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. Indications for medical treatment of ectopic pregnancy.

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2. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Hypovolemic shock
Type II (proximal) RTA
Observational bias


3. Flat - topped papules.
Febrile seizures (roseola infantum)
Lichen planus
Infection - cancer - and autoimmune disease
Treat existing heart failure and replace the tricuspid valve


4. Name the organism:
Squamous cell carcinoma
Identify cause; pressors (e.g. - dobutamine)
7-10 days
Pasteurella multocida


5. Name the organism:
Self - limited - painless vaginal bleeding
Duodenal atresia
Salmonella
50 cc/hour


6. Characteristics of 2

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7. Lab values suggestive of menopause.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
? serum FSH
O2 - analgesia - hydration - and - if severe - transfusion
Intussusception


8. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Iron deficiency anemia
1
Giardia
Hypernatremia


9. ? CO - ? PCWP - ? PVR.
Out
Benzodiazepines
Cardiogenic shock
Sulfonamides - antimalarial drugs - fava beans


10. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Prinzmetal's angina
Hypoparathyroidism
Dantrolene or bromocriptine
Seborrheic dermatitis. Treat with antifungals


11. Treatment for atrial fibrillation.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Isolation
Anticoagulation - rate control - cardioversion
68% - 95.5% - 99.7%


12. Classic ECG findings in pericarditis.
Malingering
Retinoic acid
Low - voltage - diffuse ST- segment elevation
OCP and barrier contraception


13. First - line treatment for otitis media.
Amoxicillin
B12 deficiency
1
Immediate needle thoracostomy


14. 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.
Identify cause; fluid and blood repletion
Polymyalgia rheumatica
Frotteurism (a paraphilia)
Patient on dopamine antagonist


15. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Inhaled Beta- agonists and inhaled corticosteroids
False. Withdrawing and withholding life are the same from an ethical standpoint
Fat - female - fertile - forty - flatulent
Sulfonamides - antimalarial drugs - fava beans


16. True or false: Once patients sign a statement giving consent - they must continue treatment.
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
Cerebral berry aneurysms (AD PCKD)
Lesch - Nyhan syndrome (purine salvage problem with
Reye's syndrome


17. Symptoms of placental abruption.
Continuous - painful vaginal bleeding
Bladder rupture or urethral injury
Phencyclidine hydrochloride (PCP) intoxication
Crohn's disease


18. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
S. aureus
Confounding variable
7-10 days
'Sawtooth' P waves


19. The most common inherited cause of hypercoagulability.
Pregnant women. Treat this group aggressively because of potential complications
a - antagonists (phentolamine and phenoxybenzamine)
Factor V Leiden mutation
Prevalence


20. Conditions in which confidentiality must be overridden.
? serum FSH
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
< 7.0
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


21. Antihypertensive for a diabetic patient with proteinuria.
Isolation
ACEI
Osteoarthritis
Iron deficiency anemia


22. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
Varicella zoster
68% - 95.5% - 99.7%
Klebsiella


23. Relative risk?
Observational bias
The IR of a disease in a population exposed to a particular factor
Highly sensitive for TB
ACEI


24. Pure RBC aplasia.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Nephritic syndrome
Diamond - Blackfan anemia
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


25. Medications and viruses that ? aplastic anemia.
DM - SLE - and amyloidosis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Dressler's syndrome: fever - pericarditis - ? ESR


26. 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?
IV hydration and loop diuretics (furosemide)
Parvovirus B19
Wegener's granulomatosis and Goodpasture's syndrome
Highly sensitive for TB


27. Shortest AP diameter of the pelvis.
Small cell lung cancer (SCLC)
Diphenhydramine or epinephrine 1:1000
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


28. The most common form of nephritic syndrome.
Prevalence
Nephritic syndrome
Membranous glomerulonephritis
Phencyclidine hydrochloride (PCP) intoxication


29. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Nephrotic syndrome
Seborrheic keratosis


30. Hematuria - flank pain - and palpable flank mass.
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Substance abuse
Hypernatremia
Renal cell carcinoma (RCC)


31. The most frequent presentation of intracranial neoplasm.
Identify cause; fluid and blood repletion
Prinzmetal's angina
Clostridium difficile
Headache


32. The most common pathogen causing croup.
Neuroleptic malignant syndrome
Parainfluenza virus type 1
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Nephritic syndrome


33. Amenorrhea - bradycardia - and abnormal body image in a young female.
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Isolation
Anorexia
Placental abruption and placenta previa


34. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Absence seizures
Subdural hematoma
Suspect ankylosing spondylitis. Check HLA- B27
Anticoagulation - rate control - cardioversion


35. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Cirrhosis - CHF - nephritic syndrome
HBV immunoglobulin
MS


36. Peaked T waves and widened QRS.
They can mask symptoms of hypoglycemia
Hyperkalemia
Osgood - Schlatter disease
Lyme disease - Ixodes tick - doxycycline


37. Identify key organisms causing diarrhea:
Stasis - hypercoagulability - endothelial damage
E. coli O157:H7
Anorexia
Biliary tract obstruction


38. Fetal mortality?

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39. ? CO - ? PCWP - ? PVR.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Pseudomonas
Septic or anaphylactic shock


40. 'Dewdrop on a rose petal.'
Broca's aphasia. Frontal lobe - left MCA distribution
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Lesions of 1
Hypotension - distant heart sounds - and JVD


41. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Polymyalgia rheumatica
Contact dermatitis
Infection - febrile seizures - trauma - idiopathic
Anemia of chronic disease


42. Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Hodgkin's lymphoma
Yersinia
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch


43. Laparoscopic findings in endometriosis.

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44. Appropriate diagnostic test?
Conflict of interest
Exercise stress treadmill with ECG
Uterine atony
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


45. Goal hemoglobin A1c for a patient with DM.
Alport's syndrome
Spinal stenosis
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
< 7.0


46. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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47. Evaluation of a pulsatile abdominal mass and bruit.
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Abdominal ultrasound and CT
50 cc/hour
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


48. 'Cradle cap.'
MS
Seborrheic dermatitis. Treat with antifungals
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


49. The most likely cause of acute lower GI bleed in patients > 40 years old.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
? serum FSH
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Diverticulosis


50. Vaccinations at a six- month well - child visit.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
HBV - DTaP - Hib - IPV - PCV
Rett's disorder
Wait - surgical resection - radiation and/or androgen suppression