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. The most common organism in burn - related infections.
Beta- hCG; the most common cause of amenorrhea is pregnancy
Transitional cell carcinoma
Pseudomonas
Highly sensitive for TB


2. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Glanzmann's thrombasthenia
Colposcopy and endocervical curettage
Check for ? ICP; look for papilledema
Malignancy and hyperparathyroidism


3. Odds ratio?
Acne vulgaris
Administration of DDAVP ? serum osmolality and free water restriction
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots


4. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Ulcerative colitis
Sporothrix schenckii


5. True or false: Once patients sign a statement giving consent - they must continue treatment.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Polymyalgia rheumatica
Reye's syndrome
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision - making capacity


6. Lung cancer highly related to cigarette exposure.
Low - voltage - diffuse ST- segment elevation
Hashimoto's thyroiditis
SCLC
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


7. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Anion gap acidosis and 1
Lead - time bias
Cluster headache
Sarcoidosis


8. A newborn female has continuous 'machinery murmur.'
Immediate needle thoracostomy
Iron deficiency anemia
Alopecia areata (autoimmune process)
Patent ductus arteriosus (PDA)


9. The most common cause of hypothyroidism.

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10. The most common cause of bloody nipple discharge.
BP > 140/90 on three separate occasions two weeks apart
Paget's disease
Intraductal papilloma
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


11. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Anorexia
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


12. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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13. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Trauma; the second most common is berry aneurysm
Duchenne muscular dystrophy
Type I (distal) RTA
Polymyalgia rheumatica


14. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Nephritic syndrome
Uremic syndrome seen in patients with renal failure
Neisseria meningitidis
Erythema multiforme


15. Classic causes of drug - induced hepatitis.
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
All - compartment fasciotomy for suspected compartment syndrome
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Impetigo


16. PFT showing ? FEV1/FVC.
Diamond - Blackfan anemia
Restrictive pulmonary disease
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Fanconi's anemia


17. Tanner stage 3 in a six-year - old female.
Clostridium difficile
Precocious puberty
Identify cause; fluid and blood repletion
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


18. A two - month - old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Chronic lymphocytic leukemia (CLL)


19. Inspiratory arrest during palpation of the RUQ.

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20. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
Nephrotic syndrome
Wait - surgical resection - radiation and/or androgen suppression
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
V/Q scan


21. A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
Neurofibromatosis 1
Multiple myeloma
Pityriasis rosea


22. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
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
Frotteurism (a paraphilia)
Hypotension - distant heart sounds - and JVD
RCC or other erythropoietin - producing tumor; evaluate with CT scan


23. Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Beta- blockers - Ca2+ channel blockers - TCAs
Observational bias


24. Hematuria - hypertension - and oliguria.
Guillain - Barr
Neurofibromatosis 1
Nephritic syndrome
Suspect retinoblastoma


25. Characteristics of 2

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26. Mortality rate?
Number of deaths per 1000 population
Treat existing heart failure and replace the tricuspid valve
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Endometrial or estrogen receptor - breast cancer


27. Virus associated with aplastic anemia in patients with sickle cell anemia.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Frotteurism (a paraphilia)
Parvovirus B19
RSV bronchiolitis


28. Medical treatment for IBD.
Ampulla of the oviduct
Campylobacter
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Hypoparathyroidism


29. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Hereditary spherocytosis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Prinzmetal's angina
Biliary tract obstruction


30. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
Erythema multiforme
Sheehan's syndrome (postpartum pituitary necrosis)
Check for ? ICP; look for papilledema


31. A 49-year - old male presents with acute - onset flank pain and hematuria.
Sarcoidosis
Osmotic fragility test
Nephrolithiasis
Coarctation of the aorta


32. Shortest AP diameter of the pelvis.
Low - voltage - diffuse ST- segment elevation
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Uremic syndrome seen in patients with renal failure
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis


33. Supportive treatment for ARDS.
Continuous - painful vaginal bleeding
Continuous positive airway pressure
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Glanzmann's thrombasthenia


34. What is the immunodeficiency?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Wiskott - Aldrich syndrome
ETEC
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


35. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Cerebral berry aneurysms (AD PCKD)
No. Parental consent is not necessary for the medical treatment of pregnant minors
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Uterine atony


36. Which healthy population is susceptible to UTIs?
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Renal cell carcinoma (RCC)
Pregnant women. Treat this group aggressively because of potential complications
Factor V Leiden mutation


37. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Bacillus cereus
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
IV penicillin or ampicillin
Polymyalgia rheumatica


38. Glomerulonephritis with deafness.

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39. The most common cause of female infertility.
S. aureus
Endometriosis
Inevitable abortion
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


40. Causes of drug - induced SLE.
Number of deaths from 28 days to one year per 1000 live births
INH - penicillamine - hydralazine - procainamide
Anorexia
Check for ? ICP; look for papilledema


41. Causes of transudative effusion.
Higher prevalence
Selective IgA deficiency
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Factitious disorder (Munchausen syndrome)


42. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Choriocarcinoma
DM - SLE - and amyloidosis
Substance abuse
Alport's syndrome


43. Test to rule out urethral injury.
Pharmacologic stress test (e.g. - dobutamine echo)
Retrograde cystourethrogram
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


44. Lab findings in Hashimoto's thyroiditis.
Impetigo
Slipped capital femoral epiphyses. AP and frog - leg lateral view
High TSH - low T4 - antimicrosomal antibodies
HGPRTase deficiency)


45. Low urine specific gravity in the presence of high serum osmolality.
DI
Reye's syndrome
High TSH - low T4 - antimicrosomal antibodies
Check for ? ICP; look for papilledema


46. Asplenic patients are particularly susceptible to these organisms.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Klebsiella
HBV - DTaP - Hib - IPV - PCV
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


47. Three systemic diseases ? nephrotic syndrome.
DM - SLE - and amyloidosis
Pasteurella multocida
Agranulocytosis
V/Q scan


48. Identify key organisms causing diarrhea:
E. coli O157:H7
Parainfluenza virus type 1
Neurofibromatosis 1
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)


49. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Sulfonamides - antimalarial drugs - fava beans
Lesch - Nyhan syndrome (purine salvage problem with
Placental abruption and placenta previa
Actinic keratosis


50. Infant mortality?
OCPs - danazol - GnRH agonists
M3
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)