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. Relative risk?
The IR of a disease in a population exposed to a particular factor
Parvovirus B19
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Nephrogenic diabetes insipidus (DI)


2. Reynolds' pentad.

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3. What is the immunodeficiency?
Impetigo
Wiskott - Aldrich syndrome
IV hydration and loop diuretics (furosemide)
Selective IgA deficiency


4. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Anticoagulation - rate control - cardioversion
Fatigue and impending respiratory failure
IV benzodiazepine


5. Name the organism:
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Fat - female - fertile - forty - flatulent
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Haemophilus ducreyi


6. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
IV penicillin or ampicillin
Pheochromocytoma
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Check for ? ICP; look for papilledema


7. Treatment for Guillain - Barr
OCPs - danazol - GnRH agonists
IVIG or plasmapheresis
Polymyalgia rheumatica
Sporothrix schenckii


8. The most common 1
Lung - breast - skin (melanoma) - kidney - GI tract
Hodgkin's lymphoma
Lichen sclerosus
'Sawtooth' P waves


9. The most common cause of hypertension in young women.
OCPs
Central pontine myelinolysis
Lichen sclerosus
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


10. Trauma series.
No. Parental consent is not necessary for the medical treatment of pregnant minors
AP chest - AP/lateral C- spine - AP pelvis
Fluids and antibiotics
OCP and barrier contraception


11. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Fluid restriction - demeclocycline
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Iron deficiency anemia
Beta- hCG; the most common cause of amenorrhea is pregnancy


12. Glomerulonephritis with hemoptysis.

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13. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Hypotension and bradycardia
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
HIDA scan
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


14. 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
Osgood - Schlatter disease
IgA nephropathy (Berger's disease)
Conduct disorder


15. First - line treatment for otitis media.
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Chronic lymphocytic leukemia (CLL)
Amoxicillin
Rate control with carotid massasge or other vagal stimulation


16. The most common 1
CHF - shock - and altered mental status
Endometrial biopsy
Multiple myeloma
Beta- blockers - Ca2+ channel blockers - TCAs


17. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
All - compartment fasciotomy for suspected compartment syndrome
Inevitable abortion
No. Parental consent is not necessary for the medical treatment of pregnant minors
1


18. PFT showing ? FEV1/FVC.
Restrictive pulmonary disease
Hypernatremia
Excessive EtOH
CA-125 and transvaginal ultrasound


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

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20. Exophthalmos - pretibial myxedema - and ? TSH.

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21. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
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
Wait - surgical resection - radiation and/or androgen suppression
Pulsus paradoxus (seen in cardiac tamponade)
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


22. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Kegel exercises - estrogen - pessaries for stress incontinence
Bladder rupture or urethral injury
Nephrotic syndrome
1


23. Medical options for endometriosis.
Number of deaths from 28 days to one year per 1000 live births
Cluster headache
OCPs - danazol - GnRH agonists
Toxoplasma gondii


24. Presence of red cell casts in urine sediment.
Weight loss and OCPs
Patient on dopamine antagonist
Glomerulonephritis/nephritic syndrome
? serum FSH


25. Classic causes of drug - induced hepatitis.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Higher incidence
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


26. Treatment for AML M3.
Retinoic acid
Septic or anaphylactic shock
Weight gain - type 2 DM - QT prolongation
Crohn's disease


27. Treatment for DTs.
Benzodiazepines
Conversion disorder
Highly sensitive for TB
Angina - ST- segment changes on ECG - or ? BP


28. A neonate has meconium ileus.

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29. 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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30. How to distinguish polycythemia vera from 2
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Depersonalization disorder
Mallory- Weiss
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


31. The most common type of testicular cancer.
Seminoma
Sarcoidosis
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured


32. Infection of small airways with epidemics in winter and spring.
Bladder rupture or urethral injury
Parvovirus B19
RSV bronchiolitis
Renal cell carcinoma (RCC)


33. Salicylate ingestion ? In What type of acid - base disorder?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Ophthalmologic exam - CT - and MRI
Anion gap acidosis and 1
? Ca2+ - ? K- - ? phosphate - ? uric acid


34. Treatment of septic shock.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Seminoma
Fluids and antibiotics
Glomerulonephritis/nephritic syndrome


35. 'Doughy skin.'
Kwashiorkor (protein malnutrition)
Hypernatremia
Neurofibromatosis 1
Asherman's syndrome


36. An antidiabetic agent associated with lactic acidosis.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Bacterial meningitis
Metformin
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


37. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Small cell lung cancer (SCLC)
Phencyclidine hydrochloride (PCP) intoxication


38. When can a physician refuse to continue treating a patient on the grounds of futility?
HBV - DTaP - Hib - IPV - PCV
Subdural hematoma
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
a - antagonists (phentolamine and phenoxybenzamine)


39. Diagnostic test for hereditary spherocytosis.
Pseudogout
Osmotic fragility test
Ophthalmologic exam - CT - and MRI
Anion gap acidosis and 1


40. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Observational bias


41. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Low - voltage - diffuse ST- segment elevation
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
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


42. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Isolation
Obstructive pulmonary disease (e.g. - asthma)


43. What should always be done prior to LP?
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Acute pancreatitis
Check for ? ICP; look for papilledema
Oral surgery


44. Unopposed estrogen is contraindicated in which cancers?
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Endometrial or estrogen receptor - breast cancer
Contact dermatitis
Hypoparathyroidism


45. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Cirrhosis - CHF - nephritic syndrome
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
IV penicillin or ampicillin


46. Treatment of anaphylactic shock.
Cirrhosis - CHF - nephritic syndrome
Diphenhydramine or epinephrine 1:1000
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Kl


47. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Lichen sclerosus
ARDS
Yersinia
Consider Fitz - Hugh - Curtis syndrome


48. Heinz bodies?
Salmonella
Radiation
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Suspect ankylosing spondylitis. Check HLA- B27


49. First - line pharmacotherapy for depression.
CHF - shock - and altered mental status
Hypoxia and hypocarbia
SSRIs
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


50. Honeycomb pattern on CXR. Diagnosis? Treatment?
Neuroblastoma
Check for ? ICP; look for papilledema
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed