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 middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
Endometriosis
Hypokalemia
Lyme disease - Ixodes tick - doxycycline
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


2. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Inevitable abortion
Squamous cell carcinoma
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


3. Eight surgically correctable causes of hypertension.

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4. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
MS
HIDA scan
Sarcoidosis
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


5. The most common form of glomerulonephritis.

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6. The most common histology of bladder cancer.
Transitional cell carcinoma
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Dressler's syndrome: fever - pericarditis - ? ESR
Acute myelogenous leukemia (AML)


7. The most common cause of hypertension in young women.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Ampulla of the oviduct
OCPs
Sporothrix schenckii


8. Meningitis in neonates. Causes? Treatment?
Weight gain - type 2 DM - QT prolongation
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Sporothrix schenckii


9. 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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10. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Spinal stenosis
Kegel exercises - estrogen - pessaries for stress incontinence
Actinomyces israelii
MCP and PIP joints; DIP joints are spared


11. Flat - topped papules.
Number of deaths per 1000 population
Hypoxia and hypocarbia
Basal cell carcinoma
Lichen planus


12. Antihypertensive for a diabetic patient with proteinuria.
Central pontine myelinolysis
Cardiogenic shock
Vibrio - HAV
ACEI


13. An agent that reverses the effects of heparin.
Multiple myeloma
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Protamine
Septic or anaphylactic shock


14. The most common cause of female infertility.
Displacement
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Basal cell carcinoma
Endometriosis


15. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Erythema multiforme
Kl
Acne vulgaris


16. Inspiratory arrest during palpation of the RUQ.

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17. Medication given to accelerate fetal lung maturity.
Seborrheic keratosis
Betamethasone or dexamethasone
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


18. What should always be done prior to LP?
Check for ? ICP; look for papilledema
Bruton's X- linked agammaglobulinemia
105 bacteria/mL
7-10 days


19. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Neuroleptic malignant syndrome
Sarcoidosis
Salmonella


20. Classic ECG finding in atrial flutter.

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21. The most frequent presentation of intracranial neoplasm.
Headache
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Lung - breast - skin (melanoma) - kidney - GI tract


22. Albuminocytologic dissociation.
Rate control - rhythm conversion - and anticoagulation
Nephrogenic diabetes insipidus (DI)
Guillain - Barr
Iron deficiency anemia


23. Signs of active ischemia during stress testing.
PT
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Graves' disease
Angina - ST- segment changes on ECG - or ? BP


24. CSF findings with SAH.
Squamous cell carcinoma
Prevalence
Suspect ankylosing spondylitis. Check HLA- B27
Elevated ICP - RBCs - xanthochromia


25. Mortality rate?
Number of deaths per 1000 population
Weight loss and OCPs
CHF - shock - and altered mental status
Low - voltage - diffuse ST- segment elevation


26. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Hypocalcemia
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Patent ductus arteriosus (PDA)


27. The most common location for an ectopic pregnancy.
Lobular carcinoma in situ
Signs and symptoms of hypercalcemia
Ampulla of the oviduct
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


28. RTA associated with aldosterone defect.
Type IV (distal) RTA
Continuous positive airway pressure
Taenia solium (cysticercosis)
Agranulocytosis


29. Lung cancer associated with SIADH.
Threatened abortion
Treat immediately. Consent is implied in emergency situations
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Small cell lung cancer (SCLC)


30. Honeycomb pattern on CXR. Diagnosis? Treatment?
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Pulsus paradoxus (seen in cardiac tamponade)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Neither


31. Heinz bodies?
Sensitivity
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Toxoplasma gondii
Obstructive pulmonary disease (e.g. - asthma)


32. RTA associated with abnormal HCO3 - and rickets.
Legionella pneumonia
Administration of DDAVP ? serum osmolality and free water restriction
Wiskott - Aldrich syndrome
Type II (proximal) RTA


33. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Infection - febrile seizures - trauma - idiopathic
Normal
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Uterine massage; if that fails - give oxytocin


34. Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Observational bias


35. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
30 cc/hour
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Kegel exercises - estrogen - pessaries for stress incontinence
Respiratory alkalosis


36. Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor - breast cancer
Amoxicillin
Ophthalmologic exam - CT - and MRI
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


37. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Protamine
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Frotteurism (a paraphilia)


38. Red plaques with silvery- white scales and sharp margins.
Anorexia
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
HIDA scan
Psoriasis


39. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Pityriasis versicolor
Check for ? ICP; look for papilledema
BP > 140/90 on three separate occasions two weeks apart
PT


40. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
1
Membranous glomerulonephritis
Diverticulosis
Hypovolemic shock


41. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
OCP and barrier contraception
ARDS
No. Parental consent is not necessary for the medical treatment of pregnant minors
Highly sensitive for TB


42. PFT showing ? FEV1/FVC.
Obstructive pulmonary disease (e.g. - asthma)
Osteogenesis imperfecta
Anion gap acidosis and 1
Cirrhosis - CHF - nephritic syndrome


43. The most common 1
Nephrolithiasis
Betamethasone or dexamethasone
Selective IgA deficiency
Hypoxia and hypocarbia


44. Infant mortality?
Higher incidence
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Distal radius (Colles' fracture)


45. Cross - sectional survey
Cluster headache
Prevalence
Angina is new - is worsening - or occurs at rest
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


46. Electrolyte changes in tumor lysis syndrome.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Infection - febrile seizures - trauma - idiopathic
? Ca2+ - ? K- - ? phosphate - ? uric acid
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


47. Identify key organisms causing diarrhea:
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Pentad of TTP
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


48. A young patient with a family history of sudden death collapses and dies while exercising.
Self - limited - painless vaginal bleeding
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Subarachnoid hemorrhage (SAH)
Hypertrophic cardiomyopathy


49. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Bullous pemphigoid
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


50. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Trauma; the second most common is berry aneurysm
Niacin
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Protamine