing and withholding life are the same from an ethical standpoint


29. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Surfactant deficiency
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Treat immediately. Consent is implied in emergency situations


30. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Continuous - painful vaginal bleeding
Beta- blockers - digoxin - calcium channel blockers
HIDA scan
Highly sensitive for TB


31. Odds ratio?
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
1


32. The most common 1
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Reaction formation
Weight loss and OCPs
Lung - breast - skin (melanoma) - kidney - GI tract


33. Infection of small airways with epidemics in winter and spring.
Oral or topical metronidazole
Hodgkin's lymphoma
RSV bronchiolitis
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


34. What is the immunodeficiency?
OCP and barrier contraception
Treat immediately. Consent is implied in emergency situations
High reliability - low validity
Chronic granulomatous disease


35. Treatment of AF.
IgA nephropathy (Berger's disease)
Rate control - rhythm conversion - and anticoagulation
Menometrorrhagia
Mallory- Weiss


36. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Infection - febrile seizures - trauma - idiopathic
HIDA scan
Campylobacter


37. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Actinomyces israelii
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Never
Basal cell carcinoma


38. Hypercholesterolemia treatment that ? flushing and pruritus.
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
Niacin
Higher prevalence
Panic disorder


39. Findings in 3
IV penicillin or ampicillin
Asherman's syndrome
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms


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

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41. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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42. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Mallory- Weiss
Cerebral berry aneurysms (AD PCKD)
? protein intake - lactulose - neomycin
Erythema multiforme


43. Treatment for mild - persistent asthma.
Identify cause; fluid and blood repletion
Renal cell carcinoma (RCC)
Lung - breast - skin (melanoma) - kidney - GI tract
Inhaled Beta- agonists and inhaled corticosteroids


44. Classic ECG finding in atrial flutter.

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45. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Rett's disorder
Nephrotic syndrome
Headache
Antipsychotics (neuroleptic malignant syndrome)


46. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Alport's syndrome
IVIG or plasmapheresis
Infection - cancer - and autoimmune disease
CML


47. Acute - phase treatment for Kawasaki disease.
Stasis - hypercoagulability - endothelial damage
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
OCPs
Febrile seizures (roseola infantum)


48. T- wave flattening and U waves.
Yersinia
All - compartment fasciotomy for suspected compartment syndrome
Excessive EtOH
Hypokalemia


49. Differential of hypervolemic hyponatremia.
Pulsus paradoxus (seen in cardiac tamponade)
Emergent laparotomy to repair perforated viscus - likely stomach
Cirrhosis - CHF - nephritic syndrome
Fluid restriction - demeclocycline


50. Three systemic diseases ? nephrotic syndrome.
Hashimoto's thyroiditis
Kegel exercises - estrogen - pessaries for stress incontinence
DM - SLE - and amyloidosis
Pemphigus vulgaris