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. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Folate deficiency
ALS
Ulcerative colitis


2. Name the defense mechanism:
Hypertrophic cardiomyopathy
Conversion disorder
Isolation
Taenia solium (cysticercosis)


3. Medical options for endometriosis.
Yersinia
Prevalence
Angina - ST- segment changes on ECG - or ? BP
OCPs - danazol - GnRH agonists


4. What is the immunodeficiency?
Neurofibromatosis 1
Distal radius (Colles' fracture)
Hypocalcemia
Wiskott - Aldrich syndrome


5. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Iron overload; use deferoxamine
Angina - ST- segment changes on ECG - or ? BP
Beta- hCG; the most common cause of amenorrhea is pregnancy
Inevitable abortion


6. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Fluids and antibiotics
Anion gap acidosis and 1
Squamous cell carcinoma
OCPs - danazol - GnRH agonists


7. A 49-year - old male presents with acute - onset flank pain and hematuria.
B12 deficiency
Reye's syndrome
Edrophonium
Nephrolithiasis


8. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Salmonella
Biliary tract obstruction
Pseudomonas
Exercise stress treadmill with ECG


9. What % lesion is an indication for carotid endarterectomy?
Impetigo
Patent ductus arteriosus (PDA)
Seventy percent if the stenosis is symptomatic
Pulsus paradoxus (seen in cardiac tamponade)


10. Signs of neurogenic shock.
Paget's disease
Hypotension and bradycardia
Squamous cell carcinoma
Pseudomonas


11. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
OCPs - danazol - GnRH agonists
Central pontine myelinolysis
Factitious disorder (Munchausen syndrome)
Lead - time bias


12. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Diphenhydramine or epinephrine 1:1000
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Chronic lymphocytic leukemia (CLL)


13. Treatment of central DI.
Seborrheic dermatitis. Treat with antifungals
Administration of DDAVP ? serum osmolality and free water restriction
Depersonalization disorder
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births


14. Name the defense mechanism:
Anion gap acidosis and 1
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Reaction formation
INH - penicillamine - hydralazine - procainamide


15. The number of true positives divided by the number of patients with the disease is _____.
Biliary tract obstruction
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Continuous - painful vaginal bleeding
Sensitivity


16. Pure RBC aplasia.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Amoxicillin
Diamond - Blackfan anemia
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


17. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Beta- blockers - Ca2+ channel blockers - TCAs
Hypoparathyroidism
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Phototherapy (mild) or exchange transfusion (severe)


18. Identify key organisms causing diarrhea:
Vibrio - HAV
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Varicella zoster
O2 - analgesia - hydration - and - if severe - transfusion


19. Classic ECG findings in pericarditis.
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Anemia of chronic disease
Low - voltage - diffuse ST- segment elevation
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


20. Sensitive tests have few false negatives and are used to rule _____ a disease.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Retinoic acid
Out


21. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Elevated ICP - RBCs - xanthochromia
Parvovirus B19
No. Parental consent is not necessary for the medical treatment of pregnant minors
Bullous pemphigoid


22. Causes of transudative effusion.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Antipsychotics (neuroleptic malignant syndrome)
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
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


23. Causes of drug - induced SLE.
INH - penicillamine - hydralazine - procainamide
Prevalence
Highly sensitive for TB
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


24. CSF findings with SAH.
Abdominal ultrasound and CT
Elevated ICP - RBCs - xanthochromia
Cirrhosis - CHF - nephritic syndrome
Impetigo


25. Fertility rate?
Type II (proximal) RTA
Number of live births per 1000 women 15-44 years of age
Glanzmann's thrombasthenia
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


26. Treatment for Guillain - Barr
CA-125 and transvaginal ultrasound
IVIG or plasmapheresis
Giardia
Squamous cell carcinoma


27. The most serious side effect of clozapine.
Agranulocytosis
INH - penicillamine - hydralazine - procainamide
Pasteurella multocida
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


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

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29. Hypercholesterolemia treatment that ? flushing and pruritus.
SCLC
Kl
Kwashiorkor (protein malnutrition)
Niacin


30. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Coccidioidomycosis. Amphotericin B
RSV bronchiolitis
Osteogenesis imperfecta
50 cc/hour


31. Natural history of a leiomyoma.
Surfactant deficiency
Regresses after menopause
Avascular necrosis
Rubella


32. The three most common causes of fever of unknown origin (FUO).
Infection - cancer - and autoimmune disease
Colposcopy and endocervical curettage
Mycoplasma
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


33. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


34. Treatment of DKA.
IgA nephropathy (Berger's disease)
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Crohn's disease


35. Unopposed estrogen is contraindicated in which cancers?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Endometrial or estrogen receptor - breast cancer
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births


36. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Septic or anaphylactic shock
Higher incidence
Restrictive pulmonary disease


37. The coagulation parameter affected by warfarin.
Bacillus cereus
PT
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Substance abuse


38. Shortest AP diameter of the pelvis.
Trauma; the second most common is berry aneurysm
Trauma - alcohol withdrawal - brain tumor
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Fatigue and impending respiratory failure


39. A son asks that his mother not be told about her recently discovered cancer.

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40. Classic ECG finding in atrial flutter.

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41. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Substance abuse
Choriocarcinoma
AP chest - AP/lateral C- spine - AP pelvis
Parkinson's disease


42. Acute - phase treatment for Kawasaki disease.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Parvovirus B19
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Murphy's sign - seen in acute cholecystitis


43. Combined UMN and LMN disorder.
ALS
Guillain - Barr
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Subdural hematoma


44. Antibiotics with teratogenic effects.
TICS
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Graves' disease
Lesch - Nyhan syndrome (purine salvage problem with


45. Treatment of cardiogenic shock.
Anion gap acidosis and 1
Identify cause; pressors (e.g. - dobutamine)
Lichen planus
Chronic lymphocytic leukemia (CLL)


46. The most common cause of hypothyroidism.

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47. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Observational bias
Crohn's disease
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Hypotension - distant heart sounds - and JVD


48. The most common pathogen causing croup.
Wrist drop - loss of thumb abduction
Asherman's syndrome
Oral surgery
Parainfluenza virus type 1


49. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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50. Classic CXR findings for pulmonary edema.

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