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. Treatment of supraventricular tachycardia (SVT).
Rate control with carotid massasge or other vagal stimulation
IgA nephropathy (Berger's disease)
Oral or topical metronidazole
Betamethasone or dexamethasone


2. The most common inherited cause of hypercoagulability.
Pharmacologic stress test (e.g. - dobutamine echo)
Allergic interstitial nephritis
Neuroblastoma
Factor V Leiden mutation


3. Name the defense mechanism:
Impetigo
Non - Hodgkin's lymphoma
Displacement
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


4. The most common location for an ectopic pregnancy.
Ampulla of the oviduct
Lichen planus
Duodenal atresia
Excessive EtOH


5. Classic CXR findings for pulmonary edema.

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6. Risk factors for cholelithiasis.
Dissociative fugue
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Osmotic fragility test
Fat - female - fertile - forty - flatulent


7. Not contraindications to vaccination.
Inevitable abortion
ETEC
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Suspect retinoblastoma


8. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
Selective IgA deficiency
Identify cause; fluid and blood repletion
Asherman's syndrome


9. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Obstructive pulmonary disease (e.g. - asthma)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Fat - female - fertile - forty - flatulent


10. Salicylate ingestion ? In What type of acid - base disorder?
Higher prevalence
Hypotension and bradycardia
Anion gap acidosis and 1
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis


11. Lab values suggestive of menopause.
? serum FSH
Pityriasis versicolor
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Sulfonamides - antimalarial drugs - fava beans


12. Acceptable urine output in a trauma patient.
Iron overload; use deferoxamine
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Abdominal ultrasound and CT
50 cc/hour


13. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Pulsus paradoxus (seen in cardiac tamponade)
Cellulitis
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Hypoparathyroidism


14. The most common 1
Flumazenil
Lung - breast - skin (melanoma) - kidney - GI tract
SCLC
Wernicke's encephalopathy due to a deficiency of thiamine


15. + Nikolsky's sign.
Pemphigus vulgaris
Seborrheic dermatitis. Treat with antifungals
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Taenia solium (cysticercosis)


16. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Substance abuse
30 cc/hour
RCC or other erythropoietin - producing tumor; evaluate with CT scan
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


17. An agent that reverses the effects of heparin.
Phencyclidine hydrochloride (PCP) intoxication
Protamine
Streptococcus pneumoniae
Biliary tract obstruction


18. Name the organism:
Neisseria meningitidis
Allergic interstitial nephritis
Seminoma
Nephrotic syndrome


19. Erythema migrans.
RSV bronchiolitis
Lesion of 1
Rubella
Broca's aphasia. Frontal lobe - left MCA distribution


20. True or false: Once patients sign a statement giving consent - they must continue treatment.
Radiation
Never
1
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


21. Lab findings in Hashimoto's thyroiditis.
High TSH - low T4 - antimicrosomal antibodies
Nephrolithiasis
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Pityriasis rosea


22. An antidiabetic agent associated with lactic acidosis.
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Metformin
ETEC
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


23. The most common cause of seizures in young adults (18-35 years).
Anion gap acidosis and 1
Phencyclidine hydrochloride (PCP) intoxication
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Trauma - alcohol withdrawal - brain tumor


24. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Nephrogenic diabetes insipidus (DI)
Mallory- Weiss
Surfactant deficiency
Polymyalgia rheumatica


25. Relative risk?
Hereditary spherocytosis
The IR of a disease in a population exposed to a particular factor
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
BP > 140/90 on three separate occasions two weeks apart


26. 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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27. Macrocytic - megaloblastic anemia without neurologic symptoms.
MAOIs
Diamond - Blackfan anemia
Folate deficiency
Immediate cardioversion


28. Thrombotic thrombocytopenic purpura (TTP) pentad?
Murphy's sign - seen in acute cholecystitis
Number of deaths from 28 days to one year per 1000 live births
Ultrasound
Pentad of TTP


29. Indications for medical treatment of ectopic pregnancy.

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30. Test to rule out urethral injury.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Retrograde cystourethrogram
Restrictive pulmonary disease
Weight loss and OCPs


31. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Infection - cancer - and autoimmune disease
Bacterial meningitis
False. Withdrawing and withholding life are the same from an ethical standpoint
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


32. PFT showing ? FEV1/FVC.
Abdominal ultrasound and CT
Lung - breast - skin (melanoma) - kidney - GI tract
Obstructive pulmonary disease (e.g. - asthma)
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


33. The most common cause of hypertension in young men.
Multiple myeloma
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Malignancy and hyperparathyroidism
Excessive EtOH


34. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
IV penicillin or ampicillin
Rubella


35. Name the organism:
Pseudomonas
The IR of a disease in a population exposed to a particular factor
Femoral hernia
Normal


36. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
CA-125 and transvaginal ultrasound
Hypoparathyroidism
Actinic keratosis


37. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
No. Parental consent is not necessary for the medical treatment of pregnant minors
Observational bias
False. Withdrawing and withholding life are the same from an ethical standpoint


38. Hypercholesterolemia treatment that ? flushing and pruritus.
Lead - time bias
Alport's syndrome
Lesch - Nyhan syndrome (purine salvage problem with
Niacin


39. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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40. First step in the management of a patient with acute GI bleed.
Fanconi's anemia
Nephrogenic diabetes insipidus (DI)
Establish the ABCs
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


41. Signs suggesting radial nerve damage with humeral fracture.
MCP and PIP joints; DIP joints are spared
Wrist drop - loss of thumb abduction
Self - limited - painless vaginal bleeding
Bacterial meningitis


42. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Crohn's disease
High TSH - low T4 - antimicrosomal antibodies
Observational bias


43. Asplenic patients are particularly susceptible to these organisms.
Hypocalcemia
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
? serum FSH
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


44. Findings in 3
Pseudomonas
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Dantrolene or bromocriptine
Lead - time bias


45. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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46. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
7-10 days
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Lesion of 1


47. Life - threatening muscle rigidity - fever - and rhabdomyolysis.
Neuroleptic malignant syndrome
Edrophonium
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
RCC or other erythropoietin - producing tumor; evaluate with CT scan


48. Sensitive tests have few false negatives and are used to rule _____ a disease.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Out
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


49. Identify key organisms causing diarrhea:
Diamond - Blackfan anemia
Anemia - thrombocytopenia - and acute renal failure
Wait - surgical resection - radiation and/or androgen suppression
Campylobacter


50. Treatment for Guillain - Barr
Vibrio - HAV
IVIG or plasmapheresis
Hypertension - bradycardia - and abnormal respirations
Varicella zoster