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. What is the immunodeficiency?
Depersonalization disorder
HBV - DTaP - Hib - IPV - PCV
Rett's disorder
Chronic granulomatous disease


2. 'Dewdrop on a rose petal.'
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Dantrolene or bromocriptine
Lesions of 1
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch


3. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
105 bacteria/mL
Seborrheic keratosis
HGPRTase deficiency)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


4. Administer to a symptomatic patient to diagnose myasthenia gravis.
Fat - female - fertile - forty - flatulent
Ophthalmologic exam - CT - and MRI
Edrophonium
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


5. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Neither
Dissociative fugue
7-10 days
Confounding variable


6. Describe a test that consistently gives identical results - but the results are wrong.
High reliability - low validity
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Alzheimer's and multi - infarct
Ulcerative colitis


7. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Fluids and antibiotics
Choriocarcinoma
Lung - breast - skin (melanoma) - kidney - GI tract


8. Name the organism:
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Streptococcus pneumoniae
Paget's disease
1


9. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Neuroleptic malignant syndrome
Infection - cancer - and autoimmune disease
Partial mole


10. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Hypertrophic cardiomyopathy
Pasteurella multocida
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Suspect ankylosing spondylitis. Check HLA- B27


11. Tests to rule out shaken baby syndrome.
Ampulla of the oviduct
Ophthalmologic exam - CT - and MRI
Treat existing heart failure and replace the tricuspid valve
'Sawtooth' P waves


12. A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Factor V Leiden mutation
No. Parental consent is not necessary for the medical treatment of pregnant minors


13. Mortality rate?
Hypokalemia
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Number of deaths per 1000 population
Suspect retinoblastoma


14. Presents with a herald patch - Christmas - tree pattern.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Septic or anaphylactic shock
Pityriasis rosea
Metformin


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

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16. Classic ECG finding in atrial flutter.

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17. First - line treatment for otitis media.
Reaction formation
CHF - shock - and altered mental status
Amoxicillin
Precocious puberty


18. Chronic diseases such as SLE
Subarachnoid hemorrhage (SAH)
Administration of DDAVP ? serum osmolality and free water restriction
Higher prevalence
Suspect ankylosing spondylitis. Check HLA- B27


19. Tanner stage 3 in a six-year - old female.
Precocious puberty
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Consider Fitz - Hugh - Curtis syndrome
Prinzmetal's angina


20. Red plaques with silvery- white scales and sharp margins.
Prinzmetal's angina
Psoriasis
Hypoxia and hypocarbia
Pityriasis rosea


21. Which healthy population is susceptible to UTIs?
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Isolation
Pregnant women. Treat this group aggressively because of potential complications
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


22. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
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
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Displacement
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


23. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Kl
Dantrolene or bromocriptine
'Chocolate cysts -' powder burns
Regresses after menopause


24. The most common type of nephrolithiasis.
Reye's syndrome
Calcium oxalate
Ophthalmologic exam - CT - and MRI
Absence seizures


25. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
BP > 140/90 on three separate occasions two weeks apart
68% - 95.5% - 99.7%
Number of live births per 1000 population
IVIG or plasmapheresis


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

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27. Four signs and symptoms of streptococcal pharyngitis.
Calcium oxalate
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Inhaled Beta- agonists and inhaled corticosteroids


28. Meningitis in infants. Causes? Treatment?
Number of live births per 1000 women 15-44 years of age
Febrile seizures (roseola infantum)
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Paget's disease


29. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Incidence and prevalence
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Establish the ABCs
Duchenne muscular dystrophy


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

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31. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Alport's syndrome
DI
Anemia of chronic disease
Emergent laparotomy to repair perforated viscus - likely stomach


32. Pure RBC aplasia.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Diamond - Blackfan anemia
Neither
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


33. Bilious emesis within hours after the first feeding.
Duodenal atresia
Hereditary spherocytosis
ACEI
Biliary tract obstruction


34. Name the organism:
Reye's syndrome
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Klebsiella
Haemophilus ducreyi


35. The most common cause of postpartum hemorrhage.
Uterine atony
Confounding variable
Never
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


36. When can a physician refuse to continue treating a patient on the grounds of futility?
Weight loss and OCPs
Low - voltage - diffuse ST- segment elevation
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
Allergic interstitial nephritis


37. Key side effects of atypical antipsychotics.
Mycobacterium tuberculosis
Iron overload; use deferoxamine
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Weight gain - type 2 DM - QT prolongation


38. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Stasis - hypercoagulability - endothelial damage
Parkland formula
Osteogenesis imperfecta


39. Inspiratory arrest during palpation of the RUQ.

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40. The most common cause of SAH.
Uterine massage; if that fails - give oxytocin
Betamethasone or dexamethasone
Conflict of interest
Trauma; the second most common is berry aneurysm


41. Medications and viruses that ? aplastic anemia.
HGPRTase deficiency)
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Klebsiella
? serum FSH


42. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
SSRIs
Asymmetry - border irregularity - color variation - large diameter
Diverticulosis
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


43. Treatment for acute coronary syndrome.
Nitroprusside
S. aureus
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Conversion disorder


44. A patient with a history of lithium use presents with copious amounts of dilute urine.
Duchenne muscular dystrophy
Patent ductus arteriosus (PDA)
Nephrogenic diabetes insipidus (DI)
Higher prevalence


45. Characteristics of 2

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46. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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47. Autoimmune complication occurring 2-4 weeks post - MI.

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48. The most common cause of female infertility.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Lesion of 1
Consider Fitz - Hugh - Curtis syndrome
Endometriosis


49. Term for heavy bleeding during and between menstrual periods.
Ultrasound
Intussusception
Menometrorrhagia
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


50. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Clostridium difficile
Colposcopy and endocervical curettage
Bladder rupture or urethral injury
Hypoxia and hypocarbia