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. Name the defense mechanism:
Sarcoidosis
SSRIs
Substance abuse
Displacement


2. Complication of scaphoid fracture.
Avascular necrosis
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs


3. A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Varicella zoster
No. Parental consent is not necessary for the medical treatment of pregnant minors
Factitious disorder (Munchausen syndrome)
Actinomyces israelii


4. Inspiratory arrest during palpation of the RUQ.

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5. Identify key organisms causing diarrhea:
? protein intake - lactulose - neomycin
S. aureus
Distal radius (Colles' fracture)
RCC or other erythropoietin - producing tumor; evaluate with CT scan


6. A patient continues to use cocaine after being in jail - losing his job - and not paying child support.
Septic or anaphylactic shock
Substance abuse
Cellulitis
Oral surgery


7. Dermatomal distribution.
Haemophilus ducreyi
Varicella zoster
Wegener's granulomatosis and Goodpasture's syndrome
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6


8. A man unexpectedly flies across the country - takes a new name - and has no memory of his prior life.
Flumazenil
Regression
Dantrolene or bromocriptine
Dissociative fugue


9. A late - life - threatening complication of chronic myelogenous leukemia (CML).
Nitroprusside
Chronic granulomatous disease
Benzodiazepines
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)


10. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
Salmonella
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)


11. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Wiskott - Aldrich syndrome
Intussusception
Actinic keratosis
Neurofibromatosis 1


12. Identify key organisms causing diarrhea:
Wiskott - Aldrich syndrome
Angina is new - is worsening - or occurs at rest
Displacement
Giardia


13. 'Stones - bones - groans - psychiatric overtones.'
Rett's disorder
Angina is new - is worsening - or occurs at rest
Signs and symptoms of hypercalcemia
Asherman's syndrome


14. Hyperphagia - hypersexuality - hyperorality - and hyperdocility.
Isolation
von Willebrand's disease; treat with desmopressin - FFP - or cryoprecipitate
Sheehan's syndrome (postpartum pituitary necrosis)
Kl


15. Treatment for acetaminophen overdose.
N- acetylcysteine
Actinic keratosis
SSRIs
Neither


16. First step in the management of a patient with acute GI bleed.
Wegener's granulomatosis and Goodpasture's syndrome
Beta- blockers - digoxin - calcium channel blockers
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Establish the ABCs


17. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
Factitious disorder (Munchausen syndrome)
Pityriasis rosea
Chronic lymphocytic leukemia (CLL)
Glanzmann's thrombasthenia


18. Symptoms of placenta previa.
Anticoagulation - rate control - cardioversion
Self - limited - painless vaginal bleeding
Broca's aphasia. Frontal lobe - left MCA distribution
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin


19. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
Cellulitis
Diverticulosis
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
Psoriasis


20. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Osteogenesis imperfecta
68% - 95.5% - 99.7%
Alport's syndrome
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


21. Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Acute myelogenous leukemia (AML)
Iatrogenic steroid administration. The second most common cause is Cushing's disease


22. A violent patient has vertical and horizontal nystagmus.
Placental abruption and placenta previa
Phencyclidine hydrochloride (PCP) intoxication
Patent ductus arteriosus (PDA)
Osmotic fragility test


23. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
1
Malignancy and hyperparathyroidism
Hypoparathyroidism
Nephrotic syndrome


24. A crescent - shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma
1
Placental abruption and placenta previa
E. coli O157:H7


25. Microcytic anemia with ? serum iron - ? ferritin - and ? TIBC.
Treat existing heart failure and replace the tricuspid valve
Iron deficiency anemia
Regresses after menopause
Nephrolithiasis


26. Identify key organisms causing diarrhea:
Partial mole
INH - penicillamine - hydralazine - procainamide
Isolation
Bacillus cereus


27. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Low - voltage - diffuse ST- segment elevation
SIADH due to stress
Beta- blockers - digoxin - calcium channel blockers
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


28. Caf
Neurofibromatosis 1
Abdominal ultrasound and CT
Pregnant women. Treat this group aggressively because of potential complications
Subarachnoid hemorrhage (SAH)


29. The most common inherited hemolytic anemia.
Actinomyces israelii
Lesion of 1
Hereditary spherocytosis
Hypotension and bradycardia


30. Exophthalmos - pretibial myxedema - and ? TSH.

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31. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Allergic interstitial nephritis
Lead - time bias
Confounding variable
HBV - DTaP - Hib - IPV - PCV


32. Unilateral - severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
Folate deficiency
Huntington's disease
PT


33. The first test to perform when a woman presents with amenorrhea.
Pulsus paradoxus (seen in cardiac tamponade)
Beta- hCG; the most common cause of amenorrhea is pregnancy
Diamond - Blackfan anemia
Postinfectious glomerulonephritis


34. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Nephrotic syndrome
S. aureus or S. epidermidis.
Pharmacologic stress test (e.g. - dobutamine echo)


35. A patient fails to lactate after an emergency C- section with marked blood loss.

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

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37. Cross - sectional survey
Phencyclidine hydrochloride (PCP) intoxication
Out
Prevalence
SCLC


38. Name the organism:
Toxoplasma gondii
a - antagonists (phentolamine and phenoxybenzamine)
Herpes simplex
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation


39. 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
E. coli O157:H7
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
Asymmetry - border irregularity - color variation - large diameter


40. The most common cause of hypothyroidism.

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41. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
1
Patent ductus arteriosus (PDA)
Hypovolemic shock
Lichen planus


42. Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
Hereditary spherocytosis
Iron deficiency anemia
Endometrial biopsy


43. Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
V/Q scan
Polymyalgia rheumatica
Kwashiorkor (protein malnutrition)


44. Asplenic patients are particularly susceptible to these organisms.
Febrile seizures (roseola infantum)
DM - SLE - and amyloidosis
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
RCC or other erythropoietin - producing tumor; evaluate with CT scan


45. Treatment of tension pneumothorax.
Immediate needle thoracostomy
Malingering
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Osmotic fragility test


46. Cohort study
Incidence and prevalence
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Broca's aphasia. Frontal lobe - left MCA distribution
Sensitivity


47. IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Diverticulosis
Treat existing heart failure and replace the tricuspid valve
Pulsus paradoxus (seen in cardiac tamponade)
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


48. A 10-year - old child presents in status epilepticus - but her parents refuse treatment on religious grounds.

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49. Drowsiness - asterixis - nausea - and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Pharmacologic stress test (e.g. - dobutamine echo)
Fat - female - fertile - forty - flatulent


50. Characteristics of 2

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