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 patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
PT
Cluster headache
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Hypoparathyroidism


2. Acute - phase treatment for Kawasaki disease.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Acne vulgaris
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
'Sawtooth' P waves


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

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4. Classic CXR findings for pulmonary edema.

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5. The first test to perform when a woman presents with amenorrhea.
Endometrial biopsy
Beta- hCG; the most common cause of amenorrhea is pregnancy
? Ca2+ - ? K- - ? phosphate - ? uric acid
Neuroblastoma


6. Three systemic diseases ? nephrotic syndrome.
High TSH - low T4 - antimicrosomal antibodies
Multiple myeloma
Treat existing heart failure and replace the tricuspid valve
DM - SLE - and amyloidosis


7. Name the defense mechanism:
Higher prevalence
Renal cell carcinoma (RCC)
Isolation
V/Q scan


8. Identify key organisms causing diarrhea:
Vibrio - HAV
Cerebral berry aneurysms (AD PCKD)
Contact dermatitis
Iron deficiency anemia


9. Difference between a cohort and a case - control study.
Anorexia
Hypertension - bradycardia - and abnormal respirations
Fatigue and impending respiratory failure
Cohort studies can be used to calculate relative risk (RR) - incidence - and/or odds ratio (OR). Case - control studies can be used to calculate an OR


10. The most serious side effect of clozapine.
Vibrio - HAV
Agranulocytosis
OCPs
Nephritic syndrome


11. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Oral surgery
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Wegener's granulomatosis and Goodpasture's syndrome
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


12. The most common form of nephritic syndrome.
Sheehan's syndrome (postpartum pituitary necrosis)
Membranous glomerulonephritis
Fat - female - fertile - forty - flatulent
Transitional cell carcinoma


13. The number of true positives divided by the number of patients with the disease is _____.
Retinoic acid
Sensitivity
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Central pontine myelinolysis


14. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Confounding variable
Lesion of 1
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
No. Parental consent is not necessary for the medical treatment of pregnant minors


15. Four signs and symptoms of streptococcal pharyngitis.
N- acetylcysteine
Hypertension - bradycardia - and abnormal respirations
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Pityriasis rosea


16. Endocarditis prophylaxis regimens.
Febrile seizures (roseola infantum)
Acute pancreatitis
False. Withdrawing and withholding life are the same from an ethical standpoint
Oral surgery


17. Thrombotic thrombocytopenic purpura (TTP) pentad?
Phototherapy (mild) or exchange transfusion (severe)
A patient with chest trauma who was previously stable suddenly dies
Pentad of TTP
Isolation


18. Treatment of supraventricular tachycardia (SVT).
Higher incidence
Rate control with carotid massasge or other vagal stimulation
Factitious disorder (Munchausen syndrome)
Pharmacologic stress test (e.g. - dobutamine echo)


19. Acceptable urine output in a trauma patient.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
50 cc/hour
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Colposcopy and endocervical curettage


20. Name the organism:
Pasteurella multocida
Regresses after menopause
Edrophonium
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


21. What is the metabolic syndrome?
Duchenne muscular dystrophy
Cellulitis
Number of deaths from 28 days to one year per 1000 live births
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


22. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
High reliability - low validity
Hypernatremia
Broca's aphasia. Frontal lobe - left MCA distribution


23. The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Parkland formula
Glomerulonephritis/nephritic syndrome
Seborrheic dermatitis. Treat with antifungals


24. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Nephrogenic diabetes insipidus (DI)
Graves' disease


25. Rigidity and stiffness with resting tremor and masked facies.

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26. Rhomboid - shaped - positively birefringent crystals on joint fluid aspirate.
Anticoagulation - rate control - cardioversion
Number of live births per 1000 women 15-44 years of age
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Pseudogout


27. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
1
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Cellulitis
Coccidioidomycosis. Amphotericin B


28. Antihypertensive for a diabetic patient with proteinuria.
ACEI
Parvovirus B19
Conduct disorder
Endometrial or estrogen receptor - breast cancer


29. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
CF or Hirschsprung's disease
Suspect ankylosing spondylitis. Check HLA- B27
Wernicke's encephalopathy due to a deficiency of thiamine


30. Eight surgically correctable causes of hypertension.

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31. PFT showing ? FEV1/FVC.
Pharmacologic stress test (e.g. - dobutamine echo)
E. coli O157:H7
Radiation
Obstructive pulmonary disease (e.g. - asthma)


32. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Reaction formation
RSV bronchiolitis
Pseudomonas


33. Classic physical findings for endocarditis.

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34. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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35. Glomerulonephritis with hemoptysis.

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36. A child has loss of red light reflex. Diagnosis?
Suspect retinoblastoma
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Rate control - rhythm conversion - and anticoagulation
INH - penicillamine - hydralazine - procainamide


37. Diagnostic test for hereditary spherocytosis.
Taenia solium (cysticercosis)
Osmotic fragility test
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Higher prevalence


38. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Retrograde cystourethrogram
Pseudomonas


39. Albuminocytologic dissociation.
Lesions of 1
Emergent laparotomy to repair perforated viscus - likely stomach
Guillain - Barr
Flumazenil


40. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Agranulocytosis
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
IV penicillin or ampicillin
OCP and barrier contraception


41. 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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42. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Squamous cell carcinoma
Spinal stenosis
Cellulitis


43. Treatment of septic shock.
Sheehan's syndrome (postpartum pituitary necrosis)
Pityriasis rosea
Fluids and antibiotics
Nephritic syndrome


44. Symptoms of placenta previa.
Alopecia areata (autoimmune process)
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Rate control with carotid massasge or other vagal stimulation
Self - limited - painless vaginal bleeding


45. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Radiation
Asymmetry - border irregularity - color variation - large diameter
Hereditary spherocytosis


46. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Number of deaths from 28 days to one year per 1000 live births
High reliability - low validity
All - compartment fasciotomy for suspected compartment syndrome
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


47. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
IV hydration and loop diuretics (furosemide)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Choriocarcinoma
SSRIs


48. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Treat immediately. Consent is implied in emergency situations
Neuroleptic malignant syndrome
Infection - febrile seizures - trauma - idiopathic
Oral surgery


49. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
B12 deficiency
Wait - surgical resection - radiation and/or androgen suppression


50. 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.
Anemia - thrombocytopenia - and acute renal failure
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Precocious puberty
Highly sensitive for TB