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. Unopposed estrogen is contraindicated in which cancers?
Type I (distal) RTA
Endometrial or estrogen receptor - breast cancer
Benzodiazepines
ETEC


2. Key side effects of atypical antipsychotics.
Glomerulonephritis/nephritic syndrome
Anticoagulation - rate control - cardioversion
Parainfluenza virus type 1
Weight gain - type 2 DM - QT prolongation


3. Identify key organisms causing diarrhea:
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Fanconi's anemia
Bacillus cereus
Menometrorrhagia


4. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
SCLC
Phencyclidine hydrochloride (PCP) intoxication
Trichomonas vaginitis


5. Hypercholesterolemia treatment that ? flushing and pruritus.
'Chocolate cysts -' powder burns
Niacin
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Cellulitis


6. Classic ECG finding in atrial flutter.

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7. A child has loss of red light reflex. Diagnosis?
Legionella pneumonia
Suspect retinoblastoma
Inhaled Beta- agonists and inhaled corticosteroids
Edrophonium


8. Antidepressants associated with hypertensive crisis.
Dantrolene or bromocriptine
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
MAOIs
Slipped capital femoral epiphyses. AP and frog - leg lateral view


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

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10. Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
OCPs
1
Reaction formation


11. Diagnostic test for hypertrophic cardiomyopathy.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Squamous cell carcinoma
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


12. Inflammatory disease of the colon with ? risk of colon cancer.
Ulcerative colitis
Dressler's syndrome: fever - pericarditis - ? ESR
Hereditary spherocytosis
Guillain - Barr


13. Reed - Sternberg cells

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14. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

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15. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Anemia - thrombocytopenia - and acute renal failure
Factitious disorder (Munchausen syndrome)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


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

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17. The most common organism in burn - related infections.
Asherman's syndrome
Pseudomonas
68% - 95.5% - 99.7%
Neisseria meningitidis


18. Ring - enhancing brain lesion on CT with seizures
Parkland formula
Taenia solium (cysticercosis)
Pityriasis versicolor
CA-125 and transvaginal ultrasound


19. Lab values suggestive of menopause.
Hashimoto's thyroiditis
Uterine atony
Elevated ICP - RBCs - xanthochromia
? serum FSH


20. Iris - like target lesions.
M3
'Sawtooth' P waves
Erythema multiforme
Isolation


21. Peaked T waves and widened QRS.
Surfactant deficiency
Dissociative fugue
Hyperkalemia
S. aureus or S. epidermidis.


22. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Huntington's disease
Nephrogenic diabetes insipidus (DI)


23. 'Stuck - on' appearance.
Seventy percent if the stenosis is symptomatic
Herpes simplex
Seborrheic keratosis
Broca's aphasia. Frontal lobe - left MCA distribution


24. Definition of unstable angina.
Trauma; the second most common is berry aneurysm
Angina is new - is worsening - or occurs at rest
Pseudomonas
Clomiphene citrate


25. Test to rule out urethral injury.
Prerenal
Retrograde cystourethrogram
Asymmetry - border irregularity - color variation - large diameter
Nephrotic syndrome


26. The most common cause of hypertension in young women.
OCPs
S. aureus
Asymmetry - border irregularity - color variation - large diameter
Squamous cell carcinoma


27. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
False. Withdrawing and withholding life are the same from an ethical standpoint
Alopecia areata (autoimmune process)
Acne vulgaris
Type II (proximal) RTA


28. Name the organism:
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Klebsiella
Antipsychotics (neuroleptic malignant syndrome)
Dantrolene or bromocriptine


29. Perinatal mortality?

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30. Defect in an X- linked syndrome with mental retardation -
Lesch - Nyhan syndrome (purine salvage problem with
ACEI
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Glanzmann's thrombasthenia


31. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Osteoarthritis
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


32. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Lung - breast - skin (melanoma) - kidney - GI tract
Type II (proximal) RTA
Folate deficiency


33. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Immediate needle thoracostomy
All - compartment fasciotomy for suspected compartment syndrome
Amoxicillin
Iron overload; use deferoxamine


34. The most common 1
Multiple myeloma
TICS
Lyme disease - Ixodes tick - doxycycline
Subarachnoid hemorrhage (SAH)


35. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Flumazenil
Reye's syndrome
Sensitivity
Hypoparathyroidism


36. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first - degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
Transitional cell carcinoma
Murphy's sign - seen in acute cholecystitis
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


37. What is the immunodeficiency?
Chronic granulomatous disease
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
OCPs - danazol - GnRH agonists
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


38. When should a vaginal exam be performed with suspected placenta previa?
S. aureus or S. epidermidis.
A patient with chest trauma who was previously stable suddenly dies
Never
Choriocarcinoma


39. Treatment for opioid overdose.
Naloxone
Fatigue and impending respiratory failure
a - antagonists (phentolamine and phenoxybenzamine)
Giardia


40. Common symptoms associated with silent MIs.
Clomiphene citrate
CHF - shock - and altered mental status
Emergent laparotomy to repair perforated viscus - likely stomach
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


41. Acid - base disturbance commonly seen in pregnant women.
Wiskott - Aldrich syndrome
Calcium oxalate
S. aureus or S. epidermidis.
Respiratory alkalosis


42. Reynolds' pentad.

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43. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Highly sensitive for TB
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Uremic syndrome seen in patients with renal failure
Identify cause; pressors (e.g. - dobutamine)


44. Conditions in which confidentiality must be overridden.
OCP and barrier contraception
Dressler's syndrome: fever - pericarditis - ? ESR
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Nephritic syndrome


45. Annual screening for women with a strong family history of ovarian cancer.
Beta- blockers - digoxin - calcium channel blockers
Haemophilus ducreyi
CA-125 and transvaginal ultrasound
Hypertrophic cardiomyopathy


46. Odds ratio?
Bladder rupture or urethral injury
Hypovolemic shock
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Calcium oxalate


47. Chromosomal pattern of a complete mole.
46 -XX
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Inevitable abortion
Parkland formula


48. Treatment for mild and severe unconjugated hyperbilirubinemia.
Wegener's granulomatosis and Goodpasture's syndrome
Pregnant women. Treat this group aggressively because of potential complications
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Phototherapy (mild) or exchange transfusion (severe)


49. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
a - antagonists (phentolamine and phenoxybenzamine)
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Amoxicillin
Headache


50. Acceptable urine output in a stable patient.
Squamous cell carcinoma
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Third - degree heart block
30 cc/hour