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 patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Pityriasis versicolor
Hypoparathyroidism
Displacement
SIADH due to stress


2. Risk factors for pyelonephritis.
Pityriasis versicolor
Respiratory alkalosis
Exercise stress treadmill with ECG
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones


3. Name the defense mechanism:
Actinomyces israelii
Displacement
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Antipsychotics (neuroleptic malignant syndrome)


4. Prophylactic treatment for migraine.
Beta- blockers - Ca2+ channel blockers - TCAs
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
Septic or anaphylactic shock
Threatened abortion


5. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
CML
Mycoplasma
Type IV (distal) RTA
Basal cell carcinoma


6. Hematuria - flank pain - and palpable flank mass.
Febrile seizures (roseola infantum)
Chronic lymphocytic leukemia (CLL)
Renal cell carcinoma (RCC)
Ophthalmologic exam - CT - and MRI


7. A late - life - threatening complication of chronic myelogenous leukemia (CML).
a - antagonists (phentolamine and phenoxybenzamine)
Cerebral berry aneurysms (AD PCKD)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


8. Neutropenic nadir postchemotherapy.
Herpes simplex
7-10 days
Graves' disease
Fat - female - fertile - forty - flatulent


9. T- wave flattening and U waves.
Hypokalemia
Glomerulonephritis/nephritic syndrome
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Treat existing heart failure and replace the tricuspid valve


10. Odds ratio?
Murphy's sign - seen in acute cholecystitis
Alopecia areata (autoimmune process)
Intraductal papilloma
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


11. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Rett's disorder
Biliary tract obstruction
Emergent laparotomy to repair perforated viscus - likely stomach
Factor V Leiden mutation


12. Glomerulonephritis with deafness.

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

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14. Medication used to induce ovulation.
Clomiphene citrate
Seborrheic dermatitis. Treat with antifungals
E. coli O157:H7
Avascular necrosis


15. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Sarcoidosis
Number of live births per 1000 women 15-44 years of age
Ophthalmologic exam - CT - and MRI


16. Acid - base disturbance commonly seen in pregnant women.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
SIADH due to stress
Respiratory alkalosis
IVIG or plasmapheresis


17. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Oral surgery
Subdural hematoma


18. Nonpainful chancre.
MAOIs
Infection - febrile seizures - trauma - idiopathic
Self - limited - painless vaginal bleeding
1


19. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Varicella zoster
Normal
No. Parental consent is not necessary for the medical treatment of pregnant minors
Spinal stenosis


20. The most common type of nephrolithiasis.
Reye's syndrome
Calcium oxalate
68% - 95.5% - 99.7%
Distal radius (Colles' fracture)


21. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Subarachnoid hemorrhage (SAH)
Conversion disorder
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Actinomyces israelii


22. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Wernicke's encephalopathy due to a deficiency of thiamine
Levodopa/carbidopa
Threatened abortion
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


23. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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24. Charcot's triad.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Postinfectious glomerulonephritis
Administration of DDAVP ? serum osmolality and free water restriction
CHF - shock - and altered mental status


25. Name the organism:
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
MAOIs
Reye's syndrome
Klebsiella


26. What is the immunodeficiency?

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27. Supportive treatment for ARDS.
Glanzmann's thrombasthenia
Neuroblastoma
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Continuous positive airway pressure


28. Identify key organisms causing diarrhea:
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
IV penicillin or ampicillin
Campylobacter
High TSH - low T4 - antimicrosomal antibodies


29. Causes of drug - induced SLE.
Metformin
INH - penicillamine - hydralazine - procainamide
Folate deficiency
Anion gap acidosis and 1


30. What is the metabolic syndrome?
Paget's disease
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Actinic keratosis


31. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
MS
Varicella zoster
IV penicillin or ampicillin
Protamine


32. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
IV benzodiazepine
ACEI
Herpes simplex
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


33. Treatment of AF.
Sarcoidosis
Toxoplasma gondii
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Rate control - rhythm conversion - and anticoagulation


34. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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35. Characteristics of 2

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36. Erythema migrans.
Mycobacterium tuberculosis
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Hypovolemic shock
Lesion of 1


37. Peaked T waves and widened QRS.
Abdominal ultrasound and CT
Type I (distal) RTA
Lesch - Nyhan syndrome (purine salvage problem with
Hyperkalemia


38. Attributable risk?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Salmonella
Hypotension and bradycardia
Endometriosis


39. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Dressler's syndrome: fever - pericarditis - ? ESR
Trichomonas vaginitis
Intraductal papilloma
Pseudomonas


40. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Alopecia areata (autoimmune process)
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Cluster headache


41. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Contact dermatitis
Renal cell carcinoma (RCC)
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Endometrial or estrogen receptor - breast cancer


42. The most frequent presentation of intracranial neoplasm.
Impetigo
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
Headache
Lung - breast - skin (melanoma) - kidney - GI tract


43. Identify key organisms causing diarrhea:
Salmonella
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Phencyclidine hydrochloride (PCP) intoxication
'Chocolate cysts -' powder burns


44. Low urine specific gravity in the presence of high serum osmolality.
Non - Hodgkin's lymphoma
DI
Osgood - Schlatter disease
Phototherapy (mild) or exchange transfusion (severe)


45. 1
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Psoriasis
Placental abruption and placenta previa


46. Causes of hypoxemia.
Lyme disease - Ixodes tick - doxycycline
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Placental abruption and placenta previa
50 cc/hour


47. Albuminocytologic dissociation.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Guillain - Barr
Weight loss and OCPs
Establish the ABCs


48. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Incidence and prevalence
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


49. Lab values suggestive of menopause.
Salmonella
Inhaled Beta- agonists and inhaled corticosteroids
Angina is new - is worsening - or occurs at rest
? serum FSH


50. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Threatened abortion
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Vibrio - HAV
Substance abuse