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. Flat - topped papules.
Lichen planus
Sarcoidosis
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
ETEC


2. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Clostridium difficile
Wegener's granulomatosis and Goodpasture's syndrome
Acute myelogenous leukemia (AML)
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


3. Complication of scaphoid fracture.
Signs and symptoms of hypercalcemia
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
< 7.0
Avascular necrosis


4. An eight -year - old child is in a serious accident. She requires emergent transfusion - but her parents are not present.
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
High reliability - low validity
Treat immediately. Consent is implied in emergency situations
Pseudomonas


5. PFT showing ? FEV1/FVC.
Obstructive pulmonary disease (e.g. - asthma)
Acute myelogenous leukemia (AML)
7-10 days
Number of deaths from 20 weeks' gestation to birth per 1000 total births


6. Name the organism:
Hypoxia and hypocarbia
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Amoxicillin
Sporothrix schenckii


7. Annual screening for women with a strong family history of ovarian cancer.
CA-125 and transvaginal ultrasound
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Seborrheic dermatitis. Treat with antifungals
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant


8. Infant mortality?
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
False. Withdrawing and withholding life are the same from an ethical standpoint
Third - degree heart block
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


9. Identify key organisms causing diarrhea:
Sensitivity
Pemphigus vulgaris
Polymyalgia rheumatica
Bacillus cereus


10. Blood in the urethral meatus or high - riding prostate.
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Bladder rupture or urethral injury
IV benzodiazepine
Alzheimer's and multi - infarct


11. In which patients do you initiate colorectal cancer screening early?
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
High TSH - low T4 - antimicrosomal antibodies
Inhaled Beta- agonists and inhaled corticosteroids
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


12. ? CO - ? PCWP - ? PVR.
Cardiogenic shock
Precocious puberty
Immediate cardioversion
Menometrorrhagia


13. CSF findings with SAH.
Agranulocytosis
Elevated ICP - RBCs - xanthochromia
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Neuroleptic malignant syndrome


14. The diagnostic test for pulmonary embolism.
V/Q scan
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Rate control - rhythm conversion - and anticoagulation
Protamine


15. Drugs that slow AV node transmission.
Actinic keratosis
Endometrial biopsy
Beta- blockers - digoxin - calcium channel blockers
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


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

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17. Classic causes of drug - induced hepatitis.
Clostridium difficile
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
? serum FSH
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


18. Name the defense mechanism:
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Osteoarthritis
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Reaction formation


19. A 20-year - old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Cerebral berry aneurysms (AD PCKD)


20. Indications for surgical repair of abdominal aortic aneurysm.
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
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
OCPs
Iatrogenic steroid administration. The second most common cause is Cushing's disease


21. Microcytic anemia with ? serum iron - ? total iron - binding capacity (TIBC) - and normal or ? ferritin.
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Anemia of chronic disease
Headache
Lead - time bias


22. Treatment of tension pneumothorax.
Higher incidence
All - compartment fasciotomy for suspected compartment syndrome
Immediate needle thoracostomy
Nephritic syndrome


23. Acute - phase treatment for Kawasaki disease.
Higher prevalence
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Kegel exercises - estrogen - pessaries for stress incontinence
Sulfonamides - antimalarial drugs - fava beans


24. Bilious emesis within hours after the first feeding.
Prerenal
Duodenal atresia
Mycoplasma
Acne vulgaris


25. Administer to a symptomatic patient to diagnose myasthenia gravis.
S. aureus or S. epidermidis.
Pseudogout
Edrophonium
Intussusception


26. The most common causes of dementia.

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27. The three most common causes of fever of unknown origin (FUO).
HBV - DTaP - Hib - IPV - PCV
Infection - febrile seizures - trauma - idiopathic
Infection - cancer - and autoimmune disease
1


28. Classic physical findings for endocarditis.

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29. Laparoscopic findings in endometriosis.

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30. Defect in an X- linked syndrome with mental retardation -
Pityriasis versicolor
Higher prevalence
Lesch - Nyhan syndrome (purine salvage problem with
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


31. The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Anticoagulation - rate control - cardioversion
Prinzmetal's angina
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.


32. Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV- positive patient At what CD4 count? Mycobacterium avium - intracellulare (MAI) prophylaxis?
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Seborrheic dermatitis. Treat with antifungals
Nephritic syndrome
Klebsiella


33. Postnatal mortality?
Neisseria meningitidis
Number of deaths from 28 days to one year per 1000 live births
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Incidence and prevalence


34. 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.
Lesch - Nyhan syndrome (purine salvage problem with
Erythema multiforme
Central pontine myelinolysis
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


35. Name the organism:
Polymyalgia rheumatica
Haemophilus ducreyi
Uterine atony
HGPRTase deficiency)


36. Definition of unstable angina.
Angina is new - is worsening - or occurs at rest
Administration of DDAVP ? serum osmolality and free water restriction
Acute myelogenous leukemia (AML)
Sheehan's syndrome (postpartum pituitary necrosis)


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

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38. What should always be done prior to LP?
Chronic lymphocytic leukemia (CLL)
Check for ? ICP; look for papilledema
Hypovolemic shock
Intussusception


39. Causes of hypoxemia.
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Pseudomonas
Haemophilus ducreyi
Rett's disorder


40. AML subtype associated with DIC.
Femoral hernia
M3
Sensitivity
AP chest - AP/lateral C- spine - AP pelvis


41. Risk factors for cholelithiasis.
Fat - female - fertile - forty - flatulent
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Bacterial meningitis
1


42. Antibiotics with teratogenic effects.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Hyperkalemia
Infection - febrile seizures - trauma - idiopathic


43. Asplenic patients are particularly susceptible to these organisms.
High reliability - low validity
Ophthalmologic exam - CT - and MRI
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed


44. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Substance abuse
Factitious disorder (Munchausen syndrome)
Dissociative fugue
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


45. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
CA-125 and transvaginal ultrasound
Actinomyces israelii
Basal cell carcinoma
Hypertension - bradycardia - and abnormal respirations


46. Peaked T waves and widened QRS.
Weight loss and OCPs
Hyperkalemia
Fanconi's anemia
Menometrorrhagia


47. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Impetigo
Sulfonamides - antimalarial drugs - fava beans
DM - SLE - and amyloidosis
Niacin


48. Glomerulonephritis with deafness.

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49. Name the organism:
CA-125 and transvaginal ultrasound
Toxoplasma gondii
Salmonella
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin


50. T- wave flattening and U waves.
Lung - breast - skin (melanoma) - kidney - GI tract
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Hypokalemia
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.