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 young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Panic disorder
Duchenne muscular dystrophy
Dressler's syndrome: fever - pericarditis - ? ESR
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine


2. Cause of amenorrhea with normal prolactin - no response to estrogen - progesterone challenge - and a history of D&C.

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3. Treatment for acetaminophen overdose.
No. Parental consent is not necessary for the medical treatment of pregnant minors
N- acetylcysteine
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
SIADH due to stress


4. The most common cause of female infertility.
ALS
HBV - DTaP - Hib - IPV - PCV
Endometriosis
Cluster headache


5. Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Sporothrix schenckii
Hereditary spherocytosis


6. Four causes of microcytic anemia.
Ampulla of the oviduct
TICS
Klebsiella
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


7. + Nikolsky's sign.
Pemphigus vulgaris
ARDS
Flumazenil
Sulfonamides - antimalarial drugs - fava beans


8. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Herpes simplex
Phencyclidine hydrochloride (PCP) intoxication
Neuroleptic malignant syndrome
Dissociative fugue


9. 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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10. Identify key organisms causing diarrhea:
MS
E. coli O157:H7
Lyme disease - Ixodes tick - doxycycline
Conflict of interest


11. A congenital heart disease that cause 2
Glanzmann's thrombasthenia
Weight gain - type 2 DM - QT prolongation
Coarctation of the aorta
a - antagonists (phentolamine and phenoxybenzamine)


12. 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
Hypotension - distant heart sounds - and JVD
Factitious disorder (Munchausen syndrome)
Exercise stress treadmill with ECG


13. Meningitis in infants. Causes? Treatment?
Lung - breast - skin (melanoma) - kidney - GI tract
Selective IgA deficiency
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin


14. Antidepressants associated with hypertensive crisis.
1
Anemia of chronic disease
MAOIs
Sarcoidosis


15. Eight surgically correctable causes of hypertension.

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16. Presents with a herald patch - Christmas - tree pattern.
Hypotension - distant heart sounds - and JVD
Highly sensitive for TB
Continuous - painful vaginal bleeding
Pityriasis rosea


17. A painful - recurrent vesicular eruption of mucocutaneous surfaces.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Herpes simplex
SIADH due to stress


18. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Radiation
Naloxone
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


19. A patient from California or Arizona presents with fever - malaise - cough - and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
Hodgkin's lymphoma
Administration of DDAVP ? serum osmolality and free water restriction
All - compartment fasciotomy for suspected compartment syndrome


20. Presence of red cell casts in urine sediment.
Conversion disorder
Glomerulonephritis/nephritic syndrome
Beta- blockers - digoxin - calcium channel blockers
Continuous positive airway pressure


21. Should a - or Beta- antagonists be used first in treating pheochromocytoma?
1
a - antagonists (phentolamine and phenoxybenzamine)
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Fatigue and impending respiratory failure


22. The number of true positives divided by the number of patients with the disease is _____.
Sensitivity
Mycoplasma
Legionella pneumonia
Prinzmetal's angina


23. The diagnostic test for pulmonary embolism.
V/Q scan
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Restrictive pulmonary disease
Bacterial meningitis


24. Amenorrhea - bradycardia - and abnormal body image in a young female.
Neuroleptic malignant syndrome
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Anorexia
Paget's disease


25. Complication of scaphoid fracture.
68% - 95.5% - 99.7%
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Avascular necrosis
Continuous positive airway pressure


26. Treatment of septic shock.
Malingering
46 -XX
Fluids and antibiotics
68% - 95.5% - 99.7%


27. Name the organism:
Neisseria meningitidis
Elevated ICP - RBCs - xanthochromia
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
OCP and barrier contraception


28. Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Septic or anaphylactic shock
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Pseudomonas


29. Identify key organisms causing diarrhea:
Neisseria meningitidis
Wegener's granulomatosis and Goodpasture's syndrome
Duodenal atresia
S. aureus


30. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Spinal stenosis
Amoxicillin
TICS


31. Electrolyte changes in tumor lysis syndrome.
Precocious puberty
? Ca2+ - ? K- - ? phosphate - ? uric acid
Placental abruption and placenta previa
Selective IgA deficiency


32. Conditions in which confidentiality must be overridden.
Graves' disease
Retinoic acid
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Aseptic (viral) meningitis


33. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Anorexia
Chronic lymphocytic leukemia (CLL)
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
68% - 95.5% - 99.7%


34. Treatment for postpartum hemorrhage.
Anion gap acidosis and 1
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Uterine massage; if that fails - give oxytocin
Endometriosis


35. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Sensitivity
Clostridium difficile
DI


36. The most common cause of seizures in children (2-10 years).
Anemia of chronic disease
Calcium oxalate
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Infection - febrile seizures - trauma - idiopathic


37. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
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
50 cc/hour
Femoral hernia


38. The first test to perform when a woman presents with amenorrhea.
Threatened abortion
Beta- hCG; the most common cause of amenorrhea is pregnancy
MS
SCLC


39. A 25-year - old African - American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
Placental abruption and placenta previa
O2 - analgesia - hydration - and - if severe - transfusion
Hypertension - bradycardia - and abnormal respirations
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


40. Fetal mortality?

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41. First - line treatment for otitis media.
Uterine massage; if that fails - give oxytocin
Amoxicillin
Beta- blockers - Ca2+ channel blockers - TCAs
Transitional cell carcinoma


42. Cold agglutinins.
Respiratory alkalosis
Pheochromocytoma
Mycoplasma
Reaction formation


43. Drugs that slow AV node transmission.
Fat - female - fertile - forty - flatulent
Beta- blockers - digoxin - calcium channel blockers
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Identify cause; pressors (e.g. - dobutamine)


44. What is the immunodeficiency?

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45. PFT showing ? FEV1/FVC.
Hypokalemia
Seborrheic keratosis
Obstructive pulmonary disease (e.g. - asthma)
AP chest - AP/lateral C- spine - AP pelvis


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

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47. The most common cause of SAH.
Retinoic acid
Establish the ABCs
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Trauma; the second most common is berry aneurysm


48. 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)
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Kwashiorkor (protein malnutrition)
Legionella pneumonia


49. Epidemics such as influenza
Varicella zoster
Nephritic syndrome
B12 deficiency
Higher incidence


50. Associated with Propionibacterium acnes and changes in androgen levels.
Streptococcus pneumoniae
Acne vulgaris
Coccidioidomycosis. Amphotericin B
Paget's disease