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 of AF.
Rate control - rhythm conversion - and anticoagulation
1
CHF - shock - and altered mental status
Number of deaths from birth to 28 days per 1000 live births


2. Treatment of tension pneumothorax.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Immediate needle thoracostomy
1
Type I (distal) RTA


3. Treatment for mild and severe unconjugated hyperbilirubinemia.
Sheehan's syndrome (postpartum pituitary necrosis)
Phototherapy (mild) or exchange transfusion (severe)
Lesch - Nyhan syndrome (purine salvage problem with
Lung - breast - skin (melanoma) - kidney - GI tract


4. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Lichen sclerosus
Sensitivity
Coccidioidomycosis. Amphotericin B


5. What should always be done prior to LP?
Placental abruption and placenta previa
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Check for ? ICP; look for papilledema


6. Evaluation of a pulsatile abdominal mass and bruit.
Pulsus paradoxus (seen in cardiac tamponade)
O2 - analgesia - hydration - and - if severe - transfusion
Abdominal ultrasound and CT
Varicella zoster


7. Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Trauma - alcohol withdrawal - brain tumor
Pentad of TTP
Bruton's X- linked agammaglobulinemia


8. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Ophthalmologic exam - CT - and MRI
No. Parental consent is not necessary for the medical treatment of pregnant minors
Osteoarthritis


9. Acid - base disorder in pulmonary embolism.
Fluid restriction - demeclocycline
Hypoxia and hypocarbia
Phencyclidine hydrochloride (PCP) intoxication
CA-125 and transvaginal ultrasound


10. Four characteristics of a nevus suggestive of melanoma.
Asymmetry - border irregularity - color variation - large diameter
Septic or anaphylactic shock
Guillain - Barr
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


11. Treatment for opioid overdose.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Infection - cancer - and autoimmune disease
V/Q scan
Naloxone


12. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Pentad of TTP
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Angina is new - is worsening - or occurs at rest


13. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Patient on dopamine antagonist
68% - 95.5% - 99.7%
Lead - time bias


14. Honey- crusted lesions.
Impetigo
Neurofibromatosis 1
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
MCP and PIP joints; DIP joints are spared


15. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Beta- hCG; the most common cause of amenorrhea is pregnancy
Dissociative fugue


16. Glomerulonephritis with hemoptysis.

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17. Presence of red cell casts in urine sediment.
Fat - female - fertile - forty - flatulent
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Glomerulonephritis/nephritic syndrome


18. The most common type of testicular cancer.
Number of live births per 1000 women 15-44 years of age
TICS
Seminoma
Factor V Leiden mutation


19. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
ACEI
Lobular carcinoma in situ
ALS
Lesions of 1


20. Identify key organisms causing diarrhea:
IgA nephropathy (Berger's disease)
Vibrio - HAV
Guillain - Barr
Folate deficiency


21. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Stasis - hypercoagulability - endothelial damage
Klebsiella
Hypotension and bradycardia
Inevitable abortion


22. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Retinoic acid
Kl
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
HGPRTase deficiency)


23. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
IgA nephropathy (Berger's disease)
Vibrio - HAV
Nitroprusside
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


24. Classic ECG findings in pericarditis.
Suspect retinoblastoma
Fluids and antibiotics
Low - voltage - diffuse ST- segment elevation
Osteoarthritis


25. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Neurofibromatosis 1
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


26. Case - control study
Reye's syndrome
Neither
Higher incidence
Retinoic acid


27. Classic CXR findings for pulmonary edema.

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28. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
BP > 140/90 on three separate occasions two weeks apart
Sulfonamides - antimalarial drugs - fava beans
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Isolation


29. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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30. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Regression
Asherman's syndrome
A patient with chest trauma who was previously stable suddenly dies


31. Bilious emesis within hours after the first feeding.
M3
Rubella
Duodenal atresia
Intussusception


32. Asplenic patients are particularly susceptible to these organisms.
Oral surgery
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Glomerulonephritis/nephritic syndrome


33. Name the organism:
Colposcopy and endocervical curettage
Pseudomonas
Seventy percent if the stenosis is symptomatic
Neurofibromatosis 1


34. A newborn female has continuous 'machinery murmur.'
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Glanzmann's thrombasthenia
Patent ductus arteriosus (PDA)


35. The 6 P's of ischemia due to peripheral vascular disease.
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Type I (distal) RTA
MAOIs
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


36. The most common pathogen causing croup.
Murphy's sign - seen in acute cholecystitis
Sulfonamides - antimalarial drugs - fava beans
Parainfluenza virus type 1
Surfactant deficiency


37. Identify key organisms causing diarrhea:
INH - penicillamine - hydralazine - procainamide
Elevated ICP - RBCs - xanthochromia
Self - limited - painless vaginal bleeding
E. coli O157:H7


38. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Respiratory alkalosis
AP chest - AP/lateral C- spine - AP pelvis
Angina - ST- segment changes on ECG - or ? BP
Factitious disorder (Munchausen syndrome)


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

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40. 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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41. Dermatomal distribution.
Varicella zoster
Never
Multiple myeloma
Coarctation of the aorta


42. Which healthy population is susceptible to UTIs?
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Hypotension - distant heart sounds - and JVD
Pregnant women. Treat this group aggressively because of potential complications


43. Eosinophils in urine sediment.
Hodgkin's lymphoma
Allergic interstitial nephritis
Aseptic (viral) meningitis
Anticoagulation - rate control - cardioversion


44. The most common histology of bladder cancer.
Transitional cell carcinoma
Cluster headache
Lesions of 1
Panic disorder


45. Associated with Propionibacterium acnes and changes in androgen levels.
Low - voltage - diffuse ST- segment elevation
Acne vulgaris
CML
Non - Hodgkin's lymphoma


46. Appropriate diagnostic test?
M3
DM - SLE - and amyloidosis
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Pharmacologic stress test (e.g. - dobutamine echo)


47. Nonpainful chancre.
1
Continuous positive airway pressure
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Lead - time bias


48. First - line treatment for moderate hypercalcemia.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
IV hydration and loop diuretics (furosemide)
Basal cell carcinoma
Iron deficiency anemia


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

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50. Meningitis in neonates. Causes? Treatment?
Antipsychotics (neuroleptic malignant syndrome)
Huntington's disease
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Infection - febrile seizures - trauma - idiopathic