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. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Endometrial biopsy
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
105 bacteria/mL
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


2. Reynolds' pentad.

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3. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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4. The most common type of testicular cancer.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Seminoma
Precocious puberty
HGPRTase deficiency)


5. Chromosomal pattern of a complete mole.
Polymyalgia rheumatica
Septic or anaphylactic shock
46 -XX
Seventy percent if the stenosis is symptomatic


6. Nontender abdominal mass associated with elevated VMA and HVA.
Biliary tract obstruction
Hereditary spherocytosis
Neuroblastoma
Nephritic syndrome


7. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Diamond - Blackfan anemia
Pseudogout
Actinomyces israelii
HIDA scan


8. A condition associated with red 'currant - jelly' stools.
Intussusception
Intraductal papilloma
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Nephritic syndrome


9. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Type I (distal) RTA
Septic or anaphylactic shock
Angina is new - is worsening - or occurs at rest


10. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
Levodopa/carbidopa
Confounding variable
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


11. A congenital heart disease that cause 2
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Seminoma
Coarctation of the aorta
? serum FSH


12. Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Lichen sclerosus
Hashimoto's thyroiditis
Transitional cell carcinoma


13. 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 _____.
Selective IgA deficiency
Identify cause; pressors (e.g. - dobutamine)
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Confounding variable


14. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Streptococcus pneumoniae
Emergent laparotomy to repair perforated viscus - likely stomach
Dissociative fugue


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

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16. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Herpes simplex
Bruton's X- linked agammaglobulinemia
Crohn's disease
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


17. Treatment of septic shock.
Pseudomonas
Naloxone
Edrophonium
Fluids and antibiotics


18. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Hypertension - bradycardia - and abnormal respirations
Actinic keratosis
Central pontine myelinolysis
Acute mania. Start a mood stabilizer (e.g. - lithium)


19. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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20. Virchow's triad.
Suspect retinoblastoma
Stasis - hypercoagulability - endothelial damage
Number of deaths from birth to 28 days per 1000 live births
Herpes simplex


21. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Dissociative fugue
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Suspect ankylosing spondylitis. Check HLA- B27
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'


22. Treatment of supraventricular tachycardia (SVT).
Rate control with carotid massasge or other vagal stimulation
MAOIs
Femoral hernia
Partial mole


23. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Alopecia areata (autoimmune process)
Surfactant deficiency
Menometrorrhagia
Diphenhydramine or epinephrine 1:1000


24. After a minor fender bender - a man wears a neck brace and requests permanent disability.
68% - 95.5% - 99.7%
'Sawtooth' P waves
Phototherapy (mild) or exchange transfusion (severe)
Malingering


25. Administer to a symptomatic patient to diagnose myasthenia gravis.
Klebsiella
MS
Edrophonium
Cluster headache


26. Acute - phase treatment for Kawasaki disease.
B12 deficiency
Number of deaths from birth to 28 days per 1000 live births
Administration of DDAVP ? serum osmolality and free water restriction
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms


27. Charcot's triad.
ARDS
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Elevated ICP - RBCs - xanthochromia
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


28. Asplenic patients are particularly susceptible to these organisms.
Dressler's syndrome: fever - pericarditis - ? ESR
Cellulitis
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Anemia - thrombocytopenia - and acute renal failure


29. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Parkland formula
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Trichomonas vaginitis
Infection - febrile seizures - trauma - idiopathic


30. Fetal mortality?

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31. Vaccinations at a six- month well - child visit.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
HBV - DTaP - Hib - IPV - PCV
Beta- blockers - Ca2+ channel blockers - TCAs
Factitious disorder (Munchausen syndrome)


32. PFT showing ? FEV1/FVC.
Clostridium difficile
Femoral hernia
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Obstructive pulmonary disease (e.g. - asthma)


33. Medical treatment for IBD.
Phencyclidine hydrochloride (PCP) intoxication
SSRIs
Check for ? ICP; look for papilledema
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


34. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Lichen sclerosus
Dressler's syndrome: fever - pericarditis - ? ESR
Flumazenil
Sulfonamides - antimalarial drugs - fava beans


35. A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
Conversion disorder
Basal cell carcinoma
Menometrorrhagia


36. How to diagnose and follow a leiomyoma.
Benzodiazepines
Regresses after menopause
Ultrasound
Consider Fitz - Hugh - Curtis syndrome


37. Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Graves' disease
Infection - febrile seizures - trauma - idiopathic
Allergic interstitial nephritis


38. True or false: Once patients sign a statement giving consent - they must continue treatment.
Radiation
Hypernatremia
Immediate needle thoracostomy
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


39. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Rubella
TICS


40. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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41. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Consider Fitz - Hugh - Curtis syndrome
Conversion disorder
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


42. A doctor refers a patient for an MRI at a facility he/she owns.
'Chocolate cysts -' powder burns
Patent ductus arteriosus (PDA)
Factitious disorder (Munchausen syndrome)
Conflict of interest


43. Cross - sectional survey
Prevalence
O2 - analgesia - hydration - and - if severe - transfusion
All - compartment fasciotomy for suspected compartment syndrome
Observational bias


44. Sensitive tests have few false negatives and are used to rule _____ a disease.
Wait - surgical resection - radiation and/or androgen suppression
Out
Bullous pemphigoid
Diverticulosis


45. Risk factors for cholelithiasis.
Chronic lymphocytic leukemia (CLL)
Inhaled Beta- agonists and inhaled corticosteroids
Out
Fat - female - fertile - forty - flatulent


46. The most common inherited cause of hypercoagulability.
1
Factor V Leiden mutation
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
High reliability - low validity


47. A newborn female has continuous 'machinery murmur.'
Pseudomonas
Actinic keratosis
Patent ductus arteriosus (PDA)
Hypernatremia


48. The three most common causes of fever of unknown origin (FUO).
Trauma; the second most common is berry aneurysm
Lobular carcinoma in situ
Uterine massage; if that fails - give oxytocin
Infection - cancer - and autoimmune disease


49. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Ulcerative colitis
Self - limited - painless vaginal bleeding
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


50. Risk factors for pyelonephritis.
Pulsus paradoxus (seen in cardiac tamponade)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
IVIG or plasmapheresis
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones