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. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Patient on dopamine antagonist
Confounding variable
Ampulla of the oviduct
Third - degree heart block


2. A congenital heart disease that cause 2
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Ampulla of the oviduct
Coarctation of the aorta
Pentad of TTP


3. Treatment for atrial fibrillation.
Pheochromocytoma
Lobular carcinoma in situ
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Anticoagulation - rate control - cardioversion


4. Lab values suggestive of menopause.
< 7.0
? serum FSH
Precocious puberty
High reliability - low validity


5. Name the organism:
Central pontine myelinolysis
Klebsiella
Seborrheic dermatitis. Treat with antifungals
a - antagonists (phentolamine and phenoxybenzamine)


6. Caf
Seborrheic keratosis
Frotteurism (a paraphilia)
Treat immediately. Consent is implied in emergency situations
Neurofibromatosis 1


7. The diagnostic test for pulmonary embolism.
V/Q scan
CF or Hirschsprung's disease
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Colposcopy and endocervical curettage


8. Name the organism:
46 -XX
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Haemophilus ducreyi
Allergic interstitial nephritis


9. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Mallory- Weiss
Seborrheic keratosis
Iron deficiency anemia
Substance abuse


10. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Observational bias
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Low - voltage - diffuse ST- segment elevation
Third - degree heart block


11. 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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12. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Type II (proximal) RTA
Acute mania. Start a mood stabilizer (e.g. - lithium)
Osteogenesis imperfecta
Kegel exercises - estrogen - pessaries for stress incontinence


13. Confusion - confabulation - ophthalmoplegia - ataxia.

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14. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Acute pancreatitis
Factitious disorder (Munchausen syndrome)
Contact dermatitis
Toxoplasma gondii


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

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16. PFT showing ? FEV1/FVC.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Obstructive pulmonary disease (e.g. - asthma)
Sensitivity


17. Identify key organisms causing diarrhea:
Salmonella
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


18. The most common form of nephritic syndrome.
Hypernatremia
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Membranous glomerulonephritis
Mallory- Weiss


19. Acute - phase treatment for Kawasaki disease.
AP chest - AP/lateral C- spine - AP pelvis
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
High reliability - low validity


20. Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
a - antagonists (phentolamine and phenoxybenzamine)
Basal cell carcinoma
Yersinia


21. Eosinophils in urine sediment.
Parainfluenza virus type 1
Allergic interstitial nephritis
Low - voltage - diffuse ST- segment elevation
IVIG or plasmapheresis


22. A 'blueberry muffin' rash is characteristic of what congenital infection?
PT
Giardia
A patient's family cannot require that a doctor withhold information from the patient
Rubella


23. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Seborrheic dermatitis. Treat with antifungals
Actinomyces israelii
Pemphigus vulgaris
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


24. Inspiratory arrest during palpation of the RUQ.

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25. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Niacin
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Salmonella
Cellulitis


26. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Multiple myeloma
Conduct disorder
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Niacin


27. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Out
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
Type I (distal) RTA
V/Q scan


28. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Surfactant deficiency
Diphenhydramine or epinephrine 1:1000
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


29. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Infection - febrile seizures - trauma - idiopathic
Hypertension - bradycardia - and abnormal respirations
Nephrotic syndrome


30. Cause of neonatal RDS.
Squamous cell carcinoma
CF or Hirschsprung's disease
Consider Fitz - Hugh - Curtis syndrome
Surfactant deficiency


31. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Paget's disease
Number of deaths per 1000 population
Septic or anaphylactic shock


32. First - line treatment for otitis media.
OCPs - danazol - GnRH agonists
Seborrheic dermatitis. Treat with antifungals
Transitional cell carcinoma
Amoxicillin


33. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
Consider Fitz - Hugh - Curtis syndrome
Neurofibromatosis 1
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


34. CSF findings:
Alopecia areata (autoimmune process)
Coarctation of the aorta
Aseptic (viral) meningitis
Third - degree heart block


35. Chromosomal pattern of a complete mole.
46 -XX
Duchenne muscular dystrophy
Wegener's granulomatosis and Goodpasture's syndrome
Giardia


36. Infant mortality?
Weight loss and OCPs
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Squamous cell carcinoma
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


37. 'Dewdrop on a rose petal.'
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Pasteurella multocida
Conflict of interest
Lesions of 1


38. 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
O2 - analgesia - hydration - and - if severe - transfusion
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Actinic keratosis


39. An agent that reverses the effects of heparin.
Hyperkalemia
IgA nephropathy (Berger's disease)
Stasis - hypercoagulability - endothelial damage
Protamine


40. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
IV penicillin or ampicillin
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Postinfectious glomerulonephritis


41. The most common cause of postpartum hemorrhage.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Conversion disorder
Uterine atony


42. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
Squamous cell carcinoma
Pseudomonas
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


43. What is the immunodeficiency?
Placental abruption and placenta previa
Chronic granulomatous disease
Flumazenil
Uterine massage; if that fails - give oxytocin


44. ECG findings suggesting MI.
Hypoxia and hypocarbia
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Bruton's X- linked agammaglobulinemia
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


45. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Glanzmann's thrombasthenia
Kegel exercises - estrogen - pessaries for stress incontinence


46. A fall in systolic BP of > 10 mmHg with inspiration.
Postinfectious glomerulonephritis
Pulsus paradoxus (seen in cardiac tamponade)
Alport's syndrome
'Sawtooth' P waves


47. True or false: Once patients sign a statement giving consent - they must continue treatment.
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
Mallory- Weiss
Absence seizures
46 -XX


48. What is the immunodeficiency?

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49. Treatment for acute coronary syndrome.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Febrile seizures (roseola infantum)
Klebsiella


50. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Femoral hernia
Fatigue and impending respiratory failure
High TSH - low T4 - antimicrosomal antibodies
Check for ? ICP; look for papilledema