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. Medical treatment for hepatic encephalopathy.
Lobular carcinoma in situ
'Chocolate cysts -' powder burns
? protein intake - lactulose - neomycin
Edrophonium


2. Name the defense mechanism:
Check for ? ICP; look for papilledema
Septic or anaphylactic shock
Displacement
IV hydration and loop diuretics (furosemide)


3. Bias introduced into a study when a clinician is aware of the patient's treatment type.
CML
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Observational bias


4. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Placental abruption and placenta previa
Benzodiazepines
Consider Fitz - Hugh - Curtis syndrome
Cellulitis


5. Symptoms of placental abruption.
Continuous - painful vaginal bleeding
Clomiphene citrate
S. aureus
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


6. Low urine specific gravity in the presence of high serum osmolality.
Iron deficiency anemia
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Intraductal papilloma
DI


7. Name the organism:
Factor V Leiden mutation
Streptococcus pneumoniae
Hypotension - distant heart sounds - and JVD
Yersinia


8. Three systemic diseases ? nephrotic syndrome.
DM - SLE - and amyloidosis
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Biliary tract obstruction
1


9. Medical treatment for IBD.
Naloxone
Displacement
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
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


10. Treatment for benzodiazepine overdose.
Neurofibromatosis 1
Flumazenil
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Hypertension - bradycardia - and abnormal respirations


11. Classic causes of drug - induced hepatitis.
Pseudomonas
Prinzmetal's angina
B12 deficiency
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


12. Autoimmune complication occurring 2-4 weeks post - MI.

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13. Key side effects of atypical antipsychotics.
Weight gain - type 2 DM - QT prolongation
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Hypotension and bradycardia


14. Eosinophils in urine sediment.
Highly sensitive for TB
Number of deaths from 28 days to one year per 1000 live births
Allergic interstitial nephritis
Number of deaths per 1000 population


15. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Lichen sclerosus
Hypovolemic shock
Glanzmann's thrombasthenia
Identify cause; fluid and blood repletion


16. A crescent - shaped hyperdensity on CT that does not cross the midline.
Osmotic fragility test
Number of deaths per 1000 population
Polymyalgia rheumatica
Subdural hematoma


17. Treatment for bacterial vaginosis.
Prevalence
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Oral or topical metronidazole
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


18. Aplastic crisis in sickle cell disease.
Number of deaths per 1000 population
Actinomyces israelii
Levodopa/carbidopa
Parvovirus B19


19. Blood in the urethral meatus or high - riding prostate.
Fluid restriction - demeclocycline
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Bladder rupture or urethral injury
Acute myelogenous leukemia (AML)


20. Appropriate diagnostic test?
Sulfonamides - antimalarial drugs - fava beans
OCP and barrier contraception
Exercise stress treadmill with ECG
Neuroleptics


21. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Ulcerative colitis
Pharmacologic stress test (e.g. - dobutamine echo)
Allergic interstitial nephritis
False. Withdrawing and withholding life are the same from an ethical standpoint


22. 'Stuck - on' appearance.
< 7.0
Hashimoto's thyroiditis
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Seborrheic keratosis


23. Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
A patient with chest trauma who was previously stable suddenly dies
Rett's disorder
Number of live births per 1000 women 15-44 years of age


24. Acute - phase treatment for Kawasaki disease.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Partial mole
Mallory- Weiss
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


25. 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
Kegel exercises - estrogen - pessaries for stress incontinence
Administration of DDAVP ? serum osmolality and free water restriction
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones


26. Identify key organisms causing diarrhea:
Bacillus cereus
Alport's syndrome
Reaction formation
Sensitivity


27. Confusion - confabulation - ophthalmoplegia - ataxia.

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28. Heinz bodies?
Haemophilus ducreyi
Mallory- Weiss
Hypotension - distant heart sounds - and JVD
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


29. Treatment of septic shock.
Fluids and antibiotics
Hypoparathyroidism
Number of live births per 1000 women 15-44 years of age
TICS


30. Not contraindications to vaccination.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Ophthalmologic exam - CT - and MRI


31. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
MS
Substance abuse
Cardiogenic shock


32. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Beta- hCG; the most common cause of amenorrhea is pregnancy
Diamond - Blackfan anemia
Hodgkin's lymphoma
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


33. Rigidity and stiffness with resting tremor and masked facies.

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34. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Pharmacologic stress test (e.g. - dobutamine echo)
Bruton's X- linked agammaglobulinemia
Continuous - painful vaginal bleeding
Normal


35. The most common causes of dementia.

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36. Acceptable urine output in a trauma patient.
Guillain - Barr
50 cc/hour
Non - Hodgkin's lymphoma
Legionella pneumonia


37. Reynolds' pentad.

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38. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
105 bacteria/mL
Immediate cardioversion
MS
Wiskott - Aldrich syndrome


39. Nonpainful chancre.
Chronic granulomatous disease
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
1
Transitional cell carcinoma


40. Chvostek's and Trousseau's signs.
Actinomyces israelii
Hypocalcemia
Dantrolene or bromocriptine
Rubella


41. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Chronic granulomatous disease
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Never


42. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
50 cc/hour
Factitious disorder (Munchausen syndrome)
Hypertension - bradycardia - and abnormal respirations
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


43. Difference between Mallory- Weiss and Boerhaave tears.
Hashimoto's thyroiditis
Pulsus paradoxus (seen in cardiac tamponade)
Mallory- Weiss
Incidence and prevalence


44. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Seborrheic keratosis
Squamous cell carcinoma
Sarcoidosis
Exercise stress treadmill with ECG


45. In which patients do you initiate colorectal cancer screening early?
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
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
BP > 140/90 on three separate occasions two weeks apart
Pityriasis versicolor


46. Differential of hypervolemic hyponatremia.
Nephrolithiasis
Cirrhosis - CHF - nephritic syndrome
Stasis - hypercoagulability - endothelial damage
Sensitivity


47. Radiographic evidence of aortic disruption or dissection.
A patient with chest trauma who was previously stable suddenly dies
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
ACEI
a - antagonists (phentolamine and phenoxybenzamine)


48. Conditions in which confidentiality must be overridden.
Cerebral berry aneurysms (AD PCKD)
Taenia solium (cysticercosis)
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


49. Risk factors for pyelonephritis.
Femoral hernia
Actinomyces israelii
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
? serum FSH


50. Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
Anemia - thrombocytopenia - and acute renal failure
Amoxicillin
Threatened abortion