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. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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2. A homeless child is small for his age and has peeling skin and a swollen belly.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Kwashiorkor (protein malnutrition)
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
M3


3. Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Ultrasound
Threatened abortion
Endometrial biopsy
Transitional cell carcinoma


4. A patient complains of headache - weakness - and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia - hypokalemia - and metabolic alkalosis.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
S. aureus or S. epidermidis.
IV hydration and loop diuretics (furosemide)
1


5. Diagnostic modality used when ultrasound is equivocal for cholecystitis.
HIDA scan
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Weight gain - type 2 DM - QT prolongation


6. The most common form of nephritic syndrome.
Parvovirus B19
Pasteurella multocida
Membranous glomerulonephritis
1


7. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Absence seizures
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Normal


8. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Type I (distal) RTA
Fluids and antibiotics
Squamous cell carcinoma
Febrile seizures (roseola infantum)


9. A son asks that his mother not be told about her recently discovered cancer.

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10. Inflammatory disease of the colon with ? risk of colon cancer.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Ulcerative colitis
Non - Hodgkin's lymphoma
Duodenal atresia


11. Which healthy population is susceptible to UTIs?
Inevitable abortion
Pregnant women. Treat this group aggressively because of potential complications
Amoxicillin
AP chest - AP/lateral C- spine - AP pelvis


12. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Femoral hernia
Prinzmetal's angina
Factitious disorder (Munchausen syndrome)
Self - limited - painless vaginal bleeding


13. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Neurofibromatosis 1
Psoriasis


14. Dermatomal distribution.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Varicella zoster
Nephrotic syndrome
Crohn's disease


15. Chronic diseases such as SLE
Haemophilus ducreyi
Kwashiorkor (protein malnutrition)
Higher prevalence
Weight gain - type 2 DM - QT prolongation


16. A newborn female has continuous 'machinery murmur.'
Patent ductus arteriosus (PDA)
Renal cell carcinoma (RCC)
Inevitable abortion
SIADH due to stress


17. Tests to rule out shaken baby syndrome.
Chronic lymphocytic leukemia (CLL)
Sporothrix schenckii
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Ophthalmologic exam - CT - and MRI


18. + Nikolsky's sign.
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
Pemphigus vulgaris
Metformin
Non - Hodgkin's lymphoma


19. When can a physician refuse to continue treating a patient on the grounds of futility?
Lesion of 1
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
Neurofibromatosis 1
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


20. Treatment of septic shock.
Graves' disease
Trichomonas vaginitis
Fluids and antibiotics
Clomiphene citrate


21. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Malignancy and hyperparathyroidism
Salmonella
Anemia of chronic disease
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured


22. The most common inherited hemolytic anemia.
Anion gap acidosis and 1
Klebsiella
Kwashiorkor (protein malnutrition)
Hereditary spherocytosis


23. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Contact dermatitis
Confounding variable
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Acne vulgaris


24. Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Sarcoidosis
Rubella
Flumazenil


25. Treatment for ventricular fibrillation.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
OCPs - danazol - GnRH agonists
The IR of a disease in a population exposed to a particular factor
Immediate cardioversion


26. What should always be done prior to LP?
Pentad of TTP
Legionella pneumonia
Check for ? ICP; look for papilledema
IVIG or plasmapheresis


27. Medical treatment for hepatic encephalopathy.
Anion gap acidosis and 1
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
? protein intake - lactulose - neomycin
Number of live births per 1000 population


28. A 49-year - old male presents with acute - onset flank pain and hematuria.
Anorexia
Nephrolithiasis
Conversion disorder
Central pontine myelinolysis


29. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Dressler's syndrome: fever - pericarditis - ? ESR
Threatened abortion


30. Which of the following are ? in DIC: fibrin split products - D- dimer - fibrinogen - platelets - and hematocrit.
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Edrophonium
Endometriosis
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


31. Treatment of cardiogenic shock.
Slipped capital femoral epiphyses. AP and frog - leg lateral view
Kl
a - antagonists (phentolamine and phenoxybenzamine)
Identify cause; pressors (e.g. - dobutamine)


32. Sentinel loop on AXR.
Acute pancreatitis
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Third - degree heart block
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels


33. A young patient with a family history of sudden death collapses and dies while exercising.
Pseudogout
SSRIs
Hypertrophic cardiomyopathy
Yersinia


34. Dyspnea - lateral hilar lymphodenopathy on CXR - noncaseating granulomas - increased ACE - and hypercalcemia.
Sarcoidosis
Slipped capital femoral epiphyses. AP and frog - leg lateral view
46 -XX
Chronic granulomatous disease


35. Glomerulonephritis with deafness.

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36. Name the defense mechanism:
Nephritic syndrome
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
E. coli O157:H7
Reaction formation


37. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
Legionella pneumonia
Wait - surgical resection - radiation and/or androgen suppression
Iron deficiency anemia
Duodenal atresia


38. Glomerulonephritis with hemoptysis.

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39. Blood in the urethral meatus or high - riding prostate.
Substance abuse
Bladder rupture or urethral injury
Clomiphene citrate
Cellulitis


40. Identify key organisms causing diarrhea:
They can mask symptoms of hypoglycemia
False. Withdrawing and withholding life are the same from an ethical standpoint
Pulsus paradoxus (seen in cardiac tamponade)
Bacillus cereus


41. How to diagnose and follow a leiomyoma.
Actinomyces israelii
Neurofibromatosis 1
Flumazenil
Ultrasound


42. 1
Treat existing heart failure and replace the tricuspid valve
Placental abruption and placenta previa
? Ca2+ - ? K- - ? phosphate - ? uric acid
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


43. A 60-year - old African - American male presents with bone pain. Workup for multiple myeloma might reveal?

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44. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Retinoic acid
High reliability - low validity
Basal cell carcinoma
A patient's family cannot require that a doctor withhold information from the patient


45. CSF findings with SAH.
Campylobacter
Polymyalgia rheumatica
Elevated ICP - RBCs - xanthochromia
Weight loss and OCPs


46. An active 13-year - old boy has anterior knee pain. Diagnosis?
Toxoplasma gondii
Dissociative fugue
Osgood - Schlatter disease
A patient with chest trauma who was previously stable suddenly dies


47. The most common inherited cause of hypercoagulability.
Wiskott - Aldrich syndrome
Seminoma
Multiple myeloma
Factor V Leiden mutation


48. True or false: Once patients sign a statement giving consent - they must continue treatment.
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
Actinic keratosis
Elevated ICP - RBCs - xanthochromia
'Chocolate cysts -' powder burns


49. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Number of live births per 1000 population
Antipsychotics (neuroleptic malignant syndrome)
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Febrile seizures (roseola infantum)


50. Amenorrhea - bradycardia - and abnormal body image in a young female.
Broca's aphasia. Frontal lobe - left MCA distribution
Anorexia
Pemphigus vulgaris
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer