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 patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Type I (distal) RTA
Dressler's syndrome: fever - pericarditis - ? ESR
All - compartment fasciotomy for suspected compartment syndrome
Polymyalgia rheumatica


2. Postnatal mortality?
Identify cause; fluid and blood repletion
Klebsiella
Placental abruption and placenta previa
Number of deaths from 28 days to one year per 1000 live births


3. A doctor refers a patient for an MRI at a facility he/she owns.
Conflict of interest
Duodenal atresia
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
RSV bronchiolitis


4. What is the immunodeficiency?
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Factor V Leiden mutation
Wiskott - Aldrich syndrome
Diamond - Blackfan anemia


5. Fetal mortality?

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6. Identify key organisms causing diarrhea:
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Osgood - Schlatter disease
S. aureus
Actinic keratosis


7. Signs of ? ICP (Cushing's triad).
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Fluid restriction - demeclocycline
Diverticulosis
Hypertension - bradycardia - and abnormal respirations


8. Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Consider Fitz - Hugh - Curtis syndrome
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Vibrio - HAV


9. Complication of overly rapid correction of hyponatremia.
Glanzmann's thrombasthenia
Lichen sclerosus
Central pontine myelinolysis
Inevitable abortion


10. Signs of active ischemia during stress testing.
Calcium oxalate
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
IV penicillin or ampicillin
Angina - ST- segment changes on ECG - or ? BP


11. Radiographic evidence of aortic disruption or dissection.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Prerenal
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


12. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Herpes simplex
Signs and symptoms of hypercalcemia
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Partial mole


13. Lung cancer highly related to cigarette exposure.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation
SCLC
A patient's family cannot require that a doctor withhold information from the patient


14. Sentinel loop on AXR.
Basal cell carcinoma
Acute pancreatitis
They can mask symptoms of hypoglycemia
Erythema multiforme


15. The most common cause of hypertension in young women.
Regresses after menopause
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
? serum FSH
OCPs


16. Albuminocytologic dissociation.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Identify cause; pressors (e.g. - dobutamine)
Parkland formula
Guillain - Barr


17. The most common 1
105 bacteria/mL
Lichen sclerosus
Multiple myeloma
Hashimoto's thyroiditis


18. The most serious side effect of clozapine.
Exercise stress treadmill with ECG
Agranulocytosis
Pregnant women. Treat this group aggressively because of potential complications
Abdominal ultrasound and CT


19. Macrocytic - megaloblastic anemia without neurologic symptoms.
Intussusception
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Folate deficiency
Parainfluenza virus type 1


20. Glomerulonephritis with hemoptysis.

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21. The most common cancer in men and the most common cause of death from cancer in men.
1
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Salmonella


22. Meningitis in infants. Causes? Treatment?
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Sarcoidosis
Self - limited - painless vaginal bleeding
Weight loss and OCPs


23. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
Number of live births per 1000 population
Nephrotic syndrome
Sarcoidosis


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. Goal hemoglobin A1c for a patient with DM.
Cellulitis
Conversion disorder
Haemophilus ducreyi
< 7.0


26. Classic ultrasound and gross appearance of complete hydatidiform mole.

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27. Identify key organisms causing diarrhea:
Oral surgery
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Clostridium difficile


28. Number needed to treat?
Panic disorder
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
1
Type I (distal) RTA


29. Classic physical findings for endocarditis.

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30. A child has loss of red light reflex. Diagnosis?
Huntington's disease
Rate control - rhythm conversion - and anticoagulation
Beta- hCG; the most common cause of amenorrhea is pregnancy
Suspect retinoblastoma


31. Bilious emesis within hours after the first feeding.
Lichen sclerosus
Beta- blockers - digoxin - calcium channel blockers
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Duodenal atresia


32. Name the defense mechanism:
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Trauma; the second most common is berry aneurysm
Regression
Osmotic fragility test


33. Name the organism:
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
Pasteurella multocida
Wiskott - Aldrich syndrome
Seminoma


34. Blood in the urethral meatus or high - riding prostate.
Ultrasound
Bladder rupture or urethral injury
Hypoparathyroidism
Anorexia


35. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
50 cc/hour
Ultrasound
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


36. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Identify cause; fluid and blood repletion
Sheehan's syndrome (postpartum pituitary necrosis)
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


37. A 'blueberry muffin' rash is characteristic of what congenital infection?
Rubella
Acne vulgaris
Elevated ICP - RBCs - xanthochromia
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


38. First - line treatment for otitis media.
Amoxicillin
Uremic syndrome seen in patients with renal failure
Paget's disease
1


39. How to distinguish polycythemia vera from 2
Vibrio - HAV
Identify cause; pressors (e.g. - dobutamine)
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Folate deficiency


40. An agent that reverses the effects of heparin.
Hashimoto's thyroiditis
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Protamine
Oral or topical metronidazole


41. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
DI
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Multiple myeloma
Acute mania. Start a mood stabilizer (e.g. - lithium)


42. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Menometrorrhagia
Weight gain - type 2 DM - QT prolongation
'Sawtooth' P waves


43. Annual screening for women with a strong family history of ovarian cancer.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Fat - female - fertile - forty - flatulent
Number of deaths per 1000 population
CA-125 and transvaginal ultrasound


44. Difference between a cohort and a case - control study.
68% - 95.5% - 99.7%
Membranous glomerulonephritis
Lobular carcinoma in situ
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


45. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Prerenal
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Weight loss and OCPs


46. Unopposed estrogen is contraindicated in which cancers?
Anemia - thrombocytopenia - and acute renal failure
Endometrial or estrogen receptor - breast cancer
Beta- blockers - Ca2+ channel blockers - TCAs
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


47. Treatment for postpartum hemorrhage.
A patient with chest trauma who was previously stable suddenly dies
Oral or topical metronidazole
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Uterine massage; if that fails - give oxytocin


48. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Angina is new - is worsening - or occurs at rest
Parkland formula
Fatigue and impending respiratory failure
Acute mania. Start a mood stabilizer (e.g. - lithium)


49. Identify key organisms causing diarrhea:
ETEC
Herpes simplex
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
CHF - shock - and altered mental status


50. Criteria for exudative effusion.
50 cc/hour
'Chocolate cysts -' powder burns
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Pseudomonas