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. Treatment for malignant hypertension.
INH - penicillamine - hydralazine - procainamide
Nitroprusside
Factor V Leiden mutation
Salmonella


2. Name the organism:
Graves' disease
Parvovirus B19
Incidence and prevalence
Sporothrix schenckii


3. Cohort study
Pemphigus vulgaris
Establish the ABCs
Nephrogenic diabetes insipidus (DI)
Incidence and prevalence


4. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Alopecia areata (autoimmune process)
CHF - shock - and altered mental status
HGPRTase deficiency)
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


5. Lab findings in Hashimoto's thyroiditis.
Sarcoidosis
High TSH - low T4 - antimicrosomal antibodies
Number of live births per 1000 population
Low - voltage - diffuse ST- segment elevation


6. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Asherman's syndrome
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Betamethasone or dexamethasone
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)


7. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
Patient on dopamine antagonist
Campylobacter
Lyme disease - Ixodes tick - doxycycline
Paget's disease


8. When should a vaginal exam be performed with suspected placenta previa?
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Edrophonium
Never
Selective IgA deficiency


9. Treatment for mild and severe unconjugated hyperbilirubinemia.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Phototherapy (mild) or exchange transfusion (severe)
N- acetylcysteine
Pregnant women. Treat this group aggressively because of potential complications


10. A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
High reliability - low validity
Partial mole
Coccidioidomycosis. Amphotericin B


11. Asplenic patients are particularly susceptible to these organisms.
Nephrotic syndrome
Excessive EtOH
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Sulfonamides - antimalarial drugs - fava beans


12. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Reaction formation
Salmonella
Lyme disease - Ixodes tick - doxycycline


13. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Neuroleptic malignant syndrome
Febrile seizures (roseola infantum)
Aseptic (viral) meningitis
Chronic granulomatous disease


14. Treatment for bacterial vaginosis.
Elevated ICP - RBCs - xanthochromia
Neuroleptics
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Oral or topical metronidazole


15. Hematuria - flank pain - and palpable flank mass.
Osteoarthritis
Varicella zoster
Renal cell carcinoma (RCC)
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


16. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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17. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Fat - female - fertile - forty - flatulent
Angina is new - is worsening - or occurs at rest
Chronic lymphocytic leukemia (CLL)


18. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead - time bias
Inhaled Beta- agonists and inhaled corticosteroids
Normal
105 bacteria/mL


19. Low urine specific gravity in the presence of high serum osmolality.
Flumazenil
DI
Wegener's granulomatosis and Goodpasture's syndrome
Seborrheic dermatitis. Treat with antifungals


20. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Allergic interstitial nephritis
Alport's syndrome
Nephrotic syndrome


21. Method of calculating fluid repletion in burn patients.
Parkland formula
Acute mania. Start a mood stabilizer (e.g. - lithium)
Campylobacter
Angina - ST- segment changes on ECG - or ? BP


22. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Streptococcus pneumoniae
Normal
Hypotension and bradycardia
Bullous pemphigoid


23. 'Doughy skin.'
Hypernatremia
Osgood - Schlatter disease
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Chronic lymphocytic leukemia (CLL)


24. Fetal mortality?

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25. Defect in an X- linked syndrome with mental retardation -
N- acetylcysteine
Lesch - Nyhan syndrome (purine salvage problem with
1
Aseptic (viral) meningitis


26. First - line treatment for otitis media.
Amoxicillin
Cluster headache
Kwashiorkor (protein malnutrition)
Pseudomonas


27. Endocarditis prophylaxis regimens.
Partial mole
Oral surgery
Alzheimer's and multi - infarct
Highly sensitive for TB


28. Chromosomal pattern of a complete mole.
Conflict of interest
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
46 -XX


29. The 6 P's of ischemia due to peripheral vascular disease.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Trichomonas vaginitis
Restrictive pulmonary disease
Trauma; the second most common is berry aneurysm


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

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31. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Erythema multiforme
Nephrotic syndrome
OCPs
50 cc/hour


32. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Neurofibromatosis 1
Dissociative fugue
Alopecia areata (autoimmune process)
Pityriasis versicolor


33. In which patients do you initiate colorectal cancer screening early?
Femoral hernia
Pharmacologic stress test (e.g. - dobutamine echo)
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first - degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer


34. Identify key organisms causing diarrhea:
Avascular necrosis
7-10 days
Yersinia
Hypertension - bradycardia - and abnormal respirations


35. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
Osteogenesis imperfecta
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Hypovolemic shock


36. A 'blueberry muffin' rash is characteristic of what congenital infection?
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Nephrolithiasis
Guillain - Barr
Rubella


37. A child has loss of red light reflex. Diagnosis?
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Regression
Suspect retinoblastoma
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


38. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
Reaction formation
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Levodopa/carbidopa


39. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Neuroleptic malignant syndrome
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
Osteogenesis imperfecta
Sporothrix schenckii


40. The most common organism in burn - related infections.
Pseudomonas
Cardiogenic shock
Biliary tract obstruction
Regresses after menopause


41. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Endometrial biopsy
Malignancy and hyperparathyroidism
105 bacteria/mL


42. A newborn female has continuous 'machinery murmur.'
Intussusception
Emergent laparotomy to repair perforated viscus - likely stomach
Patent ductus arteriosus (PDA)
Lead - time bias


43. Macrocytic - megaloblastic anemia without neurologic symptoms.
Pityriasis rosea
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Folate deficiency
Sensitivity


44. Antibiotics with teratogenic effects.
Treat immediately. Consent is implied in emergency situations
Fatigue and impending respiratory failure
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Iron deficiency anemia


45. The most common cause of hypothyroidism.

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46. Hernia with highest risk of incarceration
Polymyalgia rheumatica
Giardia
Femoral hernia
Haemophilus ducreyi


47. Fertility rate?
Spinal stenosis
30 cc/hour
Number of live births per 1000 women 15-44 years of age
Crohn's disease


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

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49. Mortality rate?
Number of deaths per 1000 population
Septic or anaphylactic shock
Basal cell carcinoma
Uterine atony


50. An antidiabetic agent associated with lactic acidosis.
Alzheimer's and multi - infarct
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Hodgkin's lymphoma
Metformin