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. Natural history of a leiomyoma.
Mycoplasma
Regresses after menopause
Elevated ICP - RBCs - xanthochromia
Confounding variable


2. What should always be done prior to LP?
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
MAOIs
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Check for ? ICP; look for papilledema


3. Amenorrhea - bradycardia - and abnormal body image in a young female.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Anorexia
Cellulitis
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms


4. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Sarcoidosis
Surfactant deficiency
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


5. 'Doughy skin.'
Hypernatremia
Pityriasis versicolor
Signs and symptoms of hypercalcemia
Consider Fitz - Hugh - Curtis syndrome


6. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
105 bacteria/mL
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


7. ? risk of what infection with silicosis?
Mycobacterium tuberculosis
Spinal stenosis
Asherman's syndrome
Lesion of 1


8. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Wegener's granulomatosis and Goodpasture's syndrome
Antipsychotics (neuroleptic malignant syndrome)
Elevated ICP - RBCs - xanthochromia
Type I (distal) RTA


9. Confusion - confabulation - ophthalmoplegia - ataxia.

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10. Treatment of cardiogenic shock.
Pemphigus vulgaris
Identify cause; pressors (e.g. - dobutamine)
Edrophonium
Benzodiazepines


11. Name the organism:
Anemia of chronic disease
Sporothrix schenckii
Panic disorder
Fanconi's anemia


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

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13. What is the immunodeficiency?
Actinomyces israelii
Beta- blockers - digoxin - calcium channel blockers
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Chronic granulomatous disease


14. Honey- crusted lesions.
Impetigo
OCPs
B12 deficiency
Amoxicillin


15. Tests to rule out shaken baby syndrome.
Precocious puberty
DM - SLE - and amyloidosis
Fatigue and impending respiratory failure
Ophthalmologic exam - CT - and MRI


16. What % lesion is an indication for carotid endarterectomy?
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
High reliability - low validity
Contact dermatitis
Seventy percent if the stenosis is symptomatic


17. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Sarcoidosis
OCP and barrier contraception
Flumazenil
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


18. A patient presents with recent PID with RUQ pain.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Levodopa/carbidopa
Consider Fitz - Hugh - Curtis syndrome
Out


19. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Amoxicillin
Osgood - Schlatter disease
Trauma - alcohol withdrawal - brain tumor
Lead - time bias


20. Eosinophils in urine sediment.
Pemphigus vulgaris
Restrictive pulmonary disease
Allergic interstitial nephritis
Hypokalemia


21. CSF findings:
Subarachnoid hemorrhage (SAH)
Antipsychotics (neuroleptic malignant syndrome)
? Ca2+ - ? K- - ? phosphate - ? uric acid
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


22. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
Sulfonamides - antimalarial drugs - fava beans
Betamethasone or dexamethasone
Hypoparathyroidism


23. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides - antimalarial drugs - fava beans
OCP and barrier contraception
Identify cause; fluid and blood repletion
Number of deaths from birth to 28 days per 1000 live births


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

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25. Cause of neonatal RDS.
ARDS
Oral surgery
Rett's disorder
Surfactant deficiency


26. Lab values suggestive of menopause.
Retrograde cystourethrogram
Acne vulgaris
MCP and PIP joints; DIP joints are spared
? serum FSH


27. Antihypertensive for a diabetic patient with proteinuria.
Multiple myeloma
Trauma - alcohol withdrawal - brain tumor
ACEI
Kegel exercises - estrogen - pessaries for stress incontinence


28. Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Infection - cancer - and autoimmune disease
No. Parental consent is not necessary for the medical treatment of pregnant minors
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


29. Type of ARF in a patient with FeNa < 1%.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Abdominal ultrasound and CT
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Prerenal


30. Name the organism:
Type I (distal) RTA
Pseudomonas
Out
Stable - unruptured ectopic pregnancy of &lt; 3.5 cm at &lt; 6 weeks' gestation


31. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Consider Fitz - Hugh - Curtis syndrome
Angina is new - is worsening - or occurs at rest
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones


32. Electrolyte changes in tumor lysis syndrome.
Benzodiazepines
? Ca2+ - ? K- - ? phosphate - ? uric acid
Intraductal papilloma
Seborrheic keratosis


33. 'Dewdrop on a rose petal.'
IVIG or plasmapheresis
Isolation
Lesions of 1
Acute myelogenous leukemia (AML)


34. Symptoms of placenta previa.
OCPs - danazol - GnRH agonists
The IR of a disease in a population exposed to a particular factor
Incidence and prevalence
Self - limited - painless vaginal bleeding


35. Caf
Neurofibromatosis 1
Hypertension - bradycardia - and abnormal respirations
Type IV (distal) RTA
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


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

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37. Mortality rate?
Number of deaths per 1000 population
Edrophonium
Klebsiella
Never


38. Causes of hypoxemia.
Pemphigus vulgaris
Hypertension - bradycardia - and abnormal respirations
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Edrophonium


39. Annual screening for women with a strong family history of ovarian cancer.
ACEI
68% - 95.5% - 99.7%
CA-125 and transvaginal ultrasound
Seminoma


40. 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.
Polymyalgia rheumatica
Low - voltage - diffuse ST- segment elevation
? Ca2+ - ? K- - ? phosphate - ? uric acid
Incidence and prevalence


41. An active 13-year - old boy has anterior knee pain. Diagnosis?
Parkland formula
Osgood - Schlatter disease
30 cc/hour
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


42. Describe a test that consistently gives identical results - but the results are wrong.
Biliary tract obstruction
High reliability - low validity
Precocious puberty
Weight gain - type 2 DM - QT prolongation


43. The most common histology of bladder cancer.
Antipsychotics (neuroleptic malignant syndrome)
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Transitional cell carcinoma
E. coli O157:H7


44. Treatment of supraventricular tachycardia (SVT).
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Klebsiella
Rate control with carotid massasge or other vagal stimulation
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


45. The most common type of testicular cancer.
Fat - female - fertile - forty - flatulent
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Seminoma


46. Treatment for malignant hypertension.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Lesch - Nyhan syndrome (purine salvage problem with
Nitroprusside
Pulsus paradoxus (seen in cardiac tamponade)


47. Signs suggesting radial nerve damage with humeral fracture.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
'Chocolate cysts -' powder burns
a - antagonists (phentolamine and phenoxybenzamine)
Wrist drop - loss of thumb abduction


48. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
1
Edrophonium
Yersinia


49. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
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
Yersinia
Iron deficiency anemia
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


50. Eight surgically correctable causes of hypertension.

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