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. Lung cancer associated with SIADH.
IgA nephropathy (Berger's disease)
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
Small cell lung cancer (SCLC)
IVIG or plasmapheresis


2. Reed - Sternberg cells

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3. Definition of unstable angina.
Angina is new - is worsening - or occurs at rest
Sheehan's syndrome (postpartum pituitary necrosis)
Sensitivity
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


4. The most common histology of bladder cancer.
Transitional cell carcinoma
Sarcoidosis
Type IV (distal) RTA
Chronic lymphocytic leukemia (CLL)


5. The most common cause of hypothyroidism.

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6. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Asymmetry - border irregularity - color variation - large diameter
Prerenal
Legionella pneumonia
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


7. Hernia with highest risk of incarceration
Femoral hernia
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Parvovirus B19


8. HUS triad?
Wait - surgical resection - radiation and/or androgen suppression
Anemia - thrombocytopenia - and acute renal failure
Neisseria meningitidis
Placental abruption and placenta previa


9. Combined UMN and LMN disorder.
Conversion disorder
ALS
MS
Restrictive pulmonary disease


10. CSF findings:
? protein intake - lactulose - neomycin
CML
Subarachnoid hemorrhage (SAH)
High reliability - low validity


11. Endocarditis prophylaxis regimens.
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
IgA nephropathy (Berger's disease)
Oral surgery
BP > 140/90 on three separate occasions two weeks apart


12. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Uremic syndrome seen in patients with renal failure
Number of deaths from 28 days to one year per 1000 live births
1
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)


13. What should always be done prior to LP?
Check for ? ICP; look for papilledema
Impetigo
Radiation
? protein intake - lactulose - neomycin


14. Peaked T waves and widened QRS.
Hyperkalemia
Lichen planus
Parvovirus B19
Erythema multiforme


15. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
RSV bronchiolitis
Sarcoidosis
Asymmetry - border irregularity - color variation - large diameter
Infection - cancer - and autoimmune disease


16. PFT showing ? FEV1/FVC.
Alzheimer's and multi - infarct
Obstructive pulmonary disease (e.g. - asthma)
S. aureus
Pentad of TTP


17. Acid - base disturbance commonly seen in pregnant women.
Kl
Respiratory alkalosis
Iron overload; use deferoxamine
No. Parental consent is not necessary for the medical treatment of pregnant minors


18. First - line treatment for otitis media.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Amoxicillin
Actinic keratosis
Bruton's X- linked agammaglobulinemia


19. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
Pseudogout
Kl
O2 - analgesia - hydration - and - if severe - transfusion
A patient with chest trauma who was previously stable suddenly dies


20. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Rate control with carotid massasge or other vagal stimulation
Incidence and prevalence
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Fatigue and impending respiratory failure


21. The most common inherited cause of hypercoagulability.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
30 cc/hour
Factor V Leiden mutation
Mycoplasma


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

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23. Name the organism:
Conduct disorder
Actinomyces israelii
Administration of DDAVP ? serum osmolality and free water restriction
RCC or other erythropoietin - producing tumor; evaluate with CT scan


24. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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25. Charcot's triad.
Pharmacologic stress test (e.g. - dobutamine echo)
'Chocolate cysts -' powder burns
30 cc/hour
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


26. The most common cause of seizures in children (2-10 years).
Aseptic (viral) meningitis
Infection - febrile seizures - trauma - idiopathic
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
IVIG or plasmapheresis


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

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28. 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.
Rubella
Polymyalgia rheumatica
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Transitional cell carcinoma


29. How to diagnose and follow a leiomyoma.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
High TSH - low T4 - antimicrosomal antibodies
Ultrasound


30. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Hypovolemic shock
Sensitivity
Endometrial biopsy


31. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Dantrolene or bromocriptine
Hypocalcemia
Colposcopy and endocervical curettage
Phencyclidine hydrochloride (PCP) intoxication


32. When should a vaginal exam be performed with suspected placenta previa?
Calcium oxalate
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Never
Lung - breast - skin (melanoma) - kidney - GI tract


33. Name the defense mechanism:
BP > 140/90 on three separate occasions two weeks apart
Streptococcus pneumoniae
Reaction formation
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


34. Identify key organisms causing diarrhea:
Bacillus cereus
PT
Threatened abortion
? serum FSH


35. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA- B27
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Number of deaths from 28 days to one year per 1000 live births
Intussusception


36. PFT showing ? FEV1/FVC.
Coarctation of the aorta
Restrictive pulmonary disease
Wrist drop - loss of thumb abduction
Fluids and antibiotics


37. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
O2 - analgesia - hydration - and - if severe - transfusion
Cerebral berry aneurysms (AD PCKD)
Acute mania. Start a mood stabilizer (e.g. - lithium)


38. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Malingering
Coarctation of the aorta
CF or Hirschsprung's disease


39. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Depersonalization disorder
Coccidioidomycosis. Amphotericin B


40. Cold agglutinins.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Sarcoidosis
Mycoplasma
Crohn's disease


41. Name the organism:
Identify cause; pressors (e.g. - dobutamine)
Klebsiella
Immediate needle thoracostomy
Small cell lung cancer (SCLC)


42. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Nitroprusside
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


43. Treatment for opioid overdose.
Iron deficiency anemia
Lesch - Nyhan syndrome (purine salvage problem with
Type I (distal) RTA
Naloxone


44. Cannon 'a' waves.
Distal radius (Colles' fracture)
Third - degree heart block
Kl
They can mask symptoms of hypoglycemia


45. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Colposcopy and endocervical curettage
IV penicillin or ampicillin
Higher prevalence
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


46. An antidiabetic agent associated with lactic acidosis.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Metformin
Squamous cell carcinoma
Lesions of 1


47. The most common type of testicular cancer.
Sulfonamides - antimalarial drugs - fava beans
Seminoma
SSRIs
Alopecia areata (autoimmune process)


48. Chromosomal pattern of a complete mole.
Spinal stenosis
46 -XX
? Ca2+ - ? K- - ? phosphate - ? uric acid
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


49. The most serious side effect of clozapine.
Agranulocytosis
Respiratory alkalosis
Regresses after menopause
Sarcoidosis


50. Lung cancer highly related to cigarette exposure.
Anemia - thrombocytopenia - and acute renal failure
SCLC
HBV - DTaP - Hib - IPV - PCV
Hypernatremia