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. Not contraindications to vaccination.
IV penicillin or ampicillin
High TSH - low T4 - antimicrosomal antibodies
Duchenne muscular dystrophy
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


2. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Clomiphene citrate
Renal cell carcinoma (RCC)
46 -XX
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


3. Honey- crusted lesions.
Alport's syndrome
Impetigo
Pseudomonas
Prerenal


4. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
M3
Diverticulosis
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


5. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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6. Diagnostic test for hereditary spherocytosis.
Type IV (distal) RTA
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Rate control - rhythm conversion - and anticoagulation
Osmotic fragility test


7. Name the organism:
Inevitable abortion
Rubella
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Haemophilus ducreyi


8. Contraceptive methods that protect against PID.
Mallory- Weiss
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
TICS
OCP and barrier contraception


9. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Immediate needle thoracostomy
Identify cause; fluid and blood repletion
Basal cell carcinoma
Clomiphene citrate


10. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Pheochromocytoma
Usually resolves spontaneously; may require IVIG and/or corticosteroids
A patient's family cannot require that a doctor withhold information from the patient
Impetigo


11. Medications and viruses that ? aplastic anemia.
OCP and barrier contraception
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
ACEI
ETEC


12. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Febrile seizures (roseola infantum)
Threatened abortion
Pemphigus vulgaris


13. Therapy for polycystic ovarian syndrome.
Lesch - Nyhan syndrome (purine salvage problem with
Fat - female - fertile - forty - flatulent
Weight loss and OCPs
Type IV (distal) RTA


14. Appropriate diagnostic test?
Pharmacologic stress test (e.g. - dobutamine echo)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Seminoma
Dressler's syndrome: fever - pericarditis - ? ESR


15. Type of ARF in a patient with FeNa < 1%.
Prerenal
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
V/Q scan
Anemia - thrombocytopenia - and acute renal failure


16. CSF findings with SAH.
Pulsus paradoxus (seen in cardiac tamponade)
Campylobacter
Pregnant women. Treat this group aggressively because of potential complications
Elevated ICP - RBCs - xanthochromia


17. Eosinophils in urine sediment.
Allergic interstitial nephritis
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
Placental abruption and placenta previa
Lesion of 1


18. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Sarcoidosis
Angina is new - is worsening - or occurs at rest
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


19. The most common cause of bloody nipple discharge.
Renal cell carcinoma (RCC)
Intraductal papilloma
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Glomerulonephritis/nephritic syndrome


20. RTA associated with aldosterone defect.
Benzodiazepines
ALS
Malignancy and hyperparathyroidism
Type IV (distal) RTA


21. CSF findings:
Subarachnoid hemorrhage (SAH)
Distal radius (Colles' fracture)
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Stasis - hypercoagulability - endothelial damage


22. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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23. Heinz bodies?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Chronic lymphocytic leukemia (CLL)
Higher incidence
Broca's aphasia. Frontal lobe - left MCA distribution


24. Annual screening for women with a strong family history of ovarian cancer.
Type IV (distal) RTA
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
CA-125 and transvaginal ultrasound
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


25. Exophthalmos - pretibial myxedema - and ? TSH.

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26. Natural history of a leiomyoma.
Agranulocytosis
Spinal stenosis
Regresses after menopause
Abdominal ultrasound and CT


27. Identify key organisms causing diarrhea:
Toxoplasma gondii
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Salmonella
Bullous pemphigoid


28. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides - antimalarial drugs - fava beans
Nitroprusside
Headache
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


29. Supportive treatment for ARDS.
Number of live births per 1000 women 15-44 years of age
Continuous positive airway pressure
Immediate needle thoracostomy
Selective IgA deficiency


30. The most common causes of hypercalcemia.
Hypoxia and hypocarbia
Malignancy and hyperparathyroidism
Pregnant women. Treat this group aggressively because of potential complications
Emergent laparotomy to repair perforated viscus - likely stomach


31. Postnatal mortality?
Agranulocytosis
Number of deaths from 28 days to one year per 1000 live births
Fanconi's anemia
105 bacteria/mL


32. Antihypertensive for a diabetic patient with proteinuria.
Establish the ABCs
ACEI
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Paget's disease


33. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Taenia solium (cysticercosis)
Frotteurism (a paraphilia)
Malignancy and hyperparathyroidism
Kegel exercises - estrogen - pessaries for stress incontinence


34. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
1
Sheehan's syndrome (postpartum pituitary necrosis)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Normal


35. Identify key organisms causing diarrhea:
Consider Fitz - Hugh - Curtis syndrome
ETEC
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
? Ca2+ - ? K- - ? phosphate - ? uric acid


36. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Prerenal
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Spinal stenosis
Lobular carcinoma in situ


37. The most common cause of hypertension in young men.
OCP and barrier contraception
Subarachnoid hemorrhage (SAH)
Niacin
Excessive EtOH


38. HUS triad?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Anemia - thrombocytopenia - and acute renal failure
Neurofibromatosis 1
BP > 140/90 on three separate occasions two weeks apart


39. Antibiotics with teratogenic effects.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Self - limited - painless vaginal bleeding
Identify cause; pressors (e.g. - dobutamine)


40. Name the organism:
Actinomyces israelii
Varicella zoster
Restrictive pulmonary disease
Wernicke's encephalopathy due to a deficiency of thiamine


41. Symptoms of placenta previa.
Prevalence
Self - limited - painless vaginal bleeding
Type IV (distal) RTA
Pityriasis rosea


42. PFT showing ? FEV1/FVC.
Restrictive pulmonary disease
Hyperkalemia
Bruton's X- linked agammaglobulinemia
Glomerulonephritis/nephritic syndrome


43. The most common 1
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Subdural hematoma
Benzodiazepines
Lung - breast - skin (melanoma) - kidney - GI tract


44. Treatment of supraventricular tachycardia (SVT).
N- acetylcysteine
Weight loss and OCPs
Threatened abortion
Rate control with carotid massasge or other vagal stimulation


45. A young patient with a family history of sudden death collapses and dies while exercising.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Inevitable abortion
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Hypertrophic cardiomyopathy


46. What is the immunodeficiency?

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47. Infant mortality?
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
N- acetylcysteine
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


48. A child has loss of red light reflex. Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Allergic interstitial nephritis
Suspect retinoblastoma
a - antagonists (phentolamine and phenoxybenzamine)


49. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins
Signs and symptoms of hypercalcemia
Bladder rupture or urethral injury


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

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