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. Name the organism:
MCP and PIP joints; DIP joints are spared
Klebsiella
Suspect retinoblastoma
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


2. Antibiotics with teratogenic effects.
Pityriasis versicolor
Bladder rupture or urethral injury
Distal radius (Colles' fracture)
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


3. The number of true positives divided by the number of patients with the disease is _____.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Malingering
Sensitivity
Giardia


4. Risk factors for cholelithiasis.
Fat - female - fertile - forty - flatulent
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
ETEC
Pemphigus vulgaris


5. CSF findings:
Femoral hernia
Herpes simplex
Identify cause; pressors (e.g. - dobutamine)
Bacterial meningitis


6. A son asks that his mother not be told about her recently discovered cancer.

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7. Name the defense mechanism:
Isolation
Conflict of interest
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Signs and symptoms of hypercalcemia


8. Eosinophils in urine sediment.
SCLC
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Pityriasis rosea
Allergic interstitial nephritis


9. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Herpes simplex
E. coli O157:H7
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


10. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Rate control - rhythm conversion - and anticoagulation
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Parkinson's disease
Coccidioidomycosis. Amphotericin B


11. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Sheehan's syndrome (postpartum pituitary necrosis)
Conversion disorder
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing


12. The most common cause of SAH.
Mycobacterium tuberculosis
Regresses after menopause
OCPs - danazol - GnRH agonists
Trauma; the second most common is berry aneurysm


13. Administer to a symptomatic patient to diagnose myasthenia gravis.
Reaction formation
Avascular necrosis
Anion gap acidosis and 1
Edrophonium


14. Acceptable urine output in a stable patient.
Third - degree heart block
30 cc/hour
Actinic keratosis
Hypovolemic shock


15. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Anemia of chronic disease
Stasis - hypercoagulability - endothelial damage
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Impetigo


16. Iris - like target lesions.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Erythema multiforme
< 7.0
Immediate cardioversion


17. Meningitis in neonates. Causes? Treatment?
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Niacin
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Incidence and prevalence


18. The most common cause of female infertility.
IV benzodiazepine
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
SSRIs
Endometriosis


19. Risk factors for DVT.

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20. Medication given to accelerate fetal lung maturity.
Colposcopy and endocervical curettage
Betamethasone or dexamethasone
Exercise stress treadmill with ECG
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


21. Reynolds' pentad.

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22. The most common cause of hypothyroidism.

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23. Postnatal mortality?
Salmonella
Number of deaths from 28 days to one year per 1000 live births
Sarcoidosis
Nephrogenic diabetes insipidus (DI)


24. Contraceptive methods that protect against PID.
OCP and barrier contraception
Femoral hernia
Elevated ICP - RBCs - xanthochromia
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


25. Treatment for ventricular fibrillation.
Immediate cardioversion
Observational bias
Glomerulonephritis/nephritic syndrome
Neuroleptic malignant syndrome


26. Supportive treatment for ARDS.
Febrile seizures (roseola infantum)
1
Chronic granulomatous disease
Continuous positive airway pressure


27. Low urine specific gravity in the presence of high serum osmolality.
DI
RSV bronchiolitis
Hypocalcemia
'Sawtooth' P waves


28. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Alzheimer's and multi - infarct
Bacterial meningitis
Fatigue and impending respiratory failure
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


29. Not contraindications to vaccination.
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Acute mania. Start a mood stabilizer (e.g. - lithium)
Streptococcus pneumoniae
Weight loss and OCPs


30. Treatment for atrial fibrillation.
Bullous pemphigoid
? serum FSH
Metformin
Anticoagulation - rate control - cardioversion


31. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Anorexia
CA-125 and transvaginal ultrasound
Malingering
Neuroblastoma


32. Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
Osmotic fragility test
Infection - febrile seizures - trauma - idiopathic
Parainfluenza virus type 1


33. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Impetigo
Levodopa/carbidopa
Emergent laparotomy to repair perforated viscus - likely stomach
Inevitable abortion


34. 'Dewdrop on a rose petal.'
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
Lesions of 1
Nephritic syndrome
Weight gain - type 2 DM - QT prolongation


35. Antihypertensive for a diabetic patient with proteinuria.
Fatigue and impending respiratory failure
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
ACEI
Cluster headache


36. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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37. First step in the management of a patient with acute GI bleed.
Basal cell carcinoma
Placental abruption and placenta previa
High TSH - low T4 - antimicrosomal antibodies
Establish the ABCs


38. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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

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40. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Subdural hematoma
Higher prevalence
S. aureus or S. epidermidis.
Ampulla of the oviduct


41. PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Consider Fitz - Hugh - Curtis syndrome
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Highly sensitive for TB
Isolation


42. Fetal mortality?

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43. Medications and viruses that ? aplastic anemia.
Pseudomonas
Sulfonamides - antimalarial drugs - fava beans
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Malingering


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

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45. Autoimmune complication occurring 2-4 weeks post - MI.

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46. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Weight gain - type 2 DM - QT prolongation
Dressler's syndrome: fever - pericarditis - ? ESR
Beta- hCG; the most common cause of amenorrhea is pregnancy
IV penicillin or ampicillin


47. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Parkland formula
Beta- blockers - digoxin - calcium channel blockers
Osteoarthritis
A patient with chest trauma who was previously stable suddenly dies


48. Macrocytic - megaloblastic anemia with neurologic symptoms.
Pseudomonas
B12 deficiency
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


49. Beck's triad for cardiac tamponade.
Hypotension - distant heart sounds - and JVD
Seborrheic keratosis
DI
Wegener's granulomatosis and Goodpasture's syndrome


50. Classic ECG findings in pericarditis.
Distal radius (Colles' fracture)
Low - voltage - diffuse ST- segment elevation
Headache
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes