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. Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
Calcium oxalate
Pemphigus vulgaris
Substance abuse


2. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
Wiskott - Aldrich syndrome
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
a - antagonists (phentolamine and phenoxybenzamine)
Febrile seizures (roseola infantum)


3. Reynolds' pentad.

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4. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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5. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Ulcerative colitis
Pheochromocytoma
'Chocolate cysts -' powder burns
Out


6. CSF findings:
Coarctation of the aorta
Subarachnoid hemorrhage (SAH)
Hypokalemia
Iron deficiency anemia


7. Virus associated with aplastic anemia in patients with sickle cell anemia.
Biliary tract obstruction
Depersonalization disorder
Parvovirus B19
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis


8. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Patient on dopamine antagonist
Confounding variable
Number of deaths from 28 days to one year per 1000 live births
Reaction formation


9. Risk factors for pyelonephritis.
Bladder rupture or urethral injury
Retrograde cystourethrogram
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones


10. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
Bladder rupture or urethral injury
Inhaled Beta- agonists and inhaled corticosteroids
Type IV (distal) RTA


11. Mortality rate?
Number of deaths per 1000 population
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma


12. When should a vaginal exam be performed with suspected placenta previa?
Hypotension - distant heart sounds - and JVD
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Metformin
Never


13. Albuminocytologic dissociation.
Elevated ICP - RBCs - xanthochromia
Type I (distal) RTA
Contact dermatitis
Guillain - Barr


14. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Obstructive pulmonary disease (e.g. - asthma)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


15. Treatment for SVC syndrome.
Radiation
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Hypoparathyroidism
Bruton's X- linked agammaglobulinemia


16. The most common type of nephrolithiasis.
INH - penicillamine - hydralazine - procainamide
Flumazenil
Calcium oxalate
Lichen planus


17. A fall in systolic BP of > 10 mmHg with inspiration.
Fanconi's anemia
Pulsus paradoxus (seen in cardiac tamponade)
Hypotension - distant heart sounds - and JVD
Confounding variable


18. Classic physical findings for endocarditis.

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19. Identify key organisms causing diarrhea:
ETEC
Diamond - Blackfan anemia
Femoral hernia
Prerenal


20. What should always be done prior to LP?
Klebsiella
Ulcerative colitis
Clostridium difficile
Check for ? ICP; look for papilledema


21. A homeless child is small for his age and has peeling skin and a swollen belly.
Intraductal papilloma
Mallory- Weiss
Kwashiorkor (protein malnutrition)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


22. Acid - base disorder in pulmonary embolism.
Mycoplasma
Hypoxia and hypocarbia
A patient's family cannot require that a doctor withhold information from the patient
Parkinson's disease


23. Medications and viruses that ? aplastic anemia.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Multiple myeloma
Alport's syndrome
Chronic lymphocytic leukemia (CLL)


24. Diagnostic test for hypertrophic cardiomyopathy.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Fanconi's anemia
Toxoplasma gondii
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


25. Drowsiness - asterixis - nausea - and a pericardial friction rub.
CF or Hirschsprung's disease
Uremic syndrome seen in patients with renal failure
Phencyclidine hydrochloride (PCP) intoxication
IVIG or plasmapheresis


26. The most common cause of female infertility.
Endometriosis
105 bacteria/mL
Kl
Incidence and prevalence


27. Administer to a symptomatic patient to diagnose myasthenia gravis.
Obstructive pulmonary disease (e.g. - asthma)
Edrophonium
< 7.0
Isolation


28. Nikolsky's sign.
Pityriasis rosea
Bullous pemphigoid
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


29. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Guillain - Barr
Rate control - rhythm conversion - and anticoagulation


30. 'Cradle cap.'
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Seborrheic dermatitis. Treat with antifungals
IV penicillin or ampicillin
Duchenne muscular dystrophy


31. What is the immunodeficiency?

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32. Characteristics of 2

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33. RTA associated with abnormal HCO3 - and rickets.
Type II (proximal) RTA
OCP and barrier contraception
PT
TICS


34. Odds ratio?
A patient's family cannot require that a doctor withhold information from the patient
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
MAOIs


35. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins
Third - degree heart block
Treat existing heart failure and replace the tricuspid valve
Restrictive pulmonary disease


36. Name the organism:
Haemophilus ducreyi
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
Signs and symptoms of hypercalcemia
Number of deaths per 1000 population


37. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Kegel exercises - estrogen - pessaries for stress incontinence
Pseudogout
Hypoparathyroidism
Postinfectious glomerulonephritis


38. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
1
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
HBV - DTaP - Hib - IPV - PCV


39. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Restrictive pulmonary disease
Lichen sclerosus
Beta- blockers - Ca2+ channel blockers - TCAs
Bladder rupture or urethral injury


40. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Menometrorrhagia
A patient's family cannot require that a doctor withhold information from the patient
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


41. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Treat existing heart failure and replace the tricuspid valve
Polymyalgia rheumatica
ACEI
Hypotension - distant heart sounds - and JVD


42. Vaccinations at a six- month well - child visit.
Fatigue and impending respiratory failure
HBV - DTaP - Hib - IPV - PCV
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
? serum FSH


43. Red plaques with silvery- white scales and sharp margins.
Psoriasis
Crohn's disease
Parvovirus B19
Establish the ABCs


44. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Type II (proximal) RTA
Seventy percent if the stenosis is symptomatic
Antipsychotics (neuroleptic malignant syndrome)
The IR of a disease in a population exposed to a particular factor


45. Extraintestinal manifestations of IBD.
Hypotension - distant heart sounds - and JVD
Asymmetry - border irregularity - color variation - large diameter
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


46. ? CO - ? PCWP - ? PVR.
Pseudomonas
Neither
Septic or anaphylactic shock
HBV immunoglobulin


47. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Malingering
Conduct disorder
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Hypoparathyroidism


48. The coagulation parameter affected by warfarin.
Asymmetry - border irregularity - color variation - large diameter
Panic disorder
PT
Sarcoidosis


49. Fertility rate?
High reliability - low validity
Antipsychotics (neuroleptic malignant syndrome)
Number of live births per 1000 women 15-44 years of age
Reye's syndrome


50. A woman who was abused as a child frequently feels outside of or detached from her body.
No. Parental consent is not necessary for the medical treatment of pregnant minors
IVIG or plasmapheresis
OCPs
Depersonalization disorder