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. The most common cause of female infertility.
< 7.0
Inhaled Beta- agonists and inhaled corticosteroids
Allergic interstitial nephritis
Endometriosis


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

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3. Indications for medical treatment of ectopic pregnancy.

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4. Chronic diseases such as SLE
Neurofibromatosis 1
Bacterial meningitis
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Higher prevalence


5. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Coarctation of the aorta
Nephrogenic diabetes insipidus (DI)
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


6. Name the organism:
Type II (proximal) RTA
Weight loss and OCPs
Haemophilus ducreyi
Substance abuse


7. Inspiratory arrest during palpation of the RUQ.

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8. Molar pregnancy containing fetal tissue.
Parkinson's disease
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Partial mole
OCPs


9. Name the organism:
Varicella zoster
BP > 140/90 on three separate occasions two weeks apart
Small cell lung cancer (SCLC)
Salmonella


10. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Chronic lymphocytic leukemia (CLL)
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
? Ca2+ - ? K- - ? phosphate - ? uric acid


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

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12. Hematuria - flank pain - and palpable flank mass.
Anorexia
Infection - febrile seizures - trauma - idiopathic
Renal cell carcinoma (RCC)
Never


13. Peaked T waves and widened QRS.
Pityriasis rosea
Hyperkalemia
Guillain - Barr
Oral or topical metronidazole


14. Treatment of supraventricular tachycardia (SVT).
Mycoplasma
IVIG or plasmapheresis
DI
Rate control with carotid massasge or other vagal stimulation


15. RTA associated with aldosterone defect.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Type IV (distal) RTA
50 cc/hour
Reye's syndrome


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

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17. What is the immunodeficiency?
Lyme disease - Ixodes tick - doxycycline
Wiskott - Aldrich syndrome
Inevitable abortion
Lead - time bias


18. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Number of deaths per 1000 population
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


19. 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?
Highly sensitive for TB
Neuroleptics
Coarctation of the aorta
1


20. Which healthy population is susceptible to UTIs?
Menometrorrhagia
Pregnant women. Treat this group aggressively because of potential complications
Lesch - Nyhan syndrome (purine salvage problem with
Precocious puberty


21. Name the organism:
Klebsiella
SSRIs
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Streptococcus pneumoniae


22. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Duchenne muscular dystrophy
Iron deficiency anemia
Acute mania. Start a mood stabilizer (e.g. - lithium)
Precocious puberty


23. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
HBV immunoglobulin
Consider Fitz - Hugh - Curtis syndrome
OCPs - danazol - GnRH agonists


24. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Distal radius (Colles' fracture)
Number of live births per 1000 women 15-44 years of age
Excessive EtOH
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


25. Name the organism:
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Duodenal atresia
Patent ductus arteriosus (PDA)
Klebsiella


26. When should a vaginal exam be performed with suspected placenta previa?
Nephrotic syndrome
Never
Protamine
Seborrheic dermatitis. Treat with antifungals


27. Identify key organisms causing diarrhea:
CA-125 and transvaginal ultrasound
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Suspect retinoblastoma
Vibrio - HAV


28. Tests to rule out shaken baby syndrome.
Broca's aphasia. Frontal lobe - left MCA distribution
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
IV penicillin or ampicillin
Ophthalmologic exam - CT - and MRI


29. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Sarcoidosis
Trauma; the second most common is berry aneurysm
Osteoarthritis
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


30. Eosinophils in urine sediment.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Cerebral berry aneurysms (AD PCKD)
Allergic interstitial nephritis
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


31. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Dissociative fugue
Check for ? ICP; look for papilledema
Neisseria meningitidis
Signs and symptoms of hypercalcemia


32. Classic physical findings for endocarditis.

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33. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
False. Withdrawing and withholding life are the same from an ethical standpoint
Rate control - rhythm conversion - and anticoagulation
AP chest - AP/lateral C- spine - AP pelvis


34. Name the organism:
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Restrictive pulmonary disease
Streptococcus pneumoniae
Sporothrix schenckii


35. Defect in an X- linked syndrome with mental retardation -
Salmonella
Lesch - Nyhan syndrome (purine salvage problem with
Sheehan's syndrome (postpartum pituitary necrosis)
Septic or anaphylactic shock


36. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Iron deficiency anemia
Hodgkin's lymphoma
Squamous cell carcinoma
Partial mole


37. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Fluid restriction - demeclocycline
E. coli O157:H7
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


38. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Alport's syndrome
Ophthalmologic exam - CT - and MRI
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Anemia of chronic disease


39. Antidepressants associated with hypertensive crisis.
MAOIs
They can mask symptoms of hypoglycemia
Infection - cancer - and autoimmune disease
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


40. Hypercholesterolemia treatment that ? flushing and pruritus.
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
Flumazenil
Intraductal papilloma
Niacin


41. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Beta- hCG; the most common cause of amenorrhea is pregnancy
Abdominal ultrasound and CT
Factor V Leiden mutation
1


42. Signs of neurogenic shock.
ALS
Hypotension and bradycardia
O2 - analgesia - hydration - and - if severe - transfusion
Anorexia


43. Name the organism:
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Pseudomonas
Murphy's sign - seen in acute cholecystitis
Cluster headache


44. Unopposed estrogen is contraindicated in which cancers?
Headache
Trauma; the second most common is berry aneurysm
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Endometrial or estrogen receptor - breast cancer


45. Risk factors for cholelithiasis.
Erythema multiforme
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Fat - female - fertile - forty - flatulent
Oral surgery


46. Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Never
Endometrial or estrogen receptor - breast cancer
Bruton's X- linked agammaglobulinemia


47. Attributable risk?
MCP and PIP joints; DIP joints are spared
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Conduct disorder
'Chocolate cysts -' powder burns


48. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Betamethasone or dexamethasone
Number of live births per 1000 population
Rate control - rhythm conversion - and anticoagulation
Lichen sclerosus


49. Causes of transudative effusion.
Lichen sclerosus
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Lobular carcinoma in situ
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


50. Cohort study
Incidence and prevalence
Yersinia
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
CA-125 and transvaginal ultrasound