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. Criteria for exudative effusion.
Fat - female - fertile - forty - flatulent
Erythema multiforme
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Number of deaths per 1000 population


2. Extraintestinal manifestations of IBD.
Radiation
Never
1
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


3. Joints in the hand affected in rheumatoid arthritis.
ETEC
MCP and PIP joints; DIP joints are spared
CML
HBV - DTaP - Hib - IPV - PCV


4. The most common pathogen causing croup.
Metformin
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Parainfluenza virus type 1
Identify cause; fluid and blood repletion


5. Classic ECG finding in atrial flutter.

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6. Albuminocytologic dissociation.
Sarcoidosis
Niacin
Guillain - Barr
Lesions of 1


7. Name the organism:
Spinal stenosis
Neisseria meningitidis
Fatigue and impending respiratory failure
Iron deficiency anemia


8. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Conduct disorder
Threatened abortion
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Malignancy and hyperparathyroidism


9. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
Kegel exercises - estrogen - pessaries for stress incontinence
Parkland formula
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


10. Causes of exudative effusion.
Infection - febrile seizures - trauma - idiopathic
Dantrolene or bromocriptine
High TSH - low T4 - antimicrosomal antibodies
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis


11. The most common type of testicular cancer.
Seminoma
Nephrotic syndrome
Iron overload; use deferoxamine
Hyperkalemia


12. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Neuroleptics
Intussusception
Cardiogenic shock
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


13. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Uterine massage; if that fails - give oxytocin
Angina is new - is worsening - or occurs at rest
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


14. Identify key organisms causing diarrhea:
Consider Fitz - Hugh - Curtis syndrome
Subarachnoid hemorrhage (SAH)
Patent ductus arteriosus (PDA)
Salmonella


15. Blood in the urethral meatus or high - riding prostate.
Nephritic syndrome
Bladder rupture or urethral injury
HBV - DTaP - Hib - IPV - PCV
Trauma - alcohol withdrawal - brain tumor


16. Postnatal mortality?
Pseudomonas
Seventy percent if the stenosis is symptomatic
Number of deaths from 28 days to one year per 1000 live births
Inhaled Beta- agonists and inhaled corticosteroids


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

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18. Antidepressants associated with hypertensive crisis.
MAOIs
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Pseudomonas
Lobular carcinoma in situ


19. Aplastic crisis in sickle cell disease.
Asherman's syndrome
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
IV benzodiazepine
Parvovirus B19


20. Inflammatory disease of the colon with ? risk of colon cancer.
IV benzodiazepine
Giardia
Out
Ulcerative colitis


21. Characteristics of 2

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22. Confusion - confabulation - ophthalmoplegia - ataxia.

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23. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Nitroprusside
Retinoic acid
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


24. Treatment for malignant hypertension.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Observational bias
Nitroprusside
Reye's syndrome


25. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Consider Fitz - Hugh - Curtis syndrome
Lichen sclerosus
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


26. Cause of neonatal RDS.
Surfactant deficiency
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Obstructive pulmonary disease (e.g. - asthma)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


27. The most common cause of seizures in children (2-10 years).
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Hypovolemic shock
Infection - febrile seizures - trauma - idiopathic
DI


28. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
DI
Niacin
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Malingering


29. A significant cause of morbidity in thalassemia patients. Treatment?
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Weight gain - type 2 DM - QT prolongation
Iron overload; use deferoxamine
Lesions of 1


30. Pure RBC aplasia.
Squamous cell carcinoma
Diamond - Blackfan anemia
Wrist drop - loss of thumb abduction
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


31. What is the immunodeficiency?
Prerenal
Anion gap acidosis and 1
1
Chronic granulomatous disease


32. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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33. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Abdominal ultrasound and CT
Hashimoto's thyroiditis
68% - 95.5% - 99.7%
Uterine atony


34. Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Neisseria meningitidis
HBV - DTaP - Hib - IPV - PCV
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


35. Eight surgically correctable causes of hypertension.

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36. Identify key organisms causing diarrhea:
Duodenal atresia
Protamine
Legionella pneumonia
ETEC


37. 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 _____.
Third - degree heart block
Confounding variable
Reye's syndrome
Broca's aphasia. Frontal lobe - left MCA distribution


38. Lab values suggestive of menopause.
Hereditary spherocytosis
Legionella pneumonia
Squamous cell carcinoma
? serum FSH


39. Treatment of tension pneumothorax.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Immediate needle thoracostomy
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Threatened abortion


40. The most common 1
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
Lung - breast - skin (melanoma) - kidney - GI tract
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Headache


41. Maternal mortality?
IV benzodiazepine
AP chest - AP/lateral C- spine - AP pelvis
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


42. Treatment for benzodiazepine overdose.
Flumazenil
Avascular necrosis
IV penicillin or ampicillin
Osteoarthritis


43. Treatment of central DI.
ACEI
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Crohn's disease
Administration of DDAVP ? serum osmolality and free water restriction


44. First - line pharmacotherapy for depression.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Type II (proximal) RTA
SSRIs
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones


45. Treatment for DTs.
1
Benzodiazepines
Treat immediately. Consent is implied in emergency situations
Neisseria meningitidis


46. Causes of transudative effusion.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Calcium oxalate
Threatened abortion
Clostridium difficile


47. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Edrophonium
INH - penicillamine - hydralazine - procainamide
Lead - time bias
Ampulla of the oviduct


48. ? CO - ? PCWP - ? PVR.
Retinoic acid
AP chest - AP/lateral C- spine - AP pelvis
46 -XX
Cardiogenic shock


49. ? risk of what infection with silicosis?
Mycobacterium tuberculosis
Precocious puberty
Rett's disorder
They can mask symptoms of hypoglycemia


50. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Acne vulgaris
Membranous glomerulonephritis
Nephrotic syndrome
Intraductal papilloma