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. Treatment for opioid overdose.
Wegener's granulomatosis and Goodpasture's syndrome
Naloxone
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Crohn's disease


2. The most common type of nephrolithiasis.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
7-10 days
Calcium oxalate


3. An antidiabetic agent associated with lactic acidosis.
Metformin
INH - penicillamine - hydralazine - procainamide
Higher prevalence
Pityriasis rosea


4. Lung cancer associated with SIADH.
HBV - DTaP - Hib - IPV - PCV
Small cell lung cancer (SCLC)
Actinic keratosis
68% - 95.5% - 99.7%


5. The most common organism in burn - related infections.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Exercise stress treadmill with ECG
Pseudomonas


6. Perinatal mortality?

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7. AML subtype associated with DIC.
Distal radius (Colles' fracture)
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
M3
'Chocolate cysts -' powder burns


8. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Uremic syndrome seen in patients with renal failure
Anion gap acidosis and 1
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


9. When should a vaginal exam be performed with suspected placenta previa?
Flumazenil
Streptococcus pneumoniae
Never
Erythema multiforme


10. Treatment of tension pneumothorax.
M3
Immediate needle thoracostomy
Pseudogout
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


11. May be seen in children who are accused of inattention in class and confused with ADHD.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
'Chocolate cysts -' powder burns
Absence seizures
Regression


12. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
S. aureus or S. epidermidis.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Central pontine myelinolysis


13. Cold agglutinins.
Endometrial or estrogen receptor - breast cancer
Acute pancreatitis
Mycoplasma
Factitious disorder (Munchausen syndrome)


14. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Herpes simplex
Incidence and prevalence
Trichomonas vaginitis


15. Causes of transudative effusion.
Pasteurella multocida
Small cell lung cancer (SCLC)
Wegener's granulomatosis and Goodpasture's syndrome
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


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

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17. A young patient with a family history of sudden death collapses and dies while exercising.
INH - penicillamine - hydralazine - procainamide
Beta- blockers - Ca2+ channel blockers - TCAs
'Chocolate cysts -' powder burns
Hypertrophic cardiomyopathy


18. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Respiratory alkalosis
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
N- acetylcysteine


19. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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20. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Elevated ICP - RBCs - xanthochromia
Patient on dopamine antagonist
Yersinia
Diphenhydramine or epinephrine 1:1000


21. What should always be done prior to LP?
Factitious disorder (Munchausen syndrome)
Phototherapy (mild) or exchange transfusion (severe)
Check for ? ICP; look for papilledema
ALS


22. Heinz bodies?
Hypertension - bradycardia - and abnormal respirations
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


23. PFT showing ? FEV1/FVC.
Huntington's disease
Conversion disorder
Neither
Restrictive pulmonary disease


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

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25. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Central pontine myelinolysis
Fat - female - fertile - forty - flatulent
Seminoma
RCC or other erythropoietin - producing tumor; evaluate with CT scan


26. Characteristics of 2

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27. Name the organism:
Guillain - Barr
Klebsiella
N- acetylcysteine
RCC or other erythropoietin - producing tumor; evaluate with CT scan


28. Causes of exudative effusion.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Seborrheic dermatitis. Treat with antifungals
MS


29. Relative risk?
The IR of a disease in a population exposed to a particular factor
Uterine atony
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


30. Iris - like target lesions.
Erythema multiforme
SSRIs
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Selective IgA deficiency


31. Test to rule out urethral injury.
Infection - cancer - and autoimmune disease
Retrograde cystourethrogram
Precocious puberty
Nephritic syndrome


32. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
CA-125 and transvaginal ultrasound
Intussusception
a - antagonists (phentolamine and phenoxybenzamine)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


33. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Osgood - Schlatter disease
Beta- hCG; the most common cause of amenorrhea is pregnancy
Diamond - Blackfan anemia


34. Lab findings in Hashimoto's thyroiditis.
Seventy percent if the stenosis is symptomatic
Sarcoidosis
Squamous cell carcinoma
High TSH - low T4 - antimicrosomal antibodies


35. Causes of drug - induced SLE.
Seborrheic dermatitis. Treat with antifungals
Isolation
M3
INH - penicillamine - hydralazine - procainamide


36. The most serious side effect of clozapine.
A patient's family cannot require that a doctor withhold information from the patient
Yersinia
Lead - time bias
Agranulocytosis


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

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38. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68% - 95.5% - 99.7%
Reye's syndrome
Chronic granulomatous disease
Nephritic syndrome


39. The most common causes of dementia.

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40. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Conduct disorder
Subarachnoid hemorrhage (SAH)
Sulfonamides - antimalarial drugs - fava beans
Postinfectious glomerulonephritis


41. First - line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide)
Hypotension and bradycardia
Salmonella
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


42. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Parainfluenza virus type 1
IV penicillin or ampicillin
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


43. A violent patient has vertical and horizontal nystagmus.
Weight loss and OCPs
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Phencyclidine hydrochloride (PCP) intoxication
Bacillus cereus


44. The most common cause of SAH.
Emergent laparotomy to repair perforated viscus - likely stomach
Headache
Trauma; the second most common is berry aneurysm
Parvovirus B19


45. 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.
OCPs
Polymyalgia rheumatica
Glomerulonephritis/nephritic syndrome
Toxoplasma gondii


46. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Number of live births per 1000 population
Nephrotic syndrome
A patient with chest trauma who was previously stable suddenly dies
Distal radius (Colles' fracture)


47. Treatment for ventricular fibrillation.
Immediate cardioversion
Ophthalmologic exam - CT - and MRI
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Iron overload; use deferoxamine


48. ECG findings suggesting MI.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
105 bacteria/mL
AP chest - AP/lateral C- spine - AP pelvis
1


49. Name the defense mechanism:
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
MCP and PIP joints; DIP joints are spared
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Isolation


50. A homeless child is small for his age and has peeling skin and a swollen belly.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Kwashiorkor (protein malnutrition)
Murphy's sign - seen in acute cholecystitis
Fanconi's anemia