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

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2. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Suspect ankylosing spondylitis. Check HLA- B27
Cirrhosis - CHF - nephritic syndrome


3. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
30 cc/hour
Chronic lymphocytic leukemia (CLL)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Klebsiella


4. The most common organism in burn - related infections.
Treat existing heart failure and replace the tricuspid valve
OCPs
Pseudomonas
Lichen sclerosus


5. Presence of red cell casts in urine sediment.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
68% - 95.5% - 99.7%
Glomerulonephritis/nephritic syndrome
Sensitivity


6. Amenorrhea - bradycardia - and abnormal body image in a young female.
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
MCP and PIP joints; DIP joints are spared
Anorexia
Cardiogenic shock


7. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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8. Diagnostic test for hereditary spherocytosis.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Prerenal
Selective IgA deficiency
Osmotic fragility test


9. Treatment of supraventricular tachycardia (SVT).
Central pontine myelinolysis
Rate control with carotid massasge or other vagal stimulation
Higher prevalence
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


10. Findings in 3
Dantrolene or bromocriptine
Duodenal atresia
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Prinzmetal's angina


11. Relative risk?
Erythema multiforme
The IR of a disease in a population exposed to a particular factor
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Treat immediately. Consent is implied in emergency situations


12. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
CML
Phencyclidine hydrochloride (PCP) intoxication
Kl


13. Criteria for exudative effusion.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Weight loss and OCPs
RSV bronchiolitis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


14. 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
Naloxone
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
'Chocolate cysts -' powder burns


15. The most common location for an ectopic pregnancy.
Bullous pemphigoid
Parainfluenza virus type 1
Hypotension and bradycardia
Ampulla of the oviduct


16. Case - control study
Contact dermatitis
Neither
Mycobacterium tuberculosis
Intussusception


17. Peaked T waves and widened QRS.
Basal cell carcinoma
Rett's disorder
Beta- blockers - Ca2+ channel blockers - TCAs
Hyperkalemia


18. Treatment for neuroleptic malignant syndrome.
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Type I (distal) RTA
Dantrolene or bromocriptine
Osteoarthritis


19. Blood in the urethral meatus or high - riding prostate.
50 cc/hour
Chronic granulomatous disease
Bladder rupture or urethral injury
Non - Hodgkin's lymphoma


20. Characteristics of 2

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21. The diagnostic test for pulmonary embolism.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
V/Q scan
Identify cause; pressors (e.g. - dobutamine)
Anorexia


22. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Observational bias
Squamous cell carcinoma
Colposcopy and endocervical curettage
Weight loss and OCPs


23. Symptoms of placental abruption.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Continuous - painful vaginal bleeding
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
HGPRTase deficiency)


24. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
68% - 95.5% - 99.7%
BP > 140/90 on three separate occasions two weeks apart
Seminoma


25. A condition associated with red 'currant - jelly' stools.
Septic or anaphylactic shock
Panic disorder
Intussusception
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


26. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Osmotic fragility test
7-10 days
OCPs
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


27. Antibiotics with teratogenic effects.
Central pontine myelinolysis
Coarctation of the aorta
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


28. Honeycomb pattern on CXR. Diagnosis? Treatment?
Dissociative fugue
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


29. Four causes of microcytic anemia.
TICS
Allergic interstitial nephritis
INH - penicillamine - hydralazine - procainamide
False. Withdrawing and withholding life are the same from an ethical standpoint


30. How to diagnose and follow a leiomyoma.
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Ultrasound
Immediate cardioversion
Oral surgery


31. Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Salmonella
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Subdural hematoma


32. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Protamine
Paget's disease
Emergent laparotomy to repair perforated viscus - likely stomach
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


33. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises - estrogen - pessaries for stress incontinence
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Iatrogenic steroid administration. The second most common cause is Cushing's disease
HGPRTase deficiency)


34. Method of calculating fluid repletion in burn patients.
Panic disorder
OCP and barrier contraception
50 cc/hour
Parkland formula


35. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Choriocarcinoma
1


36. The most common cause of seizures in children (2-10 years).
Femoral hernia
Infection - febrile seizures - trauma - idiopathic
Phototherapy (mild) or exchange transfusion (severe)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


37. Extraintestinal manifestations of IBD.
PT
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Phencyclidine hydrochloride (PCP) intoxication


38. Antidepressants associated with hypertensive crisis.
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
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
MAOIs
Obstructive pulmonary disease (e.g. - asthma)


39. Name the organism:
Sporothrix schenckii
Chronic lymphocytic leukemia (CLL)
Signs and symptoms of hypercalcemia
Uterine massage; if that fails - give oxytocin


40. Reynolds' pentad.

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41. Identify key organisms causing diarrhea:
HGPRTase deficiency)
Bruton's X- linked agammaglobulinemia
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Yersinia


42. Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
M3
No. Parental consent is not necessary for the medical treatment of pregnant minors


43. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Iron deficiency anemia
Broca's aphasia. Frontal lobe - left MCA distribution
SCLC


44. Glomerulonephritis with hemoptysis.

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45. Signs of ? ICP (Cushing's triad).
Sporothrix schenckii
Suspect retinoblastoma
Hypertension - bradycardia - and abnormal respirations
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1


46. An agent that reverses the effects of heparin.
Protamine
Observational bias
Agranulocytosis
IVIG or plasmapheresis


47. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Neither
Actinic keratosis
Number of live births per 1000 population


48. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
A patient with chest trauma who was previously stable suddenly dies
Nephrotic syndrome
Conversion disorder
Protamine


49. T- wave flattening and U waves.
Hypokalemia
Panic disorder
CF or Hirschsprung's disease
Obstructive pulmonary disease (e.g. - asthma)


50. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Dantrolene or bromocriptine
Contact dermatitis
Normal
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin