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. First - line medication for status epilepticus.
Diphenhydramine or epinephrine 1:1000
Depersonalization disorder
Normal
IV benzodiazepine


2. Name the organism:
Reaction formation
Sporothrix schenckii
Pityriasis versicolor
Weight gain - type 2 DM - QT prolongation


3. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Cellulitis
Higher prevalence
Polymyalgia rheumatica
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity


4. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Polymyalgia rheumatica
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Lesch - Nyhan syndrome (purine salvage problem with
Guillain - Barr


5. Antihypertensive for a diabetic patient with proteinuria.
Mycobacterium tuberculosis
ACEI
Levodopa/carbidopa
Malingering


6. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
a - antagonists (phentolamine and phenoxybenzamine)
Hypertrophic cardiomyopathy
Hypernatremia
Dissociative fugue


7. Identify key organisms causing diarrhea:
Distal radius (Colles' fracture)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Yersinia
Endometrial biopsy


8. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Klebsiella
Actinic keratosis
Cellulitis
Pityriasis versicolor


9. A significant cause of morbidity in thalassemia patients. Treatment?
Continuous - painful vaginal bleeding
Iron overload; use deferoxamine
CHF - shock - and altered mental status
Squamous cell carcinoma


10. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Giardia
Sarcoidosis
Trauma - alcohol withdrawal - brain tumor
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


11. Nontender abdominal mass associated with elevated VMA and HVA.
Neurofibromatosis 1
Neuroblastoma
Inevitable abortion
Herpes simplex


12. Medication used to induce ovulation.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Clomiphene citrate
Hereditary spherocytosis
Fatigue and impending respiratory failure


13. Tests to rule out shaken baby syndrome.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Diamond - Blackfan anemia
Ulcerative colitis
Ophthalmologic exam - CT - and MRI


14. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Avascular necrosis
Number of deaths from 28 days to one year per 1000 live births
Uremic syndrome seen in patients with renal failure
Septic or anaphylactic shock


15. Lab values suggestive of menopause.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
N- acetylcysteine
? serum FSH
Guillain - Barr


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

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17. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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18. CSF findings:
Subarachnoid hemorrhage (SAH)
Sensitivity
Fatigue and impending respiratory failure
Emergent laparotomy to repair perforated viscus - likely stomach


19. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Wegener's granulomatosis and Goodpasture's syndrome
Abdominal ultrasound and CT
Lesion of 1
S. aureus or S. epidermidis.


20. Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
Wiskott - Aldrich syndrome
Septic or anaphylactic shock
Usually resolves spontaneously; may require IVIG and/or corticosteroids


21. A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Ophthalmologic exam - CT - and MRI
HGPRTase deficiency)


22. A doctor refers a patient for an MRI at a facility he/she owns.
Partial mole
Conflict of interest
Avascular necrosis
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


23. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
Trichomonas vaginitis
? protein intake - lactulose - neomycin
Oral or topical metronidazole


24. Definition of hypertension.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Fatigue and impending respiratory failure
BP > 140/90 on three separate occasions two weeks apart
Intraductal papilloma


25. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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26. What is the immunodeficiency?
Mycoplasma
Chronic granulomatous disease
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms


27. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Rate control with carotid massasge or other vagal stimulation
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Parainfluenza virus type 1


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

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29. RTA associated with aldosterone defect.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Lyme disease - Ixodes tick - doxycycline
Type IV (distal) RTA
Glomerulonephritis/nephritic syndrome


30. Maternal mortality?
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Contact dermatitis
Treat existing heart failure and replace the tricuspid valve
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


31. Signs of ? ICP (Cushing's triad).
Hypertension - bradycardia - and abnormal respirations
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Erythema multiforme
ALS


32. Macrocytic - megaloblastic anemia with neurologic symptoms.
Inhaled Beta- agonists and inhaled corticosteroids
B12 deficiency
OCPs - danazol - GnRH agonists
Hypotension - distant heart sounds - and JVD


33. Chromosomal pattern of a complete mole.
Abdominal ultrasound and CT
Bladder rupture or urethral injury
Pseudomonas
46 -XX


34. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
No. Parental consent is not necessary for the medical treatment of pregnant minors
Bullous pemphigoid
Bruton's X- linked agammaglobulinemia


35. 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?
Identify cause; fluid and blood repletion
Highly sensitive for TB
Squamous cell carcinoma
M3


36. A son asks that his mother not be told about her recently discovered cancer.

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37. Treatment for ventricular fibrillation.
Ampulla of the oviduct
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Immediate cardioversion
Low - voltage - diffuse ST- segment elevation


38. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

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39. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Pseudomonas
Legionella pneumonia
Phencyclidine hydrochloride (PCP) intoxication
Normal


40. Antibiotics with teratogenic effects.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Kl
ARDS
Chronic lymphocytic leukemia (CLL)


41. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Guillain - Barr
Renal cell carcinoma (RCC)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


42. Treatment of hypovolemic shock.
Pulsus paradoxus (seen in cardiac tamponade)
Identify cause; fluid and blood repletion
Absence seizures
Wait - surgical resection - radiation and/or androgen suppression


43. Meningitis in infants. Causes? Treatment?
Parkinson's disease
< 7.0
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Establish the ABCs


44. Not contraindications to vaccination.
Hypokalemia
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Biliary tract obstruction
Prerenal


45. Treatment of tension pneumothorax.
Lead - time bias
Clomiphene citrate
Immediate needle thoracostomy
? protein intake - lactulose - neomycin


46. Auer rods on blood smear.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Coccidioidomycosis. Amphotericin B
Nephrogenic diabetes insipidus (DI)
Acute myelogenous leukemia (AML)


47. Honey- crusted lesions.
BP > 140/90 on three separate occasions two weeks apart
Pseudomonas
Bullous pemphigoid
Impetigo


48. Identify key organisms causing diarrhea:
S. aureus
Psoriasis
Beta- hCG; the most common cause of amenorrhea is pregnancy
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


49. Neutropenic nadir postchemotherapy.
Salmonella
7-10 days
Protamine
Higher incidence


50. Medication given to accelerate fetal lung maturity.
Pseudomonas
Reye's syndrome
Mycoplasma
Betamethasone or dexamethasone