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. Definition of hypertension.
Number of live births per 1000 population
BP > 140/90 on three separate occasions two weeks apart
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


2. ? CO - ? PCWP - ? PVR.
Pharmacologic stress test (e.g. - dobutamine echo)
Nephrotic syndrome
Septic or anaphylactic shock
Hypocalcemia


3. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Lung - breast - skin (melanoma) - kidney - GI tract
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Campylobacter
Kl


4. Administer to a symptomatic patient to diagnose myasthenia gravis.
Patient on dopamine antagonist
Fatigue and impending respiratory failure
Edrophonium
? Ca2+ - ? K- - ? phosphate - ? uric acid


5. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
OCPs - danazol - GnRH agonists
Acute mania. Start a mood stabilizer (e.g. - lithium)
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


6. 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?
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
SIADH due to stress
Bruton's X- linked agammaglobulinemia
Highly sensitive for TB


7. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Small cell lung cancer (SCLC)
Oral surgery
'Chocolate cysts -' powder burns
Contact dermatitis


8. PFT showing ? FEV1/FVC.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Restrictive pulmonary disease
Murphy's sign - seen in acute cholecystitis
Number of live births per 1000 women 15-44 years of age


9. Perinatal mortality?

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10. Honey- crusted lesions.
Osmotic fragility test
Broca's aphasia. Frontal lobe - left MCA distribution
Impetigo
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


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

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12. Identify key organisms causing diarrhea:
Wrist drop - loss of thumb abduction
Low - voltage - diffuse ST- segment elevation
Iron deficiency anemia
E. coli O157:H7


13. How to diagnose and follow a leiomyoma.
Depersonalization disorder
Ultrasound
Colposcopy and endocervical curettage
MAOIs


14. How to distinguish polycythemia vera from 2
Osmotic fragility test
Central pontine myelinolysis
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Glanzmann's thrombasthenia


15. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Neuroleptics
Intraductal papilloma
Diphenhydramine or epinephrine 1:1000
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


16. Identify key organisms causing diarrhea:
OCPs
Fluid restriction - demeclocycline
Campylobacter
Hereditary spherocytosis


17. The most common cause of SAH.
Hypovolemic shock
High reliability - low validity
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Trauma; the second most common is berry aneurysm


18. Chromosomal pattern of a complete mole.
Dissociative fugue
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Type I (distal) RTA
46 -XX


19. What is the immunodeficiency?

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20. Pure RBC aplasia.
Impetigo
Diamond - Blackfan anemia
E. coli O157:H7
HGPRTase deficiency)


21. 1
Placental abruption and placenta previa
Neisseria meningitidis
N- acetylcysteine
Bruton's X- linked agammaglobulinemia


22. A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
S. aureus or S. epidermidis.
Spinal stenosis


23. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Cluster headache
Postinfectious glomerulonephritis
Identify cause; pressors (e.g. - dobutamine)
HIDA scan


24. Cannon 'a' waves.
Impetigo
Sulfonamides - antimalarial drugs - fava beans
Third - degree heart block
Depersonalization disorder


25. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
'Chocolate cysts -' powder burns
E. coli O157:H7
Factitious disorder (Munchausen syndrome)
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


26. The most common type of testicular cancer.
Incidence and prevalence
Spinal stenosis
Osteoarthritis
Seminoma


27. Indications for medical treatment of ectopic pregnancy.

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28. An agent that reverses the effects of heparin.
Anemia - thrombocytopenia - and acute renal failure
Partial mole
A patient's family cannot require that a doctor withhold information from the patient
Protamine


29. Shortest AP diameter of the pelvis.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Trauma - alcohol withdrawal - brain tumor
Endometrial biopsy


30. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Clostridium difficile
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Signs and symptoms of hypercalcemia
Confounding variable


31. Bilious emesis within hours after the first feeding.
Reye's syndrome
Sensitivity
Isolation
Duodenal atresia


32. Nikolsky's sign.
Bullous pemphigoid
Metformin
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Trauma; the second most common is berry aneurysm


33. Number needed to treat?
RSV bronchiolitis
Cirrhosis - CHF - nephritic syndrome
1
'Chocolate cysts -' powder burns


34. The most common type of nephrolithiasis.
Yersinia
Hypoxia and hypocarbia
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
Calcium oxalate


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

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36. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Nephrotic syndrome
Surfactant deficiency
Neuroleptic malignant syndrome
Elevated ICP - RBCs - xanthochromia


37. Tests to rule out shaken baby syndrome.
Multiple myeloma
Chronic granulomatous disease
Uterine massage; if that fails - give oxytocin
Ophthalmologic exam - CT - and MRI


38. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Stasis - hypercoagulability - endothelial damage
OCPs
Pseudogout
Patient on dopamine antagonist


39. Antihypertensive for a diabetic patient with proteinuria.
Weight loss and OCPs
ACEI
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
MCP and PIP joints; DIP joints are spared


40. A 49-year - old male presents with acute - onset flank pain and hematuria.
Diverticulosis
Bullous pemphigoid
Broca's aphasia. Frontal lobe - left MCA distribution
Nephrolithiasis


41. First - line treatment for moderate hypercalcemia.
Acute pancreatitis
1
Continuous - painful vaginal bleeding
IV hydration and loop diuretics (furosemide)


42. Drugs that slow AV node transmission.
Non - Hodgkin's lymphoma
Beta- blockers - digoxin - calcium channel blockers
Abdominal ultrasound and CT
Salmonella


43. T- wave flattening and U waves.
Rett's disorder
Avascular necrosis
Pheochromocytoma
Hypokalemia


44. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Ultrasound
Diphenhydramine or epinephrine 1:1000
Hypoparathyroidism
Wrist drop - loss of thumb abduction


45. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
1
Lichen planus
Conflict of interest
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


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

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47. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Hypertrophic cardiomyopathy
ETEC
Cerebral berry aneurysms (AD PCKD)
Parkinson's disease


48. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
A patient's family cannot require that a doctor withhold information from the patient
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Excessive EtOH


49. The mainstay of Parkinson's therapy.
Uremic syndrome seen in patients with renal failure
Levodopa/carbidopa
Cardiogenic shock
Malignancy and hyperparathyroidism


50. RTA associated with abnormal HCO3 - and rickets.
Amoxicillin
Polymyalgia rheumatica
Type II (proximal) RTA
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis