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

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2. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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3. The most common cause of seizures in children (2-10 years).
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Continuous - painful vaginal bleeding
Radiation
Infection - febrile seizures - trauma - idiopathic


4. Name the organism:
Sporothrix schenckii
Parkinson's disease
Selective IgA deficiency
Oral or topical metronidazole


5. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Metformin
S. aureus
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


6. Name the organism:
Actinomyces israelii
Pulsus paradoxus (seen in cardiac tamponade)
Guillain - Barr
Higher incidence


7. Complication of overly rapid correction of hyponatremia.
Niacin
Guillain - Barr
Nephrotic syndrome
Central pontine myelinolysis


8. Nontender abdominal mass associated with elevated VMA and HVA.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Pemphigus vulgaris
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Neuroblastoma


9. The most common cause of hypertension in young women.
Respiratory alkalosis
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
OCPs
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


10. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
Allergic interstitial nephritis
Depersonalization disorder
Check for ? ICP; look for papilledema


11. The most frequent presentation of intracranial neoplasm.
Headache
Hypocalcemia
Frotteurism (a paraphilia)
Pityriasis versicolor


12. What is the immunodeficiency?
Chronic granulomatous disease
Postinfectious glomerulonephritis
Phototherapy (mild) or exchange transfusion (severe)
Kl


13. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Intussusception
Pityriasis versicolor
Elevated ICP - RBCs - xanthochromia
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


14. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Partial mole
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Antipsychotics (neuroleptic malignant syndrome)
SIADH due to stress


15. Treatment for SVC syndrome.
Streptococcus pneumoniae
Oral surgery
Dantrolene or bromocriptine
Radiation


16. May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Administration of DDAVP ? serum osmolality and free water restriction
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


17. Treatment of cardiogenic shock.
Central pontine myelinolysis
Identify cause; pressors (e.g. - dobutamine)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Lichen planus


18. Rigidity and stiffness with resting tremor and masked facies.

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19. The most common 1
Emergent laparotomy to repair perforated viscus - likely stomach
Regression
Coccidioidomycosis. Amphotericin B
Multiple myeloma


20. The most common 1
SCLC
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Cluster headache
Lung - breast - skin (melanoma) - kidney - GI tract


21. A 40-year - old obese female with elevated alkaline phosphatase - elevated bilirubin - pruritus - dark urine - and clay- colored stools.
Biliary tract obstruction
Bullous pemphigoid
Sensitivity
Clomiphene citrate


22. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Edrophonium
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Seborrheic dermatitis. Treat with antifungals
Administration of DDAVP ? serum osmolality and free water restriction


23. Honey- crusted lesions.
7-10 days
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Impetigo
Bullous pemphigoid


24. Presence of red cell casts in urine sediment.
Angina is new - is worsening - or occurs at rest
Parvovirus B19
SCLC
Glomerulonephritis/nephritic syndrome


25. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
High TSH - low T4 - antimicrosomal antibodies
Glomerulonephritis/nephritic syndrome
No. Parental consent is not necessary for the medical treatment of pregnant minors
? serum FSH


26. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Protamine
Squamous cell carcinoma
Hypoxia and hypocarbia


27. Eight surgically correctable causes of hypertension.

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28. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Neurofibromatosis 1
Febrile seizures (roseola infantum)
Kl
1


29. Which healthy population is susceptible to UTIs?
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
IgA nephropathy (Berger's disease)
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Pregnant women. Treat this group aggressively because of potential complications


30. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises - estrogen - pessaries for stress incontinence
Anorexia
Identify cause; pressors (e.g. - dobutamine)
HGPRTase deficiency)


31. Treatment for opioid overdose.
7-10 days
Toxoplasma gondii
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Naloxone


32. Cohort study
Incidence and prevalence
Isolation
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Coccidioidomycosis. Amphotericin B


33. CSF findings:
BP > 140/90 on three separate occasions two weeks apart
They can mask symptoms of hypoglycemia
Bacterial meningitis
Establish the ABCs


34. Acceptable urine output in a stable patient.
Prevalence
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Actinic keratosis
30 cc/hour


35. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Diamond - Blackfan anemia
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Fatigue and impending respiratory failure
Endometrial or estrogen receptor - breast cancer


36. Epidemics such as influenza
Identify cause; fluid and blood repletion
Higher incidence
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Endometriosis


37. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. 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
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Anemia of chronic disease
Cirrhosis - CHF - nephritic syndrome


38. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
False. Withdrawing and withholding life are the same from an ethical standpoint
Subdural hematoma
Squamous cell carcinoma


39. Odds ratio?
Diamond - Blackfan anemia
Depersonalization disorder
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Mallory- Weiss


40. Symptoms of placental abruption.
SSRIs
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Continuous - painful vaginal bleeding
Transitional cell carcinoma


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

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

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43. Peaked T waves and widened QRS.
Hyperkalemia
Intraductal papilloma
Establish the ABCs
Subarachnoid hemorrhage (SAH)


44. Endocarditis prophylaxis regimens.
1
Oral surgery
105 bacteria/mL
Clostridium difficile


45. ? risk of what infection with silicosis?
Pregnant women. Treat this group aggressively because of potential complications
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
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Mycobacterium tuberculosis


46. Bone is fractured in fall on outstretched hand.

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47. An active 13-year - old boy has anterior knee pain. Diagnosis?
Osgood - Schlatter disease
Self - limited - painless vaginal bleeding
Coarctation of the aorta
Wait - surgical resection - radiation and/or androgen suppression


48. 'Doughy skin.'
Wegener's granulomatosis and Goodpasture's syndrome
Naloxone
Selective IgA deficiency
Hypernatremia


49. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA
Number of deaths per 1000 population
Murphy's sign - seen in acute cholecystitis
Diamond - Blackfan anemia


50. Classic ultrasound and gross appearance of complete hydatidiform mole.

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