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. Cannon 'a' waves.
Suspect ankylosing spondylitis. Check HLA- B27
Third - degree heart block
Precocious puberty
Sarcoidosis


2. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Displacement
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
a - antagonists (phentolamine and phenoxybenzamine)


3. Epidemics such as influenza
Immediate needle thoracostomy
Flumazenil
Higher incidence
All - compartment fasciotomy for suspected compartment syndrome


4. Risk factors for DVT.

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5. 1
Uterine massage; if that fails - give oxytocin
Malingering
Placental abruption and placenta previa
Neuroleptics


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

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7. Number needed to treat?
Sensitivity
50 cc/hour
DM - SLE - and amyloidosis
1


8. Identify key organisms causing diarrhea:
Pityriasis rosea
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Clomiphene citrate
S. aureus


9. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Hypernatremia
Malingering
Psoriasis


10. Low urine specific gravity in the presence of high serum osmolality.
Parvovirus B19
DI
Impetigo
1


11. Tests to rule out shaken baby syndrome.
Ophthalmologic exam - CT - and MRI
Streptococcus pneumoniae
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
S. aureus or S. epidermidis.


12. Treatment for mild - persistent asthma.
Parvovirus B19
Inhaled Beta- agonists and inhaled corticosteroids
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Nephrolithiasis


13. Cold agglutinins.
OCPs - danazol - GnRH agonists
Squamous cell carcinoma
Check for ? ICP; look for papilledema
Mycoplasma


14. Inspiratory arrest during palpation of the RUQ.

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

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16. Mortality rate?
Number of deaths per 1000 population
Amoxicillin
Pasteurella multocida
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


17. Eight surgically correctable causes of hypertension.

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18. The most common cause of hypertension in young women.
OCPs
Conversion disorder
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Kwashiorkor (protein malnutrition)


19. The most common type of nephrolithiasis.
M3
Calcium oxalate
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Conflict of interest


20. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Number of live births per 1000 population
Nephrotic syndrome
Kl
Slipped capital femoral epiphyses. AP and frog - leg lateral view


21. Nikolsky's sign.
Malignancy and hyperparathyroidism
Taenia solium (cysticercosis)
Bullous pemphigoid
Continuous positive airway pressure


22. Treatment for SVC syndrome.
IV hydration and loop diuretics (furosemide)
'Chocolate cysts -' powder burns
Anticoagulation - rate control - cardioversion
Radiation


23. Erythema migrans.
IgA nephropathy (Berger's disease)
Lesion of 1
Self - limited - painless vaginal bleeding
Placental abruption and placenta previa


24. Bilious emesis within hours after the first feeding.
Anemia of chronic disease
Parvovirus B19
Duodenal atresia
Acute mania. Start a mood stabilizer (e.g. - lithium)


25. Treatment for postpartum hemorrhage.
Alopecia areata (autoimmune process)
Confounding variable
Asherman's syndrome
Uterine massage; if that fails - give oxytocin


26. An agent that reverses the effects of heparin.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Lesch - Nyhan syndrome (purine salvage problem with
Protamine
Angina is new - is worsening - or occurs at rest


27. Identify key organisms causing diarrhea:
Neisseria meningitidis
S. aureus or S. epidermidis.
Actinomyces israelii
Yersinia


28. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Conflict of interest
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Avascular necrosis


29. The most common pathogen causing croup.
Antipsychotics (neuroleptic malignant syndrome)
Parainfluenza virus type 1
Continuous positive airway pressure
Parkinson's disease


30. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Depersonalization disorder
Neisseria meningitidis


31. Acid - base disturbance commonly seen in pregnant women.
Cluster headache
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Polymyalgia rheumatica
Respiratory alkalosis


32. Honeycomb pattern on CXR. Diagnosis? Treatment?
Isolation
Endometrial biopsy
'Sawtooth' P waves
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


33. 'Dewdrop on a rose petal.'
HIDA scan
Signs and symptoms of hypercalcemia
Lesions of 1
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


34. Glomerulonephritis with deafness.

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35. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
IV benzodiazepine
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Elevated ICP - RBCs - xanthochromia


36. Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Small cell lung cancer (SCLC)
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Pheochromocytoma


37. First - line treatment for otitis media.
Acne vulgaris
Amoxicillin
Fatigue and impending respiratory failure
Sporothrix schenckii


38. Perinatal mortality?

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39. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Colposcopy and endocervical curettage
SIADH due to stress
Precocious puberty
Osmotic fragility test


40. Cross - sectional survey
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Prevalence
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


41. Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Immediate needle thoracostomy


42. Antidepressants associated with hypertensive crisis.
Hypokalemia
Suspect retinoblastoma
Fat - female - fertile - forty - flatulent
MAOIs


43. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Observational bias
Herpes simplex
Rate control - rhythm conversion - and anticoagulation
ETEC


44. Pure RBC aplasia.
Wernicke's encephalopathy due to a deficiency of thiamine
Dantrolene or bromocriptine
Pentad of TTP
Diamond - Blackfan anemia


45. Identify key organisms causing diarrhea:
E. coli O157:H7
Nephrogenic diabetes insipidus (DI)
HIDA scan
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


46. Difference between a cohort and a case - control study.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Hypoxia and hypocarbia
Parkland formula
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


47. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Bullous pemphigoid
Phencyclidine hydrochloride (PCP) intoxication
CML


48. A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
E. coli O157:H7
Wrist drop - loss of thumb abduction


49. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Salmonella
Slipped capital femoral epiphyses. AP and frog - leg lateral view
TICS
ARDS


50. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Hypotension and bradycardia
a - antagonists (phentolamine and phenoxybenzamine)
Femoral hernia