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. Name the defense mechanism:
Parvovirus B19
Isolation
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Parvovirus B19


2. Birth rate?
Sporothrix schenckii
Number of live births per 1000 population
Kl
Oral surgery


3. Treatment for AML M3.
Retinoic acid
Rett's disorder
Cerebral berry aneurysms (AD PCKD)
Asherman's syndrome


4. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Regression
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Hypoparathyroidism
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


5. Trauma series.
Malingering
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
AP chest - AP/lateral C- spine - AP pelvis
Cardiogenic shock


6. Indications for medical treatment of ectopic pregnancy.

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7. Macrocytic - megaloblastic anemia with neurologic symptoms.
Seminoma
46 -XX
Guillain - Barr
B12 deficiency


8. A 49-year - old male presents with acute - onset flank pain and hematuria.
Taenia solium (cysticercosis)
Broca's aphasia. Frontal lobe - left MCA distribution
Nephrolithiasis
OCPs - danazol - GnRH agonists


9. The most common cause of hypertension in young women.
OCPs
S. aureus or S. epidermidis.
Pseudomonas
Beta- blockers - digoxin - calcium channel blockers


10. Treatment for acetaminophen overdose.
Folate deficiency
N- acetylcysteine
Asherman's syndrome
Ophthalmologic exam - CT - and MRI


11. Characteristics of 2

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12. Erythema migrans.
BP > 140/90 on three separate occasions two weeks apart
Lesion of 1
Diphenhydramine or epinephrine 1:1000
O2 - analgesia - hydration - and - if severe - transfusion


13. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Guillain - Barr
Legionella pneumonia
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


14. 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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15. Treatment of DKA.
Number of live births per 1000 population
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Diphenhydramine or epinephrine 1:1000
Kwashiorkor (protein malnutrition)


16. The most common cause of bloody nipple discharge.
Lesion of 1
Intraductal papilloma
Hypertrophic cardiomyopathy
Pseudomonas


17. AML subtype associated with DIC.
Clostridium difficile
Weight gain - type 2 DM - QT prolongation
Bullous pemphigoid
M3


18. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides - antimalarial drugs - fava beans
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Yersinia
Cirrhosis - CHF - nephritic syndrome


19. Name the organism:
Neuroleptics
Isolation
Anorexia
Haemophilus ducreyi


20. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Number of deaths per 1000 population
DM - SLE - and amyloidosis
Diverticulosis
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


21. Name the organism:
Duchenne muscular dystrophy
Sporothrix schenckii
Ultrasound
Never


22. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Membranous glomerulonephritis
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


23. 'Stones - bones - groans - psychiatric overtones.'
Signs and symptoms of hypercalcemia
Aseptic (viral) meningitis
Campylobacter
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


24. An agent that reverses the effects of heparin.
Iron deficiency anemia
Protamine
Reaction formation
A patient's family cannot require that a doctor withhold information from the patient


25. A 'blueberry muffin' rash is characteristic of what congenital infection?
Rubella
Cirrhosis - CHF - nephritic syndrome
Beta- hCG; the most common cause of amenorrhea is pregnancy
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


26. Molar pregnancy containing fetal tissue.
Acute mania. Start a mood stabilizer (e.g. - lithium)
Cardiogenic shock
Lesion of 1
Partial mole


27. Exophthalmos - pretibial myxedema - and ? TSH.

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28. Inspiratory arrest during palpation of the RUQ.

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29. Identify key organisms causing diarrhea:
Aseptic (viral) meningitis
Reye's syndrome
Lichen sclerosus
E. coli O157:H7


30. Acute - phase treatment for Kawasaki disease.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Klebsiella
Acute pancreatitis


31. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
1
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Prevalence
Kwashiorkor (protein malnutrition)


32. Endocarditis prophylaxis regimens.
HBV immunoglobulin
Oral surgery
HBV - DTaP - Hib - IPV - PCV
Immediate needle thoracostomy


33. Asplenic patients are particularly susceptible to these organisms.
Trauma - alcohol withdrawal - brain tumor
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Rate control with carotid massasge or other vagal stimulation
Wernicke's encephalopathy due to a deficiency of thiamine


34. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Anion gap acidosis and 1
Weight gain - type 2 DM - QT prolongation
Acute mania. Start a mood stabilizer (e.g. - lithium)
Osteogenesis imperfecta


35. CSF findings with SAH.
Immediate needle thoracostomy
Elevated ICP - RBCs - xanthochromia
Weight gain - type 2 DM - QT prolongation
Selective IgA deficiency


36. Diagnostic test for hypertrophic cardiomyopathy.
High reliability - low validity
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Seborrheic dermatitis. Treat with antifungals
Low - voltage - diffuse ST- segment elevation


37. Eight surgically correctable causes of hypertension.

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38. The most common cause of hypertension in young men.
The IR of a disease in a population exposed to a particular factor
Renal cell carcinoma (RCC)
Excessive EtOH
IVIG or plasmapheresis


39. Difference between a cohort and a case - control study.
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
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Abdominal ultrasound and CT
Naloxone


40. The most common cause of female infertility.
Membranous glomerulonephritis
Basal cell carcinoma
Endometriosis
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


41. Shortest AP diameter of the pelvis.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Streptococcus pneumoniae
Factitious disorder (Munchausen syndrome)


42. Treatment of SIADH?
Fluid restriction - demeclocycline
Alport's syndrome
Regression
Yersinia


43. Postnatal mortality?
ETEC
Number of deaths from 28 days to one year per 1000 live births
Mycobacterium tuberculosis
Beta- blockers - digoxin - calcium channel blockers


44. Glomerulonephritis with deafness.

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45. Criteria for exudative effusion.
Lead - time bias
Hypertension - bradycardia - and abnormal respirations
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


46. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Legionella pneumonia
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Incidence and prevalence
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


47. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Anemia - thrombocytopenia - and acute renal failure
Infection - febrile seizures - trauma - idiopathic
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


48. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conduct disorder
Conversion disorder
IgA nephropathy (Berger's disease)
105 bacteria/mL


49. A six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Chronic granulomatous disease
Taenia solium (cysticercosis)
Lyme disease - Ixodes tick - doxycycline
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


50. The first test to perform when a woman presents with amenorrhea.
Wernicke's encephalopathy due to a deficiency of thiamine
Beta- hCG; the most common cause of amenorrhea is pregnancy
Identify cause; pressors (e.g. - dobutamine)
Membranous glomerulonephritis