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. PFT showing ? FEV1/FVC.
Squamous cell carcinoma
Impetigo
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Obstructive pulmonary disease (e.g. - asthma)


2. The most common cause of postpartum hemorrhage.
Uterine atony
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
? Ca2+ - ? K- - ? phosphate - ? uric acid
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


3. Cohort study
Bullous pemphigoid
Incidence and prevalence
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
IVIG or plasmapheresis


4. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Betamethasone or dexamethasone
MS
Femoral hernia
Colposcopy and endocervical curettage


5. Fetal mortality?

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6. The most common cause of hypothyroidism.

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7. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Polymyalgia rheumatica
Anion gap acidosis and 1
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Sulfonamides - antimalarial drugs - fava beans


8. Test to rule out urethral injury.
Anemia - thrombocytopenia - and acute renal failure
Retrograde cystourethrogram
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Nephritic syndrome


9. Combined UMN and LMN disorder.
ALS
Psoriasis
Cirrhosis - CHF - nephritic syndrome
Iron deficiency anemia


10. 'Stones - bones - groans - psychiatric overtones.'
Factitious disorder (Munchausen syndrome)
Signs and symptoms of hypercalcemia
Diamond - Blackfan anemia
Cirrhosis - CHF - nephritic syndrome


11. Heinz bodies?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Hypernatremia
Pseudomonas
Respiratory alkalosis


12. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
Cirrhosis - CHF - nephritic syndrome
Anemia of chronic disease
Uremic syndrome seen in patients with renal failure


13. Name the organism:
Pseudomonas
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Endometrial biopsy
Folate deficiency


14. Causes of drug - induced SLE.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Crohn's disease
INH - penicillamine - hydralazine - procainamide
Bacterial meningitis


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

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16. Molar pregnancy containing fetal tissue.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Wegener's granulomatosis and Goodpasture's syndrome
Partial mole
Treat immediately. Consent is implied in emergency situations


17. Causes of exudative effusion.
Septic or anaphylactic shock
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Nephrolithiasis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


18. Method of calculating fluid repletion in burn patients.
IgA nephropathy (Berger's disease)
Amoxicillin
Neuroleptic malignant syndrome
Parkland formula


19. Autoimmune complication occurring 2-4 weeks post - MI.

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20. Infection of small airways with epidemics in winter and spring.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Avascular necrosis
SSRIs
RSV bronchiolitis


21. Diagnostic test for hypertrophic cardiomyopathy.
Wrist drop - loss of thumb abduction
Renal cell carcinoma (RCC)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Weight loss and OCPs


22. Treatment of hypovolemic shock.
M3
Murphy's sign - seen in acute cholecystitis
Multiple myeloma
Identify cause; fluid and blood repletion


23. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Fatigue and impending respiratory failure
Malignancy and hyperparathyroidism
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Number of deaths from 20 weeks' gestation to birth per 1000 total births


24. Virus associated with aplastic anemia in patients with sickle cell anemia.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Parvovirus B19
IVIG or plasmapheresis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


25. Diagnostic test for hereditary spherocytosis.
Anticoagulation - rate control - cardioversion
Fat - female - fertile - forty - flatulent
OCP and barrier contraception
Osmotic fragility test


26. The three most common causes of fever of unknown origin (FUO).
ACEI
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
CML
Infection - cancer - and autoimmune disease


27. Risk factors for cholelithiasis.
Hypertension - bradycardia - and abnormal respirations
Osgood - Schlatter disease
Metformin
Fat - female - fertile - forty - flatulent


28. Risk factors for DVT.

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29. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Toxoplasma gondii
Neuroleptics
A patient with chest trauma who was previously stable suddenly dies


30. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Observational bias
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Suspect retinoblastoma
Basal cell carcinoma


31. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Emergent laparotomy to repair perforated viscus - likely stomach
Ultrasound
Menometrorrhagia


32. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Menometrorrhagia
'Chocolate cysts -' powder burns
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


33. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Patent ductus arteriosus (PDA)
MCP and PIP joints; DIP joints are spared
Duchenne muscular dystrophy
Conduct disorder


34. Gout - self - mutilation - and choreoathetosis.
ALS
The IR of a disease in a population exposed to a particular factor
Nephrolithiasis
HGPRTase deficiency)


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

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36. 'Doughy skin.'
Hypernatremia
50 cc/hour
A patient's family cannot require that a doctor withhold information from the patient
MS


37. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
IV hydration and loop diuretics (furosemide)
Squamous cell carcinoma
50 cc/hour


38. How to distinguish polycythemia vera from 2
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care
Observational bias
OCPs - danazol - GnRH agonists
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


39. What is the immunodeficiency?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Nephrotic syndrome
Herpes simplex
Chronic granulomatous disease


40. Charcot's triad.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Parvovirus B19
Neurofibromatosis 1
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


41. Medication given to accelerate fetal lung maturity.
Highly sensitive for TB
Naloxone
Betamethasone or dexamethasone
Continuous positive airway pressure


42. Identify key organisms causing diarrhea:
Sporothrix schenckii
Fat - female - fertile - forty - flatulent
Giardia
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


43. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Lesch - Nyhan syndrome (purine salvage problem with
Acute mania. Start a mood stabilizer (e.g. - lithium)
Parkland formula
Out


44. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Fatigue and impending respiratory failure
Infection - cancer - and autoimmune disease
Pentad of TTP


45. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
a - antagonists (phentolamine and phenoxybenzamine)
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Reye's syndrome


46. Epidemics such as influenza
A patient with chest trauma who was previously stable suddenly dies
Biliary tract obstruction
Rett's disorder
Higher incidence


47. Mortality rate?
Menometrorrhagia
Protamine
MCP and PIP joints; DIP joints are spared
Number of deaths per 1000 population


48. Term for heavy bleeding during and between menstrual periods.
Depersonalization disorder
Absence seizures
Menometrorrhagia
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


49. Reynolds' pentad.

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50. Name the organism:
Angina - ST- segment changes on ECG - or ? BP
Edrophonium
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Toxoplasma gondii