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. CSF findings with SAH.
Pulsus paradoxus (seen in cardiac tamponade)
Restrictive pulmonary disease
Elevated ICP - RBCs - xanthochromia
MCP and PIP joints; DIP joints are spared


2. Sentinel loop on AXR.
Conduct disorder
Acute pancreatitis
Headache
Anemia - thrombocytopenia - and acute renal failure


3. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Rett's disorder
Conversion disorder
Hypotension - distant heart sounds - and JVD
50 cc/hour


4. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Neisseria meningitidis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Type I (distal) RTA


5. Goal hemoglobin A1c for a patient with DM.
Acute mania. Start a mood stabilizer (e.g. - lithium)
? protein intake - lactulose - neomycin
< 7.0
Check for ? ICP; look for papilledema


6. Complication of overly rapid correction of hyponatremia.
Sensitivity
AP chest - AP/lateral C- spine - AP pelvis
Normal
Central pontine myelinolysis


7. Low urine specific gravity in the presence of high serum osmolality.
Central pontine myelinolysis
Phencyclidine hydrochloride (PCP) intoxication
DI
MS


8. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Selective IgA deficiency
Osteogenesis imperfecta
Rubella
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


9. Name the organism:
N- acetylcysteine
Salmonella
Pemphigus vulgaris
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


10. When can a physician refuse to continue treating a patient on the grounds of futility?
Selective IgA deficiency
Pseudomonas
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
Flumazenil


11. An agent that reverses the effects of heparin.
Contact dermatitis
Partial mole
Protamine
Hypoparathyroidism


12. Infection of small airways with epidemics in winter and spring.
Pasteurella multocida
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
RSV bronchiolitis
Bruton's X- linked agammaglobulinemia


13. Glomerulonephritis with hemoptysis.

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14. The most common 1
Multiple myeloma
Alport's syndrome
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


15. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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16. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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17. The most common 1
Actinomyces israelii
Reaction formation
Lung - breast - skin (melanoma) - kidney - GI tract
Parvovirus B19


18. A crescent - shaped hyperdensity on CT that does not cross the midline.
Kwashiorkor (protein malnutrition)
Lesch - Nyhan syndrome (purine salvage problem with
Squamous cell carcinoma
Subdural hematoma


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

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20. Medical treatment for hepatic encephalopathy.
Anticoagulation - rate control - cardioversion
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
SIADH due to stress
? protein intake - lactulose - neomycin


21. Treatment of central DI.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Administration of DDAVP ? serum osmolality and free water restriction
Acute mania. Start a mood stabilizer (e.g. - lithium)
Folate deficiency


22. Signs of neurogenic shock.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Hypotension and bradycardia
False. Withdrawing and withholding life are the same from an ethical standpoint


23. Reynolds' pentad.

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24. Signs suggesting radial nerve damage with humeral fracture.
1
Wrist drop - loss of thumb abduction
Clomiphene citrate
Broca's aphasia. Frontal lobe - left MCA distribution


25. Name the organism:
Hodgkin's lymphoma
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Pseudomonas
? protein intake - lactulose - neomycin


26. Sensitive tests have few false negatives and are used to rule _____ a disease.
Antipsychotics (neuroleptic malignant syndrome)
Trauma - alcohol withdrawal - brain tumor
Out
Weight gain - type 2 DM - QT prolongation


27. Complication of scaphoid fracture.
Avascular necrosis
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Inevitable abortion
Prerenal


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

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29. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Nephritic syndrome
OCPs - danazol - GnRH agonists
Identify cause; fluid and blood repletion
Contact dermatitis


30. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Hypoparathyroidism
Respiratory alkalosis
Hypocalcemia


31. Term for heavy bleeding during and between menstrual periods.
Renal cell carcinoma (RCC)
Nephrogenic diabetes insipidus (DI)
Menometrorrhagia
? serum FSH


32. Radiographic evidence of aortic disruption or dissection.
Selective IgA deficiency
Check for ? ICP; look for papilledema
Regression
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus


33. ? risk of what infection with silicosis?
Self - limited - painless vaginal bleeding
MAOIs
Nephritic syndrome
Mycobacterium tuberculosis


34. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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35. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Angina - ST- segment changes on ECG - or ? BP
105 bacteria/mL
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Low - voltage - diffuse ST- segment elevation


36. The most common causes of hypercalcemia.
Dressler's syndrome: fever - pericarditis - ? ESR
Chronic lymphocytic leukemia (CLL)
Malignancy and hyperparathyroidism
Seventy percent if the stenosis is symptomatic


37. HUS triad?
Normal
IV hydration and loop diuretics (furosemide)
Anemia - thrombocytopenia - and acute renal failure
Inevitable abortion


38. Amenorrhea - bradycardia - and abnormal body image in a young female.
Anorexia
Campylobacter
Phototherapy (mild) or exchange transfusion (severe)
Naloxone


39. First step in the management of a patient with acute GI bleed.
Acute mania. Start a mood stabilizer (e.g. - lithium)
Osgood - Schlatter disease
Establish the ABCs
Malingering


40. An antidiabetic agent associated with lactic acidosis.
Metformin
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Pregnant women. Treat this group aggressively because of potential complications
Biliary tract obstruction


41. Eosinophils in urine sediment.
Cardiogenic shock
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Polymyalgia rheumatica
Allergic interstitial nephritis


42. 'Cradle cap.'
Lesions of 1
A patient with chest trauma who was previously stable suddenly dies
Actinomyces israelii
Seborrheic dermatitis. Treat with antifungals


43. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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44. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
? serum FSH
Observational bias
Nephrotic syndrome
Hyperkalemia


45. Cannon 'a' waves.
Third - degree heart block
Graves' disease
< 7.0
CF or Hirschsprung's disease


46. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Amoxicillin
Duchenne muscular dystrophy
Biliary tract obstruction
Glanzmann's thrombasthenia


47. After a minor fender bender - a man wears a neck brace and requests permanent disability.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Malingering
Immediate needle thoracostomy
Sheehan's syndrome (postpartum pituitary necrosis)


48. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
SSRIs
ACEI
Ampulla of the oviduct
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


49. 'Stones - bones - groans - psychiatric overtones.'
Fatigue and impending respiratory failure
Signs and symptoms of hypercalcemia
Surfactant deficiency
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


50. Treatment for atrial fibrillation.
Exercise stress treadmill with ECG
Anticoagulation - rate control - cardioversion
HIDA scan
Ultrasound