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. An antidiabetic agent associated with lactic acidosis.
Stasis - hypercoagulability - endothelial damage
Oral surgery
Metformin
ALS


2. Honeycomb pattern on CXR. Diagnosis? Treatment?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Hyperkalemia
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Nephrogenic diabetes insipidus (DI)


3. The most common causes of hypercalcemia.
Crohn's disease
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Malignancy and hyperparathyroidism
IV hydration and loop diuretics (furosemide)


4. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Osgood - Schlatter disease
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


5. Classic ECG findings in pericarditis.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Emergent laparotomy to repair perforated viscus - likely stomach
Low - voltage - diffuse ST- segment elevation
Inevitable abortion


6. Identify key organisms causing diarrhea:
Factor V Leiden mutation
Pemphigus vulgaris
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
E. coli O157:H7


7. Symptoms of placental abruption.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Rett's disorder
Continuous - painful vaginal bleeding
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


8. Findings in 3
Angina - ST- segment changes on ECG - or ? BP
CA-125 and transvaginal ultrasound
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Identify cause; pressors (e.g. - dobutamine)


9. Lab findings in Hashimoto's thyroiditis.
Amoxicillin
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Incidence and prevalence
High TSH - low T4 - antimicrosomal antibodies


10. Glomerulonephritis with hemoptysis.

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11. Eight surgically correctable causes of hypertension.

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12. The most frequent presentation of intracranial neoplasm.
Panic disorder
Headache
105 bacteria/mL
Higher prevalence


13. Causes of hypoxemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Pseudogout
Lead - time bias
Dantrolene or bromocriptine


14. RTA associated with aldosterone defect.
Type IV (distal) RTA
Number of deaths per 1000 population
Mallory- Weiss
SCLC


15. Identify key organisms causing diarrhea:
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
IV benzodiazepine
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Pityriasis versicolor


16. Birth rate?
Actinomyces israelii
Number of live births per 1000 population
Endometrial biopsy
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


17. Treatment of central DI.
Administration of DDAVP ? serum osmolality and free water restriction
Pityriasis versicolor
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Excessive EtOH


18. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Number of live births per 1000 population
Hypoparathyroidism
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Hypernatremia


19. Characteristics of 2

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20. Gout - self - mutilation - and choreoathetosis.
HGPRTase deficiency)
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Fatigue and impending respiratory failure
Elevated ICP - RBCs - xanthochromia


21. Hematuria - flank pain - and palpable flank mass.
Renal cell carcinoma (RCC)
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
HBV immunoglobulin
Seventy percent if the stenosis is symptomatic


22. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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23. Tests to rule out shaken baby syndrome.
CA-125 and transvaginal ultrasound
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Ophthalmologic exam - CT - and MRI
Dissociative fugue


24. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Ulcerative colitis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Toxoplasma gondii


25. A newborn female has continuous 'machinery murmur.'
Pseudomonas
Malignancy and hyperparathyroidism
V/Q scan
Patent ductus arteriosus (PDA)


26. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Hypocalcemia
Alopecia areata (autoimmune process)
Levodopa/carbidopa
Glomerulonephritis/nephritic syndrome


27. Bone is fractured in fall on outstretched hand.

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28. Defect in an X- linked syndrome with mental retardation -
Lesch - Nyhan syndrome (purine salvage problem with
Never
DM - SLE - and amyloidosis
Herpes simplex


29. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Confounding variable
Duchenne muscular dystrophy
Observational bias


30. Bilious emesis within hours after the first feeding.
Incidence and prevalence
Small cell lung cancer (SCLC)
Duodenal atresia
Membranous glomerulonephritis


31. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
? serum FSH
Lichen sclerosus
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Signs and symptoms of hypercalcemia


32. The most common cause of hypothyroidism.

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33. A fall in systolic BP of > 10 mmHg with inspiration.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Fat - female - fertile - forty - flatulent
46 -XX
Pulsus paradoxus (seen in cardiac tamponade)


34. Risk factors for DVT.

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35. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Yersinia
Third - degree heart block
False. Withdrawing and withholding life are the same from an ethical standpoint
Treat immediately. Consent is implied in emergency situations


36. A young patient with a family history of sudden death collapses and dies while exercising.
CML
Klebsiella
Hypertrophic cardiomyopathy
ETEC


37. 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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38. Treatment for Guillain - Barr
IVIG or plasmapheresis
Antipsychotics (neuroleptic malignant syndrome)
Weight loss and OCPs
Pseudomonas


39. A homeless child is small for his age and has peeling skin and a swollen belly.
Cerebral berry aneurysms (AD PCKD)
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Kwashiorkor (protein malnutrition)
Weight loss and OCPs


40. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Low - voltage - diffuse ST- segment elevation
Nephrolithiasis
Pseudomonas


41. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Femoral hernia
Substance abuse
SIADH due to stress
Hereditary spherocytosis


42. Medication given to accelerate fetal lung maturity.
HIDA scan
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Betamethasone or dexamethasone
1


43. A violent patient has vertical and horizontal nystagmus.
Identify cause; fluid and blood repletion
Isolation
< 7.0
Phencyclidine hydrochloride (PCP) intoxication


44. Name the organism:
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Identify cause; fluid and blood repletion
Haemophilus ducreyi
Weight gain - type 2 DM - QT prolongation


45. Three systemic diseases ? nephrotic syndrome.
Lichen planus
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
DM - SLE - and amyloidosis
Betamethasone or dexamethasone


46. The most common cause of Cushing's syndrome.

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47. Shortest AP diameter of the pelvis.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
'Sawtooth' P waves
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
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


48. Medications and viruses that ? aplastic anemia.
Patent ductus arteriosus (PDA)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
S. aureus or S. epidermidis.
Klebsiella


49. Name the defense mechanism:
Displacement
Signs and symptoms of hypercalcemia
Diamond - Blackfan anemia
Kl


50. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Small cell lung cancer (SCLC)
Actinic keratosis
MCP and PIP joints; DIP joints are spared
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins