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. Diagnostic test for hypertrophic cardiomyopathy.
105 bacteria/mL
Nephrogenic diabetes insipidus (DI)
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


2. The most common histology of bladder cancer.
Transitional cell carcinoma
a - antagonists (phentolamine and phenoxybenzamine)
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Cerebral berry aneurysms (AD PCKD)


3. Confusion - confabulation - ophthalmoplegia - ataxia.

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4. Asplenic patients are particularly susceptible to these organisms.
Infection - cancer - and autoimmune disease
MAOIs
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
IV hydration and loop diuretics (furosemide)


5. 1
Emergent laparotomy to repair perforated viscus - likely stomach
Radiation
Trichomonas vaginitis
Placental abruption and placenta previa


6. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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7. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Intussusception
Rate control - rhythm conversion - and anticoagulation
Infection - cancer - and autoimmune disease
SIADH due to stress


8. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Incidence and prevalence
Nephrolithiasis
S. aureus or S. epidermidis.
Selective IgA deficiency


9. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Squamous cell carcinoma
SIADH due to stress
Intraductal papilloma


10. An antidiabetic agent associated with lactic acidosis.
Selective IgA deficiency
Metformin
ALS
Pityriasis rosea


11. Cannon 'a' waves.
Third - degree heart block
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Continuous - painful vaginal bleeding
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


12. Cohort study
Hypoxia and hypocarbia
Betamethasone or dexamethasone
Incidence and prevalence
< 7.0


13. Risk factors for DVT.

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14. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Ulcerative colitis
50 cc/hour
Chronic lymphocytic leukemia (CLL)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


15. A patient presents with recent PID with RUQ pain.
Consider Fitz - Hugh - Curtis syndrome
O2 - analgesia - hydration - and - if severe - transfusion
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Inevitable abortion


16. Identify key organisms causing diarrhea:
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Avascular necrosis
Salmonella
Iron deficiency anemia


17. The most common location for an ectopic pregnancy.
Sarcoidosis
46 -XX
Actinomyces israelii
Ampulla of the oviduct


18. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Nephrogenic diabetes insipidus (DI)
Anorexia
Continuous - painful vaginal bleeding


19. Treatment of hypovolemic shock.
Emergent laparotomy to repair perforated viscus - likely stomach
Seborrheic dermatitis. Treat with antifungals
Aseptic (viral) meningitis
Identify cause; fluid and blood repletion


20. Treatment for AML M3.
Pityriasis rosea
Fatigue and impending respiratory failure
Retinoic acid
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins


21. Lung cancer highly related to cigarette exposure.
Fanconi's anemia
Fatigue and impending respiratory failure
RSV bronchiolitis
SCLC


22. Classic ECG finding in atrial flutter.

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23. A patient fails to lactate after an emergency C- section with marked blood loss.

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24. Name the defense mechanism:
Isolation
Cluster headache
Displacement
Nephrotic syndrome


25. Macrocytic - megaloblastic anemia with neurologic symptoms.
Signs and symptoms of hypercalcemia
B12 deficiency
Kegel exercises - estrogen - pessaries for stress incontinence
Postinfectious glomerulonephritis


26. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Squamous cell carcinoma
Angina - ST- segment changes on ECG - or ? BP
Parainfluenza virus type 1
Sarcoidosis


27. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Rate control - rhythm conversion - and anticoagulation
IV benzodiazepine
Type I (distal) RTA
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


28. PFT showing ? FEV1/FVC.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Identify cause; pressors (e.g. - dobutamine)
Obstructive pulmonary disease (e.g. - asthma)
Weight gain - type 2 DM - QT prolongation


29. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
Postinfectious glomerulonephritis
Observational bias
Respiratory alkalosis
Lichen planus


30. The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
Mycobacterium tuberculosis
Treat existing heart failure and replace the tricuspid valve
ALS


31. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
IV hydration and loop diuretics (furosemide)
Neuroleptics
Observational bias


32. A crescent - shaped hyperdensity on CT that does not cross the midline.
Suspect retinoblastoma
Subdural hematoma
Febrile seizures (roseola infantum)
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


33. Name the organism:
Giardia
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Lyme disease - Ixodes tick - doxycycline
Klebsiella


34. Lab values suggestive of menopause.
Lesions of 1
? serum FSH
Squamous cell carcinoma
Number of deaths per 1000 population


35. Thrombotic thrombocytopenic purpura (TTP) pentad?
30 cc/hour
CML
Pregnant women. Treat this group aggressively because of potential complications
Pentad of TTP


36. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Acne vulgaris
TICS
ACEI


37. Treatment for bacterial vaginosis.
Identify cause; pressors (e.g. - dobutamine)
a - antagonists (phentolamine and phenoxybenzamine)
B12 deficiency
Oral or topical metronidazole


38. True or false: Once patients sign a statement giving consent - they must continue treatment.
< 7.0
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity
Pseudomonas
IgA nephropathy (Berger's disease)


39. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
M3
SSRIs
Spinal stenosis
Wegener's granulomatosis and Goodpasture's syndrome


40. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Higher prevalence
Frotteurism (a paraphilia)
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Avascular necrosis


41. Treatment for acetaminophen overdose.
Regression
Duodenal atresia
N- acetylcysteine
< 7.0


42. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Rubella
Lung - breast - skin (melanoma) - kidney - GI tract
Conduct disorder
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


43. Exophthalmos - pretibial myxedema - and ? TSH.

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44. Neutropenic nadir postchemotherapy.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
7-10 days


45. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Uremic syndrome seen in patients with renal failure
Iron deficiency anemia
Conflict of interest
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


46. Causes of exudative effusion.
High reliability - low validity
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Lichen planus
Malingering


47. HUS triad?
Contact dermatitis
Polymyalgia rheumatica
Anemia - thrombocytopenia - and acute renal failure
1


48. PFT showing ? FEV1/FVC.
Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Restrictive pulmonary disease
Parainfluenza virus type 1


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

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50. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides - antimalarial drugs - fava beans
Selective IgA deficiency
Toxoplasma gondii
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus