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. Inspiratory arrest during palpation of the RUQ.

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2. Postnatal mortality?
Factor V Leiden mutation
Number of deaths from 28 days to one year per 1000 live births
Transitional cell carcinoma
Anemia - thrombocytopenia - and acute renal failure


3. The 6 P's of ischemia due to peripheral vascular disease.
Squamous cell carcinoma
Duchenne muscular dystrophy
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Contact dermatitis


4. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Kl
Emergent laparotomy to repair perforated viscus - likely stomach
Uterine massage; if that fails - give oxytocin
Pseudomonas


5. ? CO - ? PCWP - ? PVR.
Parkinson's disease
Cardiogenic shock
Flumazenil
Inevitable abortion


6. Pure RBC aplasia.
Phencyclidine hydrochloride (PCP) intoxication
Diamond - Blackfan anemia
Wegener's granulomatosis and Goodpasture's syndrome
Respiratory alkalosis


7. A homeless child is small for his age and has peeling skin and a swollen belly.
RSV bronchiolitis
Erythema multiforme
Kwashiorkor (protein malnutrition)
Continuous - painful vaginal bleeding


8. Signs of ? ICP (Cushing's triad).
Distal radius (Colles' fracture)
Stasis - hypercoagulability - endothelial damage
Osgood - Schlatter disease
Hypertension - bradycardia - and abnormal respirations


9. Classic CXR findings for pulmonary edema.

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10. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Lichen planus
Ultrasound
Acute pancreatitis


11. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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12. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Bacterial meningitis
Pseudomonas
Glanzmann's thrombasthenia


13. Red plaques with silvery- white scales and sharp margins.
They can mask symptoms of hypoglycemia
Type IV (distal) RTA
Psoriasis
Seborrheic dermatitis. Treat with antifungals


14. Cannon 'a' waves.
Distal radius (Colles' fracture)
Giardia
Third - degree heart block
Hypoxia and hypocarbia


15. Peaked T waves and widened QRS.
Hodgkin's lymphoma
Hyperkalemia
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Broca's aphasia. Frontal lobe - left MCA distribution


16. Signs suggesting radial nerve damage with humeral fracture.
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Wrist drop - loss of thumb abduction
False. Withdrawing and withholding life are the same from an ethical standpoint
IV hydration and loop diuretics (furosemide)


17. Mortality rate?
Number of deaths per 1000 population
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Ampulla of the oviduct
Precocious puberty


18. Symptoms of placental abruption.
Continuous - painful vaginal bleeding
DI
Hypoxia and hypocarbia
HBV immunoglobulin


19. Treatment of DKA.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Osteoarthritis
a - antagonists (phentolamine and phenoxybenzamine)


20. Flat - topped papules.
HBV immunoglobulin
Lichen planus
Anemia - thrombocytopenia - and acute renal failure
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


21. Diagnostic test for hereditary spherocytosis.
Obstructive pulmonary disease (e.g. - asthma)
False. Withdrawing and withholding life are the same from an ethical standpoint
Bacillus cereus
Osmotic fragility test


22. Exophthalmos - pretibial myxedema - and ? TSH.

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23. ? risk of what infection with silicosis?
Sarcoidosis
Mycobacterium tuberculosis
Lesion of 1
Seventy percent if the stenosis is symptomatic


24. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Displacement
Identify cause; pressors (e.g. - dobutamine)
Reye's syndrome
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


25. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Never
DM - SLE - and amyloidosis
105 bacteria/mL
Anemia of chronic disease


26. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Hypokalemia
Alzheimer's and multi - infarct
Highly sensitive for TB
Patient on dopamine antagonist


27. Appropriate diagnostic test?
Huntington's disease
Subdural hematoma
Exercise stress treadmill with ECG
RSV bronchiolitis


28. Identify key organisms causing diarrhea:
Giardia
Central pontine myelinolysis
They can mask symptoms of hypoglycemia
RCC or other erythropoietin - producing tumor; evaluate with CT scan


29. Classic physical findings for endocarditis.

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30. The most common type of testicular cancer.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Seminoma
Neuroblastoma


31. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Squamous cell carcinoma
Diamond - Blackfan anemia
Folate deficiency


32. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Biliary tract obstruction
Glanzmann's thrombasthenia
The IR of a disease in a population exposed to a particular factor
Hypovolemic shock


33. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Patent ductus arteriosus (PDA)
Glomerulonephritis/nephritic syndrome
1
Actinic keratosis


34. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Anemia - thrombocytopenia - and acute renal failure
Multiple myeloma
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


35. Complication of scaphoid fracture.
1
Avascular necrosis
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Endometrial or estrogen receptor - breast cancer


36. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Varicella zoster
Nephrolithiasis


37. Indications for medical treatment of ectopic pregnancy.

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38. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Endometrial biopsy
Iron overload; use deferoxamine
Factitious disorder (Munchausen syndrome)


39. Inflammatory disease of the colon with ? risk of colon cancer.
SIADH due to stress
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Streptococcus pneumoniae
Ulcerative colitis


40. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Renal cell carcinoma (RCC)
Phencyclidine hydrochloride (PCP) intoxication
ALS


41. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Immediate needle thoracostomy
Absence seizures
Neuroleptic malignant syndrome
Osmotic fragility test


42. Four causes of microcytic anemia.
Pityriasis versicolor
TICS
Iron deficiency anemia
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


43. The most common cause of hypothyroidism.

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44. Identify key organisms causing diarrhea:
IgA nephropathy (Berger's disease)
Cirrhosis - CHF - nephritic syndrome
Graves' disease
Bacillus cereus


45. A patient with a history of lithium use presents with copious amounts of dilute urine.
Dantrolene or bromocriptine
Ophthalmologic exam - CT - and MRI
Nephrogenic diabetes insipidus (DI)
Parvovirus B19


46. Testicular cancer associated with Beta- hCG - AFP.
V/Q scan
Panic disorder
Identify cause; fluid and blood repletion
Choriocarcinoma


47. Reed - Sternberg cells

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48. Virchow's triad.
Trichomonas vaginitis
Lyme disease - Ixodes tick - doxycycline
Asherman's syndrome
Stasis - hypercoagulability - endothelial damage


49. Hypercholesterolemia treatment that ? flushing and pruritus.
Contact dermatitis
Clostridium difficile
Niacin
105 bacteria/mL


50. CSF findings with SAH.
Hodgkin's lymphoma
Elevated ICP - RBCs - xanthochromia
Lichen planus
Endometrial or estrogen receptor - breast cancer