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. Chvostek's and Trousseau's signs.
Non - Hodgkin's lymphoma
Hypotension - distant heart sounds - and JVD
Amoxicillin
Hypocalcemia


2. Acid - base disturbance commonly seen in pregnant women.
B12 deficiency
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Spinal stenosis
Respiratory alkalosis


3. Ring - enhancing brain lesion on CT with seizures
HBV - DTaP - Hib - IPV - PCV
< 7.0
ACEI
Taenia solium (cysticercosis)


4. Signs of ? ICP (Cushing's triad).
Subdural hematoma
Conflict of interest
Hypertension - bradycardia - and abnormal respirations
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


5. Treatment for DTs.
1
Coccidioidomycosis. Amphotericin B
Third - degree heart block
Benzodiazepines


6. Characteristics of 2

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7. Reynolds' pentad.

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8. Combined UMN and LMN disorder.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Suspect retinoblastoma
ALS
Low - voltage - diffuse ST- segment elevation


9. The 6 P's of ischemia due to peripheral vascular disease.
MAOIs
Coccidioidomycosis. Amphotericin B
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Acne vulgaris


10. Classic ECG finding in atrial flutter.

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11. Name the organism:
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Haemophilus ducreyi
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Calcium oxalate


12. Nontender abdominal mass associated with elevated VMA and HVA.
Amoxicillin
Postinfectious glomerulonephritis
S. aureus
Neuroblastoma


13. A fall in systolic BP of > 10 mmHg with inspiration.
Highly sensitive for TB
CA-125 and transvaginal ultrasound
Pulsus paradoxus (seen in cardiac tamponade)
Lead - time bias


14. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Self - limited - painless vaginal bleeding
Normal
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


15. Causes of transudative effusion.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
DM - SLE - and amyloidosis
Patent ductus arteriosus (PDA)


16. The most common form of nephritic syndrome.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Membranous glomerulonephritis
Clostridium difficile
Klebsiella


17. Method of calculating fluid repletion in burn patients.
Stable - unruptured ectopic pregnancy of &lt; 3.5 cm at &lt; 6 weeks' gestation
Actinic keratosis
Cellulitis
Parkland formula


18. Epidemics such as influenza
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Higher incidence
Seborrheic keratosis
Salmonella


19. A 49-year - old male presents with acute - onset flank pain and hematuria.
Exercise stress treadmill with ECG
Treat existing heart failure and replace the tricuspid valve
Naloxone
Nephrolithiasis


20. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
Immediate cardioversion
M3
Phencyclidine hydrochloride (PCP) intoxication


21. Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Pseudomonas
Osgood - Schlatter disease
Pharmacologic stress test (e.g. - dobutamine echo)


22. Lab values suggestive of menopause.
Folate deficiency
? serum FSH
Anorexia
Calcium oxalate


23. RTA associated with abnormal HCO3 - and rickets.
Murphy's sign - seen in acute cholecystitis
Central pontine myelinolysis
Type II (proximal) RTA
Dressler's syndrome: fever - pericarditis - ? ESR


24. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Hodgkin's lymphoma
Self - limited - painless vaginal bleeding
Suspect ankylosing spondylitis. Check HLA- B27
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


25. Difference between Mallory- Weiss and Boerhaave tears.
Mallory- Weiss
Hereditary spherocytosis
? protein intake - lactulose - neomycin
Pheochromocytoma


26. Beck's triad for cardiac tamponade.
Identify cause; fluid and blood repletion
Hypotension - distant heart sounds - and JVD
B12 deficiency
HBV immunoglobulin


27. Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Sarcoidosis
ETEC
Observational bias


28. A young patient with a family history of sudden death collapses and dies while exercising.
Anemia - thrombocytopenia - and acute renal failure
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Rate control - rhythm conversion - and anticoagulation
Hypertrophic cardiomyopathy


29. Treatment for benzodiazepine overdose.
1
Flumazenil
Lichen sclerosus
Inevitable abortion


30. The most common cause of Cushing's syndrome.

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31. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Chronic lymphocytic leukemia (CLL)
Rett's disorder
Alopecia areata (autoimmune process)


32. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Dissociative fugue
Immediate cardioversion
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Number of deaths from 28 days to one year per 1000 live births


33. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Parvovirus B19
Chronic lymphocytic leukemia (CLL)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)


34. Hematuria - flank pain - and palpable flank mass.
Pheochromocytoma
Suspect retinoblastoma
Actinic keratosis
Renal cell carcinoma (RCC)


35. Confusion - confabulation - ophthalmoplegia - ataxia.

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36. Bilious emesis within hours after the first feeding.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Duodenal atresia
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Parkland formula


37. Virus associated with aplastic anemia in patients with sickle cell anemia.
Conduct disorder
Parvovirus B19
Precocious puberty
1


38. Name the organism:
Klebsiella
M3
Niacin
Number of live births per 1000 women 15-44 years of age


39. Identify key organisms causing diarrhea:
Bacillus cereus
Intraductal papilloma
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Threatened abortion


40. RTA associated with aldosterone defect.
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Cardiogenic shock
Type IV (distal) RTA
Phototherapy (mild) or exchange transfusion (severe)


41. A 17-year - old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Varicella zoster
Conversion disorder
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Obstructive pulmonary disease (e.g. - asthma)


42. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Retinoic acid
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states


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

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44. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Streptococcus pneumoniae
Retrograde cystourethrogram
Malingering
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations


45. The most serious side effect of clozapine.
Folate deficiency
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Agranulocytosis


46. The most common cause of seizures in children (2-10 years).
Infection - febrile seizures - trauma - idiopathic
Ampulla of the oviduct
Fluids and antibiotics
Iron overload; use deferoxamine


47. Goal hemoglobin A1c for a patient with DM.
Hereditary spherocytosis
< 7.0
Patent ductus arteriosus (PDA)
Low - voltage - diffuse ST- segment elevation


48. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Ulcerative colitis
Subarachnoid hemorrhage (SAH)
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Emergent laparotomy to repair perforated viscus - likely stomach


49. A congenital heart disease that cause 2
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Nitroprusside
Glomerulonephritis/nephritic syndrome
Coarctation of the aorta


50. Appropriate diagnostic test?
Squamous cell carcinoma
Pharmacologic stress test (e.g. - dobutamine echo)
Higher incidence
IV benzodiazepine