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:
Intraductal papilloma
Neisseria meningitidis
Parvovirus B19
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


2. The most common type of testicular cancer.
Sheehan's syndrome (postpartum pituitary necrosis)
Angina is new - is worsening - or occurs at rest
Seminoma
Fatigue and impending respiratory failure


3. Pure RBC aplasia.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Dissociative fugue
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Diamond - Blackfan anemia


4. The most common cause of seizures in young adults (18-35 years).
Anemia - thrombocytopenia - and acute renal failure
Trauma - alcohol withdrawal - brain tumor
Levodopa/carbidopa
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


5. Auer rods on blood smear.
Beta- blockers - Ca2+ channel blockers - TCAs
Rett's disorder
A patient with chest trauma who was previously stable suddenly dies
Acute myelogenous leukemia (AML)


6. Term for heavy bleeding during and between menstrual periods.
Anemia of chronic disease
Hypertrophic cardiomyopathy
Pityriasis rosea
Menometrorrhagia


7. Glomerulonephritis with hemoptysis.

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8. Nontender abdominal mass associated with elevated VMA and HVA.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Reye's syndrome
Neuroblastoma
Allergic interstitial nephritis


9. What is the metabolic syndrome?
Pentad of TTP
Diamond - Blackfan anemia
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Salmonella


10. The most common cause of female infertility.
Endometriosis
Rate control - rhythm conversion - and anticoagulation
Erythema multiforme
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


11. Tanner stage 3 in a six-year - old female.
Factor V Leiden mutation
Precocious puberty
Guillain - Barr
Hypocalcemia


12. Evaluation of a pulsatile abdominal mass and bruit.
Reaction formation
False. Withdrawing and withholding life are the same from an ethical standpoint
Abdominal ultrasound and CT
DM - SLE - and amyloidosis


13. Treatment of cardiogenic shock.
Consider Fitz - Hugh - Curtis syndrome
Identify cause; pressors (e.g. - dobutamine)
Coccidioidomycosis. Amphotericin B
ETEC


14. Combined UMN and LMN disorder.
Ophthalmologic exam - CT - and MRI
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
PT
ALS


15. Lung cancer associated with SIADH.
O2 - analgesia - hydration - and - if severe - transfusion
Small cell lung cancer (SCLC)
Sporothrix schenckii
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


16. An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ? ESR.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Suspect retinoblastoma
Polymyalgia rheumatica
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


17. Treatment of tension pneumothorax.
Pemphigus vulgaris
Alopecia areata (autoimmune process)
Immediate needle thoracostomy
SIADH due to stress


18. Findings in 3
Septic or anaphylactic shock
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Clostridium difficile
Diphenhydramine or epinephrine 1:1000


19. Side effects of corticosteroids.
Sarcoidosis
Toxoplasma gondii
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
IgA nephropathy (Berger's disease)


20. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Regresses after menopause
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
Seborrheic dermatitis. Treat with antifungals


21. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA
Betamethasone or dexamethasone
Nephritic syndrome
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms


22. Causes of drug - induced SLE.
Signs and symptoms of hypercalcemia
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
INH - penicillamine - hydralazine - procainamide
Agranulocytosis


23. The most common type of nephrolithiasis.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Check for ? ICP; look for papilledema
Calcium oxalate
Type I (distal) RTA


24. Treatment for acute coronary syndrome.
Malignancy and hyperparathyroidism
Administration of DDAVP ? serum osmolality and free water restriction
Osteoarthritis
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin


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

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26. The most common cause of seizures in children (2-10 years).
Reaction formation
Infection - febrile seizures - trauma - idiopathic
Small cell lung cancer (SCLC)
Sensitivity


27. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Normal
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Osmotic fragility test
Agranulocytosis


28. Signs of ? ICP (Cushing's triad).
Wernicke's encephalopathy due to a deficiency of thiamine
Hypertension - bradycardia - and abnormal respirations
Obstructive pulmonary disease (e.g. - asthma)
? protein intake - lactulose - neomycin


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

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30. Exophthalmos - pretibial myxedema - and ? TSH.

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31. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Retrograde cystourethrogram
All - compartment fasciotomy for suspected compartment syndrome
Hypoparathyroidism
Pheochromocytoma


32. Treatment for DTs.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Nephrogenic diabetes insipidus (DI)
HGPRTase deficiency)
Benzodiazepines


33. Signs suggesting radial nerve damage with humeral fracture.
Wrist drop - loss of thumb abduction
< 7.0
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
S. aureus


34. A significant cause of morbidity in thalassemia patients. Treatment?
Crohn's disease
Immediate needle thoracostomy
MS
Iron overload; use deferoxamine


35. Classic ECG finding in atrial flutter.

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36. A 'blueberry muffin' rash is characteristic of what congenital infection?
Angina - ST- segment changes on ECG - or ? BP
Rubella
Hodgkin's lymphoma
Intraductal papilloma


37. Four characteristics of a nevus suggestive of melanoma.
Anemia - thrombocytopenia - and acute renal failure
Nephritic syndrome
Number of deaths from 28 days to one year per 1000 live births
Asymmetry - border irregularity - color variation - large diameter


38. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Trichomonas vaginitis
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
No. Parental consent is not necessary for the medical treatment of pregnant minors


39. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
V/Q scan
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Dantrolene or bromocriptine


40. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
A patient with chest trauma who was previously stable suddenly dies
Acute myelogenous leukemia (AML)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Wegener's granulomatosis and Goodpasture's syndrome


41. Treatment for mild and severe unconjugated hyperbilirubinemia.
Substance abuse
Phototherapy (mild) or exchange transfusion (severe)
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Sporothrix schenckii


42. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
30 cc/hour
Angina is new - is worsening - or occurs at rest
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


43. The most frequent presentation of intracranial neoplasm.
Squamous cell carcinoma
Headache
Klebsiella
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


44. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
'Chocolate cysts -' powder burns
Surfactant deficiency
Number of deaths from 28 days to one year per 1000 live births


45. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Bruton's X- linked agammaglobulinemia
Substance abuse
Ampulla of the oviduct
A patient's family cannot require that a doctor withhold information from the patient


46. A 16-year - old presents with an annular patch of alopecia with broken - off - stubby hairs.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Alopecia areata (autoimmune process)
Type IV (distal) RTA
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


47. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma
Contact dermatitis
Neuroleptics
Nephrolithiasis


48. Endocarditis prophylaxis regimens.
Signs and symptoms of hypercalcemia
Prevalence
Sulfonamides - antimalarial drugs - fava beans
Oral surgery


49. Name the organism:
Chronic lymphocytic leukemia (CLL)
MAOIs
Giardia
Streptococcus pneumoniae


50. Goal hemoglobin A1c for a patient with DM.
Infection - cancer - and autoimmune disease
< 7.0
Multiple myeloma
Alport's syndrome