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. Unopposed estrogen is contraindicated in which cancers?
Nephritic syndrome
Higher incidence
Endometrial or estrogen receptor - breast cancer
Inhaled Beta- agonists and inhaled corticosteroids


2. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Anticoagulation - rate control - cardioversion
Neither
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first - degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer


3. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Prerenal
Angina is new - is worsening - or occurs at rest
Fatigue and impending respiratory failure
Contact dermatitis


4. The diagnostic test for pulmonary embolism.
Neuroleptic malignant syndrome
Guillain - Barr
Murphy's sign - seen in acute cholecystitis
V/Q scan


5. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Antipsychotics (neuroleptic malignant syndrome)
Ultrasound


6. Signs of active ischemia during stress testing.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Nephrotic syndrome
Angina - ST- segment changes on ECG - or ? BP
Coccidioidomycosis. Amphotericin B


7. Acid - base disturbance commonly seen in pregnant women.
Pityriasis rosea
Reaction formation
Respiratory alkalosis
Metformin


8. Tests to rule out shaken baby syndrome.
OCP and barrier contraception
The IR of a disease in a population exposed to a particular factor
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Ophthalmologic exam - CT - and MRI


9. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Oral or topical metronidazole
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
CF or Hirschsprung's disease
50 cc/hour


10. Reed - Sternberg cells

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11. Complication of overly rapid correction of hyponatremia.
Restrictive pulmonary disease
CML
Elevated ICP - RBCs - xanthochromia
Central pontine myelinolysis


12. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
Reye's syndrome
No. Parental consent is not necessary for the medical treatment of pregnant minors
O2 - analgesia - hydration - and - if severe - transfusion
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


13. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Beta- blockers - digoxin - calcium channel blockers
CML
Graves' disease
Prevalence


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

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15. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Hypertrophic cardiomyopathy
Lead - time bias
Treat existing heart failure and replace the tricuspid valve
Conversion disorder


16. Eight surgically correctable causes of hypertension.

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17. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Lichen planus
Sulfonamides - antimalarial drugs - fava beans
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Basal cell carcinoma


18. A 'blueberry muffin' rash is characteristic of what congenital infection?
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Yersinia
Rubella


19. Classic ECG finding in atrial flutter.

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20. The most common type of testicular cancer.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Seminoma
Parainfluenza virus type 1
Protamine


21. Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Anemia - thrombocytopenia - and acute renal failure
Phototherapy (mild) or exchange transfusion (severe)
All - compartment fasciotomy for suspected compartment syndrome


22. First - line treatment for moderate hypercalcemia.
Subdural hematoma
Multiple myeloma
IV hydration and loop diuretics (furosemide)
Hypocalcemia


23. Treatment for malignant hypertension.
Nitroprusside
Pemphigus vulgaris
Anemia - thrombocytopenia - and acute renal failure
Rett's disorder


24. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Nephrotic syndrome
Squamous cell carcinoma
Diverticulosis
ARDS


25. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
INH - penicillamine - hydralazine - procainamide
Bacillus cereus
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Partial mole


26. Albuminocytologic dissociation.
Levodopa/carbidopa
Out
Guillain - Barr
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


27. A fall in systolic BP of > 10 mmHg with inspiration.
Haemophilus ducreyi
OCPs - danazol - GnRH agonists
Duodenal atresia
Pulsus paradoxus (seen in cardiac tamponade)


28. Presents with a herald patch - Christmas - tree pattern.
Asymmetry - border irregularity - color variation - large diameter
Prinzmetal's angina
Pityriasis rosea
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


29. Common symptoms associated with silent MIs.
CHF - shock - and altered mental status
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Herpes simplex


30. The most common cause of hypothyroidism.

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31. Virchow's triad.
Oral surgery
Stasis - hypercoagulability - endothelial damage
Contact dermatitis
Subarachnoid hemorrhage (SAH)


32. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
SCLC
Cellulitis
They can mask symptoms of hypoglycemia
ETEC


33. Appropriate diagnostic test?
Lung - breast - skin (melanoma) - kidney - GI tract
Salmonella
CHF - shock - and altered mental status
Pharmacologic stress test (e.g. - dobutamine echo)


34. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
All - compartment fasciotomy for suspected compartment syndrome
Pityriasis versicolor
Menometrorrhagia
Inevitable abortion


35. Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Number of live births per 1000 population
Acute myelogenous leukemia (AML)
V/Q scan


36. Cause of neonatal RDS.
Nephritic syndrome
Sheehan's syndrome (postpartum pituitary necrosis)
Surfactant deficiency
Seborrheic keratosis


37. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
N- acetylcysteine
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
1
Alport's syndrome


38. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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39. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Iron deficiency anemia
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Wait - surgical resection - radiation and/or androgen suppression


40. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Restrictive pulmonary disease
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Iron deficiency anemia


41. Treatment for DTs.
Benzodiazepines
HBV - DTaP - Hib - IPV - PCV
Regresses after menopause
Excessive EtOH


42. Fertility rate?
Number of live births per 1000 women 15-44 years of age
E. coli O157:H7
Vibrio - HAV
Suspect ankylosing spondylitis. Check HLA- B27


43. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Obstructive pulmonary disease (e.g. - asthma)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Panic disorder


44. Medication given to accelerate fetal lung maturity.
IV benzodiazepine
Betamethasone or dexamethasone
Trichomonas vaginitis
Bacillus cereus


45. Treatment for neuroleptic malignant syndrome.
IV penicillin or ampicillin
Contact dermatitis
Dantrolene or bromocriptine
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


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

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47. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Lichen sclerosus
Cerebral berry aneurysms (AD PCKD)
Contact dermatitis


48. Tanner stage 3 in a six-year - old female.
IV benzodiazepine
Ampulla of the oviduct
Trichomonas vaginitis
Precocious puberty


49. The three most common causes of fever of unknown origin (FUO).
Reye's syndrome
MAOIs
Endometrial biopsy
Infection - cancer - and autoimmune disease


50. Attributable risk?
Restrictive pulmonary disease
Beta- blockers - Ca2+ channel blockers - TCAs
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
SCLC