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. A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
Malingering
Parainfluenza virus type 1
1


2. Identify key organisms causing diarrhea:
Salmonella
Lesions of 1
Pregnancy - vesicoureteral reflux - anatomic anomalies - indwelling catheters - kidney stones
M3


3. Identify key organisms causing diarrhea:
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Multiple myeloma
Vibrio - HAV


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

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5. Cold water is flushed into a patient's ear - and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Hypotension and bradycardia
The patient is a danger to self - a danger to others - or gravely disabled (unable to provide for basic needs)
Conversion disorder
Normal


6. Difference between Mallory- Weiss and Boerhaave tears.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Emergent large - volume plasmapheresis - corticosteroids - antiplatelet drugs
Mallory- Weiss
ALS


7. Involuntary commitment or isolation for medical treatment may be undertaken For what reason?
When treatment noncompliance represents a serious danger to public health (e.g. - active TB)
Klebsiella
High reliability - low validity
Hypotension and bradycardia


8. Medication to avoid in patients with a history of alcohol withdrawal seizures.
Sheehan's syndrome (postpartum pituitary necrosis)
OCPs - danazol - GnRH agonists
Neuroleptics
Hypernatremia


9. Flat - topped papules.
Lichen planus
Displacement
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
ALS


10. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Graves' disease
Neurofibromatosis 1
Seventy percent if the stenosis is symptomatic


11. Acid - base disorder in pulmonary embolism.
Trauma - alcohol withdrawal - brain tumor
Endometriosis
Hypoxia and hypocarbia
OCP and barrier contraception


12. Prophylactic treatment for migraine.
Third - degree heart block
Beta- blockers - Ca2+ channel blockers - TCAs
Depersonalization disorder
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


13. Identify key organisms causing diarrhea:
AP chest - AP/lateral C- spine - AP pelvis
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Frotteurism (a paraphilia)


14. The most common type of nephrolithiasis.
SIADH due to stress
Cardiogenic shock
Calcium oxalate
Impetigo


15. A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Out
Squamous cell carcinoma


16. Nikolsky's sign.
Bullous pemphigoid
Subarachnoid hemorrhage (SAH)
Campylobacter
TB medications (INH - rifampin - pyrazinamide) - acetaminophen - and tetracycline


17. Aplastic crisis in sickle cell disease.
Parvovirus B19
Nephrotic syndrome
Panic disorder
Fibrin split products and D- dimer are elevated; platelets - fibrinogen - and hematocrit are ?.


18. The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Neuroleptics
Surfactant deficiency
Lichen planus


19. Eight surgically correctable causes of hypertension.

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20. Treatment for atrial fibrillation.
Phencyclidine hydrochloride (PCP) intoxication
Anticoagulation - rate control - cardioversion
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Lesch - Nyhan syndrome (purine salvage problem with


21. Which healthy population is susceptible to UTIs?
MAOIs
Acute myelogenous leukemia (AML)
Giardia
Pregnant women. Treat this group aggressively because of potential complications


22. A violent patient has vertical and horizontal nystagmus.
N- acetylcysteine
Reaction formation
Phototherapy (mild) or exchange transfusion (severe)
Phencyclidine hydrochloride (PCP) intoxication


23. Type of ARF in a patient with FeNa < 1%.
Reye's syndrome
Prerenal
Low - voltage - diffuse ST- segment elevation
No. Parental consent is not necessary for the medical treatment of pregnant minors


24. A patient with a history of lithium use presents with copious amounts of dilute urine.
Sporothrix schenckii
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus
Nephrogenic diabetes insipidus (DI)
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


25. A crescent - shaped hyperdensity on CT that does not cross the midline.
Hypokalemia
MCP and PIP joints; DIP joints are spared
Subdural hematoma
Abdominal ultrasound and CT


26. Treatment for neuroleptic malignant syndrome.
Observational bias
Niacin
Dantrolene or bromocriptine
Chronic granulomatous disease


27. Causes of drug - induced SLE.
Number of deaths from birth to 28 days per 1000 live births
OCPs - danazol - GnRH agonists
Amoxicillin
INH - penicillamine - hydralazine - procainamide


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

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29. Risk factors for DVT.

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30. The mainstay of Parkinson's therapy.
Surfactant deficiency
Levodopa/carbidopa
Precocious puberty
RSV bronchiolitis


31. Test to rule out urethral injury.
Osmotic fragility test
Retrograde cystourethrogram
Clomiphene citrate
Nitroprusside


32. The coagulation parameter affected by warfarin.
Infection - cancer - and autoimmune disease
PT
B12 deficiency
Stasis - endothelial injury and hypercoagulability (Virchow's triad)


33. Electrolyte changes in tumor lysis syndrome.
Pemphigus vulgaris
? Ca2+ - ? K- - ? phosphate - ? uric acid
Benzodiazepines
Displacement


34. The diagnostic test for pulmonary embolism.
Ophthalmologic exam - CT - and MRI
Isolation
ALS
V/Q scan


35. Defect in an X- linked syndrome with mental retardation -
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
Uterine atony
Lesch - Nyhan syndrome (purine salvage problem with
Rubella


36. A febrile patient with a history of diabetes presents with a red - swollen - painful lower extremity.
MS
Cellulitis
Calcium oxalate
Hereditary spherocytosis


37. 1
Placental abruption and placenta previa
S. aureus or S. epidermidis.
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Hypotension - distant heart sounds - and JVD


38. 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)
M3
? Ca2+ - ? K- - ? phosphate - ? uric acid
Varicella zoster


39. ? CO - ? pulmonary capillary wedge pressure (PCWP) - ? peripheral vascular resistance (PVR).
Naloxone
Lead - time bias
Hypovolemic shock
Third - degree heart block


40. Not contraindications to vaccination.
Betamethasone or dexamethasone
Parvovirus B19
Pulsus paradoxus (seen in cardiac tamponade)
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity


41. CSF findings:
Infection - cancer - and autoimmune disease
Aseptic (viral) meningitis
Neuroblastoma
Beta- hCG; the most common cause of amenorrhea is pregnancy


42. What is the metabolic syndrome?
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Menometrorrhagia
Emergent laparotomy to repair perforated viscus - likely stomach
68% - 95.5% - 99.7%


43. Drugs that slow AV node transmission.
Vibrio - HAV
Pheochromocytoma
Fat - female - fertile - forty - flatulent
Beta- blockers - digoxin - calcium channel blockers


44. Symptoms of placenta previa.
High TSH - low T4 - antimicrosomal antibodies
Self - limited - painless vaginal bleeding
False. Withdrawing and withholding life are the same from an ethical standpoint
Edrophonium


45. A condition associated with red 'currant - jelly' stools.
Uterine massage; if that fails - give oxytocin
CF or Hirschsprung's disease
CA-125 and transvaginal ultrasound
Intussusception


46. Therapy for polycystic ovarian syndrome.
Parkinson's disease
Lesch - Nyhan syndrome (purine salvage problem with
Weight loss and OCPs
ARDS


47. Exophthalmos - pretibial myxedema - and ? TSH.

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48. Identify key organisms causing diarrhea:
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Klebsiella
Yersinia
Lung - breast - skin (melanoma) - kidney - GI tract


49. Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Immediate cardioversion
Phencyclidine hydrochloride (PCP) intoxication
Folate deficiency


50. Chromosomal pattern of a complete mole.
Intraductal papilloma
Osmotic fragility test
ACEI
46 -XX