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. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Inhaled Beta- agonists and inhaled corticosteroids
Klebsiella
Patient on dopamine antagonist
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


2. An agent that reverses the effects of heparin.
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
Protamine
Regression
Number of deaths from 28 days to one year per 1000 live births


3. An autosomal - recessive disorder with a defect in the GPIIbIIIa platelet receptor and ? platelet aggregation.

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4. Laparoscopic findings in endometriosis.

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5. In which patients do you initiate colorectal cancer screening early?
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
B12 deficiency
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Treat existing heart failure and replace the tricuspid valve


6. Birth rate?
Bladder rupture or urethral injury
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Abdominal ultrasound and CT
Number of live births per 1000 population


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

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8. Acceptable urine output in a stable patient.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Diamond - Blackfan anemia
Stable - unruptured ectopic pregnancy of &lt; 3.5 cm at &lt; 6 weeks' gestation
30 cc/hour


9. Treatment for AML M3.
Duchenne muscular dystrophy
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Retinoic acid
Coccidioidomycosis. Amphotericin B


10. The most common causes of dementia.

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11. Antidepressants associated with hypertensive crisis.
MAOIs
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Taenia solium (cysticercosis)
Hypotension - distant heart sounds - and JVD


12. Medication given to accelerate fetal lung maturity.
IV benzodiazepine
Retinoic acid
Betamethasone or dexamethasone
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


13. Presents with a herald patch - Christmas - tree pattern.
Iron deficiency anemia
Check for ? ICP; look for papilledema
Neither
Pityriasis rosea


14. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Administration of DDAVP ? serum osmolality and free water restriction
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Anorexia
Hypotension - distant heart sounds - and JVD


15. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Dressler's syndrome: fever - pericarditis - ? ESR
Sarcoidosis
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Lesions of 1


16. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Prerenal
Conduct disorder
Fluids and antibiotics


17. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Malignancy and hyperparathyroidism
Surfactant deficiency
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Nephrogenic diabetes insipidus (DI)


18. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Beta- blockers - Ca2+ channel blockers - TCAs
Trichomonas vaginitis
Taenia solium (cysticercosis)


19. Identify key organisms causing diarrhea:
CF or Hirschsprung's disease
HBV immunoglobulin
Squamous cell carcinoma
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


20. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Kwashiorkor (protein malnutrition)
Antipsychotics (neuroleptic malignant syndrome)
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


21. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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22. Conditions in which confidentiality must be overridden.
ACEI
Mallory- Weiss
Retrograde cystourethrogram
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


23. Treatment for opioid overdose.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Intraductal papilloma
Naloxone
68% - 95.5% - 99.7%


24. A late - life - threatening complication of chronic myelogenous leukemia (CML).
CA-125 and transvaginal ultrasound
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Substance abuse
Hypocalcemia


25. Indications for surgical repair of abdominal aortic aneurysm.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity


26. Salicylate ingestion ? In What type of acid - base disorder?
Anion gap acidosis and 1
Neuroblastoma
Sarcoidosis
Wait - surgical resection - radiation and/or androgen suppression


27. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Malingering
HIDA scan
Normal
Actinic keratosis


28. Asplenic patients are particularly susceptible to these organisms.
Nephrogenic diabetes insipidus (DI)
Administration of DDAVP ? serum osmolality and free water restriction
Hereditary spherocytosis
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


29. Medical options for endometriosis.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Hyperkalemia
Hypovolemic shock
OCPs - danazol - GnRH agonists


30. Appropriate diagnostic test?
Pasteurella multocida
Iron deficiency anemia
1
Exercise stress treadmill with ECG


31. Four characteristics of a nevus suggestive of melanoma.
Asymmetry - border irregularity - color variation - large diameter
Depersonalization disorder
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Acute myelogenous leukemia (AML)


32. How to diagnose and follow a leiomyoma.
Levodopa/carbidopa
Ultrasound
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
Klebsiella


33. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Hypertension - bradycardia - and abnormal respirations
Small cell lung cancer (SCLC)
HIDA scan
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


34. A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Seborrheic dermatitis. Treat with antifungals
Non - Hodgkin's lymphoma
SIADH due to stress
Acute mania. Start a mood stabilizer (e.g. - lithium)


35. Infection of small airways with epidemics in winter and spring.
Nephrotic syndrome
B12 deficiency
Fluids and antibiotics
RSV bronchiolitis


36. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Mycobacterium tuberculosis
Fat - female - fertile - forty - flatulent
Contact dermatitis
Abdominal ultrasound and CT


37. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Consider Fitz - Hugh - Curtis syndrome
Infection - cancer - and autoimmune disease
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Flumazenil


38. Four causes of microcytic anemia.
Parkland formula
Osmotic fragility test
Acute pancreatitis
TICS


39. The most common organism in burn - related infections.
Rett's disorder
Bruton's X- linked agammaglobulinemia
Diphenhydramine or epinephrine 1:1000
Pseudomonas


40. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Hypertension - bradycardia - and abnormal respirations
Graves' disease
CHF - shock - and altered mental status
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


41. The most common pathogen causing croup.
Phototherapy (mild) or exchange transfusion (severe)
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Establish the ABCs
Parainfluenza virus type 1


42. Presence of red cell casts in urine sediment.
ETEC
Glomerulonephritis/nephritic syndrome
Biliary tract obstruction
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


43. Risk factors for DVT.

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44. Meningitis in neonates. Causes? Treatment?
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Nephrogenic diabetes insipidus (DI)
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


45. Pinkish - scaling - flat lesions on the chest and back. KOH prep has a 'spaghetti - and - meatballs' appearance.
Osteogenesis imperfecta
Weight loss and OCPs
Pityriasis versicolor
Headache


46. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2 - analgesia - hydration - and - if severe - transfusion
Toxoplasma gondii
Agranulocytosis
ARDS


47. Molar pregnancy containing fetal tissue.
Partial mole
Duchenne muscular dystrophy
Glanzmann's thrombasthenia
Parainfluenza virus type 1


48. + Nikolsky's sign.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Conflict of interest
Pemphigus vulgaris
1


49. Treatment for DTs.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Malingering
30 cc/hour
Benzodiazepines


50. First - line treatment for otitis media.
Amoxicillin
Actinomyces israelii
Angina is new - is worsening - or occurs at rest
1