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. Side effects of corticosteroids.
Graves' disease
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Contact dermatitis


2. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Cerebral berry aneurysms (AD PCKD)
BP > 140/90 on three separate occasions two weeks apart
High reliability - low validity
Fatigue and impending respiratory failure


3. Low urine specific gravity in the presence of high serum osmolality.
DI
Ampulla of the oviduct
Rate control - rhythm conversion - and anticoagulation
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides


4. Acute - phase treatment for Kawasaki disease.
B12 deficiency
High - dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Malingering
Esophageal atresia with distal TEF (85%). Unable to pass NG tube


5. 'Stones - bones - groans - psychiatric overtones.'
Renal cell carcinoma (RCC)
Basal cell carcinoma
Signs and symptoms of hypercalcemia
Chronic lymphocytic leukemia (CLL)


6. CSF findings:
Duchenne muscular dystrophy
Anemia of chronic disease
Aseptic (viral) meningitis
Obstructive pulmonary disease (e.g. - asthma)


7. A middle - aged man presents with acute - onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis - and how did he get it? Treatment?
Endometrial or estrogen receptor - breast cancer
Bladder rupture or urethral injury
Lyme disease - Ixodes tick - doxycycline
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms


8. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Weight gain - type 2 DM - QT prolongation
Fatigue and impending respiratory failure
All - compartment fasciotomy for suspected compartment syndrome
Prinzmetal's angina


9. Causes of drug - induced SLE.
Selective IgA deficiency
INH - penicillamine - hydralazine - procainamide
Higher incidence
Mycobacterium tuberculosis


10. Drugs that slow AV node transmission.
Neuroleptics
Beta- blockers - Ca2+ channel blockers - TCAs
IVIG or plasmapheresis
Beta- blockers - digoxin - calcium channel blockers


11. A patient hasn't slept for days - lost $20 -000 gambling - is agitated - and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g. - lithium)
Hypokalemia
Fluid restriction - demeclocycline
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured


12. Fetal mortality?

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13. Conditions in which confidentiality must be overridden.
RCC or other erythropoietin - producing tumor; evaluate with CT scan
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Number of live births per 1000 women 15-44 years of age


14. Vaccinations at a six- month well - child visit.
They can mask symptoms of hypoglycemia
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
HBV - DTaP - Hib - IPV - PCV
Actinic keratosis


15. May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
Murphy's sign - seen in acute cholecystitis
Parvovirus B19
Hypotension - distant heart sounds - and JVD


16. The most common type of nephrolithiasis.
Avascular necrosis
Calcium oxalate
Allergic interstitial nephritis
Parvovirus B19


17. Treatment for atrial fibrillation.
Stasis - hypercoagulability - endothelial damage
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Cardiogenic shock
Anticoagulation - rate control - cardioversion


18. 'Doughy skin.'
Pseudomonas
Hypernatremia
Retinoic acid
Pain - pallor - pulselessness - paralysis - paresthesia - poikilothermia


19. Treatment for DTs.
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
46 -XX
Benzodiazepines
Niacin


20. Treatment for mild - persistent asthma.
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Inhaled Beta- agonists and inhaled corticosteroids
Hypoxia and hypocarbia


21. + Nikolsky's sign.
Septic or anaphylactic shock
Pemphigus vulgaris
Check for ? ICP; look for papilledema
Treat immediately. Consent is implied in emergency situations


22. Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Naloxone
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Emergent laparotomy to repair perforated viscus - likely stomach


23. A patient has ? vaginal discharge and petechial patches in the upper vagina and cervix.
Niacin
Trichomonas vaginitis
Regresses after menopause
Neuroleptic malignant syndrome


24. Acid - base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Oral surgery
Bladder rupture or urethral injury
Diphenhydramine or epinephrine 1:1000


25. 'Stuck - on' appearance.
Seborrheic keratosis
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
N- acetylcysteine
Continuous positive airway pressure


26. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
OCPs - danazol - GnRH agonists
Pseudomonas


27. Peaked T waves and widened QRS.
Klebsiella
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Hyperkalemia
Levodopa/carbidopa


28. The most common inherited cause of hypercoagulability.
HBV immunoglobulin
Partial mole
Factor V Leiden mutation
Parainfluenza virus type 1


29. 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.
Lichen sclerosus
Clostridium difficile
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe


30. Breast malignancy presenting as itching - burning - and erosion of the nipple.

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31. Treatment of tension pneumothorax.
Observational bias
Parvovirus B19
Tabes dorsalis - general paresis - gummas - Argyll Robertson pupil - aortitis - aortic root aneurysms
Immediate needle thoracostomy


32. Case - control study
E. coli O157:H7
Sarcoidosis
Conversion disorder
Neither


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

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34. Charcot's triad.
Number of live births per 1000 population
Cerebral berry aneurysms (AD PCKD)
RUQ pain - jaundice - and fever/chills in the setting of ascending cholangitis
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


35. Gout - self - mutilation - and choreoathetosis.
Osmotic fragility test
HGPRTase deficiency)
Membranous glomerulonephritis
Obstructive pulmonary disease (e.g. - asthma)


36. An eight -year - old boy presents with hemarthrosis and ? PTT with normal PT and bleeding time. Diagnosis? Treatment?
Herpes simplex
Hypovolemic shock
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements


37. Signs of neurogenic shock.
OCP and barrier contraception
Hypotension and bradycardia
Streptococcus pneumoniae
Selective IgA deficiency


38. A 55-year - old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram - negative rods. What is the diagnosis?
A patient with chest trauma who was previously stable suddenly dies
Confounding variable
Niacin
Legionella pneumonia


39. The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Subarachnoid hemorrhage (SAH)
Benzodiazepines
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
68% - 95.5% - 99.7%


40. Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Cirrhosis - CHF - nephritic syndrome
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
Partial mole


41. Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Seminoma
50 cc/hour
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


42. A homeless child is small for his age and has peeling skin and a swollen belly.
Obstructive pulmonary disease (e.g. - asthma)
Inhaled Beta- agonists and inhaled corticosteroids
Number of deaths from 28 days to one year per 1000 live births
Kwashiorkor (protein malnutrition)


43. A young patient has angina at rest with ST- segment elevation. Cardiac enzymes are normal.

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44. A 30-year - old woman has unpredictable urine loss. Examination is normal. Medical options?
Fever - pharyngeal erythema - tonsillar exudate - lack of cough
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Seventy percent if the stenosis is symptomatic
They can mask symptoms of hypoglycemia


45. Flat - topped papules.
High TSH - low T4 - antimicrosomal antibodies
Lichen planus
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


46. The most likely cause of acute lower GI bleed in patients > 40 years old.
Glomerulonephritis/nephritic syndrome
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Spinal stenosis
Diverticulosis


47. A violent patient has vertical and horizontal nystagmus.
1
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Menometrorrhagia
Phencyclidine hydrochloride (PCP) intoxication


48. Name the organism:
Actinic keratosis
Klebsiella
Duodenal atresia
Kl


49. What is the immunodeficiency?

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50. The first test to perform when a woman presents with amenorrhea.
Campylobacter
Displacement
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
Beta- hCG; the most common cause of amenorrhea is pregnancy