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. The coagulation parameter affected by warfarin.
PT
Trauma - alcohol withdrawal - brain tumor
Anemia - thrombocytopenia - and acute renal failure
All - compartment fasciotomy for suspected compartment syndrome


2. What is the immunodeficiency?

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3. Electrolyte changes in tumor lysis syndrome.
Erythema multiforme
? Ca2+ - ? K- - ? phosphate - ? uric acid
Klebsiella
Actinic keratosis


4. Characteristics of 2

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5. First - line medication for status epilepticus.
Cirrhosis - CHF - nephritic syndrome
Number of deaths per 1000 population
Treat existing heart failure and replace the tricuspid valve
IV benzodiazepine


6. Difference between Mallory- Weiss and Boerhaave tears.
Trichomonas vaginitis
Mallory- Weiss
Fanconi's anemia
Pregnant women. Treat this group aggressively because of potential complications


7. Tests to rule out shaken baby syndrome.
Nephrogenic diabetes insipidus (DI)
Ophthalmologic exam - CT - and MRI
Seborrheic dermatitis. Treat with antifungals
Treat immediately. Consent is implied in emergency situations


8. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Cerebral berry aneurysms (AD PCKD)
Incidence and prevalence
Conduct disorder
Clostridium difficile


9. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Iron deficiency anemia
Neuroleptic malignant syndrome
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


10. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
HIDA scan
Anemia - thrombocytopenia - and acute renal failure
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Wait - surgical resection - radiation and/or androgen suppression


11. Causes of transudative effusion.
Phencyclidine hydrochloride (PCP) intoxication
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
TICS
Pregnant women. Treat this group aggressively because of potential complications


12. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
ARDS
False. Withdrawing and withholding life are the same from an ethical standpoint
MAOIs
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


13. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Diverticulosis
CHF - shock - and altered mental status
Suspect ankylosing spondylitis. Check HLA- B27
Non - Hodgkin's lymphoma


14. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
False. Withdrawing and withholding life are the same from an ethical standpoint
OCPs
HIDA scan
Kegel exercises - estrogen - pessaries for stress incontinence


15. Treatment for postpartum hemorrhage.
Pasteurella multocida
Uterine massage; if that fails - give oxytocin
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Small cell lung cancer (SCLC)


16. First - line treatment for otitis media.
Amoxicillin
Hypotension - distant heart sounds - and JVD
Identify cause; fluid and blood repletion
7-10 days


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

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18. Lung cancer highly related to cigarette exposure.
Taenia solium (cysticercosis)
Asherman's syndrome
SCLC
Transitional cell carcinoma


19. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Pseudomonas
Incidence and prevalence
Threatened abortion


20. Perinatal mortality?

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21. Caf
ARDS
Iron overload; use deferoxamine
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Neurofibromatosis 1


22. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Mallory- Weiss
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Membranous glomerulonephritis
Postinfectious glomerulonephritis


23. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Postinfectious glomerulonephritis
Asymmetry - border irregularity - color variation - large diameter
Dissociative fugue
Antipsychotics (neuroleptic malignant syndrome)


24. A patient with a history of lithium use presents with copious amounts of dilute urine.
Beta- blockers - Ca2+ channel blockers - TCAs
Nephrogenic diabetes insipidus (DI)
Herpes simplex
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


25. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Guillain - Barr
Reye's syndrome
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Inevitable abortion


26. ECG findings suggesting MI.
Frotteurism (a paraphilia)
SIADH due to stress
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
CA-125 and transvaginal ultrasound


27. The most common form of nephritic syndrome.
Membranous glomerulonephritis
SCLC
INH - penicillamine - hydralazine - procainamide
Phototherapy (mild) or exchange transfusion (severe)


28. Identify key organisms causing diarrhea:
S. aureus
Paget's disease
1
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)


29. The first test to perform when a woman presents with amenorrhea.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Beta- hCG; the most common cause of amenorrhea is pregnancy
Cerebral berry aneurysms (AD PCKD)
Bacterial meningitis


30. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Pheochromocytoma
Murphy's sign - seen in acute cholecystitis
Regression
Cellulitis


31. PFT showing ? FEV1/FVC.
Neisseria meningitidis
Restrictive pulmonary disease
Paget's disease
Anemia - thrombocytopenia - and acute renal failure


32. Molar pregnancy containing fetal tissue.
Placental abruption and placenta previa
Partial mole
Uremic syndrome seen in patients with renal failure
Factor V Leiden mutation


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

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34. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Pseudomonas
All - compartment fasciotomy for suspected compartment syndrome
Psoriasis
Pseudogout


35. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Hyperkalemia
Folate deficiency
Chronic lymphocytic leukemia (CLL)


36. A 49-year - old male presents with acute - onset flank pain and hematuria.
Nephrolithiasis
Postinfectious glomerulonephritis
Hypokalemia
Out


37. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Surfactant deficiency
Suspect retinoblastoma
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
No. Parental consent is not necessary for the medical treatment of pregnant minors


38. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Stasis - hypercoagulability - endothelial damage
Hypertrophic cardiomyopathy
Multiple myeloma
Basal cell carcinoma


39. Chromosomal pattern of a complete mole.
Weight loss and OCPs
46 -XX
IgA nephropathy (Berger's disease)
Seventy percent if the stenosis is symptomatic


40. Acceptable urine output in a trauma patient.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Parkland formula
50 cc/hour
Neither


41. Identify key organisms causing diarrhea:
Pseudomonas
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Campylobacter
Oral or topical metronidazole


42. Appropriate diagnostic test?
Cirrhosis - CHF - nephritic syndrome
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
Pharmacologic stress test (e.g. - dobutamine echo)
Anion gap acidosis and 1


43. Inspiratory arrest during palpation of the RUQ.

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44. Treatment of septic shock.
Edrophonium
Fluids and antibiotics
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Osteoarthritis


45. Cold agglutinins.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Mycoplasma
N- acetylcysteine
Retinoic acid


46. Aplastic crisis in sickle cell disease.
Osteogenesis imperfecta
Parvovirus B19
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Calcium oxalate


47. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Actinic keratosis
Hypotension and bradycardia
Coarctation of the aorta


48. Symptoms of placental abruption.
Duchenne muscular dystrophy
Haemophilus ducreyi
Betamethasone or dexamethasone
Continuous - painful vaginal bleeding


49. Extraintestinal manifestations of IBD.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Cellulitis
Central pontine myelinolysis
Fanconi's anemia


50. Causes of hypoxemia.
Hypertension - bradycardia - and abnormal respirations
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Acute pancreatitis
Subarachnoid hemorrhage (SAH)