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. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Squamous cell carcinoma
Pasteurella multocida
Hashimoto's thyroiditis
Endometrial biopsy


2. CSF findings:
Nephrotic syndrome
O2 - analgesia - hydration - and - if severe - transfusion
Aseptic (viral) meningitis
Rate control with carotid massasge or other vagal stimulation


3. The most common pathogen causing croup.
Mycobacterium tuberculosis
Pityriasis rosea
Kegel exercises - estrogen - pessaries for stress incontinence
Parainfluenza virus type 1


4. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Mallory- Weiss
IVIG or plasmapheresis
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones


5. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Substance abuse
Bullous pemphigoid
Lesions of 1


6. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Hypernatremia
Graves' disease
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


7. Attributable risk?
Never
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Retrograde cystourethrogram


8. Auer rods on blood smear.
Acute myelogenous leukemia (AML)
Small cell lung cancer (SCLC)
MCP and PIP joints; DIP joints are spared
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


9. Gout - self - mutilation - and choreoathetosis.
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
HGPRTase deficiency)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Infection - cancer - and autoimmune disease


10. May be seen in children who are accused of inattention in class and confused with ADHD.
Cluster headache
False. Withdrawing and withholding life are the same from an ethical standpoint
Absence seizures
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


11. Identify key organisms causing diarrhea:
Clostridium difficile
Number of live births per 1000 population
Emergent laparotomy to repair perforated viscus - likely stomach
Nephrolithiasis


12. Nikolsky's sign.
Pityriasis versicolor
Rett's disorder
Hodgkin's lymphoma
Bullous pemphigoid


13. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Pregnant women. Treat this group aggressively because of potential complications
Hypovolemic shock


14. A neonate has meconium ileus.

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15. Tanner stage 3 in a six-year - old female.
Taenia solium (cysticercosis)
Cerebral berry aneurysms (AD PCKD)
Precocious puberty
Treat immediately. Consent is implied in emergency situations


16. Risk factors for pyelonephritis.
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Respiratory alkalosis
SIADH due to stress
Pseudomonas


17. The most serious side effect of clozapine.
Patient on dopamine antagonist
Benzodiazepines
Agranulocytosis
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


18. A congenital heart disease that cause 2
Betamethasone or dexamethasone
Number of deaths from birth to 28 days per 1000 live births
Pseudomonas
Coarctation of the aorta


19. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
ALS
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Herpes simplex


20. Name the organism:
Streptococcus pneumoniae
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Diamond - Blackfan anemia
Seminoma


21. Lab values suggestive of menopause.
? serum FSH
Coccidioidomycosis. Amphotericin B
Herpes simplex
Respiratory alkalosis


22. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Phencyclidine hydrochloride (PCP) intoxication
Wait - surgical resection - radiation and/or androgen suppression
Legionella pneumonia
Pentad of TTP


23. ECG findings suggesting MI.
Lead - time bias
Uterine massage; if that fails - give oxytocin
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


24. Peaked T waves and widened QRS.
Elevated ICP - RBCs - xanthochromia
Nephritic syndrome
Identify cause; fluid and blood repletion
Hyperkalemia


25. 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
HIDA scan
Lesion of 1
Rate control - rhythm conversion - and anticoagulation


26. The most common causes of dementia.

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27. The most common cause of SAH.
Trauma; the second most common is berry aneurysm
Seborrheic keratosis
Beta- blockers - digoxin - calcium channel blockers
Nephritic syndrome


28. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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29. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Toxoplasma gondii
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Anemia of chronic disease
Multiple myeloma


30. The most common cause of hypothyroidism.

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31. Treatment for DTs.
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Benzodiazepines
Wrist drop - loss of thumb abduction
Lesions of 1


32. Conditions in which confidentiality must be overridden.
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Neuroleptics
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


33. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Depersonalization disorder
Cluster headache
DM - SLE - and amyloidosis


34. Post - HBV exposure treatment.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
HBV immunoglobulin
? serum FSH
Erythema multiforme


35. ? CO - ? PCWP - ? PVR.
Actinic keratosis
Number of deaths per 1000 population
Cardiogenic shock
Squamous cell carcinoma


36. Differential of hypervolemic hyponatremia.
Hypotension - distant heart sounds - and JVD
Lyme disease - Ixodes tick - doxycycline
Squamous cell carcinoma
Cirrhosis - CHF - nephritic syndrome


37. True or false: Once patients sign a statement giving consent - they must continue treatment.
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
Polymyalgia rheumatica
BP > 140/90 on three separate occasions two weeks apart
Weight gain - type 2 DM - QT prolongation


38. What is the immunodeficiency?

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39. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Neisseria meningitidis
Fat - female - fertile - forty - flatulent
Check for ? ICP; look for papilledema
Nephrotic syndrome


40. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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41. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Parkland formula
ETEC
68% - 95.5% - 99.7%
Number of live births per 1000 women 15-44 years of age


42. Classic ultrasound and gross appearance of complete hydatidiform mole.

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43. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
DI
Partial mole


44. Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Pulsus paradoxus (seen in cardiac tamponade)
Anorexia
IV hydration and loop diuretics (furosemide)


45. 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.
Oral surgery
The IR of a disease in a population exposed to a particular factor
Polymyalgia rheumatica
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


46. Caf
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Neurofibromatosis 1
High TSH - low T4 - antimicrosomal antibodies
Murphy's sign - seen in acute cholecystitis


47. CSF findings:
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Bacterial meningitis
Broca's aphasia. Frontal lobe - left MCA distribution
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


48. 'Stuck - on' appearance.
Neisseria meningitidis
Seborrheic keratosis
Regresses after menopause
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


49. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

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50. Electrolyte changes in tumor lysis syndrome.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Postinfectious glomerulonephritis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
? Ca2+ - ? K- - ? phosphate - ? uric acid