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. Sensitive tests have few false negatives and are used to rule _____ a disease.
Actinic keratosis
Alport's syndrome
Higher prevalence
Out


2. Natural history of a leiomyoma.
Regresses after menopause
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
1
Pseudomonas


3. Attributable risk?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Pseudomonas


4. A congenital heart disease that cause 2
1
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Coarctation of the aorta
Fat - female - fertile - forty - flatulent


5. A 13-year - old male has a history of theft - vandalism - and violence toward family pets.
Endometriosis
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7
Endometrial or estrogen receptor - breast cancer
Conduct disorder


6. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Wernicke's encephalopathy due to a deficiency of thiamine
Trauma - alcohol withdrawal - brain tumor
They can mask symptoms of hypoglycemia
Lichen sclerosus


7. 'Doughy skin.'
Hypernatremia
Hypotension - distant heart sounds - and JVD
RSV bronchiolitis
? protein intake - lactulose - neomycin


8. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Uterine massage; if that fails - give oxytocin
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Herpes simplex


9. Risk factors for DVT.

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10. PFT showing ? FEV1/FVC.
Obstructive pulmonary disease (e.g. - asthma)
Panic disorder
Sensitivity
Pheochromocytoma


11. The most frequent presentation of intracranial neoplasm.
Headache
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
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Salmonella


12. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Fever - heart murmur - Osler's nodes - splinter hemorrhages - Janeway lesions - Roth's spots
Phototherapy (mild) or exchange transfusion (severe)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
O2 - analgesia - hydration - and - if severe - transfusion


13. Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Frotteurism (a paraphilia)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
DI


14. Perinatal mortality?

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15. Treatment for opioid overdose.
Sheehan's syndrome (postpartum pituitary necrosis)
Immediate needle thoracostomy
Pseudogout
Naloxone


16. A homeless child is small for his age and has peeling skin and a swollen belly.
Type I (distal) RTA
AP chest - AP/lateral C- spine - AP pelvis
Kwashiorkor (protein malnutrition)
CHF - shock - and altered mental status


17. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Actinic keratosis
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Acute mania. Start a mood stabilizer (e.g. - lithium)


18. Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
TICS
Obstructive pulmonary disease (e.g. - asthma)
Neither


19. Sentinel loop on AXR.
CF or Hirschsprung's disease
Angina - ST- segment changes on ECG - or ? BP
Lesions of 1
Acute pancreatitis


20. 1
Lyme disease - Ixodes tick - doxycycline
Placental abruption and placenta previa
Depersonalization disorder
Low - voltage - diffuse ST- segment elevation


21. Why are Beta- blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
Regresses after menopause
Endometrial biopsy
Wernicke's encephalopathy due to a deficiency of thiamine


22. Identify key organisms causing diarrhea:
Squamous cell carcinoma
Yersinia
Iron deficiency anemia
Number of deaths from birth to 28 days per 1000 live births


23. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
HGPRTase deficiency)
Number of deaths from birth to 28 days per 1000 live births
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


24. 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)
N- acetylcysteine
Glanzmann's thrombasthenia
No. Parental consent is not necessary for the medical treatment of pregnant minors


25. Name the organism:
Pseudomonas
? Ca2+ - ? K- - ? phosphate - ? uric acid
Lesch - Nyhan syndrome (purine salvage problem with
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


26. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Parvovirus B19
Neuroleptics
Weight gain - type 2 DM - QT prolongation
Factor V Leiden mutation


27. Treatment of central DI.
1
Number of live births per 1000 population
Administration of DDAVP ? serum osmolality and free water restriction
Neuroleptics


28. Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Exercise stress treadmill with ECG
Lesion of 1
Spinal stenosis


29. The most common cause of seizures in children (2-10 years).
Neuroleptic malignant syndrome
Hypokalemia
a - antagonists (phentolamine and phenoxybenzamine)
Infection - febrile seizures - trauma - idiopathic


30. Neonatal mortality?
Allergic interstitial nephritis
Restrictive pulmonary disease
Anticoagulation - rate control - cardioversion
Number of deaths from birth to 28 days per 1000 live births


31. Tanner stage 3 in a six-year - old female.
Postinfectious glomerulonephritis
Precocious puberty
Lead - time bias
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes


32. A 25-year - old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

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33. Classic causes of drug - induced hepatitis.
Suspect retinoblastoma
Acute pancreatitis
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


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

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35. The most common cause of SAH.
Trauma; the second most common is berry aneurysm
Threatened abortion
Cerebral berry aneurysms (AD PCKD)
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured


36. Chvostek's and Trousseau's signs.
Dissociative fugue
Hypocalcemia
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Uterine massage; if that fails - give oxytocin


37. Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides - antimalarial drugs - fava beans
Salmonella
Huntington's disease
Wegener's granulomatosis and Goodpasture's syndrome


38. 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)
The IR of a disease in a population exposed to a particular factor
Folate deficiency
Diverticulosis


39. Treatment for Guillain - Barr
Dissociative fugue
OCPs
IVIG or plasmapheresis
Incidence and prevalence


40. Sudden onset of mental status changes - emesis - and liver dysfunction after taking aspirin.

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41. Epidemics such as influenza
Erythema multiforme
Higher incidence
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
Hypocalcemia


42. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Cellulitis
Chronic lymphocytic leukemia (CLL)
Non - Hodgkin's lymphoma
Anion gap acidosis and 1


43. A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
Cirrhosis - CHF - nephritic syndrome
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


44. The first test to perform when a woman presents with amenorrhea.
Beta- hCG; the most common cause of amenorrhea is pregnancy
? Ca2+ - ? K- - ? phosphate - ? uric acid
No. Parental consent is not necessary for the medical treatment of pregnant minors
Impetigo


45. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Dantrolene or bromocriptine
CML
Factitious disorder (Munchausen syndrome)


46. A woman who was abused as a child frequently feels outside of or detached from her body.
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
Depersonalization disorder
Anticoagulation - rate control - cardioversion
Fluids and antibiotics


47. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Kwashiorkor (protein malnutrition)
Central pontine myelinolysis
A patient's family cannot require that a doctor withhold information from the patient


48. The mainstay of Parkinson's therapy.
Squamous cell carcinoma
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Levodopa/carbidopa
Giardia


49. Name the defense mechanism:
Reaction formation
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
Sarcoidosis


50. Prophylactic treatment for migraine.
Endometriosis
Anorexia
Beta- blockers - Ca2+ channel blockers - TCAs
Regression