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. Causes of exudative effusion.
Haemophilus ducreyi
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


2. Glomerulonephritis with hemoptysis.

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

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4. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Graves' disease
Pseudogout
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


5. 'Doughy skin.'
Small cell lung cancer (SCLC)
? Ca2+ - ? K- - ? phosphate - ? uric acid
Clomiphene citrate
Hypernatremia


6. Medications and viruses that ? aplastic anemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Osteoarthritis
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


7. A patient fails to lactate after an emergency C- section with marked blood loss.

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8. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Prevalence
OCPs - danazol - GnRH agonists
Antipsychotics (neuroleptic malignant syndrome)
Nephritic syndrome


9. Indications for surgical repair of abdominal aortic aneurysm.
Ulcerative colitis
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
1
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


10. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Ulcerative colitis
Neuroleptics
Restrictive pulmonary disease
Femoral hernia


11. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Small cell lung cancer (SCLC)
Multiple myeloma
Pemphigus vulgaris
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


12. Treatment for ventricular fibrillation.
Immediate cardioversion
SSRIs
BP > 140/90 on three separate occasions two weeks apart
46 -XX


13. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Nephrolithiasis
Signs and symptoms of hypercalcemia
Haemophilus ducreyi
Endometrial biopsy


14. Identify key organisms causing diarrhea:
Depersonalization disorder
Trichomonas vaginitis
Third - degree heart block
ETEC


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

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16. Cold agglutinins.
Fat - female - fertile - forty - flatulent
Postinfectious glomerulonephritis
Distal radius (Colles' fracture)
Mycoplasma


17. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Iron deficiency anemia
Ultrasound
Number of deaths from birth to 28 days per 1000 live births
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


18. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Febrile seizures (roseola infantum)
Usually resolves spontaneously; may require IVIG and/or corticosteroids
IV benzodiazepine
Alopecia areata (autoimmune process)


19. Fetal mortality?

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20. CSF findings:
Hypertension - bradycardia - and abnormal respirations
Asherman's syndrome
Varicella zoster
Bacterial meningitis


21. A 49-year - old male presents with acute - onset flank pain and hematuria.
Distal radius (Colles' fracture)
Nephrolithiasis
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


22. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
CF or Hirschsprung's disease
TICS
Regression
Emergent laparotomy to repair perforated viscus - likely stomach


23. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
False. Withdrawing and withholding life are the same from an ethical standpoint
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Graves' disease
Nephrotic syndrome


24. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
E. coli O157:H7
Suspect ankylosing spondylitis. Check HLA- B27
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Biliary tract obstruction


25. Acid - base disturbance commonly seen in pregnant women.
Flumazenil
Phencyclidine hydrochloride (PCP) intoxication
Vibrio - HAV
Respiratory alkalosis


26. Gout - self - mutilation - and choreoathetosis.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
HGPRTase deficiency)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Osmotic fragility test


27. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Graves' disease
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Septic or anaphylactic shock


28. Treatment of central DI.
IV penicillin or ampicillin
Dissociative fugue
Administration of DDAVP ? serum osmolality and free water restriction
Giardia


29. A child has loss of red light reflex. Diagnosis?
Pityriasis versicolor
Suspect retinoblastoma
Chronic lymphocytic leukemia (CLL)
Parkinson's disease


30. Perinatal mortality?

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31. Erythema migrans.
Central pontine myelinolysis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Respiratory alkalosis
Lesion of 1


32. Bilious emesis within hours after the first feeding.
46 -XX
Lichen sclerosus
Duodenal atresia
Angina - ST- segment changes on ECG - or ? BP


33. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Spinal stenosis
Normal
Retrograde cystourethrogram
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


34. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Legionella pneumonia
Flumazenil
High reliability - low validity
Coccidioidomycosis. Amphotericin B


35. Diagnostic test for hereditary spherocytosis.
Distal radius (Colles' fracture)
Osmotic fragility test
Femoral hernia
SSRIs


36. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
Duchenne muscular dystrophy
Giardia
SCLC


37. CSF findings:
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Angina - ST- segment changes on ECG - or ? BP
Observational bias
MS


38. A neonate has meconium ileus.

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39. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Fat - female - fertile - forty - flatulent
1
Seventy percent if the stenosis is symptomatic
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


40. Causes of transudative effusion.
Nephritic syndrome
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Distal radius (Colles' fracture)


41. Signs suggesting radial nerve damage with humeral fracture.
Intussusception
Type II (proximal) RTA
Clomiphene citrate
Wrist drop - loss of thumb abduction


42. RTA associated with aldosterone defect.
Type IV (distal) RTA
? protein intake - lactulose - neomycin
Febrile seizures (roseola infantum)
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


43. Autoimmune complication occurring 2-4 weeks post - MI.

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44. An antidiabetic agent associated with lactic acidosis.
Metformin
Edrophonium
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Treat existing heart failure and replace the tricuspid valve


45. Medication used to induce ovulation.
Reye's syndrome
Clomiphene citrate
Small cell lung cancer (SCLC)
Multiple myeloma


46. Identify key organisms causing diarrhea:
S. aureus
Anemia of chronic disease
Pseudomonas
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


47. Unopposed estrogen is contraindicated in which cancers?
Choriocarcinoma
Haemophilus ducreyi
Endometrial or estrogen receptor - breast cancer
Check for ? ICP; look for papilledema


48. Joints in the hand affected in rheumatoid arthritis.
Asherman's syndrome
MCP and PIP joints; DIP joints are spared
Central pontine myelinolysis
Weight gain - type 2 DM - QT prolongation


49. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Multiple myeloma
Neisseria meningitidis
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Lobular carcinoma in situ


50. ? CO - ? PCWP - ? PVR.
Septic or anaphylactic shock
Bacillus cereus
Trauma; the second most common is berry aneurysm
Substance abuse