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. Treatment of DKA.
7-10 days
BP > 140/90 on three separate occasions two weeks apart
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
1


2. Four signs and symptoms of streptococcal pharyngitis.
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Type II (proximal) RTA
Trauma - alcohol withdrawal - brain tumor
Slipped capital femoral epiphyses. AP and frog - leg lateral view


3. The most common cause of SAH.
Iron deficiency anemia
Trauma; the second most common is berry aneurysm
Salmonella
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


4. Charcot's triad.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Higher incidence
IV hydration and loop diuretics (furosemide)
Displacement


5. The diagnostic test for pulmonary embolism.
Nephrogenic diabetes insipidus (DI)
Mycobacterium tuberculosis
Pityriasis versicolor
V/Q scan


6. Nikolsky's sign.
Bullous pemphigoid
Hodgkin's lymphoma
Anorexia
Fanconi's anemia


7. Treatment of AF.
Dantrolene or bromocriptine
Cardiogenic shock
Rate control - rhythm conversion - and anticoagulation
SIADH due to stress


8. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Benzodiazepines
Wait - surgical resection - radiation and/or androgen suppression
Seborrheic dermatitis. Treat with antifungals
M3


9. The mainstay of Parkinson's therapy.
Oral or topical metronidazole
Levodopa/carbidopa
Hypotension - distant heart sounds - and JVD
Dressler's syndrome: fever - pericarditis - ? ESR


10. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Signs and symptoms of hypercalcemia
Normal
Hypocalcemia
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms


11. A patient with a history of lithium use presents with copious amounts of dilute urine.
Number of deaths from birth to 28 days per 1000 live births
Nephrogenic diabetes insipidus (DI)
Duchenne muscular dystrophy
Frotteurism (a paraphilia)


12. The number of true positives divided by the number of patients with the disease is _____.
Pregnant women. Treat this group aggressively because of potential complications
Pityriasis rosea
Rate control with carotid massasge or other vagal stimulation
Sensitivity


13. Not contraindications to vaccination.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
M3
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Uterine atony


14. Laparoscopic findings in endometriosis.

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15. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Choriocarcinoma
Seborrheic keratosis
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Pheochromocytoma


16. Cross - sectional survey
INH - penicillamine - hydralazine - procainamide
Prevalence
Asymmetry - border irregularity - color variation - large diameter
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


17. Relative risk?
Hypocalcemia
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
The IR of a disease in a population exposed to a particular factor
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


18. Risk factors for cholelithiasis.
Malingering
Angina is new - is worsening - or occurs at rest
Fat - female - fertile - forty - flatulent
Duodenal atresia


19. HUS triad?
HIDA scan
Ultrasound
Anemia - thrombocytopenia - and acute renal failure
High reliability - low validity


20. Medical treatment for hepatic encephalopathy.
1
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Seminoma
? protein intake - lactulose - neomycin


21. T- wave flattening and U waves.
Pityriasis rosea
Radiation
Hypokalemia
Actinomyces israelii


22. The three most common causes of fever of unknown origin (FUO).
Infection - cancer - and autoimmune disease
Hypoxia and hypocarbia
Angina is new - is worsening - or occurs at rest
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


23. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Neuroblastoma
Neuroleptics
IV penicillin or ampicillin
A patient's family cannot require that a doctor withhold information from the patient


24. The most likely cause of acute lower GI bleed in patients > 40 years old.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
'Sawtooth' P waves
Diverticulosis
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


25. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Anion gap acidosis and 1
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Colposcopy and endocervical curettage
Chronic lymphocytic leukemia (CLL)


26. Electrolyte changes in tumor lysis syndrome.
Naloxone
Rett's disorder
Lyme disease - Ixodes tick - doxycycline
? Ca2+ - ? K- - ? phosphate - ? uric acid


27. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Exercise stress treadmill with ECG
Clomiphene citrate
Hypernatremia
Emergent laparotomy to repair perforated viscus - likely stomach


28. Neonatal mortality?
1
Number of deaths from birth to 28 days per 1000 live births
Folate deficiency
Emergent laparotomy to repair perforated viscus - likely stomach


29. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
1
Hypernatremia
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Lesch - Nyhan syndrome (purine salvage problem with


30. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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31. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Fanconi's anemia
Diverticulosis
Treat existing heart failure and replace the tricuspid valve
Neisseria meningitidis


32. Mortality rate?
Dissociative fugue
Number of deaths per 1000 population
Hypoparathyroidism
Fat - female - fertile - forty - flatulent


33. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Suspect ankylosing spondylitis. Check HLA- B27
Parvovirus B19
Graves' disease


34. What % lesion is an indication for carotid endarterectomy?
Non - Hodgkin's lymphoma
Continuous - painful vaginal bleeding
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Seventy percent if the stenosis is symptomatic


35. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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36. Case - control study
Weight loss and OCPs
Incidence and prevalence
105 bacteria/mL
Neither


37. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Precocious puberty
Number of live births per 1000 women 15-44 years of age
Abdominal ultrasound and CT


38. Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
Polymyalgia rheumatica
BP > 140/90 on three separate occasions two weeks apart
7-10 days


39. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
IV benzodiazepine
Number of live births per 1000 women 15-44 years of age
Identify cause; pressors (e.g. - dobutamine)
Febrile seizures (roseola infantum)


40. Classic CXR findings for pulmonary edema.

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41. Fertility rate?
Number of live births per 1000 women 15-44 years of age
Signs and symptoms of hypercalcemia
Neither
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


42. The most common type of testicular cancer.
Anemia of chronic disease
Coarctation of the aorta
Seminoma
Clostridium difficile


43. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Conversion disorder
Pheochromocytoma
Hypovolemic shock
Number of deaths per 1000 population


44. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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45. 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 ?.
Low - voltage - diffuse ST- segment elevation
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
? Ca2+ - ? K- - ? phosphate - ? uric acid


46. Name the organism:
Sporothrix schenckii
Hypertension - bradycardia - and abnormal respirations
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Metformin


47. Which healthy population is susceptible to UTIs?
Rubella
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Pregnant women. Treat this group aggressively because of potential complications
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


48. Four characteristics of a nevus suggestive of melanoma.
Basal cell carcinoma
Asymmetry - border irregularity - color variation - large diameter
Taenia solium (cysticercosis)
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


49. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Acute pancreatitis
HIDA scan
Alzheimer's and multi - infarct
Radiation


50. Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Lesion of 1
Sarcoidosis
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Partial mole