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USMLE Step 2

Subjects : health-sciences, 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. T- wave flattening and U waves.
Cardiogenic shock
Wiskott - Aldrich syndrome
Hypokalemia
Erythema multiforme

2. The most common pituitary tumor. Treatment?
Tardive dyskinesia. ? or discontinue haloperidol and consider another antipsychotic (e.g. - risperidone - clozapine)
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
Likely BPH. Options include no treatment - terazosin - finasteride - or surgical intervention (TURP)
Protamine

3. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
ETEC
Headache
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Squamous cell carcinoma

4. A 15-year - old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Wegener's granulomatosis and Goodpasture's syndrome
Nephrotic syndrome
Herpes simplex
No. Parental consent is not necessary for the medical treatment of pregnant minors

5. Sentinel loop on AXR.
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Patent ductus arteriosus (PDA)
Acute mania. Start a mood stabilizer (e.g. - lithium)
Acute pancreatitis

6. Criteria for exudative effusion.
Wrist drop - loss of thumb abduction
Murphy's sign - seen in acute cholecystitis
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Diphenhydramine or epinephrine 1:1000

7. The first test to perform when a woman presents with amenorrhea.
Number of deaths per 1000 population
Beta- hCG; the most common cause of amenorrhea is pregnancy
Free air under the diaphragm - extravasation of contrast - severe bowl distention - space - occupying lesion (CT) - mesenteric occlusion (angiography)
Check for ? ICP; look for papilledema

8. Causes of exudative effusion.
Anemia of chronic disease
Lesion of 1
Beta- blockers - digoxin - calcium channel blockers
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis

9. Inspiratory arrest during palpation of the RUQ.

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10. A young child presents with proximal muscle weakness - waddling gait - and pronounced calf muscles.
Duchenne muscular dystrophy
Amoxicillin
Beta- blockers - digoxin - calcium channel blockers
Varicella zoster

11. What is the metabolic syndrome?
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Immediate cardioversion
SSRIs
Alport's syndrome

12. Proteinuria - hypoalbuminemia - hyperlipidemia - hyperlipiduria - edema.
Fluid restriction - demeclocycline
Nephrotic syndrome
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Osmotic fragility test

13. The most common cause of postpartum hemorrhage.
Uterine atony
Conduct disorder
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies
Hypovolemic shock

14. Vaccinations at a six- month well - child visit.
HBV - DTaP - Hib - IPV - PCV
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
Niacin
Lesch - Nyhan syndrome (purine salvage problem with

15. Glomerulonephritis with hemoptysis.

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16. Medical options for endometriosis.
OCPs - danazol - GnRH agonists
Uveitis - ankylosing spondylitis - pyoderma gangrenosum - erythema nodosum - 1
Hypocalcemia
Betamethasone or dexamethasone

17. Heinz bodies?
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Reaction formation
Wait - surgical resection - radiation and/or androgen suppression
Angina is new - is worsening - or occurs at rest

18. Infant mortality?
Third - degree heart block
Conduct disorder
Bruton's X- linked agammaglobulinemia
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

19. The number of true positives divided by the number of patients with the disease is _____.
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Number of deaths per 1000 population
Sensitivity
Widened mediastinum (> 8 cm) - loss of aortic knob - pleural cap - tracheal deviation to the right - depression of left main stem bronchus

20. Inflammation and epithelial thinning of the anogenital area - predominantly in postmenopausal women.
Sporothrix schenckii
Lichen sclerosus
BP > 140/90 on three separate occasions two weeks apart
Herpes simplex

21. An elderly male with hypochromic - microcytic anemia is asymptomatic. Diagnostic tests?
Cerebral berry aneurysms (AD PCKD)
Inhaled Beta- agonists and inhaled corticosteroids
Hyperkalemia
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

22. Causes of hypoxemia.
Radiation
Impetigo
Pemphigus vulgaris
Right - to - left shunt - hypoventilation - low inspired O2 tension - diffusion defect - V/Q mismatch

23. Infection of small airways with epidemics in winter and spring.
Prolactinoma. Dopamine agonists (e.g. - bromocriptine)
RSV bronchiolitis
Oral or topical metronidazole
Hereditary spherocytosis

24. Testicular cancer associated with Beta- hCG - AFP.
Choriocarcinoma
SSRIs
Haemophilus ducreyi
Sturge - Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

25. Natural history of a leiomyoma.
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis
IV hydration and loop diuretics (furosemide)
Regresses after menopause
High TSH - low T4 - antimicrosomal antibodies

26. Treatment for acute coronary syndrome.
Partial mole
'Sawtooth' P waves
Wernicke's encephalopathy due to a deficiency of thiamine
Morphine - O2 - sublingual nitroglycerin - ASA - IV Beta- blockers - heparin

27. Treatment for ventricular fibrillation.
Excessive EtOH
Immediate cardioversion
Osteogenesis imperfecta
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths

28. The most common location for an ectopic pregnancy.
ETEC
Ampulla of the oviduct
Threatened abortion
Kl

29. 'Dewdrop on a rose petal.'
Lesions of 1
Membranous glomerulonephritis
Fatigue and impending respiratory failure
Neurofibromatosis 1

30. A patient presents with tachycardia - wild swings in BP - headache - diaphoresis - altered mental status - and a sense of panic.
Retrograde cystourethrogram
Pheochromocytoma
Trauma - alcohol withdrawal - brain tumor
Kwashiorkor (protein malnutrition)

31. A patient presents with signs of hypocalcemia - high phosphorus - and low PTH.
Wiskott - Aldrich syndrome
Hypoparathyroidism
RSV bronchiolitis
1

32. A five - month - old girl has ? head growth - truncal dyscoordination - and ? social interaction.

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33. Name the organism:
Klebsiella
Transitional cell carcinoma
Higher incidence
CHF - shock - and altered mental status

34. Premalignant lesion from sun exposure that can ? squamous cell carcinoma.
Actinic keratosis
Headache
HIDA scan
Septic or anaphylactic shock

35. Causes of transudative effusion.
Signs and symptoms of hypercalcemia
Think of intact capillaries. CHF - liver or kidney disease - and protein - losing enteropathy
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves
105 bacteria/mL

36. Identify key organisms causing diarrhea:
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
< 7.0
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Isospora - Cryptosporidium - Mycobacterium avium complex (MAC)

37. A 24-year - old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Displacement
Legionella pneumonia
Tetracycline - fluoroquinolones - aminoglycosides - sulfonamides
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

38. If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status - then socioeconomic status is a _____.
Sensitivity
Confounding variable
Pasteurella multocida
Stasis - endothelial injury and hypercoagulability (Virchow's triad)

39. Case - control study
Neither
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Think of leaky capillaries. Malignancy - TB - bacterial or viral infection - pulmonary embolism with infarct - and pancreatitis
Pseudomonas

40. Complication of scaphoid fracture.
Pseudomonas
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids - O2 - analgesia - and 'tincture of time'
Herpes simplex
Avascular necrosis

41. Administer to a symptomatic patient to diagnose myasthenia gravis.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Regresses after menopause
Edrophonium
Membranous glomerulonephritis

42. The most common inherited hemolytic anemia.
Self - limited - painless vaginal bleeding
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Hereditary spherocytosis
68% - 95.5% - 99.7%

43. 'Cradle cap.'
Seborrheic dermatitis. Treat with antifungals
Lesions of 1
Pasteurella multocida
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin

44. Indications for surgical repair of abdominal aortic aneurysm.
Psoriasis
Uterine atony
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Pityriasis versicolor

45. Combined UMN and LMN disorder.
Immediate cardioversion
ALS
Confounding variable
Infection - febrile seizures - trauma - idiopathic

46. Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Malingering
Renal artery stenosis - coarctation of the aorta - pheochromocytoma - Conn's syndrome - Cushing's syndrome - unilateral renal parenchymal disease - hyperthyroidism - hyperparathyroidism
ARDS
Clomiphene citrate

47. CSF findings:
Never
Subarachnoid hemorrhage (SAH)
Psoriasis
= 200 for PCP (with TMP); = 50-100 for MAI (with clarithromycin/azithromycin)

48. Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Parkland formula
Suspect ankylosing spondylitis. Check HLA- B27
Calcium oxalate
Type I (distal) RTA

49. A 21-year - old male has three months of social withdrawal - worsening grades - flattened affect - and concrete thinking.
Allergic interstitial nephritis
Pseudomonas
Schizophreniform disorder (diagnosis of schizophrenia requires = 6 months of symptoms)
Distal radius (Colles' fracture)

50. First - line treatment for otitis media.
Reye's syndrome
Amoxicillin
? protein intake - lactulose - neomycin
Trichomonas vaginitis