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USMLE Step 2

Subjects : health-sciences, 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. Type of ARF in a patient with FeNa < 1%.
Prerenal
Reye's syndrome
Angina is new - is worsening - or occurs at rest
Fluids and antibiotics

2. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Ultrasound
Trichomonas vaginitis
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves

3. CSF findings with SAH.
Elevated ICP - RBCs - xanthochromia
Parvovirus B19
Precocious puberty
Ampulla of the oviduct

4. Chromosomal pattern of a complete mole.
Alopecia areata (autoimmune process)
Anemia - thrombocytopenia - and acute renal failure
Ophthalmologic exam - CT - and MRI
46 -XX

5. Treatment of supraventricular tachycardia (SVT).
Observational bias
Bullous pemphigoid
Rate control with carotid massasge or other vagal stimulation
Pityriasis versicolor

6. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Patent ductus arteriosus (PDA)
Inevitable abortion
Coarctation of the aorta
Lyme disease - Ixodes tick - doxycycline

7. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
Sensitivity
1
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Lichen sclerosus

8. Lung cancer associated with SIADH.
IV penicillin or ampicillin
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Small cell lung cancer (SCLC)
Wernicke's encephalopathy due to a deficiency of thiamine

9. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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10. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises - estrogen - pessaries for stress incontinence
Actinic keratosis
Cirrhosis - CHF - nephritic syndrome
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

11. Unopposed estrogen is contraindicated in which cancers?
Number of live births per 1000 population
Nephrotic syndrome
Emergent laparotomy to repair perforated viscus - likely stomach
Endometrial or estrogen receptor - breast cancer

12. Treatment for malignant hypertension.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Nitroprusside
Crohn's disease
Slipped capital femoral epiphyses. AP and frog - leg lateral view

13. Name the organism:
HBV immunoglobulin
Patent ductus arteriosus (PDA)
CML
Salmonella

14. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Polymyalgia rheumatica
Treat existing heart failure and replace the tricuspid valve
Conversion disorder
Impetigo

15. ECG findings suggesting MI.
Highly sensitive for TB
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
1
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

16. First - line treatment for otitis media.
Antipsychotics (neuroleptic malignant syndrome)
Amoxicillin
Acute myelogenous leukemia (AML)
Abdominal ultrasound and CT

17. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Huntington's disease
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Erythema multiforme
Contact dermatitis

18. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
BP > 140/90 on three separate occasions two weeks apart
'Sawtooth' P waves
Pemphigus vulgaris

19. What should always be done prior to LP?
Acne vulgaris
Neuroblastoma
Lobular carcinoma in situ
Check for ? ICP; look for papilledema

20. Honey- crusted lesions.
Impetigo
Hypokalemia
Pseudomonas
Huntington's disease

21. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Immediate needle thoracostomy
Oral surgery
Febrile seizures (roseola infantum)
Mallory- Weiss

22. In which patients do you initiate colorectal cancer screening early?
Small cell lung cancer (SCLC)
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
Anorexia
Parvovirus B19

23. Bone is fractured in fall on outstretched hand.

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24. The most serious side effect of clozapine.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Nephrogenic diabetes insipidus (DI)
Agranulocytosis

25. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
PT
Normal
Hypoparathyroidism
Slipped capital femoral epiphyses. AP and frog - leg lateral view

26. A 'blueberry muffin' rash is characteristic of what congenital infection?
CML
Rubella
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
High TSH - low T4 - antimicrosomal antibodies

27. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Seventy percent if the stenosis is symptomatic
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Uterine atony
Herpes simplex

28. Honeycomb pattern on CXR. Diagnosis? Treatment?
Varicella zoster
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Acute pancreatitis
Vibrio - HAV

29. ? CO - ? PCWP - ? PVR.
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
Cardiogenic shock
Basal cell carcinoma
Hyperkalemia

30. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
PT
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Osteogenesis imperfecta
105 bacteria/mL

31. Nonpainful chancre.
Actinomyces israelii
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
1
Prinzmetal's angina

32. Medical treatment for IBD.
Pseudogout
a - antagonists (phentolamine and phenoxybenzamine)
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Renal cell carcinoma (RCC)

33. The three most common causes of fever of unknown origin (FUO).
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Infection - cancer - and autoimmune disease
Inhaled Beta- agonists and inhaled corticosteroids
DM - SLE - and amyloidosis

34. An antidiabetic agent associated with lactic acidosis.
Depersonalization disorder
Metformin
Toxoplasma gondii
Displacement

35. CSF findings:
Sheehan's syndrome (postpartum pituitary necrosis)
Aseptic (viral) meningitis
Trichomonas vaginitis
Inhaled Beta- agonists and inhaled corticosteroids

36. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
Ulcerative colitis
Highly sensitive for TB
Bacillus cereus

37. Albuminocytologic dissociation.
Immediate needle thoracostomy
Guillain - Barr
Anion gap acidosis and 1
Fluid restriction - demeclocycline

38. 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.
Neurofibromatosis 1
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
? serum FSH
Lead - time bias

39. CSF findings:
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Subarachnoid hemorrhage (SAH)
Cirrhosis - CHF - nephritic syndrome
Rate control - rhythm conversion - and anticoagulation

40. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Aseptic (viral) meningitis
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Neurofibromatosis 1

41. Cross - sectional survey
Prevalence
Iatrogenic steroid administration. The second most common cause is Cushing's disease
They can mask symptoms of hypoglycemia
Normal

42. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Haemophilus ducreyi
Lead - time bias
Intraductal papilloma
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

43. Identify key organisms causing diarrhea:
Malignancy and hyperparathyroidism
Suspect retinoblastoma
Hodgkin's lymphoma
Clostridium difficile

44. Hernia with highest risk of incarceration
Femoral hernia
Lichen planus
Suspect retinoblastoma
Treat existing heart failure and replace the tricuspid valve

45. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Cerebral berry aneurysms (AD PCKD)
Pentad of TTP

46. Classic physical findings for endocarditis.

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47. Signs of neurogenic shock.
ETEC
Hypotension and bradycardia
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Identify cause; fluid and blood repletion

48. Difference between a cohort and a case - control study.
Suspect ankylosing spondylitis. Check HLA- B27
N- acetylcysteine
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
Higher prevalence

49. What % lesion is an indication for carotid endarterectomy?
Campylobacter
Lichen sclerosus
Seventy percent if the stenosis is symptomatic
Hypokalemia

50. The most common cause of hypothyroidism.

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