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. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Patient on dopamine antagonist
Lichen planus


2. Mortality rate?
Number of deaths per 1000 population
S. aureus
Duchenne muscular dystrophy
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


3. A violent patient has vertical and horizontal nystagmus.
Beta- blockers - digoxin - calcium channel blockers
Phencyclidine hydrochloride (PCP) intoxication
Neuroblastoma
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy


4. Lung cancer associated with SIADH.
Osmotic fragility test
Bacillus cereus
Rubella
Small cell lung cancer (SCLC)


5. An 11-year - old obese - African - American boy presents with sudden onset of limp. Diagnosis? Workup?
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Varicella zoster
Slipped capital femoral epiphyses. AP and frog - leg lateral view
IVIG or plasmapheresis


6. Fetal mortality?

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7. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Treat immediately. Consent is implied in emergency situations
CML


8. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Acne vulgaris
Antipsychotics (neuroleptic malignant syndrome)
Cerebral berry aneurysms (AD PCKD)
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


9. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Parainfluenza virus type 1
Suspect ankylosing spondylitis. Check HLA- B27
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Acute myelogenous leukemia (AML)


10. What is the immunodeficiency?
High TSH - low T4 - antimicrosomal antibodies
Wernicke's encephalopathy due to a deficiency of thiamine
Sheehan's syndrome (postpartum pituitary necrosis)
Wiskott - Aldrich syndrome


11. 'Dewdrop on a rose petal.'
E. coli O157:H7
Calcium oxalate
'Chocolate cysts -' powder burns
Lesions of 1


12. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Threatened abortion
Vibrio - HAV
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma


13. Iris - like target lesions.
Alport's syndrome
Erythema multiforme
S. aureus or S. epidermidis.
Oral or topical metronidazole


14. Inspiratory arrest during palpation of the RUQ.

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15. Four causes of microcytic anemia.
Amoxicillin
TICS
Uterine atony
Folate deficiency


16. Peaked T waves and widened QRS.
Fluid restriction - demeclocycline
Hyperkalemia
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
HBV - DTaP - Hib - IPV - PCV


17. Rigidity and stiffness that progress to choreiform movements - accompanied by moodiness and altered behavior.

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18. The most likely cause of acute lower GI bleed in patients > 40 years old.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Diverticulosis
Diamond - Blackfan anemia
MS


19. Conditions in which confidentiality must be overridden.
Regression
Parkland formula
MCP and PIP joints; DIP joints are spared
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


20. A woman who was abused as a child frequently feels outside of or detached from her body.
Radiation
Acute mania. Start a mood stabilizer (e.g. - lithium)
Depersonalization disorder
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus


21. The most common 1
Alopecia areata (autoimmune process)
Selective IgA deficiency
Fatigue and impending respiratory failure
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births


22. Common symptoms associated with silent MIs.
CHF - shock - and altered mental status
Iron deficiency anemia
Duodenal atresia
Trauma - alcohol withdrawal - brain tumor


23. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Identify cause; pressors (e.g. - dobutamine)
1
M3
Hyperkalemia


24. Differential of hypervolemic hyponatremia.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
IV penicillin or ampicillin
Cirrhosis - CHF - nephritic syndrome
Bullous pemphigoid


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

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26. 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 _____.
Prinzmetal's angina
Anticoagulation - rate control - cardioversion
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Confounding variable


27. What is the immunodeficiency?

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28. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Nephrotic syndrome
Parkinson's disease
SIADH due to stress
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


29. Involuntary psychiatric hospitalization can be undertaken for which three reasons?
Neurofibromatosis 1
Duchenne muscular dystrophy
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Campylobacter


30. + Nikolsky's sign.
Parkinson's disease
Depersonalization disorder
Pemphigus vulgaris
Hereditary spherocytosis


31. Amenorrhea - bradycardia - and abnormal body image in a young female.
Anorexia
Trauma; the second most common is berry aneurysm
Diverticulosis
Contact dermatitis


32. A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
O2 - analgesia - hydration - and - if severe - transfusion
Naloxone


33. Name the defense mechanism:
Immediate cardioversion
Edrophonium
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Regression


34. Treatment of anaphylactic shock.
HBV immunoglobulin
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Diphenhydramine or epinephrine 1:1000
Displacement


35. Medical treatment for IBD.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
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
Immediate needle thoracostomy
Treat because the disease represents an immediate threat to the child's life. Then seek a court order


36. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Normal
Postinfectious glomerulonephritis
Incidence and prevalence


37. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Neuroblastoma
Varicella zoster
S. aureus


38. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Multiple myeloma
Sarcoidosis
Niacin


39. Exophthalmos - pretibial myxedema - and ? TSH.

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40. Glomerulonephritis with deafness.

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41. Electrolyte changes in tumor lysis syndrome.
Neuroleptic malignant syndrome
'Chocolate cysts -' powder burns
? Ca2+ - ? K- - ? phosphate - ? uric acid
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


42. Natural history of a leiomyoma.
Amoxicillin
Pulsus paradoxus (seen in cardiac tamponade)
Seventy percent if the stenosis is symptomatic
Regresses after menopause


43. Term for heavy bleeding during and between menstrual periods.
Chronic granulomatous disease
Menometrorrhagia
Normal
IVIG or plasmapheresis


44. Treatment of DKA.
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
Hypertrophic cardiomyopathy
Glanzmann's thrombasthenia
HBV immunoglobulin


45. Attributable risk?
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Iatrogenic steroid administration. The second most common cause is Cushing's disease
CHF - shock - and altered mental status
Central pontine myelinolysis


46. Treatment for postpartum hemorrhage.
Kegel exercises - estrogen - pessaries for stress incontinence
Osmotic fragility test
Reaction formation
Uterine massage; if that fails - give oxytocin


47. A patient fails to lactate after an emergency C- section with marked blood loss.

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48. Joints in the hand affected in rheumatoid arthritis.
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Inevitable abortion
Acute pancreatitis
MCP and PIP joints; DIP joints are spared


49. The first test to perform when a woman presents with amenorrhea.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Anemia - thrombocytopenia - and acute renal failure
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Glomerulonephritis/nephritic syndrome


50. Endocarditis prophylaxis regimens.
Duodenal atresia
Oral surgery
Endometriosis
Number of deaths from birth to 28 days per 1000 live births