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

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2. The most common cause of Cushing's syndrome.

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3. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Colposcopy and endocervical curettage
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Postinfectious glomerulonephritis
Patent ductus arteriosus (PDA)


4. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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5. Reynolds' pentad.

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6. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Mallory- Weiss
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Uremic syndrome seen in patients with renal failure
Usually resolves spontaneously; may require IVIG and/or corticosteroids


7. How to distinguish polycythemia vera from 2
Clomiphene citrate
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


8. The most common cause of postpartum hemorrhage.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Sporothrix schenckii
Uterine atony
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


9. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
The IR of a disease in a population exposed to a particular factor
Kl
Emergent laparotomy to repair perforated viscus - likely stomach
Pemphigus vulgaris


10. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Hashimoto's thyroiditis
Cirrhosis - CHF - nephritic syndrome
False. Withdrawing and withholding life are the same from an ethical standpoint


11. Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Neither
RSV bronchiolitis
Osteoarthritis


12. Criteria for exudative effusion.
Number of live births per 1000 women 15-44 years of age
Endometrial or estrogen receptor - breast cancer
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Osteoarthritis


13. The most serious side effect of clozapine.
Agranulocytosis
1
Alport's syndrome
Infection - cancer - and autoimmune disease


14. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
N- acetylcysteine
Beta- hCG; the most common cause of amenorrhea is pregnancy
Wegener's granulomatosis and Goodpasture's syndrome


15. Cannon 'a' waves.
Broca's aphasia. Frontal lobe - left MCA distribution
Neuroleptics
Third - degree heart block
A patient's family cannot require that a doctor withhold information from the patient


16. First - line treatment for otitis media.
Flumazenil
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Amoxicillin
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


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

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18. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Conflict of interest
Lesion of 1
Osgood - Schlatter disease


19. Describe a test that consistently gives identical results - but the results are wrong.
High reliability - low validity
Hypovolemic shock
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Dressler's syndrome: fever - pericarditis - ? ESR


20. Annual screening for women with a strong family history of ovarian cancer.
They can mask symptoms of hypoglycemia
50 cc/hour
Osteoarthritis
CA-125 and transvaginal ultrasound


21. Infant mortality?
30 cc/hour
Basal cell carcinoma
Beta- blockers - digoxin - calcium channel blockers
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


22. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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23. 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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24. Three systemic diseases ? nephrotic syndrome.
Acute mania. Start a mood stabilizer (e.g. - lithium)
Fluids and antibiotics
DM - SLE - and amyloidosis
Rubella


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

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26. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Metformin
Levodopa/carbidopa
Pasteurella multocida
Uremic syndrome seen in patients with renal failure


27. Method of calculating fluid repletion in burn patients.
Bacillus cereus
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Hypocalcemia
Parkland formula


28. Signs of neurogenic shock.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Lichen sclerosus
Hypotension and bradycardia
? Ca2+ - ? K- - ? phosphate - ? uric acid


29. Identify key organisms causing diarrhea:
Elevated ICP - RBCs - xanthochromia
Diphenhydramine or epinephrine 1:1000
Salmonella
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


30. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
50 cc/hour
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Normal
Hodgkin's lymphoma


31. Identify key organisms causing diarrhea:
Niacin
Yersinia
Incidence and prevalence
Conflict of interest


32. Name the organism:
Regresses after menopause
Pseudomonas
Surfactant deficiency
Metformin


33. Albuminocytologic dissociation.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Bullous pemphigoid
MS
Guillain - Barr


34. Cause of neonatal RDS.
1
Surfactant deficiency
TICS
Hypotension - distant heart sounds - and JVD


35. A patient presents with recent PID with RUQ pain.
Number of deaths from birth to 28 days per 1000 live births
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Consider Fitz - Hugh - Curtis syndrome
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism


36. Treatment for benzodiazepine overdose.
Flumazenil
Reye's syndrome
Squamous cell carcinoma
Diphenhydramine or epinephrine 1:1000


37. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
E. coli O157:H7
Acute mania. Start a mood stabilizer (e.g. - lithium)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Hyperkalemia


38. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Parkland formula
Ultrasound
Antipsychotics (neuroleptic malignant syndrome)
Anemia of chronic disease


39. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
a - antagonists (phentolamine and phenoxybenzamine)
OCP and barrier contraception
Ultrasound
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing


40. Risk factors for DVT.

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41. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Menometrorrhagia
Anemia - thrombocytopenia - and acute renal failure
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Diphenhydramine or epinephrine 1:1000


42. Identify key organisms causing diarrhea:
E. coli O157:H7
SCLC
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Self - limited - painless vaginal bleeding


43. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
Lyme disease - Ixodes tick - doxycycline
IV benzodiazepine
M3


44. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Emergent laparotomy to repair perforated viscus - likely stomach
1
Abdominal ultrasound and CT
Osteogenesis imperfecta


45. The most common cause of bloody nipple discharge.
IV penicillin or ampicillin
Nephrogenic diabetes insipidus (DI)
Intraductal papilloma
DM - SLE - and amyloidosis


46. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Nephrotic syndrome
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
TICS
Kegel exercises - estrogen - pessaries for stress incontinence


47. Glomerulonephritis with deafness.

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48. Attributable risk?
'Sawtooth' P waves
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Phototherapy (mild) or exchange transfusion (severe)
Biliary tract obstruction


49. Differential of hypervolemic hyponatremia.
Number of live births per 1000 population
Pulsus paradoxus (seen in cardiac tamponade)
Ampulla of the oviduct
Cirrhosis - CHF - nephritic syndrome


50. A woman who was abused as a child frequently feels outside of or detached from her body.
Ampulla of the oviduct
Beta- hCG; the most common cause of amenorrhea is pregnancy
Depersonalization disorder
Huntington's disease