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. Signs of active ischemia during stress testing.
IV penicillin or ampicillin
Treat immediately. Consent is implied in emergency situations
Angina - ST- segment changes on ECG - or ? BP
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


2. Four signs and symptoms of streptococcal pharyngitis.
Actinomyces israelii
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Calcium oxalate


3. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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4. Why are Beta- blockers contraindicated in diabetics?
? serum FSH
Guillain - Barr
They can mask symptoms of hypoglycemia
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


5. What is the immunodeficiency?
Chronic granulomatous disease
Parkland formula
Prerenal
Murphy's sign - seen in acute cholecystitis


6. The most common 1
Infection - cancer - and autoimmune disease
Pregnant women. Treat this group aggressively because of potential complications
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Lung - breast - skin (melanoma) - kidney - GI tract


7. The coagulation parameter affected by warfarin.
Threatened abortion
PT
Trauma - alcohol withdrawal - brain tumor
Pregnant women. Treat this group aggressively because of potential complications


8. Classic physical findings for endocarditis.

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9. Treatment of DKA.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Murphy's sign - seen in acute cholecystitis


10. Signs of ? ICP (Cushing's triad).
Low - voltage - diffuse ST- segment elevation
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Hypertension - bradycardia - and abnormal respirations
All - compartment fasciotomy for suspected compartment syndrome


11. 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?
Spinal stenosis
Identify cause; pressors (e.g. - dobutamine)
Lyme disease - Ixodes tick - doxycycline
Protamine


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

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13. ECG findings suggesting MI.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Pharmacologic stress test (e.g. - dobutamine echo)
Pseudomonas


14. Combined UMN and LMN disorder.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
ALS
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
50 cc/hour


15. ? CO - ? PCWP - ? PVR.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Septic or anaphylactic shock
Subarachnoid hemorrhage (SAH)
Ultrasound


16. The most common cause of SAH.
Stasis - hypercoagulability - endothelial damage
Trauma; the second most common is berry aneurysm
Anemia of chronic disease
Uterine atony


17. Treatment for TTP.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Infection - febrile seizures - trauma - idiopathic
Hypernatremia
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


18. Cross - sectional survey
Prevalence
Trauma; the second most common is berry aneurysm
Angina - ST- segment changes on ECG - or ? BP
Basal cell carcinoma


19. CSF findings:
Bacterial meningitis
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Betamethasone or dexamethasone
A patient's family cannot require that a doctor withhold information from the patient


20. Name the organism:
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Neisseria meningitidis
Wegener's granulomatosis and Goodpasture's syndrome
Number of deaths from birth to 28 days per 1000 live births


21. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Fluid restriction - demeclocycline
Febrile seizures (roseola infantum)
IV penicillin or ampicillin
Folate deficiency


22. Identify key organisms causing diarrhea:
Hypoparathyroidism
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Isolation
Giardia


23. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Hyperkalemia
Bullous pemphigoid
Legionella pneumonia
Colposcopy and endocervical curettage


24. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
IV penicillin or ampicillin
105 bacteria/mL
Angina - ST- segment changes on ECG - or ? BP
TICS


25. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Identify cause; fluid and blood repletion
ETEC
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


26. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
HIDA scan
Basal cell carcinoma
Pheochromocytoma
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


27. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Anemia of chronic disease
Treat immediately. Consent is implied in emergency situations
Parkinson's disease
Bacterial meningitis


28. Dermatomal distribution.
Neuroleptics
Continuous - painful vaginal bleeding
Malingering
Varicella zoster


29. Relative risk?
Diphenhydramine or epinephrine 1:1000
Febrile seizures (roseola infantum)
The IR of a disease in a population exposed to a particular factor
Never


30. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Nephrogenic diabetes insipidus (DI)
Number of deaths from 28 days to one year per 1000 live births
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
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


31. Identify key organisms causing diarrhea:
TICS
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Campylobacter
Subdural hematoma


32. The most common type of testicular cancer.
Fat - female - fertile - forty - flatulent
Seminoma
Identify cause; pressors (e.g. - dobutamine)
Cerebral berry aneurysms (AD PCKD)


33. The most common cause of bloody nipple discharge.
Intraductal papilloma
Agranulocytosis
Protamine
Hypoxia and hypocarbia


34. AML subtype associated with DIC.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
M3
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


35. CSF findings:
7-10 days
Aseptic (viral) meningitis
Septic or anaphylactic shock
Endometrial or estrogen receptor - breast cancer


36. Risk factors for DVT.

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37. Molar pregnancy containing fetal tissue.
Taenia solium (cysticercosis)
S. aureus or S. epidermidis.
Partial mole
Inevitable abortion


38. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
Angina - ST- segment changes on ECG - or ? BP
Ampulla of the oviduct
Hypernatremia


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

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40. Case - control study
Nephrotic syndrome
Klebsiella
Neither
Trichomonas vaginitis


41. What % lesion is an indication for carotid endarterectomy?
Transitional cell carcinoma
Seborrheic keratosis
Dantrolene or bromocriptine
Seventy percent if the stenosis is symptomatic


42. Lab values suggestive of menopause.
Inevitable abortion
Legionella pneumonia
? serum FSH
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus


43. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
AP chest - AP/lateral C- spine - AP pelvis
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Renal cell carcinoma (RCC)
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


44. Endocarditis prophylaxis regimens.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Hypovolemic shock
Folate deficiency
Oral surgery


45. Electrolyte changes in tumor lysis syndrome.
Retinoic acid
Weight loss and OCPs
MS
? Ca2+ - ? K- - ? phosphate - ? uric acid


46. 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 _____.
Bullous pemphigoid
Nephrogenic diabetes insipidus (DI)
Confounding variable
Number of deaths from birth to 28 days per 1000 live births


47. Treatment for benzodiazepine overdose.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Flumazenil
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


48. Peaked T waves and widened QRS.
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Hyperkalemia
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
CF or Hirschsprung's disease


49. Natural history of a leiomyoma.
Regresses after menopause
Substance abuse
Impetigo
Pheochromocytoma


50. Auer rods on blood smear.
Acute myelogenous leukemia (AML)
Hypokalemia
Pityriasis rosea
Rett's disorder