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. Difference between Mallory- Weiss and Boerhaave tears.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Nephrotic syndrome
Mallory- Weiss
Acute pancreatitis


2. Sensitive tests have few false negatives and are used to rule _____ a disease.
Kwashiorkor (protein malnutrition)
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Iron deficiency anemia
Out


3. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Restrictive pulmonary disease
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Kwashiorkor (protein malnutrition)
1


4. The most common cause of postpartum hemorrhage.
Uterine atony
SIADH due to stress
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Metformin


5. Name the organism:
Toxoplasma gondii
CF or Hirschsprung's disease
Bacterial meningitis
Broca's aphasia. Frontal lobe - left MCA distribution


6. Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Wrist drop - loss of thumb abduction
Pharmacologic stress test (e.g. - dobutamine echo)
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)


7. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Elevated ICP - RBCs - xanthochromia
INH - penicillamine - hydralazine - procainamide


8. Lung cancer associated with SIADH.
SIADH due to stress
CML
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Small cell lung cancer (SCLC)


9. Evaluation of a pulsatile abdominal mass and bruit.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Nephritic syndrome
Abdominal ultrasound and CT


10. The most common cause of bloody nipple discharge.
Fat - female - fertile - forty - flatulent
Intraductal papilloma
Conduct disorder
Parainfluenza virus type 1


11. RTA associated with abnormal HCO3 - and rickets.
Type II (proximal) RTA
Hereditary spherocytosis
All - compartment fasciotomy for suspected compartment syndrome
Conduct disorder


12. Shortest AP diameter of the pelvis.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care
Parvovirus B19


13. Associated with Propionibacterium acnes and changes in androgen levels.
Graves' disease
Acne vulgaris
Pseudomonas
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


14. The most common pathogen causing croup.
Radiation
PT
Pityriasis versicolor
Parainfluenza virus type 1


15. Odds ratio?
Klebsiella
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Osmotic fragility test
Panic disorder


16. Combined UMN and LMN disorder.
Chronic lymphocytic leukemia (CLL)
Vibrio - HAV
ALS
Asherman's syndrome


17. Perinatal mortality?

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18. Beck's triad for cardiac tamponade.
ARDS
Self - limited - painless vaginal bleeding
Hypotension - distant heart sounds - and JVD
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


19. Bilious emesis within hours after the first feeding.
Clostridium difficile
Observational bias
All - compartment fasciotomy for suspected compartment syndrome
Duodenal atresia


20. Three systemic diseases ? nephrotic syndrome.
Small cell lung cancer (SCLC)
DM - SLE - and amyloidosis
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


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

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22. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Dissociative fugue
Naloxone
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Retinoic acid


23. Acid - base disorder in pulmonary embolism.
Hypoxia and hypocarbia
Reaction formation
Anemia of chronic disease
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


24. Infant mortality?
Febrile seizures (roseola infantum)
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Diphenhydramine or epinephrine 1:1000
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


25. Symptoms of placenta previa.
Self - limited - painless vaginal bleeding
Out
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
False. Withdrawing and withholding life are the same from an ethical standpoint


26. Appropriate diagnostic test?
Pharmacologic stress test (e.g. - dobutamine echo)
Clomiphene citrate
Angina is new - is worsening - or occurs at rest
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus


27. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Stasis - hypercoagulability - endothelial damage
Lead - time bias
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


28. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
ETEC
Betamethasone or dexamethasone
Bullous pemphigoid
Emergent laparotomy to repair perforated viscus - likely stomach


29. Reynolds' pentad.

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30. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Weight loss and OCPs
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Crohn's disease
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


31. Identify key organisms causing diarrhea:
Suspect retinoblastoma
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Uremic syndrome seen in patients with renal failure
Campylobacter


32. Post - HBV exposure treatment.
Seventy percent if the stenosis is symptomatic
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
HBV immunoglobulin


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

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34. The most common histology of bladder cancer.
IV benzodiazepine
Parainfluenza virus type 1
Pseudomonas
Transitional cell carcinoma


35. Cause of neonatal RDS.
Surfactant deficiency
Treat existing heart failure and replace the tricuspid valve
Phototherapy (mild) or exchange transfusion (severe)
Non - Hodgkin's lymphoma


36. Medical treatment for hepatic encephalopathy.
Psoriasis
? protein intake - lactulose - neomycin
Frotteurism (a paraphilia)
Normal


37. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Yersinia
Haemophilus ducreyi
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


38. Definition of hypertension.
30 cc/hour
Panic disorder
BP > 140/90 on three separate occasions two weeks apart
Bladder rupture or urethral injury


39. Albuminocytologic dissociation.
Subarachnoid hemorrhage (SAH)
Guillain - Barr
46 -XX
Ultrasound


40. What is the metabolic syndrome?
Bruton's X- linked agammaglobulinemia
Oral or topical metronidazole
7-10 days
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


41. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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42. Treatment of supraventricular tachycardia (SVT).
Small cell lung cancer (SCLC)
Rate control with carotid massasge or other vagal stimulation
Ultrasound
Type IV (distal) RTA


43. The most common cause of Cushing's syndrome.

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44. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Parkland formula
Inevitable abortion
Neither
Aseptic (viral) meningitis


45. Name the defense mechanism:
OCP and barrier contraception
Regression
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Lead - time bias


46. Antidepressants associated with hypertensive crisis.
BP > 140/90 on three separate occasions two weeks apart
MAOIs
Pseudomonas
Pseudogout


47. Eosinophils in urine sediment.
MS
Type II (proximal) RTA
Betamethasone or dexamethasone
Allergic interstitial nephritis


48. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
DI
Uremic syndrome seen in patients with renal failure
68% - 95.5% - 99.7%
1


49. Characteristics of 2

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50. Testicular cancer associated with Beta- hCG - AFP.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Choriocarcinoma
Rate control with carotid massasge or other vagal stimulation
Signs and symptoms of hypercalcemia