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. ? risk of what infection with silicosis?
Mallory- Weiss
Mycobacterium tuberculosis
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Central pontine myelinolysis


2. Goal hemoglobin A1c for a patient with DM.
Polymyalgia rheumatica
SCLC
< 7.0
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


3. A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Wiskott - Aldrich syndrome
Phototherapy (mild) or exchange transfusion (severe)


4. Reed - Sternberg cells

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5. Chronic diseases such as SLE
BP > 140/90 on three separate occasions two weeks apart
Naloxone
Higher prevalence
IVIG or plasmapheresis


6. Electrolyte changes in tumor lysis syndrome.
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
? Ca2+ - ? K- - ? phosphate - ? uric acid
Check for ? ICP; look for papilledema
Membranous glomerulonephritis


7. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Surfactant deficiency
Allergic interstitial nephritis
Fatigue and impending respiratory failure
Pasteurella multocida


8. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus - likely stomach
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Subarachnoid hemorrhage (SAH)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


9. A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Contact dermatitis


10. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Beta- blockers - Ca2+ channel blockers - TCAs
Pseudogout
IV penicillin or ampicillin
Nephritic syndrome


11. CSF findings:
Anticoagulation - rate control - cardioversion
46 -XX
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
MS


12. Name the organism:
Beta- hCG; the most common cause of amenorrhea is pregnancy
Pasteurella multocida
Obstructive pulmonary disease (e.g. - asthma)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


13. Chromosomal pattern of a complete mole.
Agranulocytosis
Parainfluenza virus type 1
False. Withdrawing and withholding life are the same from an ethical standpoint
46 -XX


14. Meningitis in neonates. Causes? Treatment?
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Paget's disease
HIDA scan
BP > 140/90 on three separate occasions two weeks apart


15. Name the organism:
A patient's family cannot require that a doctor withhold information from the patient
Toxoplasma gondii
Establish the ABCs
Subdural hematoma


16. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Reye's syndrome
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
SCLC


17. Prophylactic treatment for migraine.
Giardia
Intussusception
Beta- blockers - Ca2+ channel blockers - TCAs
B12 deficiency


18. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
1
Pheochromocytoma
Chronic granulomatous disease
Contact dermatitis


19. A 55-year - old obese patient presents with dirty - velvety patches on the back of the neck.
Herpes simplex
V/Q scan
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Anorexia


20. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Benzodiazepines
Anemia - thrombocytopenia - and acute renal failure


21. Medical treatment for hepatic encephalopathy.
Type II (proximal) RTA
Small cell lung cancer (SCLC)
OCPs
? protein intake - lactulose - neomycin


22. Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Lichen sclerosus
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Fluid restriction - demeclocycline


23. Treatment for SVC syndrome.
Radiation
Check for ? ICP; look for papilledema
Treat existing heart failure and replace the tricuspid valve
Toxoplasma gondii


24. Breast cancer type that ? the future risk of invasive carcinoma in both breasts.
E. coli O157:H7
Lobular carcinoma in situ
Isolation
Diamond - Blackfan anemia


25. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Elevated ICP - RBCs - xanthochromia
Calcium oxalate
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Acute pancreatitis


26. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Uterine atony
Cerebral berry aneurysms (AD PCKD)
Trichomonas vaginitis
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


27. Four characteristics of a nevus suggestive of melanoma.
Asymmetry - border irregularity - color variation - large diameter
Retrograde cystourethrogram
Number of deaths from 28 days to one year per 1000 live births
Aseptic (viral) meningitis


28. Classic physical findings for endocarditis.

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29. Non - small cell lung cancer (NSCLC) associated with hypercalcemia.
Absence seizures
Squamous cell carcinoma
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Rubella


30. The most common cancer in men and the most common cause of death from cancer in men.
Hyperkalemia
Factor V Leiden mutation
Lichen planus
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths


31. Treatment for TTP.
Obstructive pulmonary disease (e.g. - asthma)
Alport's syndrome
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Bladder rupture or urethral injury


32. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Giardia
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Hereditary spherocytosis
Folate deficiency


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

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34. Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Fatigue and impending respiratory failure
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Osteogenesis imperfecta
Herpes simplex


35. Glomerulonephritis with deafness.

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

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37. Name the defense mechanism:
Regression
Pityriasis rosea
Nitroprusside
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'


38. Evaluation of a pulsatile abdominal mass and bruit.
Menometrorrhagia
Abdominal ultrasound and CT
Higher incidence
Alport's syndrome


39. Identify key organisms causing diarrhea:
Multiple myeloma
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Erythema multiforme
Campylobacter


40. A crescent - shaped hyperdensity on CT that does not cross the midline.
Sarcoidosis
Conduct disorder
Subdural hematoma
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


41. Confusion - confabulation - ophthalmoplegia - ataxia.

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42. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Radiation
Conduct disorder


43. Appropriate diagnostic test?
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Hypoxia and hypocarbia
Dissociative fugue
Exercise stress treadmill with ECG


44. Antihypertensive for a diabetic patient with proteinuria.
ACEI
Surfactant deficiency
Immediate cardioversion
Infection - cancer - and autoimmune disease


45. A young patient with a family history of sudden death collapses and dies while exercising.
Rubella
Psoriasis
Hypertrophic cardiomyopathy
Menometrorrhagia


46. Term for heavy bleeding during and between menstrual periods.
CA-125 and transvaginal ultrasound
Nephrotic syndrome
Hypertension - bradycardia - and abnormal respirations
Menometrorrhagia


47. Honeycomb pattern on CXR. Diagnosis? Treatment?
Infection - febrile seizures - trauma - idiopathic
Asymmetry - border irregularity - color variation - large diameter
Osgood - Schlatter disease
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help


48. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
MS
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
IVIG or plasmapheresis


49. Chvostek's and Trousseau's signs.
Hypotension - distant heart sounds - and JVD
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Intussusception
Hypocalcemia


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

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