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. First - line pharmacotherapy for depression.
Hypoparathyroidism
Angina - ST- segment changes on ECG - or ? BP
Diamond - Blackfan anemia
SSRIs


2. Risk factors for DVT.

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3. Treatment for AML M3.
Haemophilus ducreyi
SCLC
Lead - time bias
Retinoic acid


4. The 6 P's of ischemia due to peripheral vascular disease.
Inevitable abortion
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Lesion of 1
Kwashiorkor (protein malnutrition)


5. The most common cause of Cushing's syndrome.

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6. Peaked T waves and widened QRS.
Out
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Hyperkalemia
Cirrhosis - CHF - nephritic syndrome


7. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
A patient's family cannot require that a doctor withhold information from the patient
Hypoparathyroidism
Rubella
Neuroblastoma


8. Indications for medical treatment of ectopic pregnancy.

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9. Glomerulonephritis with hemoptysis.

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10. Conditions in which confidentiality must be overridden.
7-10 days
Coarctation of the aorta
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Excessive EtOH


11. Medications and viruses that ? aplastic anemia.
Beta- blockers - Ca2+ channel blockers - TCAs
Subdural hematoma
S. aureus
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


12. A congenital heart disease that cause 2
Coarctation of the aorta
Infection - cancer - and autoimmune disease
Flumazenil
Iatrogenic steroid administration. The second most common cause is Cushing's disease


13. A patient fails to lactate after an emergency C- section with marked blood loss.

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14. The most common type of nephrolithiasis.
Calcium oxalate
They can mask symptoms of hypoglycemia
a - antagonists (phentolamine and phenoxybenzamine)
Broca's aphasia. Frontal lobe - left MCA distribution


15. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Neither
HBV - DTaP - Hib - IPV - PCV
Chronic lymphocytic leukemia (CLL)
Angina - ST- segment changes on ECG - or ? BP


16. Honey- crusted lesions.
Impetigo
Type I (distal) RTA
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Clostridium difficile


17. The most common cause of bloody nipple discharge.
Wernicke's encephalopathy due to a deficiency of thiamine
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Intraductal papilloma
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


18. Nontender abdominal mass associated with elevated VMA and HVA.
? protein intake - lactulose - neomycin
Identify cause; fluid and blood repletion
Folate deficiency
Neuroblastoma


19. Bilious emesis within hours after the first feeding.
Depersonalization disorder
Duodenal atresia
Identify cause; fluid and blood repletion
Continuous positive airway pressure


20. 'Stones - bones - groans - psychiatric overtones.'
Alopecia areata (autoimmune process)
Immediate cardioversion
Signs and symptoms of hypercalcemia
Number of deaths from birth to 28 days per 1000 live births


21. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Choriocarcinoma
Respiratory alkalosis
Uterine massage; if that fails - give oxytocin
Cerebral berry aneurysms (AD PCKD)


22. First - line treatment for moderate hypercalcemia.
Weight gain - type 2 DM - QT prolongation
Naloxone
68% - 95.5% - 99.7%
IV hydration and loop diuretics (furosemide)


23. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Transitional cell carcinoma
Confounding variable
Factitious disorder (Munchausen syndrome)


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

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25. Gout - self - mutilation - and choreoathetosis.
DM - SLE - and amyloidosis
Ulcerative colitis
Squamous cell carcinoma
HGPRTase deficiency)


26. Cross - sectional survey
Neurofibromatosis 1
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Prevalence
Intraductal papilloma


27. Criteria for exudative effusion.
Endometrial or estrogen receptor - breast cancer
Treat existing heart failure and replace the tricuspid valve
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Slipped capital femoral epiphyses. AP and frog - leg lateral view


28. Treatment for acute coronary syndrome.
Ampulla of the oviduct
Prerenal
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Identify cause; fluid and blood repletion


29. Presents with a herald patch - Christmas - tree pattern.
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Pityriasis rosea
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Usually resolves spontaneously; may require IVIG and/or corticosteroids


30. Odds ratio?
Clomiphene citrate
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Non - Hodgkin's lymphoma


31. Name the organism:
MCP and PIP joints; DIP joints are spared
Agranulocytosis
The IR of a disease in a population exposed to a particular factor
Streptococcus pneumoniae


32. Heinz bodies?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Hereditary spherocytosis
B12 deficiency
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


33. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Crohn's disease
Weight gain - type 2 DM - QT prolongation
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Prinzmetal's angina


34. The number of true positives divided by the number of patients with the disease is _____.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Sensitivity
Regresses after menopause
1


35. ? CO - ? PCWP - ? PVR.
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Prerenal
False. Withdrawing and withholding life are the same from an ethical standpoint
Cardiogenic shock


36. The most common cause of hypothyroidism.

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37. Post - HBV exposure treatment.
Type I (distal) RTA
HBV immunoglobulin
Lesion of 1
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


38. Salicylate ingestion ? In What type of acid - base disorder?
Anion gap acidosis and 1
Lobular carcinoma in situ
OCP and barrier contraception
Herpes simplex


39. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
IgA nephropathy (Berger's disease)
Reye's syndrome
Inevitable abortion
Treat immediately. Consent is implied in emergency situations


40. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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41. Radiographic indications for surgery in patients with acute abdomen.
Conflict of interest
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Absence seizures
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


42. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Identify cause; fluid and blood repletion
OCPs - danazol - GnRH agonists


43. A young patient with a family history of sudden death collapses and dies while exercising.
Normal
Hypertrophic cardiomyopathy
Hodgkin's lymphoma
E. coli O157:H7


44. Case - control study
Neither
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
MCP and PIP joints; DIP joints are spared
Continuous - painful vaginal bleeding


45. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Vibrio - HAV
Duchenne muscular dystrophy
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


46. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Duodenal atresia
Number of live births per 1000 population
B12 deficiency
Anemia of chronic disease


47. Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
1
Pseudogout
Mycoplasma


48. 'Doughy skin.'
Regression
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Endometriosis
Hypernatremia


49. Virus associated with aplastic anemia in patients with sickle cell anemia.
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
Varicella zoster
Parvovirus B19
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


50. Glomerulonephritis with deafness.

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