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. Extraintestinal manifestations of IBD.
Administration of DDAVP ? serum osmolality and free water restriction
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Hypokalemia
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


2. Inspiratory arrest during palpation of the RUQ.

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3. Hematuria - flank pain - and palpable flank mass.
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Panic disorder
Renal cell carcinoma (RCC)


4. Four signs and symptoms of streptococcal pharyngitis.
Phototherapy (mild) or exchange transfusion (severe)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Cerebral berry aneurysms (AD PCKD)
Guillain - Barr


5. Contraceptive methods that protect against PID.
Clostridium difficile
Endometrial or estrogen receptor - breast cancer
OCP and barrier contraception
Parvovirus B19


6. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Acute mania. Start a mood stabilizer (e.g. - lithium)
Impetigo
Distal radius (Colles' fracture)


7. Name the organism:
CA-125 and transvaginal ultrasound
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Streptococcus pneumoniae
Third - degree heart block


8. A doctor refers a patient for an MRI at a facility he/she owns.
Coarctation of the aorta
Acute myelogenous leukemia (AML)
Conflict of interest
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


9. Lab values suggestive of menopause.
? serum FSH
Duodenal atresia
Hypovolemic shock
All - compartment fasciotomy for suspected compartment syndrome


10. The most common causes of dementia.

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11. The most common cause of postpartum hemorrhage.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Uterine atony
46 -XX
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


12. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
AP chest - AP/lateral C- spine - AP pelvis
68% - 95.5% - 99.7%
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Factitious disorder (Munchausen syndrome)


13. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Neurofibromatosis 1
Vibrio - HAV


14. Treatment of cardiogenic shock.
Identify cause; pressors (e.g. - dobutamine)
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Pseudomonas
All - compartment fasciotomy for suspected compartment syndrome


15. Identify key organisms causing diarrhea:
46 -XX
Rate control with carotid massasge or other vagal stimulation
Giardia
Anemia - thrombocytopenia - and acute renal failure


16. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
IV benzodiazepine
Antipsychotics (neuroleptic malignant syndrome)
1
The IR of a disease in a population exposed to a particular factor


17. An antidiabetic agent associated with lactic acidosis.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Menometrorrhagia
Metformin


18. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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19. Treatment for atrial fibrillation.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Pseudomonas
Trauma; the second most common is berry aneurysm
Anticoagulation - rate control - cardioversion


20. A newborn female has continuous 'machinery murmur.'
Highly sensitive for TB
Patent ductus arteriosus (PDA)
No. Parental consent is not necessary for the medical treatment of pregnant minors
Sensitivity


21. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
OCP and barrier contraception
Fatigue and impending respiratory failure
Immediate cardioversion
Hypertension - bradycardia - and abnormal respirations


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

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23. A fall in systolic BP of > 10 mmHg with inspiration.
Sarcoidosis
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Pulsus paradoxus (seen in cardiac tamponade)
Anemia - thrombocytopenia - and acute renal failure


24. Cold agglutinins.
Spinal stenosis
Higher prevalence
Mycoplasma
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


25. Drugs that slow AV node transmission.
MCP and PIP joints; DIP joints are spared
Crohn's disease
Beta- blockers - digoxin - calcium channel blockers
Phencyclidine hydrochloride (PCP) intoxication


26. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Diamond - Blackfan anemia
Choriocarcinoma


27. Associated with Propionibacterium acnes and changes in androgen levels.
Incidence and prevalence
HBV immunoglobulin
Acne vulgaris
Suspect retinoblastoma


28. Causes of hypoxemia.
Fatigue and impending respiratory failure
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Nitroprusside
Bladder rupture or urethral injury


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

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30. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Parainfluenza virus type 1
Cluster headache
Lobular carcinoma in situ
Uterine atony


31. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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32. Molar pregnancy containing fetal tissue.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
IV hydration and loop diuretics (furosemide)
HBV immunoglobulin
Partial mole


33. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Fat - female - fertile - forty - flatulent
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Squamous cell carcinoma
Varicella zoster


34. Name the defense mechanism:
Amoxicillin
Nephritic syndrome
Reaction formation
V/Q scan


35. Name the organism:
Pseudomonas
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Frotteurism (a paraphilia)
Suspect retinoblastoma


36. Identify key organisms causing diarrhea:
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
S. aureus
Erythema multiforme


37. The most common type of nephrolithiasis.
Pulsus paradoxus (seen in cardiac tamponade)
Calcium oxalate
Femoral hernia
Administration of DDAVP ? serum osmolality and free water restriction


38. 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.
Amoxicillin
Reaction formation
Chronic lymphocytic leukemia (CLL)
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


39. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead - time bias
Anemia - thrombocytopenia - and acute renal failure
Hypernatremia
Neisseria meningitidis


40. The most serious side effect of clozapine.
Agranulocytosis
Wiskott - Aldrich syndrome
Sporothrix schenckii
Central pontine myelinolysis


41. 'Doughy skin.'
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Yersinia
Bacterial meningitis
Hypernatremia


42. Blood in the urethral meatus or high - riding prostate.
Bladder rupture or urethral injury
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Suspect ankylosing spondylitis. Check HLA- B27
Number of live births per 1000 population


43. Treatment of AF.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Cellulitis
Rate control - rhythm conversion - and anticoagulation
High reliability - low validity


44. Identify key organisms causing diarrhea:
Bacillus cereus
Basal cell carcinoma
Fat - female - fertile - forty - flatulent
Pregnant women. Treat this group aggressively because of potential complications


45. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Wait - surgical resection - radiation and/or androgen suppression
a - antagonists (phentolamine and phenoxybenzamine)
Never
Angina is new - is worsening - or occurs at rest


46. Antihypertensive for a diabetic patient with proteinuria.
Fat - female - fertile - forty - flatulent
ACEI
'Chocolate cysts -' powder burns
Biliary tract obstruction


47. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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48. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
ETEC
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


49. 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?
Femoral hernia
Wrist drop - loss of thumb abduction
Legionella pneumonia
Spinal stenosis


50. The most common cause of hypertension in young men.
Treat immediately. Consent is implied in emergency situations
Multiple myeloma
Central pontine myelinolysis
Excessive EtOH