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 most common cause of postpartum hemorrhage.
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Uterine atony
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


2. Eosinophils in urine sediment.
Psoriasis
Allergic interstitial nephritis
Polymyalgia rheumatica
Murphy's sign - seen in acute cholecystitis


3. A patient with a history of lithium use presents with copious amounts of dilute urine.
Aseptic (viral) meningitis
Hyperkalemia
Diverticulosis
Nephrogenic diabetes insipidus (DI)


4. The most common cause of hypothyroidism.

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5. Dermatomal distribution.
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin
Varicella zoster
E. coli O157:H7
Hypovolemic shock


6. Macrocytic - megaloblastic anemia with neurologic symptoms.
Number of live births per 1000 women 15-44 years of age
Radiation
Erythema multiforme
B12 deficiency


7. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
ACEI
Lead - time bias
Yersinia
Small cell lung cancer (SCLC)


8. Name the organism:
Type II (proximal) RTA
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Pseudomonas
Lichen sclerosus


9. The most common cause of seizures in children (2-10 years).
Betamethasone or dexamethasone
Clostridium difficile
IgA nephropathy (Berger's disease)
Infection - febrile seizures - trauma - idiopathic


10. 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.
Treat immediately. Consent is implied in emergency situations
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Cardiomegaly - prominent pulmonary vessels - Kerley B lines - 'bat's - wing' appearance of hilar shadows - and perivascular and peribronchial cuffing
Diverticulosis


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

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12. Anemia associated with absent radii and thumbs - diffuse hyperpigmentation - caf

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13. Combined UMN and LMN disorder.
ALS
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Ulcerative colitis
Emergent laparotomy to repair perforated viscus - likely stomach


14. Arthritis - conjunctivitis - and urethritis in young men. Associated organisms?

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15. Treatment for TTP.
Never
Out
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Pseudomonas


16. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Beta- blockers - Ca2+ channel blockers - TCAs
Calcium oxalate
Regresses after menopause
Antipsychotics (neuroleptic malignant syndrome)


17. A patient presents with weakness - nausea - vomiting - weight loss - and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Osteoarthritis
Wiskott - Aldrich syndrome
MCP and PIP joints; DIP joints are spared
1


18. Caf
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
Septic or anaphylactic shock
Spinal stenosis
Neurofibromatosis 1


19. RTA associated with aldosterone defect.
Rate control - rhythm conversion - and anticoagulation
Kwashiorkor (protein malnutrition)
MCP and PIP joints; DIP joints are spared
Type IV (distal) RTA


20. Classic physical findings for endocarditis.

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21. The mainstay of Parkinson's therapy.
Hypertension - bradycardia - and abnormal respirations
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Levodopa/carbidopa
Beta- blockers - digoxin - calcium channel blockers


22. A 55-year - old man presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Lesion of 1
Levodopa/carbidopa
Neurofibromatosis 1


23. Name the organism:
Intussusception
Number of deaths per 1000 population
Restrictive pulmonary disease
Klebsiella


24. Salicylate ingestion ? In What type of acid - base disorder?
Huntington's disease
Fluids and antibiotics
Anion gap acidosis and 1
Slipped capital femoral epiphyses. AP and frog - leg lateral view


25. CSF findings:
Hypovolemic shock
MS
'Chocolate cysts -' powder burns
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


26. Tanner stage 3 in a six-year - old female.
Lobular carcinoma in situ
Precocious puberty
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
Diamond - Blackfan anemia


27. The most common causes of dementia.

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28. CSF findings:
Dressler's syndrome: fever - pericarditis - ? ESR
Femoral hernia
Cerebral berry aneurysms (AD PCKD)
Aseptic (viral) meningitis


29. Characteristics of 2

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30. Classic ECG findings in pericarditis.
Low - voltage - diffuse ST- segment elevation
Headache
Osmotic fragility test
Anemia - thrombocytopenia - and acute renal failure


31. Glomerulonephritis with deafness.

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32. The number of bacterial culture on a clean - catch specimen to diagnose a UTI.
Neisseria meningitidis
Anticoagulation - rate control - cardioversion
105 bacteria/mL
SIADH due to stress


33. Treatment of anaphylactic shock.
7-10 days
Diphenhydramine or epinephrine 1:1000
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Coccidioidomycosis. Amphotericin B


34. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Pemphigus vulgaris
Allergic interstitial nephritis
Type I (distal) RTA
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch


35. Virus associated with aplastic anemia in patients with sickle cell anemia.
Rett's disorder
Sheehan's syndrome (postpartum pituitary necrosis)
Parvovirus B19
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


36. Goal hemoglobin A1c for a patient with DM.
< 7.0
Intussusception
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)


37. Side effects of corticosteroids.
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Anorexia
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Isolation


38. Therapy for polycystic ovarian syndrome.
Inhaled Beta- agonists and inhaled corticosteroids
Weight loss and OCPs
Retinoic acid
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse


39. Four causes of microcytic anemia.
1
Hashimoto's thyroiditis
TICS
Flumazenil


40. Elevated erythropoietin level - elevated hematocrit - and normal O2 saturation suggest?
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Subdural hematoma
Paget's disease


41. Appropriate diagnostic test?
HGPRTase deficiency)
Rubella
TICS
Pharmacologic stress test (e.g. - dobutamine echo)


42. A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Kl
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
B12 deficiency


43. Treatment for benzodiazepine overdose.
Flumazenil
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Hypertension - bradycardia - and abnormal respirations
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella


44. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Intussusception
Identify cause; fluid and blood repletion
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


45. True or false: Once patients sign a statement giving consent - they must continue treatment.
Non - Hodgkin's lymphoma
Blast crisis (fever - bone pain - splenomegaly - pancytopenia)
Stasis - endothelial injury and hypercoagulability (Virchow's triad)
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


46. What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
Yersinia
Malignancy and hyperparathyroidism
BP > 140/90 on three separate occasions two weeks apart


47. Indications for medical treatment of ectopic pregnancy.

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48. An agent that reverses the effects of heparin.
IV penicillin or ampicillin
Trauma - alcohol withdrawal - brain tumor
Prerenal
Protamine


49. An 80-year - old man presents with fatigue - lymphadenopathy - splenomegaly - and isolated lymphocytosis. Suspected diagnosis?
? Ca2+ - ? K- - ? phosphate - ? uric acid
Incidence and prevalence
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Chronic lymphocytic leukemia (CLL)


50. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
SCLC
Stasis - hypercoagulability - endothelial damage
Mycobacterium tuberculosis
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful