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 six-year - old girl presents with a port - wine stain in the V2 distribution as well as with mental retardation - seizures - and leptomeningeal angioma.
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Trauma; the second most common is berry aneurysm
High reliability - low validity
Coarctation of the aorta


2. Not contraindications to vaccination.
Kegel exercises - estrogen - pessaries for stress incontinence
Rate control - rhythm conversion - and anticoagulation
Acute mania. Start a mood stabilizer (e.g. - lithium)
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


3. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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4. Radiographic indications for surgery in patients with acute abdomen.
Substance abuse
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis


5. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA- B27
Respiratory alkalosis
Hypertrophic cardiomyopathy
CHF - shock - and altered mental status


6. After a minor fender bender - a man wears a neck brace and requests permanent disability.
Prevalence
Alport's syndrome
Paget's disease
Malingering


7. First - line medication for status epilepticus.
Pseudogout
IV benzodiazepine
Dantrolene or bromocriptine
Ultrasound


8. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
S. aureus or S. epidermidis.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones


9. Exophthalmos - pretibial myxedema - and ? TSH.

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10. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Hashimoto's thyroiditis
Coccidioidomycosis. Amphotericin B
Number of deaths from birth to 28 days per 1000 live births
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


11. A 50-year - old male presents with early satiety - splenomegaly - and bleeding. Cytogenetics show t(9 -22). Diagnosis?
Isolation
Parkland formula
CML
Salmonella


12. Definition of unstable angina.
Pregnant women. Treat this group aggressively because of potential complications
Postinfectious glomerulonephritis
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Angina is new - is worsening - or occurs at rest


13. Treatment of anaphylactic shock.
Continuous positive airway pressure
Neuroblastoma
Diphenhydramine or epinephrine 1:1000
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction


14. Name the organism:
Coccidioidomycosis. Amphotericin B
Cerebral berry aneurysms (AD PCKD)
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Streptococcus pneumoniae


15. Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone
RCC or other erythropoietin - producing tumor; evaluate with CT scan
68% - 95.5% - 99.7%
AP chest - AP/lateral C- spine - AP pelvis


16. ? risk of what infection with silicosis?
Mycobacterium tuberculosis
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Obstructive pulmonary disease (e.g. - asthma)
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births


17. Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Seminoma
Lesions of 1
Type IV (distal) RTA


18. The diagnostic test for pulmonary embolism.
Pharmacologic stress test (e.g. - dobutamine echo)
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
V/Q scan
Agranulocytosis


19. Cannon 'a' waves.
Third - degree heart block
Stasis - hypercoagulability - endothelial damage
? serum FSH
Prevalence


20. Identify key organisms causing diarrhea:
High TSH - low T4 - antimicrosomal antibodies
Varicella zoster
Psoriasis
Vibrio - HAV


21. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Subdural hematoma
Duchenne muscular dystrophy
Erythema multiforme
Hodgkin's lymphoma


22. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Suspect retinoblastoma
INH - penicillamine - hydralazine - procainamide
Isolation
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


23. A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Postinfectious glomerulonephritis
Displacement
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care


24. A fall in systolic BP of > 10 mmHg with inspiration.
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Osteoarthritis
Pulsus paradoxus (seen in cardiac tamponade)
Inhaled Beta- agonists and inhaled corticosteroids


25. Causes of transudative effusion.
V/Q scan
Basal cell carcinoma
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Uterine massage; if that fails - give oxytocin


26. An agent that reverses the effects of heparin.
Protamine
Agranulocytosis
1
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


27. Symptoms of placenta previa.
Conduct disorder
7-10 days
Lichen sclerosus
Self - limited - painless vaginal bleeding


28. Treatment of hypovolemic shock.
SIADH due to stress
Identify cause; fluid and blood repletion
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Varicella zoster


29. Nikolsky's sign.
Levodopa/carbidopa
Kl
Biliary tract obstruction
Bullous pemphigoid


30. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Kegel exercises - estrogen - pessaries for stress incontinence
Inevitable abortion
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones


31. Patient presents with sudden onset of severe - diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
HBV - DTaP - Hib - IPV - PCV
Subdural hematoma
Folate deficiency
Emergent laparotomy to repair perforated viscus - likely stomach


32. A 10-year - old boy presents with fever - weight loss - and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

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33. Goal hemoglobin A1c for a patient with DM.
Low - voltage - diffuse ST- segment elevation
CF or Hirschsprung's disease
HIDA scan
< 7.0


34. A man has repeated - intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
Inhaled Beta- agonists and inhaled corticosteroids
Klebsiella
Type II (proximal) RTA


35. Acute - phase treatment for Kawasaki disease.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Immediate needle thoracostomy
IV benzodiazepine
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms


36. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
V/Q scan
Administration of DDAVP ? serum osmolality and free water restriction
Coarctation of the aorta


37. Treatment of cardiogenic shock.
Osmotic fragility test
Identify cause; pressors (e.g. - dobutamine)
Beta- blockers - digoxin - calcium channel blockers
Normal


38. An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Wernicke's encephalopathy due to a deficiency of thiamine
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Precocious puberty
Febrile seizures (roseola infantum)


39. Name the organism:
Klebsiella
Pentad of TTP
Stable - unruptured ectopic pregnancy of &lt; 3.5 cm at &lt; 6 weeks' gestation
Graves' disease


40. Fertility rate?
Flumazenil
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Number of live births per 1000 women 15-44 years of age
Spinal stenosis


41. T- wave flattening and U waves.
SSRIs
Hypokalemia
Highly sensitive for TB
Osteogenesis imperfecta


42. Describe a test that consistently gives identical results - but the results are wrong.
High reliability - low validity
Dressler's syndrome: fever - pericarditis - ? ESR
A patient with chest trauma who was previously stable suddenly dies
Central pontine myelinolysis


43. Reed - Sternberg cells

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44. Treatment of septic shock.
Nitroprusside
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Fluids and antibiotics


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

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46. Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe)
Edrophonium
Number of live births per 1000 population
Hypertrophic cardiomyopathy


47. Treatment for mild - persistent asthma.
1
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
BP > 140/90 on three separate occasions two weeks apart
Inhaled Beta- agonists and inhaled corticosteroids


48. When can a physician refuse to continue treating a patient on the grounds of futility?
When there is no rationale for treatment - maximal intervention is failing - a given intervention has already failed - and treatment will not achieve the goals of care
Lichen planus
Higher incidence
Intussusception


49. Rigidity and stiffness with resting tremor and masked facies.

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50. Four causes of microcytic anemia.
Metformin
Restrictive pulmonary disease
TICS
Beta- blockers - digoxin - calcium channel blockers