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. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Transitional cell carcinoma
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
RCC or other erythropoietin - producing tumor; evaluate with CT scan


2. 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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3. Hernia with highest risk of incarceration
Femoral hernia
Polymyalgia rheumatica
Sporothrix schenckii
Streptococcus pneumoniae


4. Drugs that slow AV node transmission.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
All - compartment fasciotomy for suspected compartment syndrome
Ophthalmologic exam - CT - and MRI
Beta- blockers - digoxin - calcium channel blockers


5. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Hypertension - bradycardia - and abnormal respirations
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Depersonalization disorder


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

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7. Chromosomal pattern of a complete mole.
46 -XX
The IR of a disease in a population exposed to a particular factor
Continuous - painful vaginal bleeding
Infection - febrile seizures - trauma - idiopathic


8. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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9. A patient fails to lactate after an emergency C- section with marked blood loss.

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10. ECG findings suggesting MI.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
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
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
HBV - DTaP - Hib - IPV - PCV


11. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Osmotic fragility test
Type I (distal) RTA
Mycobacterium tuberculosis
Klebsiella


12. Treatment for AML M3.
S. aureus or S. epidermidis.
Toxoplasma gondii
Retinoic acid
HBV immunoglobulin


13. Identify key organisms causing diarrhea:
Salmonella
Isolation
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Number of deaths from 28 days to one year per 1000 live births


14. The most common inherited cause of hypercoagulability.
Fat - female - fertile - forty - flatulent
Factor V Leiden mutation
Colposcopy and endocervical curettage
Identify cause; fluid and blood repletion


15. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Endometrial or estrogen receptor - breast cancer
Uterine atony
Type I (distal) RTA
Factitious disorder (Munchausen syndrome)


16. A neonate has meconium ileus.

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17. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
TICS
Establish the ABCs
Suspect retinoblastoma


18. A 'blueberry muffin' rash is characteristic of what congenital infection?
Herpes simplex
Allergic interstitial nephritis
Transitional cell carcinoma
Rubella


19. Classic causes of drug - induced hepatitis.
Ophthalmologic exam - CT - and MRI
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
IVIG or plasmapheresis
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


20. The most common cause of SAH.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Trauma; the second most common is berry aneurysm
A patient with chest trauma who was previously stable suddenly dies
Hypovolemic shock


21. Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Squamous cell carcinoma
Sheehan's syndrome (postpartum pituitary necrosis)
Colposcopy and endocervical curettage


22. Causes of transudative effusion.
Confounding variable
Polymyalgia rheumatica
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Hypoparathyroidism


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

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24. Infection of small airways with epidemics in winter and spring.
HGPRTase deficiency)
RSV bronchiolitis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
? serum FSH


25. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
They can mask symptoms of hypoglycemia
Edrophonium
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


26. The diagnostic test for pulmonary embolism.
V/Q scan
Small cell lung cancer (SCLC)
A patient with chest trauma who was previously stable suddenly dies
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


27. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
CML
Cirrhosis - CHF - nephritic syndrome
ARDS


28. Definition of hypertension.
Anemia of chronic disease
Legionella pneumonia
BP > 140/90 on three separate occasions two weeks apart
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


29. Radiographic indications for surgery in patients with acute abdomen.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Trauma - alcohol withdrawal - brain tumor
Central pontine myelinolysis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


30. HUS triad?
Glanzmann's thrombasthenia
Anemia - thrombocytopenia - and acute renal failure
'Sawtooth' P waves
Contact dermatitis


31. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Edrophonium
Factitious disorder (Munchausen syndrome)
HIDA scan
Elevated ICP - RBCs - xanthochromia


32. What is the immunodeficiency?
Chronic granulomatous disease
Retrograde cystourethrogram
Pityriasis versicolor
Asymmetry - border irregularity - color variation - large diameter


33. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Uremic syndrome seen in patients with renal failure
Ultrasound
Elevated ICP - RBCs - xanthochromia
Suspect ankylosing spondylitis. Check HLA- B27


34. Red plaques with silvery- white scales and sharp margins.
All - compartment fasciotomy for suspected compartment syndrome
Klebsiella
Psoriasis
Acne vulgaris


35. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Non - Hodgkin's lymphoma
Factor V Leiden mutation
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


36. Classic ultrasound and gross appearance of complete hydatidiform mole.

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37. The mainstay of Parkinson's therapy.
Levodopa/carbidopa
Fatigue and impending respiratory failure
Seminoma
Hypertension - bradycardia - and abnormal respirations


38. Four signs and symptoms of streptococcal pharyngitis.
Dissociative fugue
Postinfectious glomerulonephritis
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


39. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Hashimoto's thyroiditis
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Neuroleptic malignant syndrome


40. Lab values suggestive of menopause.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Depersonalization disorder
Duchenne muscular dystrophy
? serum FSH


41. Inflammatory disease of the colon with ? risk of colon cancer.
Ulcerative colitis
Neuroleptics
Osteogenesis imperfecta
Low - voltage - diffuse ST- segment elevation


42. Acid - base disturbance commonly seen in pregnant women.
Depersonalization disorder
Respiratory alkalosis
Non - Hodgkin's lymphoma
Wiskott - Aldrich syndrome


43. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Spinal stenosis
Suspect retinoblastoma
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


44. Cross - sectional survey
Placental abruption and placenta previa
Prevalence
Fluids and antibiotics
Diamond - Blackfan anemia


45. Describe a test that consistently gives identical results - but the results are wrong.
High reliability - low validity
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Dissociative fugue
Osteogenesis imperfecta


46. A 49-year - old male presents with acute - onset flank pain and hematuria.
Fat - female - fertile - forty - flatulent
Diamond - Blackfan anemia
Nephrolithiasis
Lichen planus


47. Medical treatment for hepatic encephalopathy.
? protein intake - lactulose - neomycin
Exercise stress treadmill with ECG
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Type IV (distal) RTA


48. 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.
Panic disorder
SSRIs
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Varicella zoster


49. Test to rule out urethral injury.
Retrograde cystourethrogram
Lesions of 1
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Hypoxia and hypocarbia


50. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Inhaled Beta- agonists and inhaled corticosteroids
Wrist drop - loss of thumb abduction
Patient on dopamine antagonist
Asherman's syndrome