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. Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy


2. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Dissociative fugue
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
1
? protein intake - lactulose - neomycin


3. The most frequent presentation of intracranial neoplasm.
Nitroprusside
Restrictive pulmonary disease
DI
Headache


4. Method of calculating fluid repletion in burn patients.
Parkland formula
1
Endometrial or estrogen receptor - breast cancer
Treat immediately. Consent is implied in emergency situations


5. Pure RBC aplasia.
Diamond - Blackfan anemia
Highly sensitive for TB
Asherman's syndrome
SCLC


6. The most common histology of bladder cancer.
Consider Fitz - Hugh - Curtis syndrome
Transitional cell carcinoma
Number of deaths from birth to 28 days per 1000 live births
Nephritic syndrome


7. Joints in the hand affected in rheumatoid arthritis.
Basal cell carcinoma
All - compartment fasciotomy for suspected compartment syndrome
M3
MCP and PIP joints; DIP joints are spared


8. Sentinel loop on AXR.
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Acute pancreatitis
Nephrotic syndrome


9. The most common causes of dementia.

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10. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Type IV (distal) RTA
Nephrotic syndrome
A patient with chest trauma who was previously stable suddenly dies
Protamine


11. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Amoxicillin
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Normal


12. The most common pathogen causing croup.
Parainfluenza virus type 1
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Factitious disorder (Munchausen syndrome)


13. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Clostridium difficile
The IR of a disease in a population exposed to a particular factor
Iron deficiency anemia
Higher incidence


14. Reed - Sternberg cells

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15. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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16. The most common type of nephrolithiasis.
Type IV (distal) RTA
Calcium oxalate
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy


17. Treatment for AML M3.
Retinoic acid
Phototherapy (mild) or exchange transfusion (severe)
Agranulocytosis
Identify cause; pressors (e.g. - dobutamine)


18. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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19. AML subtype associated with DIC.
M3
Klebsiella
Number of deaths from birth to 28 days per 1000 live births
Toxoplasma gondii


20. Signs of ? ICP (Cushing's triad).
OCPs
Hypertension - bradycardia - and abnormal respirations
Acute myelogenous leukemia (AML)
Sensitivity


21. Complication of overly rapid correction of hyponatremia.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Central pontine myelinolysis
Menometrorrhagia


22. Classic ECG finding in atrial flutter.

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23. PFT showing ? FEV1/FVC.
Bullous pemphigoid
Obstructive pulmonary disease (e.g. - asthma)
Pasteurella multocida
Colposcopy and endocervical curettage


24. Findings in 3
TICS
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Intraductal papilloma
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


25. When can a physician refuse to continue treating a patient on the grounds of futility?
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
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
PT
HIDA scan


26. Name the defense mechanism:
Absence seizures
DM - SLE - and amyloidosis
Regression
Polymyalgia rheumatica


27. Treatment of SIADH?
Psoriasis
Coarctation of the aorta
Fluid restriction - demeclocycline
Kegel exercises - estrogen - pessaries for stress incontinence


28. Treatment for acute coronary syndrome.
Paget's disease
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
BP > 140/90 on three separate occasions two weeks apart


29. A 14-year - old girl presents with prolonged bleeding after dental surgery and with menses - normal PT - normal or ? PTT - and ? bleeding time. Diagnosis? Treatment?

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30. Medication used to induce ovulation.
Clomiphene citrate
Salmonella
Lichen planus
Wiskott - Aldrich syndrome


31. Perinatal mortality?

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32. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Ultrasound
Niacin
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus


33. Supportive treatment for ARDS.
Pentad of TTP
Continuous positive airway pressure
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Non - Hodgkin's lymphoma


34. Name the defense mechanism:
68% - 95.5% - 99.7%
Reaction formation
Spinal stenosis
Precocious puberty


35. The diagnostic test for pulmonary embolism.
Oral or topical metronidazole
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Folate deficiency
V/Q scan


36. Presents with a herald patch - Christmas - tree pattern.
Pityriasis rosea
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Lesion of 1
SIADH due to stress


37. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Incidence and prevalence
Third - degree heart block
46 -XX
Spinal stenosis


38. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Lesch - Nyhan syndrome (purine salvage problem with
Emergent laparotomy to repair perforated viscus - likely stomach
No. Parental consent is not necessary for the medical treatment of pregnant minors


39. Treatment of septic shock.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Fluids and antibiotics
Pseudomonas
OCP and barrier contraception


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

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41. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
S. aureus or S. epidermidis.
Herpes simplex
High reliability - low validity
Radiation


42. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Hashimoto's thyroiditis
Colposcopy and endocervical curettage
Osteoarthritis


43. Lung cancer associated with SIADH.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Campylobacter
Uterine massage; if that fails - give oxytocin
Small cell lung cancer (SCLC)


44. Differential of hypervolemic hyponatremia.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Reye's syndrome
Cirrhosis - CHF - nephritic syndrome
MCP and PIP joints; DIP joints are spared


45. Name the organism:
Sulfonamides - antimalarial drugs - fava beans
Nephrolithiasis
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Sporothrix schenckii


46. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Non - Hodgkin's lymphoma
Wait - surgical resection - radiation and/or androgen suppression
Transitional cell carcinoma


47. 'Dewdrop on a rose petal.'
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Suspect ankylosing spondylitis. Check HLA- B27
Multiple myeloma
Lesions of 1


48. The most common cause of seizures in young adults (18-35 years).
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Pseudomonas
Trauma - alcohol withdrawal - brain tumor


49. Treatment of AF.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Rate control - rhythm conversion - and anticoagulation
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
Inevitable abortion


50. A neonate has meconium ileus.

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