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. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Kwashiorkor (protein malnutrition)
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
? serum FSH


2. Prophylactic treatment for migraine.
Treat immediately. Consent is implied in emergency situations
Conversion disorder
Protamine
Beta- blockers - Ca2+ channel blockers - TCAs


3. The most common cause of hypothyroidism.

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4. Presents with a herald patch - Christmas - tree pattern.
DI
Toxoplasma gondii
Higher incidence
Pityriasis rosea


5. Ring - enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Beta- hCG; the most common cause of amenorrhea is pregnancy
BP > 140/90 on three separate occasions two weeks apart
Guillain - Barr


6. Name the organism:
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Hypotension - distant heart sounds - and JVD
Actinomyces israelii
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


7. Thrombotic thrombocytopenic purpura (TTP) pentad?
Higher incidence
Third - degree heart block
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Pentad of TTP


8. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Frotteurism (a paraphilia)
Wait - surgical resection - radiation and/or androgen suppression
N- acetylcysteine


9. A violent patient has vertical and horizontal nystagmus.
Lesions of 1
O2 - analgesia - hydration - and - if severe - transfusion
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
Phencyclidine hydrochloride (PCP) intoxication


10. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
MS
Substance abuse
Febrile seizures (roseola infantum)
Erythema multiforme


11. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Parvovirus B19
Septic or anaphylactic shock
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


12. Definition of unstable angina.
High reliability - low validity
Impetigo
Anemia - thrombocytopenia - and acute renal failure
Angina is new - is worsening - or occurs at rest


13. Signs of active ischemia during stress testing.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Mycoplasma
Angina - ST- segment changes on ECG - or ? BP
S. aureus


14. Radiographic evidence of aortic disruption or dissection.
Conversion disorder
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Malignancy and hyperparathyroidism
46 -XX


15. Albuminocytologic dissociation.
Guillain - Barr
ARDS
Prinzmetal's angina
Avascular necrosis


16. Birth rate?
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Number of live births per 1000 population
Streptococcus pneumoniae
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


17. Name the organism:
Asymmetry - border irregularity - color variation - large diameter
False. Withdrawing and withholding life are the same from an ethical standpoint
Higher prevalence
Haemophilus ducreyi


18. Test to rule out urethral injury.
Biliary tract obstruction
Retrograde cystourethrogram
Uremic syndrome seen in patients with renal failure
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


19. Lung cancer highly related to cigarette exposure.
SCLC
'Sawtooth' P waves
Hypotension - distant heart sounds - and JVD
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


20. Radiographic indications for surgery in patients with acute abdomen.
Kwashiorkor (protein malnutrition)
IVIG or plasmapheresis
Beta- blockers - digoxin - calcium channel blockers
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


21. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Suspect retinoblastoma
Wiskott - Aldrich syndrome
CML


22. Medication used to induce ovulation.
Factor V Leiden mutation
Cluster headache
Hypotension and bradycardia
Clomiphene citrate


23. Treatment of SIADH?
CHF - shock - and altered mental status
Normal
Fluid restriction - demeclocycline
Conversion disorder


24. Causes of exudative effusion.
Retrograde cystourethrogram
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Wiskott - Aldrich syndrome


25. Characteristics of 2

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26. CSF findings:
Neisseria meningitidis
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Osteoarthritis
MS


27. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Squamous cell carcinoma
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Lesion of 1


28. Treatment of AF.
Factor V Leiden mutation
Rate control - rhythm conversion - and anticoagulation
IV hydration and loop diuretics (furosemide)
Alport's syndrome


29. What is the immunodeficiency?
Patent ductus arteriosus (PDA)
Intraductal papilloma
Wiskott - Aldrich syndrome
Squamous cell carcinoma


30. Identify key organisms causing diarrhea:
High reliability - low validity
Giardia
Pentad of TTP
Vibrio - HAV


31. Caf
Third - degree heart block
S. aureus
Agranulocytosis
Neurofibromatosis 1


32. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Kegel exercises - estrogen - pessaries for stress incontinence
Benzodiazepines
Fluid restriction - demeclocycline
Conduct disorder


33. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Dissociative fugue
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Excessive EtOH


34. Confusion - confabulation - ophthalmoplegia - ataxia.

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35. Laparoscopic findings in endometriosis.

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36. Neutropenic nadir postchemotherapy.
CML
7-10 days
Toxoplasma gondii
Beta- hCG; the most common cause of amenorrhea is pregnancy


37. Infant mortality?
Uterine atony
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
'Sawtooth' P waves
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


38. Extraintestinal manifestations of IBD.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Glanzmann's thrombasthenia


39. Why are Beta- blockers contraindicated in diabetics?
Hypoxia and hypocarbia
Conversion disorder
Depersonalization disorder
They can mask symptoms of hypoglycemia


40. Drugs that slow AV node transmission.
Beta- blockers - digoxin - calcium channel blockers
a - antagonists (phentolamine and phenoxybenzamine)
Normal
50 cc/hour


41. Perinatal mortality?

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42. The most common organism in burn - related infections.
Establish the ABCs
Nephrogenic diabetes insipidus (DI)
Higher prevalence
Pseudomonas


43. Difference between a cohort and a case - control study.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Rate control - rhythm conversion - and anticoagulation
Neither
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR


44. Name the organism:
Isolation
Reye's syndrome
Bacillus cereus
Klebsiella


45. Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
OCPs - danazol - GnRH agonists
Diamond - Blackfan anemia
Lesion of 1


46. Classic ultrasound and gross appearance of complete hydatidiform mole.

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47. Name the organism:
Parainfluenza virus type 1
Pasteurella multocida
Angina - ST- segment changes on ECG - or ? BP
Cluster headache


48. Treatment of tension pneumothorax.
Cirrhosis - CHF - nephritic syndrome
Immediate needle thoracostomy
Out
PT


49. The most common type of nephrolithiasis.
Osteogenesis imperfecta
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Calcium oxalate
Dressler's syndrome: fever - pericarditis - ? ESR


50. Low urine specific gravity in the presence of high serum osmolality.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Guillain - Barr
Cardiogenic shock
DI