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. Laparoscopic findings in endometriosis.

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2. Birth rate?
Inevitable abortion
Number of live births per 1000 population
Respiratory alkalosis
Betamethasone or dexamethasone


3. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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4. Identify key organisms causing diarrhea:
Clostridium difficile
Pseudomonas
Emergent laparotomy to repair perforated viscus - likely stomach
Selective IgA deficiency


5. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Nephrotic syndrome
'Chocolate cysts -' powder burns
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Highly sensitive for TB


6. Cohort study
Wegener's granulomatosis and Goodpasture's syndrome
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Diverticulosis
Incidence and prevalence


7. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
1
Cerebral berry aneurysms (AD PCKD)
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


8. Auer rods on blood smear.
Number of deaths from 28 days to one year per 1000 live births
Threatened abortion
Hypertrophic cardiomyopathy
Acute myelogenous leukemia (AML)


9. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
ALS
ARDS
Toxoplasma gondii
a - antagonists (phentolamine and phenoxybenzamine)


10. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Nephrotic syndrome
Kwashiorkor (protein malnutrition)
1
1


11. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Obstructive pulmonary disease (e.g. - asthma)
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


12. Conditions in which confidentiality must be overridden.
SIADH due to stress
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Amoxicillin
Cellulitis


13. Chronic diseases such as SLE
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Hyperkalemia
Stasis - hypercoagulability - endothelial damage
Higher prevalence


14. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Allergic interstitial nephritis
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
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


15. Causes of drug - induced SLE.
Intussusception
Higher incidence
Crohn's disease
INH - penicillamine - hydralazine - procainamide


16. Classic ECG findings in pericarditis.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Low - voltage - diffuse ST- segment elevation
Nephrolithiasis
Ophthalmologic exam - CT - and MRI


17. Classic physical findings for endocarditis.

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18. Acid - base disorder in pulmonary embolism.
Edrophonium
Seventy percent if the stenosis is symptomatic
Hypoxia and hypocarbia
Protamine


19. Name the defense mechanism:
Hypoparathyroidism
Isolation
Regression
ETEC


20. Supportive treatment for ARDS.
Continuous positive airway pressure
BP > 140/90 on three separate occasions two weeks apart
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
S. aureus


21. Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Threatened abortion
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Pregnant women. Treat this group aggressively because of potential complications
Dissociative fugue


22. CSF findings:
Chronic lymphocytic leukemia (CLL)
Nephritic syndrome
Bacterial meningitis
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


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

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24. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Wegener's granulomatosis and Goodpasture's syndrome
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Menometrorrhagia


25. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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26. ? risk of what infection with silicosis?
'Sawtooth' P waves
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Mycobacterium tuberculosis


27. Tanner stage 3 in a six-year - old female.
Precocious puberty
HBV immunoglobulin
Niacin
Malingering


28. Name the organism:
Broca's aphasia. Frontal lobe - left MCA distribution
Obstructive pulmonary disease (e.g. - asthma)
Pasteurella multocida
Cirrhosis - CHF - nephritic syndrome


29. Acute - phase treatment for Kawasaki disease.
30 cc/hour
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Pseudomonas
Hypoxia and hypocarbia


30. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
DM - SLE - and amyloidosis
Retinoic acid
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
No. Parental consent is not necessary for the medical treatment of pregnant minors


31. PFT showing ? FEV1/FVC.
Malignancy and hyperparathyroidism
IV hydration and loop diuretics (furosemide)
Restrictive pulmonary disease
Nephrolithiasis


32. 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.
Polymyalgia rheumatica
Malignancy and hyperparathyroidism
Lesion of 1
Hypoxia and hypocarbia


33. Exophthalmos - pretibial myxedema - and ? TSH.

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34. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Selective IgA deficiency
Lead - time bias
Normal
Diphenhydramine or epinephrine 1:1000


35. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Hodgkin's lymphoma
Basal cell carcinoma
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Lesch - Nyhan syndrome (purine salvage problem with


36. Relative risk?
Iron overload; use deferoxamine
Osgood - Schlatter disease
The IR of a disease in a population exposed to a particular factor
Basal cell carcinoma


37. Flat - topped papules.
Basal cell carcinoma
Pheochromocytoma
Pityriasis versicolor
Lichen planus


38. PFT showing ? FEV1/FVC.
Nephrotic syndrome
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Obstructive pulmonary disease (e.g. - asthma)
Menometrorrhagia


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

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40. Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Trauma; the second most common is berry aneurysm
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


41. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Alzheimer's and multi - infarct
High reliability - low validity
Fluids and antibiotics
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


42. Nonpainful chancre.
1
Bruton's X- linked agammaglobulinemia
Ultrasound
Pseudomonas


43. Post - HBV exposure treatment.
HBV immunoglobulin
Chronic lymphocytic leukemia (CLL)
Cirrhosis - CHF - nephritic syndrome
Wegener's granulomatosis and Goodpasture's syndrome


44. ? CO - ? PCWP - ? PVR.
Septic or anaphylactic shock
Anion gap acidosis and 1
'Sawtooth' P waves
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


45. Honeycomb pattern on CXR. Diagnosis? Treatment?
Fatigue and impending respiratory failure
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Yersinia
Higher incidence


46. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
SIADH due to stress
Endometriosis
Kl
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


47. Epidemics such as influenza
Higher incidence
Anticoagulation - rate control - cardioversion
Subarachnoid hemorrhage (SAH)
Clostridium difficile


48. Which healthy population is susceptible to UTIs?
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Anticoagulation - rate control - cardioversion
Pregnant women. Treat this group aggressively because of potential complications


49. Thrombotic thrombocytopenic purpura (TTP) pentad?
Malingering
Pentad of TTP
Frotteurism (a paraphilia)
Septic or anaphylactic shock


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

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