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 neonate has meconium ileus.

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2. True or false: Withdrawing life - sustaining care is ethically distinct from withholding sustaining care.
Continuous positive airway pressure
Colposcopy and endocervical curettage
False. Withdrawing and withholding life are the same from an ethical standpoint
Uterine atony


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

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4. Virchow's triad.
Postinfectious glomerulonephritis
Nitroprusside
Stasis - hypercoagulability - endothelial damage
Abdominal ultrasound and CT


5. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
CML
PT
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


6. Treatment for ventricular fibrillation.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Immediate cardioversion
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Retinoic acid


7. Causes of exudative effusion.
V/Q scan
Spinal stenosis
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


8. The most common type of nephrolithiasis.
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Calcium oxalate
MS
Consider Fitz - Hugh - Curtis syndrome


9. 'Stones - bones - groans - psychiatric overtones.'
Number of live births per 1000 population
Haemophilus ducreyi
Nitroprusside
Signs and symptoms of hypercalcemia


10. Name the defense mechanism:
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Never
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Regression


11. Lab findings in Hashimoto's thyroiditis.
High TSH - low T4 - antimicrosomal antibodies
Identify cause; pressors (e.g. - dobutamine)
Cellulitis
Paget's disease


12. Macrocytic - megaloblastic anemia without neurologic symptoms.
Guillain - Barr
Endometrial biopsy
A patient with chest trauma who was previously stable suddenly dies
Folate deficiency


13. What should always be done prior to LP?
Check for ? ICP; look for papilledema
HIDA scan
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Conversion disorder


14. PFT showing ? FEV1/FVC.
Endometrial or estrogen receptor - breast cancer
Sulfonamides - antimalarial drugs - fava beans
Radiation
Restrictive pulmonary disease


15. Identify key organisms causing diarrhea:
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Type IV (distal) RTA
Hypotension - distant heart sounds - and JVD
Vibrio - HAV


16. Signs of active ischemia during stress testing.
Precocious puberty
Small cell lung cancer (SCLC)
Panic disorder
Angina - ST- segment changes on ECG - or ? BP


17. Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Parkinson's disease
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Administration of DDAVP ? serum osmolality and free water restriction


18. 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 _____.
Beta- blockers - Ca2+ channel blockers - TCAs
Confounding variable
Rate control with carotid massasge or other vagal stimulation
Cellulitis


19. 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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20. Medical options for endometriosis.
Hypoxia and hypocarbia
OCPs - danazol - GnRH agonists
1
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


21. Medications and viruses that ? aplastic anemia.
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Klebsiella
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Seborrheic dermatitis. Treat with antifungals


22. Cold agglutinins.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Mycoplasma
Hypotension and bradycardia
Parkland formula


23. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Confounding variable
Endometrial biopsy
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Legionella pneumonia


24. Classic ECG finding in atrial flutter.

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25. Confusion - confabulation - ophthalmoplegia - ataxia.

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26. Fetal mortality?

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27. Difference between Mallory- Weiss and Boerhaave tears.
Neuroblastoma
Mallory- Weiss
Conversion disorder
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


28. Treatment for postpartum hemorrhage.
Uterine massage; if that fails - give oxytocin
Non - Hodgkin's lymphoma
Anticoagulation - rate control - cardioversion
Threatened abortion


29. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Osteogenesis imperfecta
Parvovirus B19
Self - limited - painless vaginal bleeding
Duchenne muscular dystrophy


30. Treatment of AF.
Rate control - rhythm conversion - and anticoagulation
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Lead - time bias
M3


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

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32. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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33. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Broca's aphasia. Frontal lobe - left MCA distribution
CA-125 and transvaginal ultrasound
Fat - female - fertile - forty - flatulent


34. Findings in 3
Identify cause; pressors (e.g. - dobutamine)
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Cluster headache
Asymmetry - border irregularity - color variation - large diameter


35. Treatment for malignant hypertension.
Nitroprusside
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
High TSH - low T4 - antimicrosomal antibodies
Emergent laparotomy to repair perforated viscus - likely stomach


36. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
They can mask symptoms of hypoglycemia
Contact dermatitis
Type I (distal) RTA
Ultrasound


37. Joints in the hand affected in rheumatoid arthritis.
AP chest - AP/lateral C- spine - AP pelvis
Sarcoidosis
Neither
MCP and PIP joints; DIP joints are spared


38. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Type IV (distal) RTA
Contact dermatitis
Hypoparathyroidism
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


39. The most common cancer in men and the most common cause of death from cancer in men.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Nephrotic syndrome
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


40. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Duchenne muscular dystrophy
DI
RCC or other erythropoietin - producing tumor; evaluate with CT scan
CML


41. Epidemics such as influenza
Hypernatremia
Number of live births per 1000 women 15-44 years of age
Higher incidence
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction


42. Symptoms of placental abruption.
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
AP chest - AP/lateral C- spine - AP pelvis
Continuous - painful vaginal bleeding
Squamous cell carcinoma


43. Cohort study
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
SSRIs
Incidence and prevalence
Fatigue and impending respiratory failure


44. First step in the management of a patient with acute GI bleed.
Establish the ABCs
S. aureus or S. epidermidis.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Bullous pemphigoid


45. Meningitis in neonates. Causes? Treatment?
Wiskott - Aldrich syndrome
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Duodenal atresia
Benzodiazepines


46. Exophthalmos - pretibial myxedema - and ? TSH.

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47. Signs of air embolism.
Diamond - Blackfan anemia
A patient with chest trauma who was previously stable suddenly dies
Parvovirus B19
Niacin


48. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Broca's aphasia. Frontal lobe - left MCA distribution
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


49. Three systemic diseases ? nephrotic syndrome.
Choriocarcinoma
Calcium oxalate
DM - SLE - and amyloidosis
Non - Hodgkin's lymphoma


50. The most common cause of hypertension in young men.
Infection - febrile seizures - trauma - idiopathic
Excessive EtOH
Rubella
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy