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. The three most common causes of fever of unknown origin (FUO).
Huntington's disease
Higher incidence
Infection - cancer - and autoimmune disease
Chronic granulomatous disease


2. How to diagnose and follow a leiomyoma.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Ultrasound
Renal cell carcinoma (RCC)
Coarctation of the aorta


3. Diagnostic test for hypertrophic cardiomyopathy.
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Low - voltage - diffuse ST- segment elevation
M3


4. Reed - Sternberg cells

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5. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
MS
Squamous cell carcinoma
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Radiation


6. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
S. aureus
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)


7. Post - HBV exposure treatment.
HBV immunoglobulin
Treat immediately. Consent is implied in emergency situations
Membranous glomerulonephritis
Transitional cell carcinoma


8. Hernia with highest risk of incarceration
Seborrheic keratosis
Vibrio - HAV
Hypotension - distant heart sounds - and JVD
Femoral hernia


9. Definition of unstable angina.
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Bladder rupture or urethral injury
Angina is new - is worsening - or occurs at rest
Infection - cancer - and autoimmune disease


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

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11. A young patient with a family history of sudden death collapses and dies while exercising.
Biliary tract obstruction
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Levodopa/carbidopa
Hypertrophic cardiomyopathy


12. Trauma series.
AP chest - AP/lateral C- spine - AP pelvis
Nephrogenic diabetes insipidus (DI)
Colposcopy and endocervical curettage
Diphenhydramine or epinephrine 1:1000


13. Describe a test that consistently gives identical results - but the results are wrong.
Lobular carcinoma in situ
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Ampulla of the oviduct
High reliability - low validity


14. May be seen in children who are accused of inattention in class and confused with ADHD.
1
Absence seizures
Ophthalmologic exam - CT - and MRI
Regression


15. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Phototherapy (mild) or exchange transfusion (severe)


16. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
7-10 days
Observational bias
Uremic syndrome seen in patients with renal failure


17. Key side effects of atypical antipsychotics.
Weight gain - type 2 DM - QT prolongation
Mycoplasma
Wait - surgical resection - radiation and/or androgen suppression
1


18. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Highly sensitive for TB
Endometrial biopsy
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
S. aureus or S. epidermidis.


19. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cellulitis
Frotteurism (a paraphilia)
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Wiskott - Aldrich syndrome


20. Cannon 'a' waves.
Infection - febrile seizures - trauma - idiopathic
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Glomerulonephritis/nephritic syndrome
Third - degree heart block


21. Medication given to accelerate fetal lung maturity.
Nitroprusside
Betamethasone or dexamethasone
Prevalence
Hypovolemic shock


22. Treatment for atrial fibrillation.
Anticoagulation - rate control - cardioversion
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Wrist drop - loss of thumb abduction
M3


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

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24. Pure RBC aplasia.
Squamous cell carcinoma
Naloxone
Hypocalcemia
Diamond - Blackfan anemia


25. Antidepressants associated with hypertensive crisis.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
MAOIs
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Neither


26. Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Wait - surgical resection - radiation and/or androgen suppression
Endometriosis
CHF - shock - and altered mental status


27. 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
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma
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


28. Galactorrhea - impotence - menstrual dysfunction - and ? libido.
Contact dermatitis
Patient on dopamine antagonist
Hypoxia and hypocarbia
Number of deaths from birth to 28 days per 1000 live births


29. Indications for medical treatment of ectopic pregnancy.

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30. Name the organism:
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
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Pseudomonas
Streptococcus pneumoniae


31. Treatment of hypovolemic shock.
No. Parental consent is not necessary for the medical treatment of pregnant minors
Identify cause; fluid and blood repletion
Fluid restriction - demeclocycline
Obstructive pulmonary disease (e.g. - asthma)


32. Ring - enhancing brain lesion on CT with seizures
Nephrolithiasis
< 7.0
Taenia solium (cysticercosis)
IVIG or plasmapheresis


33. An antidiabetic agent associated with lactic acidosis.
Wait - surgical resection - radiation and/or androgen suppression
HIDA scan
Metformin
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)


34. A 55-year - old man is diagnosed with prostate cancer. Treatment options?
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
? protein intake - lactulose - neomycin
Wait - surgical resection - radiation and/or androgen suppression
All - compartment fasciotomy for suspected compartment syndrome


35. Molar pregnancy containing fetal tissue.
Observational bias
Confounding variable
Cerebral berry aneurysms (AD PCKD)
Partial mole


36. When should a vaginal exam be performed with suspected placenta previa?
Pheochromocytoma
Basal cell carcinoma
Flumazenil
Never


37. Four characteristics of a nevus suggestive of melanoma.
Nephritic syndrome
Regresses after menopause
Asymmetry - border irregularity - color variation - large diameter
Biliary tract obstruction


38. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Renal cell carcinoma (RCC)
Pheochromocytoma
Incidence and prevalence
Consider Fitz - Hugh - Curtis syndrome


39. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Diphenhydramine or epinephrine 1:1000
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Calcium oxalate
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch


40. Fetal mortality?

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41. Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Phototherapy (mild) or exchange transfusion (severe)
Spinal stenosis
Hereditary spherocytosis
Hypertension - bradycardia - and abnormal respirations


42. The most common inherited hemolytic anemia.
Hereditary spherocytosis
Sheehan's syndrome (postpartum pituitary necrosis)
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.
Trauma; the second most common is berry aneurysm


43. Signs suggesting radial nerve damage with humeral fracture.
Emergent laparotomy to repair perforated viscus - likely stomach
Seventy percent if the stenosis is symptomatic
Wrist drop - loss of thumb abduction
Clomiphene citrate


44. Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Avascular necrosis
Phototherapy (mild) or exchange transfusion (severe)
Basal cell carcinoma


45. Treatment for benzodiazepine overdose.
Flumazenil
Seborrheic dermatitis. Treat with antifungals
Hypernatremia
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


46. Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow - up evaluation?
Continuous positive airway pressure
Neurofibromatosis 1
Colposcopy and endocervical curettage
Anemia of chronic disease


47. Lung cancer highly related to cigarette exposure.
Phencyclidine hydrochloride (PCP) intoxication
SCLC
Lung - breast - skin (melanoma) - kidney - GI tract
Varicella zoster


48. Nontender abdominal mass associated with elevated VMA and HVA.
Ultrasound
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Neuroblastoma


49. The most common cause of hypertension in young men.
Cerebral berry aneurysms (AD PCKD)
Hypotension and bradycardia
Retinoic acid
Excessive EtOH


50. Reynolds' pentad.

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