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. Hernia with highest risk of incarceration
Alzheimer's and multi - infarct
Central pontine myelinolysis
Femoral hernia
Self - limited - painless vaginal bleeding


2. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
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
Trichomonas vaginitis
Factitious disorder (Munchausen syndrome)
Nephritic syndrome


3. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
1
Hashimoto's thyroiditis
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


4. A burn patient presents with cherry- red flushed skin and coma. SaO2 is normal - but carboxyhemoglobin is elevated. Treatment?
Cluster headache
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Salmonella
OCPs


5. 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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6. Exophthalmos - pretibial myxedema - and ? TSH.

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7. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
No. Parental consent is not necessary for the medical treatment of pregnant minors
Lyme disease - Ixodes tick - doxycycline
Huntington's disease


8. Identify key organisms causing diarrhea:
Sarcoidosis
Prevalence
Cluster headache
Yersinia


9. A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Levodopa/carbidopa
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Salmonella


10. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Patient on dopamine antagonist
IV penicillin or ampicillin
Hyperkalemia
Exercise stress treadmill with ECG


11. Treatment for ventricular fibrillation.
Fat - female - fertile - forty - flatulent
Beta- blockers - Ca2+ channel blockers - TCAs
Immediate cardioversion
HBV immunoglobulin


12. Cohort study
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Hashimoto's thyroiditis
Incidence and prevalence
DM - SLE - and amyloidosis


13. Caf
Neurofibromatosis 1
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Frotteurism (a paraphilia)
Seminoma


14. Acid - base disorder in pulmonary embolism.
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
1
Hypoxia and hypocarbia
Administration of DDAVP ? serum osmolality and free water restriction


15. Macrocytic - megaloblastic anemia with neurologic symptoms.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Sheehan's syndrome (postpartum pituitary necrosis)
B12 deficiency
Bacillus cereus


16. Signs of ? ICP (Cushing's triad).
Pulsus paradoxus (seen in cardiac tamponade)
Wrist drop - loss of thumb abduction
Hypertension - bradycardia - and abnormal respirations
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


17. The most common 1
30 cc/hour
Legionella pneumonia
Selective IgA deficiency
Ophthalmologic exam - CT - and MRI


18. Chronic diseases such as SLE
Dressler's syndrome: fever - pericarditis - ? ESR
Higher prevalence
Neurofibromatosis 1
Factor V Leiden mutation


19. Infection of small airways with epidemics in winter and spring.
Pseudomonas
Multiple myeloma
RSV bronchiolitis
Sporothrix schenckii


20. Four causes of microcytic anemia.
Confounding variable
Fluid restriction - demeclocycline
Wegener's granulomatosis and Goodpasture's syndrome
TICS


21. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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22. Four characteristics of a nevus suggestive of melanoma.
Alopecia areata (autoimmune process)
Kl
Trauma; the second most common is berry aneurysm
Asymmetry - border irregularity - color variation - large diameter


23. Salicylate ingestion ? In What type of acid - base disorder?
Wegener's granulomatosis and Goodpasture's syndrome
Normal
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Anion gap acidosis and 1


24. The diagnostic test for pulmonary embolism.
V/Q scan
Bladder rupture or urethral injury
Parkland formula
Oral surgery


25. The most common form of nephritic syndrome.
Membranous glomerulonephritis
Suspect ankylosing spondylitis. Check HLA- B27
Lesions of 1
Kl


26. 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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27. A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
Varicella zoster
M3
Sensitivity


28. A homeless child is small for his age and has peeling skin and a swollen belly.
Asymmetry - border irregularity - color variation - large diameter
Kwashiorkor (protein malnutrition)
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Squamous cell carcinoma


29. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Number of deaths from 28 days to one year per 1000 live births
Retrograde cystourethrogram
Patient on dopamine antagonist
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate


30. Classic ECG findings in pericarditis.
Coarctation of the aorta
Low - voltage - diffuse ST- segment elevation
IV penicillin or ampicillin
Pityriasis versicolor


31. Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Yersinia
Uterine massage; if that fails - give oxytocin
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis


32. CSF findings:
HIDA scan
Septic or anaphylactic shock
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Bacterial meningitis


33. 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
Uterine massage; if that fails - give oxytocin
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Streptococcus pneumoniae


34. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Lesch - Nyhan syndrome (purine salvage problem with
Giardia
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Self - limited - painless vaginal bleeding


35. The most common type of nephrolithiasis.
Calcium oxalate
Neisseria meningitidis
Menometrorrhagia
IV benzodiazepine


36. Name the organism:
Streptococcus pneumoniae
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Stable - unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation


37. Prophylactic treatment for migraine.
Wegener's granulomatosis and Goodpasture's syndrome
Beta- blockers - Ca2+ channel blockers - TCAs
Subarachnoid hemorrhage (SAH)
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)


38. Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Pseudogout
Salmonella
1


39. Signs suggesting radial nerve damage with humeral fracture.
HBV immunoglobulin
Wrist drop - loss of thumb abduction
Obstructive pulmonary disease (e.g. - asthma)
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


40. Indications for surgical repair of abdominal aortic aneurysm.
Diverticulosis
Choriocarcinoma
Spinal stenosis
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured


41. 'Stuck - on' appearance.
Malignancy and hyperparathyroidism
Seborrheic keratosis
Nitroprusside
Bullous pemphigoid


42. Identify key organisms causing diarrhea:
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
CML


43. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
All - compartment fasciotomy for suspected compartment syndrome
Hashimoto's thyroiditis
Ampulla of the oviduct
Endometrial biopsy


44. Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
'Chocolate cysts -' powder burns
Alport's syndrome
Administration of DDAVP ? serum osmolality and free water restriction


45. Meningitis in neonates. Causes? Treatment?
Trauma; the second most common is berry aneurysm
Nitroprusside
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
OCP and barrier contraception


46. A congenital heart disease that cause 2
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Coarctation of the aorta
Prerenal
50 cc/hour


47. Autoimmune complication occurring 2-4 weeks post - MI.

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48. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Administration of DDAVP ? serum osmolality and free water restriction
Hyperkalemia
Duchenne muscular dystrophy


49. Nikolsky's sign.
Bullous pemphigoid
Hypoparathyroidism
Levodopa/carbidopa
Conflict of interest


50. Testicular cancer associated with Beta- hCG - AFP.
Nephrotic syndrome
Choriocarcinoma
Infection - febrile seizures - trauma - idiopathic
Sensitivity