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. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Fanconi's anemia
Pseudomonas
Inevitable abortion
Kegel exercises - estrogen - pessaries for stress incontinence


2. Chvostek's and Trousseau's signs.
Prevalence
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Cardiogenic shock
Hypocalcemia


3. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Endometriosis
Fatigue and impending respiratory failure
Factor V Leiden mutation
Legionella pneumonia


4. Testicular cancer associated with Beta- hCG - AFP.
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Renal cell carcinoma (RCC)
Hypovolemic shock
Choriocarcinoma


5. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2 - analgesia - hydration - and - if severe - transfusion
Distal radius (Colles' fracture)
Pseudomonas
Squamous cell carcinoma


6. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Bullous pemphigoid
Colposcopy and endocervical curettage
Osteoarthritis


7. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Basal cell carcinoma
Seborrheic keratosis
Levodopa/carbidopa


8. Diagnostic test for hypertrophic cardiomyopathy.
Hypotension and bradycardia
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
High reliability - low validity
Hypotension - distant heart sounds - and JVD


9. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Fatigue and impending respiratory failure
Endometrial biopsy
Obstructive pulmonary disease (e.g. - asthma)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


10. Risk factors for DVT.

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11. Treatment for bacterial vaginosis.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Oral or topical metronidazole
Parvovirus B19
Duchenne muscular dystrophy


12. Fetal mortality?

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13. Tanner stage 3 in a six-year - old female.
Partial mole
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Precocious puberty
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


14. Treatment of cardiogenic shock.
Diamond - Blackfan anemia
Impetigo
Anorexia
Identify cause; pressors (e.g. - dobutamine)


15. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Yersinia
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Chronic granulomatous disease


16. The mainstay of Parkinson's therapy.
Levodopa/carbidopa
Number of live births per 1000 population
Sporothrix schenckii
Conduct disorder


17. T- wave flattening and U waves.
Elevated ICP - RBCs - xanthochromia
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Hypokalemia
Mycoplasma


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

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19. Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Cerebral berry aneurysms (AD PCKD)
Fat - female - fertile - forty - flatulent
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


20. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
INH - penicillamine - hydralazine - procainamide
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
HBV - DTaP - Hib - IPV - PCV


21. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conversion disorder
Mallory- Weiss
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Self - limited - painless vaginal bleeding


22. Virus associated with aplastic anemia in patients with sickle cell anemia.
Absence seizures
1
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Parvovirus B19


23. Treatment of DKA.
HBV - DTaP - Hib - IPV - PCV
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Osteogenesis imperfecta
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


24. Aplastic crisis in sickle cell disease.
Wiskott - Aldrich syndrome
Parvovirus B19
Hypoxia and hypocarbia
Prerenal


25. Chronic diseases such as SLE
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Lesch - Nyhan syndrome (purine salvage problem with
Higher prevalence


26. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
Naloxone
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Neuroblastoma


27. Treatment for ventricular fibrillation.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
False. Withdrawing and withholding life are the same from an ethical standpoint
Immediate cardioversion
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


28. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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29. Acid - base disturbance commonly seen in pregnant women.
V/Q scan
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Respiratory alkalosis
PT


30. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Neuroleptics
Parainfluenza virus type 1
Weight loss and OCPs
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


31. The most common form of glomerulonephritis.

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32. Combined UMN and LMN disorder.
ALS
V/Q scan
Lung - breast - skin (melanoma) - kidney - GI tract
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


33. The most common cause of female infertility.
Continuous positive airway pressure
Hyperkalemia
Metformin
Endometriosis


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

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35. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Membranous glomerulonephritis
Obstructive pulmonary disease (e.g. - asthma)
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Pityriasis rosea


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

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37. Precipitants of hemolytic crisis in patients with G6PD deficiency.
HIDA scan
Alzheimer's and multi - infarct
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Sulfonamides - antimalarial drugs - fava beans


38. Supportive treatment for ARDS.
Nitroprusside
Continuous positive airway pressure
Febrile seizures (roseola infantum)
The IR of a disease in a population exposed to a particular factor


39. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Mycoplasma
Hypertrophic cardiomyopathy
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Hypotension and bradycardia


40. What should always be done prior to LP?
Isolation
Check for ? ICP; look for papilledema
Type IV (distal) RTA
OCP and barrier contraception


41. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
A patient with chest trauma who was previously stable suddenly dies
Parvovirus B19
Osteogenesis imperfecta


42. Treatment of tension pneumothorax.
Immediate needle thoracostomy
E. coli O157:H7
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Kl


43. Cause of neonatal RDS.
Obstructive pulmonary disease (e.g. - asthma)
Pregnant women. Treat this group aggressively because of potential complications
Surfactant deficiency
INH - penicillamine - hydralazine - procainamide


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

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45. A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
Oral surgery
Chronic granulomatous disease
1


46. Cross - sectional survey
Actinomyces israelii
Prevalence
Chronic granulomatous disease
Neither


47. Four signs and symptoms of streptococcal pharyngitis.
Fluids and antibiotics
Pentad of TTP
Amoxicillin
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


48. Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
S. aureus or S. epidermidis.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Parainfluenza virus type 1


49. Joints in the hand affected in rheumatoid arthritis.
Placental abruption and placenta previa
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
MCP and PIP joints; DIP joints are spared
Pregnant women. Treat this group aggressively because of potential complications


50. Classic physical findings for endocarditis.

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