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 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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2. The most common form of glomerulonephritis.

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3. Treatment for SVC syndrome.
Radiation
CA-125 and transvaginal ultrasound
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Betamethasone or dexamethasone


4. A 35-year - old male has recurrent episodes of palpitations - diaphoresis - and fear of going crazy.
Oral or topical metronidazole
Graves' disease
50 cc/hour
Panic disorder


5. Post - HBV exposure treatment.
B12 deficiency
HBV immunoglobulin
Immediate needle thoracostomy
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


6. Low urine specific gravity in the presence of high serum osmolality.
Pulsus paradoxus (seen in cardiac tamponade)
DI
Alport's syndrome
Ampulla of the oviduct


7. Treatment for mild and severe unconjugated hyperbilirubinemia.
Fluid restriction - demeclocycline
Phototherapy (mild) or exchange transfusion (severe)
Type I (distal) RTA
Parvovirus B19


8. Peaked T waves and widened QRS.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Hyperkalemia
Actinomyces israelii
Phototherapy (mild) or exchange transfusion (severe)


9. 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.
The IR of a disease in a population exposed to a particular factor
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Polymyalgia rheumatica
Psoriasis


10. Treatment of DKA.
Pulsus paradoxus (seen in cardiac tamponade)
Kl
Prerenal
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


11. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
High TSH - low T4 - antimicrosomal antibodies
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
OCP and barrier contraception


12. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Benzodiazepines
Neither
IV penicillin or ampicillin
Endometriosis


13. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Hyperkalemia
Levodopa/carbidopa
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Neuroleptics


14. Supportive treatment for ARDS.
Prerenal
Diphenhydramine or epinephrine 1:1000
Edrophonium
Continuous positive airway pressure


15. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
Third - degree heart block
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
O2 - analgesia - hydration - and - if severe - transfusion


16. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Patent ductus arteriosus (PDA)
Dissociative fugue
1
Niacin


17. Mortality rate?
Glanzmann's thrombasthenia
Number of deaths per 1000 population
Nephritic syndrome
Lyme disease - Ixodes tick - doxycycline


18. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Diamond - Blackfan anemia
Alzheimer's and multi - infarct
a - antagonists (phentolamine and phenoxybenzamine)


19. The most serious side effect of clozapine.
Agranulocytosis
Cardiogenic shock
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


20. Medical treatment for hepatic encephalopathy.
Hypovolemic shock
S. aureus or S. epidermidis.
Anorexia
? protein intake - lactulose - neomycin


21. Name the organism:
Non - Hodgkin's lymphoma
Klebsiella
Rate control with carotid massasge or other vagal stimulation
Beta- blockers - digoxin - calcium channel blockers


22. First - line treatment for otitis media.
Amoxicillin
Oral or topical metronidazole
Number of deaths per 1000 population
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


23. Flat - topped papules.
Pseudomonas
Hypertension - bradycardia - and abnormal respirations
Lichen planus
Glomerulonephritis/nephritic syndrome


24. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
SSRIs
INH - penicillamine - hydralazine - procainamide
Small cell lung cancer (SCLC)
Antipsychotics (neuroleptic malignant syndrome)


25. Treatment for neuroleptic malignant syndrome.
ARDS
Pseudomonas
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Dantrolene or bromocriptine


26. Ring - enhancing brain lesion on CT with seizures
MAOIs
Taenia solium (cysticercosis)
Malignancy and hyperparathyroidism
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


27. The most common cause of hypertension in young women.
OCPs
Anorexia
Choriocarcinoma
Neisseria meningitidis


28. Key side effects of atypical antipsychotics.
Phencyclidine hydrochloride (PCP) intoxication
Number of live births per 1000 women 15-44 years of age
Pseudogout
Weight gain - type 2 DM - QT prolongation


29. CSF findings:
Sulfonamides - antimalarial drugs - fava beans
Aseptic (viral) meningitis
Glanzmann's thrombasthenia
HBV immunoglobulin


30. Classic ECG finding in atrial flutter.

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31. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Malignancy and hyperparathyroidism
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR
Cardiogenic shock
Fatigue and impending respiratory failure


32. The most common cause of bloody nipple discharge.
Nitroprusside
Number of live births per 1000 population
Intraductal papilloma
Parkinson's disease


33. Causes of transudative effusion.
Suspect ankylosing spondylitis. Check HLA- B27
Observational bias
Inhaled Beta- agonists and inhaled corticosteroids
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


34. The most common cause of female infertility.
Retinoic acid
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Endometriosis
Coarctation of the aorta


35. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Nephritic syndrome
Naloxone
Hypotension and bradycardia
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


36. The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
Central pontine myelinolysis
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Actinomyces israelii


37. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anticoagulation - rate control - cardioversion
Anemia of chronic disease
Endometrial or estrogen receptor - breast cancer
Ophthalmologic exam - CT - and MRI


38. Name the organism:
Bacterial meningitis
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Streptococcus pneumoniae
Haemophilus ducreyi


39. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
TICS
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


40. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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41. Name the organism:
Pseudomonas
HGPRTase deficiency)
Graves' disease
Non - Hodgkin's lymphoma


42. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Iron deficiency anemia
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Levodopa/carbidopa


43. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
ARDS
Conversion disorder
Immediate needle thoracostomy
Bladder rupture or urethral injury


44. Treatment of SIADH?
Graves' disease
Fluid restriction - demeclocycline
Neuroblastoma
Bacterial meningitis


45. Classic CXR findings for pulmonary edema.

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46. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Fluid restriction - demeclocycline
TICS
Ophthalmologic exam - CT - and MRI
Postinfectious glomerulonephritis


47. Odds ratio?
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Chronic lymphocytic leukemia (CLL)
N- acetylcysteine
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


48. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Duchenne muscular dystrophy
Diamond - Blackfan anemia
Pregnant women. Treat this group aggressively because of potential complications


49. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Cellulitis
Duchenne muscular dystrophy


50. Exophthalmos - pretibial myxedema - and ? TSH.

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