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. Supportive treatment for ARDS.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Continuous positive airway pressure
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Cardiogenic shock


2. Acid - base disorder in pulmonary embolism.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Diverticulosis
Hypoxia and hypocarbia
Varicella zoster


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

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4. Evaluation of a pulsatile abdominal mass and bruit.
Trichomonas vaginitis
Abdominal ultrasound and CT
Oral or topical metronidazole
Regresses after menopause


5. Symptoms of placenta previa.
Self - limited - painless vaginal bleeding
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Salmonella


6. Identify key organisms causing diarrhea:
Mycobacterium tuberculosis
Mycoplasma
? protein intake - lactulose - neomycin
Campylobacter


7. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Cellulitis
Oral or topical metronidazole


8. Key side effects of atypical antipsychotics.
Weight gain - type 2 DM - QT prolongation
SSRIs
Identify cause; pressors (e.g. - dobutamine)
Pityriasis versicolor


9. Tanner stage 3 in a six-year - old female.
Cellulitis
Establish the ABCs
Precocious puberty
Placental abruption and placenta previa


10. Red plaques with silvery- white scales and sharp margins.
Allergic interstitial nephritis
Psoriasis
Angina - ST- segment changes on ECG - or ? BP
50 cc/hour


11. Four characteristics of a nevus suggestive of melanoma.
Multiple myeloma
Asymmetry - border irregularity - color variation - large diameter
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Menometrorrhagia


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

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13. Tests to rule out shaken baby syndrome.
Number of live births per 1000 women 15-44 years of age
Ophthalmologic exam - CT - and MRI
The IR of a disease in a population exposed to a particular factor
Check for ? ICP; look for papilledema


14. The most common cause of hypertension in young men.
MS
Excessive EtOH
Number of deaths per 1000 population
Beta- blockers - Ca2+ channel blockers - TCAs


15. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
1
Sporothrix schenckii
Asymmetry - border irregularity - color variation - large diameter
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


16. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Malignancy and hyperparathyroidism
Emergent laparotomy to repair perforated viscus - likely stomach
Renal cell carcinoma (RCC)
Hodgkin's lymphoma


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

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18. Criteria for exudative effusion.
Panic disorder
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Type IV (distal) RTA
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


19. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
DI
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Trichomonas vaginitis
Cluster headache


20. Medical options for endometriosis.
OCPs - danazol - GnRH agonists
Hypertension - bradycardia - and abnormal respirations
Ultrasound
Asymmetry - border irregularity - color variation - large diameter


21. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Wegener's granulomatosis and Goodpasture's syndrome
Confounding variable
Coccidioidomycosis. Amphotericin B
Endometrial biopsy


22. Attributable risk?
Retrograde cystourethrogram
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Actinic keratosis
Herpes simplex


23. Four causes of microcytic anemia.
< 7.0
TICS
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Coccidioidomycosis. Amphotericin B


24. Albuminocytologic dissociation.
Neuroleptic malignant syndrome
Guillain - Barr
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


25. RTA associated with abnormal HCO3 - and rickets.
Sulfonamides - antimalarial drugs - fava beans
Osgood - Schlatter disease
Subarachnoid hemorrhage (SAH)
Type II (proximal) RTA


26. Caf
Diverticulosis
Contact dermatitis
Consider Fitz - Hugh - Curtis syndrome
Neurofibromatosis 1


27. The first test to perform when a woman presents with amenorrhea.
V/Q scan
Bladder rupture or urethral injury
Beta- hCG; the most common cause of amenorrhea is pregnancy
Niacin


28. The most common cause of female infertility.
Dressler's syndrome: fever - pericarditis - ? ESR
Endometriosis
Pityriasis rosea
Parainfluenza virus type 1


29. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Lobular carcinoma in situ
Polymyalgia rheumatica
Impetigo


30. Lung cancer associated with SIADH.
Wegener's granulomatosis and Goodpasture's syndrome
Nitroprusside
Small cell lung cancer (SCLC)
Number of deaths per 1000 population


31. Radiographic indications for surgery in patients with acute abdomen.
Displacement
Agranulocytosis
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Lobular carcinoma in situ


32. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
Lichen sclerosus
Immediate cardioversion
Vibrio - HAV


33. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Septic or anaphylactic shock
IV benzodiazepine
'Chocolate cysts -' powder burns


34. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Fat - female - fertile - forty - flatulent
Precocious puberty
Kegel exercises - estrogen - pessaries for stress incontinence
Rubella


35. Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Beta- blockers - Ca2+ channel blockers - TCAs
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Parkinson's disease


36. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Alzheimer's and multi - infarct
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Hypernatremia


37. Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Type I (distal) RTA
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Lyme disease - Ixodes tick - doxycycline


38. Therapy for polycystic ovarian syndrome.
IV hydration and loop diuretics (furosemide)
Weight loss and OCPs
Uremic syndrome seen in patients with renal failure
Herpes simplex


39. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Hypernatremia
Radiation
Contact dermatitis


40. Treatment of cardiogenic shock.
Sulfonamides - antimalarial drugs - fava beans
Identify cause; pressors (e.g. - dobutamine)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Lesch - Nyhan syndrome (purine salvage problem with


41. What should always be done prior to LP?
Uterine massage; if that fails - give oxytocin
Intraductal papilloma
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Check for ? ICP; look for papilledema


42. Acceptable urine output in a stable patient.
Anorexia
Uterine atony
Number of deaths from 28 days to one year per 1000 live births
30 cc/hour


43. Treatment for ventricular fibrillation.
Paget's disease
Glanzmann's thrombasthenia
Trauma; the second most common is berry aneurysm
Immediate cardioversion


44. Causes of transudative effusion.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Lesions of 1
M3
Chronic granulomatous disease


45. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Abdominal ultrasound and CT
Intraductal papilloma
HGPRTase deficiency)
Osteogenesis imperfecta


46. Bone is fractured in fall on outstretched hand.

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

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48. Nikolsky's sign.
Menometrorrhagia
Phototherapy (mild) or exchange transfusion (severe)
Bullous pemphigoid
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


49. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Precocious puberty
105 bacteria/mL
Cardiogenic shock
Anorexia


50. Name the defense mechanism:
Isolation
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Ultrasound
Partial mole