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 most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
ETEC
Contact dermatitis
Flumazenil
Basal cell carcinoma


2. Lab values suggestive of menopause.
? serum FSH
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Bacillus cereus
Oral surgery


3. The coagulation parameter affected by warfarin.
OCPs
Parainfluenza virus type 1
Trauma - alcohol withdrawal - brain tumor
PT


4. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Neuroleptic malignant syndrome
Number of deaths from 28 days to one year per 1000 live births
Abdominal ultrasound and CT
Polymyalgia rheumatica


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

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6. Identify key organisms causing diarrhea:
Yersinia
Angina - ST- segment changes on ECG - or ? BP
High reliability - low validity
Alzheimer's and multi - infarct


7. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Rate control with carotid massasge or other vagal stimulation
BP > 140/90 on three separate occasions two weeks apart
Usually resolves spontaneously; may require IVIG and/or corticosteroids


8. The most common cause of bloody nipple discharge.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Metformin
Intraductal papilloma


9. Presence of red cell casts in urine sediment.
Hypernatremia
Glomerulonephritis/nephritic syndrome
Menometrorrhagia
Neuroleptics


10. Eight surgically correctable causes of hypertension.

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11. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Reaction formation
Highly sensitive for TB
High TSH - low T4 - antimicrosomal antibodies
Biliary tract obstruction


12. Treatment of DKA.
Trichomonas vaginitis
Lyme disease - Ixodes tick - doxycycline
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Endometriosis


13. Cold agglutinins.
Trauma; the second most common is berry aneurysm
Mycoplasma
Inevitable abortion
Treat existing heart failure and replace the tricuspid valve


14. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Salmonella
Broca's aphasia. Frontal lobe - left MCA distribution
DI


15. Radiographic evidence of aortic disruption or dissection.
'Chocolate cysts -' powder burns
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


16. Birth rate?
Glomerulonephritis/nephritic syndrome
Oral surgery
Number of live births per 1000 population
Renal cell carcinoma (RCC)


17. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
MS
Number of deaths per 1000 population
Osteoarthritis
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


18. 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
Metformin
Wernicke's encephalopathy due to a deficiency of thiamine
Multiple myeloma


19. Medication given to accelerate fetal lung maturity.
Lung - breast - skin (melanoma) - kidney - GI tract
Hypoparathyroidism
Betamethasone or dexamethasone
Number of deaths from 20 weeks' gestation to birth per 1000 total births


20. Diagnostic test for hereditary spherocytosis.
Lyme disease - Ixodes tick - doxycycline
Bladder rupture or urethral injury
Abdominal ultrasound and CT
Osmotic fragility test


21. Tanner stage 3 in a six-year - old female.
Oral surgery
Beta- blockers - Ca2+ channel blockers - TCAs
Cardiogenic shock
Precocious puberty


22. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Beta- hCG; the most common cause of amenorrhea is pregnancy
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Dissociative fugue


23. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Sulfonamides - antimalarial drugs - fava beans
Fatigue and impending respiratory failure
Mycobacterium tuberculosis
Phencyclidine hydrochloride (PCP) intoxication


24. Nikolsky's sign.
Osteogenesis imperfecta
All - compartment fasciotomy for suspected compartment syndrome
Bullous pemphigoid
Distal radius (Colles' fracture)


25. Hypercholesterolemia treatment that ? flushing and pruritus.
Niacin
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Ophthalmologic exam - CT - and MRI
Lung - breast - skin (melanoma) - kidney - GI tract


26. Treatment of septic shock.
Anticoagulation - rate control - cardioversion
Fluids and antibiotics
Inhaled Beta- agonists and inhaled corticosteroids
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


27. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
Inevitable abortion
Choriocarcinoma
Actinomyces israelii


28. Therapy for polycystic ovarian syndrome.
Oral surgery
Choriocarcinoma
Weight loss and OCPs
Fluid restriction - demeclocycline


29. Presents with a herald patch - Christmas - tree pattern.
Pityriasis rosea
Lesions of 1
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Ampulla of the oviduct


30. Acute - phase treatment for Kawasaki disease.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
A patient's family cannot require that a doctor withhold information from the patient
46 -XX
Basal cell carcinoma


31. Administer to a symptomatic patient to diagnose myasthenia gravis.
Duodenal atresia
Parainfluenza virus type 1
Number of deaths per 1000 population
Edrophonium


32. Reed - Sternberg cells

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33. Chromosomal pattern of a complete mole.
46 -XX
Allergic interstitial nephritis
Nephrotic syndrome
S. aureus


34. Identify key organisms causing diarrhea:
Lobular carcinoma in situ
Salmonella
PT
DI


35. Treatment of tension pneumothorax.
SIADH due to stress
Haemophilus ducreyi
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Immediate needle thoracostomy


36. Key side effects of atypical antipsychotics.
Inevitable abortion
Hypokalemia
Weight gain - type 2 DM - QT prolongation
Pharmacologic stress test (e.g. - dobutamine echo)


37. Perinatal mortality?

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38. The most serious side effect of clozapine.
Uterine atony
Agranulocytosis
Acute mania. Start a mood stabilizer (e.g. - lithium)
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


39. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Cirrhosis - CHF - nephritic syndrome
Hereditary spherocytosis
Nephritic syndrome
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


40. Precipitants of hemolytic crisis in patients with G6PD deficiency.
DM - SLE - and amyloidosis
Sulfonamides - antimalarial drugs - fava beans
Rubella
RCC or other erythropoietin - producing tumor; evaluate with CT scan


41. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2 - analgesia - hydration - and - if severe - transfusion
Dantrolene or bromocriptine
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Dissociative fugue


42. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Beta- blockers - digoxin - calcium channel blockers
Treat immediately. Consent is implied in emergency situations
Phototherapy (mild) or exchange transfusion (severe)
Beta- blockers - Ca2+ channel blockers - TCAs


43. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Diverticulosis
Continuous positive airway pressure
Bacterial meningitis


44. Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
High TSH - low T4 - antimicrosomal antibodies
Clomiphene citrate
Third - degree heart block


45. Antihypertensive for a diabetic patient with proteinuria.
Uremic syndrome seen in patients with renal failure
Establish the ABCs
Trauma - alcohol withdrawal - brain tumor
ACEI


46. 1
? Ca2+ - ? K- - ? phosphate - ? uric acid
Placental abruption and placenta previa
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Hypernatremia


47. Erythema migrans.
Lesion of 1
Streptococcus pneumoniae
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Membranous glomerulonephritis


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

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49. The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
Depersonalization disorder
Cellulitis
Angina - ST- segment changes on ECG - or ? BP


50. Chronic diseases such as SLE
DI
Higher prevalence
Diamond - Blackfan anemia
Lesch - Nyhan syndrome (purine salvage problem with