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. Inflammatory disease of the colon with ? risk of colon cancer.
Ulcerative colitis
MCP and PIP joints; DIP joints are spared
Ultrasound
Reactive (Reiter's) arthritis. Associated with Campylobacter - Shigella - Salmonella - Chlamydia - and Ureaplasma


2. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
Calcium oxalate
OCP and barrier contraception
Cardiogenic shock


3. First - line medication for status epilepticus.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
IV benzodiazepine


4. A 55-year - old patient presents with acute 'broken speech.' What type of aphasia? What lobe and vascular distribution?

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5. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
AP chest - AP/lateral C- spine - AP pelvis
IV hydration and loop diuretics (furosemide)
Duchenne muscular dystrophy
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


6. PFT showing ? FEV1/FVC.
OCP and barrier contraception
Obstructive pulmonary disease (e.g. - asthma)
Choriocarcinoma
Conflict of interest


7. Key side effects of atypical antipsychotics.
Weight gain - type 2 DM - QT prolongation
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
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8. Presents with a herald patch - Christmas - tree pattern.
Pityriasis rosea
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Choriocarcinoma
Squamous cell carcinoma


9. Treatment of central DI.
Administration of DDAVP ? serum osmolality and free water restriction
Fatigue and impending respiratory failure
Isolation
Obstructive pulmonary disease (e.g. - asthma)


10. Bone is fractured in fall on outstretched hand.

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11. Exophthalmos - pretibial myxedema - and ? TSH.

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12. Radiographic indications for surgery in patients with acute abdomen.
Mallory- Weiss
Sarcoidosis
Diphenhydramine or epinephrine 1:1000
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)


13. Tanner stage 3 in a six-year - old female.
Chronic granulomatous disease
Precocious puberty
Giardia
Subarachnoid hemorrhage (SAH)


14. Beck's triad for cardiac tamponade.
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Hypotension - distant heart sounds - and JVD
Respiratory alkalosis
Hereditary spherocytosis


15. Cannon 'a' waves.
Hypertension - bradycardia - and abnormal respirations
INH - penicillamine - hydralazine - procainamide
Third - degree heart block
'Sawtooth' P waves


16. Treatment of DKA.
V/Q scan
5- aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Hypernatremia
Fluids - insulin - and aggressive replacement of electrolytes (e.g. - K+)


17. A four -year - old child presents with oliguria - petechiae - and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Establish the ABCs
Malignancy and hyperparathyroidism
Intraductal papilloma
Hemolytic - uremic syndrome (HUS) due to E. coli O157:H7


18. Signs of air embolism.
Endometrial or estrogen receptor - breast cancer
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)
Hereditary spherocytosis
A patient with chest trauma who was previously stable suddenly dies


19. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Acute pancreatitis
Trichomonas vaginitis
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


20. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Pregnant women. Treat this group aggressively because of potential complications
Acute mania. Start a mood stabilizer (e.g. - lithium)
Cardiogenic shock
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)


21. Peaked T waves and widened QRS.
Reye's syndrome
Suspect retinoblastoma
Number of deaths during pregnancy to 90 days postpartum per 100 -000 live births
Hyperkalemia


22. The most common cause of seizures in children (2-10 years).
Infection - febrile seizures - trauma - idiopathic
Establish the ABCs
Nitroprusside
Conflict of interest


23. Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Clomiphene citrate
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Varicella zoster


24. A patient with a history of lithium use presents with copious amounts of dilute urine.
Allergic interstitial nephritis
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Nephrogenic diabetes insipidus (DI)
Weight gain - type 2 DM - QT prolongation


25. RTA associated with aldosterone defect.
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Psoriasis
Membranous glomerulonephritis
Type IV (distal) RTA


26. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Taenia solium (cysticercosis)
Hypoxia and hypocarbia
Levodopa/carbidopa
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension


27. Hematuria - hypertension - and oliguria.
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Trauma - alcohol withdrawal - brain tumor
Iatrogenic steroid administration. The second most common cause is Cushing's disease
Nephritic syndrome


28. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Surfactant deficiency
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Trauma - alcohol withdrawal - brain tumor
Lead - time bias


29. Difference between Mallory- Weiss and Boerhaave tears.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Regression
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Mallory- Weiss


30. The most common type of skin cancer; the lesion is a pearly- colored papule with a translucent surface and telangiectasias.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Isolation
Basal cell carcinoma
Neither


31. 'Stones - bones - groans - psychiatric overtones.'
Signs and symptoms of hypercalcemia
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Acne vulgaris
RSV bronchiolitis


32. Name the organism:
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Toxoplasma gondii
Ultrasound


33. The most common cause of hypertension in young men.
Excessive EtOH
Hypotension - distant heart sounds - and JVD
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Pentad of TTP


34. ? CO - ? PCWP - ? PVR.
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Alzheimer's and multi - infarct
Uterine atony
Septic or anaphylactic shock


35. Vaccinations at a six- month well - child visit.
BP > 140/90 on three separate occasions two weeks apart
Ampulla of the oviduct
HBV - DTaP - Hib - IPV - PCV
Broca's aphasia. Frontal lobe - left MCA distribution


36. Treatment for benzodiazepine overdose.
Inevitable abortion
Consider Fitz - Hugh - Curtis syndrome
Seminoma
Flumazenil


37. Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Headache
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Suspect ankylosing spondylitis. Check HLA- B27
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


38. Name the defense mechanism:
Hypokalemia
Sporothrix schenckii
Group B strep - E. coli - Listeria. Treat with gentamicin and ampicillin
Reaction formation


39. Characteristics of 2

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40. Birth rate?
Lesion of 1
Number of live births per 1000 population
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Distal radius (Colles' fracture)


41. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia
Kl
Anion gap acidosis and 1
Neurofibromatosis 1


42. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
Wegener's granulomatosis and Goodpasture's syndrome
Lung - breast - skin (melanoma) - kidney - GI tract
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Reye's syndrome


43. A 50-year - old woman leaks urine when laughing or coughing. Nonsurgical options?
Lobular carcinoma in situ
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Basal cell carcinoma
Kegel exercises - estrogen - pessaries for stress incontinence


44. Treatment of septic shock.
Fluids and antibiotics
Hashimoto's thyroiditis
Membranous glomerulonephritis
Precocious puberty


45. May be seen in children who are accused of inattention in class and confused with ADHD.
Basal cell carcinoma
Absence seizures
Levodopa/carbidopa
Spinal stenosis


46. Antidepressants associated with hypertensive crisis.
Duchenne muscular dystrophy
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Chronic lymphocytic leukemia (CLL)
MAOIs


47. Gout - self - mutilation - and choreoathetosis.
The IR of a disease in a population exposed to a particular factor
Malignancy and hyperparathyroidism
Osteoarthritis
HGPRTase deficiency)


48. Rigidity and stiffness with resting tremor and masked facies.

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49. Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
Pityriasis versicolor
Femoral hernia
Hypertrophic cardiomyopathy


50. Number needed to treat?
Depersonalization disorder
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Parkland formula
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