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. True or false: Once patients sign a statement giving consent - they must continue treatment.
Identify cause; fluid and blood repletion
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
Biliary tract obstruction
Parkland formula


2. 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 _____.
Factor V Leiden mutation
Never
Confounding variable
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV


3. Conditions in which confidentiality must be overridden.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer


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

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5. Cannon 'a' waves.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Nephrotic syndrome
Third - degree heart block
Klebsiella


6. Treatment of SIADH?
Fluid restriction - demeclocycline
Seminoma
Displacement
Herpes simplex


7. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Number of live births per 1000 women 15-44 years of age
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


8. Identify key organisms causing diarrhea:
Multiple myeloma
Polymyalgia rheumatica
Clostridium difficile
Transitional cell carcinoma


9. Odds ratio?
Endometriosis
Crohn's disease
Lesch - Nyhan syndrome (purine salvage problem with
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


10. First - line pharmacotherapy for depression.
Identify cause; pressors (e.g. - dobutamine)
SSRIs
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


11. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Factitious disorder (Munchausen syndrome)
Iron deficiency anemia
Avascular necrosis
Restrictive pulmonary disease


12. 'Doughy skin.'
Radiation
Lesion of 1
Hypernatremia
High reliability - low validity


13. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Lichen planus
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


14. Treatment for mild and severe unconjugated hyperbilirubinemia.
Lung - breast - skin (melanoma) - kidney - GI tract
DI
Phototherapy (mild) or exchange transfusion (severe)
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)


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

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16. First step in the management of a patient with acute GI bleed.
Establish the ABCs
Anemia - thrombocytopenia - and acute renal failure
Osmotic fragility test
Anorexia


17. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Giardia
Chronic lymphocytic leukemia (CLL)
Number of deaths per 1000 population
Uremic syndrome seen in patients with renal failure


18. Chromosomal pattern of a complete mole.
Campylobacter
46 -XX
Hypotension - distant heart sounds - and JVD
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones


19. Tests to rule out shaken baby syndrome.
Parkinson's disease
Haemophilus ducreyi
Ophthalmologic exam - CT - and MRI
Mycoplasma


20. 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
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Giardia
Neuroleptic malignant syndrome


21. Radiographic indications for surgery in patients with acute abdomen.
Salmonella
B12 deficiency
Pharmacologic stress test (e.g. - dobutamine echo)
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


22. What is the immunodeficiency?
Chronic granulomatous disease
Choriocarcinoma
Toxoplasma gondii
Acute mania. Start a mood stabilizer (e.g. - lithium)


23. A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
Oral or topical metronidazole
Klebsiella
Fat - female - fertile - forty - flatulent


24. An antidiabetic agent associated with lactic acidosis.
Metformin
Biliary tract obstruction
Central pontine myelinolysis
Osmotic fragility test


25. A patient with a history of lithium use presents with copious amounts of dilute urine.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Nephrogenic diabetes insipidus (DI)
IV benzodiazepine


26. Classic CXR findings for pulmonary edema.

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27. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Conversion disorder
OCPs
68% - 95.5% - 99.7%


28. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Lead - time bias
Vibrio - HAV
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


29. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1
Cardiogenic shock
Mycoplasma
Placental abruption and placenta previa


30. Vaccinations at a six- month well - child visit.
HBV - DTaP - Hib - IPV - PCV
Panic disorder
Spinal stenosis
Sporothrix schenckii


31. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Nephrolithiasis
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Herpes simplex


32. Tanner stage 3 in a six-year - old female.
Precocious puberty
Hypotension and bradycardia
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Inevitable abortion


33. Treatment for ventricular fibrillation.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Subarachnoid hemorrhage (SAH)
Immediate cardioversion


34. A 'blueberry muffin' rash is characteristic of what congenital infection?
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Rubella
Pheochromocytoma
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


35. Test to rule out urethral injury.
Retrograde cystourethrogram
Stasis - hypercoagulability - endothelial damage
Check for ? ICP; look for papilledema
Factor V Leiden mutation


36. The most common form of glomerulonephritis.

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37. Method of calculating fluid repletion in burn patients.
Phencyclidine hydrochloride (PCP) intoxication
Parkland formula
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
BP > 140/90 on three separate occasions two weeks apart


38. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Low - voltage - diffuse ST- segment elevation
? protein intake - lactulose - neomycin
Exercise stress treadmill with ECG


39. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Hypotension and bradycardia
Beta- hCG; the most common cause of amenorrhea is pregnancy
Parvovirus B19
Treat existing heart failure and replace the tricuspid valve


40. What % lesion is an indication for carotid endarterectomy?
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Seventy percent if the stenosis is symptomatic
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
Confounding variable


41. Salicylate ingestion ? In What type of acid - base disorder?
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Anion gap acidosis and 1
Number of deaths from birth to 28 days per 1000 live births
Wait - surgical resection - radiation and/or androgen suppression


42. Flat - topped papules.
Hypernatremia
Ophthalmologic exam - CT - and MRI
Acute myelogenous leukemia (AML)
Lichen planus


43. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Flumazenil
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


44. Meningitis in infants. Causes? Treatment?
Elevated ICP - RBCs - xanthochromia
Mycoplasma
Lesch - Nyhan syndrome (purine salvage problem with
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


45. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Antipsychotics (neuroleptic malignant syndrome)
IV penicillin or ampicillin
Renal cell carcinoma (RCC)
Polymyalgia rheumatica


46. Confusion - confabulation - ophthalmoplegia - ataxia.

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47. Acceptable urine output in a trauma patient.
Immediate cardioversion
50 cc/hour
Endometrial or estrogen receptor - breast cancer
Malingering


48. Bias introduced into a study when a clinician is aware of the patient's treatment type.
Observational bias
Asherman's syndrome
Anticoagulation - rate control - cardioversion
Lesch - Nyhan syndrome (purine salvage problem with


49. Term for heavy bleeding during and between menstrual periods.
Acute pancreatitis
Out
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Menometrorrhagia


50. The most common cause of hypothyroidism.

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