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. Symptoms of placental abruption.
Subarachnoid hemorrhage (SAH)
Antipsychotics (neuroleptic malignant syndrome)
Continuous - painful vaginal bleeding
Diverticulosis


2. Lab values suggestive of menopause.
Prinzmetal's angina
Number of deaths from 28 days to one year per 1000 live births
Treat immediately. Consent is implied in emergency situations
? serum FSH


3. Acid - base disorder in pulmonary embolism.
Excessive EtOH
Broca's aphasia. Frontal lobe - left MCA distribution
Iron overload; use deferoxamine
Hypoxia and hypocarbia


4. Antibiotics with teratogenic effects.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Paget's disease
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Campylobacter


5. Name the organism:
Out
Beta- blockers - Ca2+ channel blockers - TCAs
Streptococcus pneumoniae
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


6. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Diphenhydramine or epinephrine 1:1000
Ultrasound
Uterine atony
Nephrotic syndrome


7. What is the metabolic syndrome?
A patient with chest trauma who was previously stable suddenly dies
Parvovirus B19
Headache
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


8. CSF findings:
Subarachnoid hemorrhage (SAH)
Trauma - alcohol withdrawal - brain tumor
Flumazenil
IVIG or plasmapheresis


9. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Duchenne muscular dystrophy
Trauma - alcohol withdrawal - brain tumor
Neither
Subdural hematoma


10. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Anorexia
HBV immunoglobulin


11. Asplenic patients are particularly susceptible to these organisms.
Non - Hodgkin's lymphoma
Seventy percent if the stenosis is symptomatic
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Dressler's syndrome: fever - pericarditis - ? ESR


12. Hernia with highest risk of incarceration
Hypertrophic cardiomyopathy
Small cell lung cancer (SCLC)
Femoral hernia
Sporothrix schenckii


13. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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14. Identify key organisms causing diarrhea:
Radiation
O2 - analgesia - hydration - and - if severe - transfusion
Salmonella
Pseudogout


15. How to diagnose and follow a leiomyoma.
Ultrasound
Lobular carcinoma in situ
Hypernatremia
Hypovolemic shock


16. Treatment for mild - persistent asthma.
Reaction formation
The IR of a disease in a population exposed to a particular factor
Fatigue and impending respiratory failure
Inhaled Beta- agonists and inhaled corticosteroids


17. Diagnostic test for hypertrophic cardiomyopathy.
Pentad of TTP
Infection - febrile seizures - trauma - idiopathic
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Suspect ankylosing spondylitis. Check HLA- B27


18. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Exercise stress treadmill with ECG
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Yersinia


19. The number of true positives divided by the number of patients with the disease is _____.
IgA nephropathy (Berger's disease)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Sensitivity
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


20. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Bacillus cereus
Exercise stress treadmill with ECG
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


21. Auer rods on blood smear.
Rate control - rhythm conversion - and anticoagulation
Acute myelogenous leukemia (AML)
N- acetylcysteine
Coccidioidomycosis. Amphotericin B


22. Treatment for ventricular fibrillation.
Immediate cardioversion
1
46 -XX
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


23. Characteristics of 2

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24. The 6 P's of ischemia due to peripheral vascular disease.
Angina is new - is worsening - or occurs at rest
a - antagonists (phentolamine and phenoxybenzamine)
Fatigue and impending respiratory failure
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


25. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
Salmonella
Pseudogout
Cellulitis


26. Name the defense mechanism:
Regression
Alzheimer's and multi - infarct
RSV bronchiolitis
Toxoplasma gondii


27. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Number of deaths per 1000 population
Pseudogout
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Klebsiella


28. + Nikolsky's sign.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Klebsiella
Pheochromocytoma
Pemphigus vulgaris


29. The most common 1
Selective IgA deficiency
Bullous pemphigoid
Inevitable abortion
Prinzmetal's angina


30. A fall in systolic BP of > 10 mmHg with inspiration.
Exercise stress treadmill with ECG
Pulsus paradoxus (seen in cardiac tamponade)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Emergent laparotomy to repair perforated viscus - likely stomach


31. Causes of transudative effusion.
Agranulocytosis
30 cc/hour
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
OCP and barrier contraception


32. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
Septic or anaphylactic shock
Naloxone
IV penicillin or ampicillin
Lobular carcinoma in situ


33. Treatment for acute coronary syndrome.
Reye's syndrome
Spinal stenosis
Hypokalemia
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


34. The most common pathogen causing croup.
Dantrolene or bromocriptine
Parkinson's disease
Parainfluenza virus type 1
7-10 days


35. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Flumazenil
Choriocarcinoma
Conversion disorder


36. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Parvovirus B19
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
'Sawtooth' P waves
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


37. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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38. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Lesion of 1
CA-125 and transvaginal ultrasound
Number of live births per 1000 women 15-44 years of age
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


39. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Subdural hematoma
Cirrhosis - CHF - nephritic syndrome
Confounding variable
Salmonella


40. CSF findings with SAH.
Beta- blockers - digoxin - calcium channel blockers
Treat existing heart failure and replace the tricuspid valve
Elevated ICP - RBCs - xanthochromia
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


41. Beck's triad for cardiac tamponade.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Hypotension - distant heart sounds - and JVD
Self - limited - painless vaginal bleeding
S. aureus or S. epidermidis.


42. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
AP chest - AP/lateral C- spine - AP pelvis
Allergic interstitial nephritis
Dissociative fugue


43. An agent that reverses the effects of heparin.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Oral or topical metronidazole
Hypernatremia
Protamine


44. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Hypokalemia
'Chocolate cysts -' powder burns
Treat existing heart failure and replace the tricuspid valve


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

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46. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Anion gap acidosis and 1
Pseudomonas
Cluster headache
Renal cell carcinoma (RCC)


47. Complication of overly rapid correction of hyponatremia.
Establish the ABCs
Hypocalcemia
Central pontine myelinolysis
Hypoxia and hypocarbia


48. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
No. Parental consent is not necessary for the medical treatment of pregnant minors
Number of live births per 1000 population
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


49. What is the immunodeficiency?

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50. Treatment for mild and severe unconjugated hyperbilirubinemia.
Fat - female - fertile - forty - flatulent
Phototherapy (mild) or exchange transfusion (severe)
Osteoarthritis
Number of deaths from birth to 28 days per 1000 live births