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. Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Respiratory alkalosis
IVIG or plasmapheresis


2. Presence of red cell casts in urine sediment.
Uterine massage; if that fails - give oxytocin
Ophthalmologic exam - CT - and MRI
Glomerulonephritis/nephritic syndrome
INH - penicillamine - hydralazine - procainamide


3. Defect in an X- linked syndrome with mental retardation -
O2 - analgesia - hydration - and - if severe - transfusion
Neuroleptic malignant syndrome
Lesch - Nyhan syndrome (purine salvage problem with
Treat immediately. Consent is implied in emergency situations


4. A 50-year - old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

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5. Annual screening for women with a strong family history of ovarian cancer.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
CA-125 and transvaginal ultrasound
A patient's family cannot require that a doctor withhold information from the patient
Fever - pharyngeal erythema - tonsillar exudate - lack of cough


6. Treatment for mild and severe unconjugated hyperbilirubinemia.
Parkland formula
Acute myelogenous leukemia (AML)
Pityriasis versicolor
Phototherapy (mild) or exchange transfusion (severe)


7. The most serious side effect of clozapine.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Diamond - Blackfan anemia
Agranulocytosis
Charcot's triad plus shock and mental status changes - with suppurative ascending cholangitis


8. ECG findings suggesting MI.
1
Both have ? hematocrit and RBC mass - but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Restrictive pulmonary disease
ST- segment elevation (depression means ischemia) - flattened T waves - and Q waves


9. A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Anion gap acidosis and 1
SSRIs
Giardia
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful


10. Low urine specific gravity in the presence of high serum osmolality.
M3
Alzheimer's and multi - infarct
DI
Conversion disorder


11. The most common cause of postpartum hemorrhage.
Check for ? ICP; look for papilledema
Absence seizures
Uterine atony
Snowstorm on ultrasound. 'Cluster - of - grapes' appearance on gross examination


12. Treatment for mild - persistent asthma.
Inhaled Beta- agonists and inhaled corticosteroids
Basal cell carcinoma
Endometrial biopsy
Elevated ICP - RBCs - xanthochromia


13. Macrocytic - megaloblastic anemia without neurologic symptoms.
Folate deficiency
Ultrasound
Exercise stress treadmill with ECG
Selective IgA deficiency


14. Hematuria - hypertension - and oliguria.
Nephritic syndrome
Administration of DDAVP ? serum osmolality and free water restriction
Endometrial or estrogen receptor - breast cancer
Glanzmann's thrombasthenia


15. Heinz bodies?
Sheehan's syndrome (postpartum pituitary necrosis)
IV penicillin or ampicillin
Intracellular inclusions seen in thalassemia - G6PD deficiency - and postsplenectomy
Coarctation of the aorta


16. The most common form of glomerulonephritis.

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17. Medical options for endometriosis.
Number of deaths from 20 weeks' gestation to birth per 1000 total births
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
Respiratory alkalosis
OCPs - danazol - GnRH agonists


18. Indications for surgical repair of abdominal aortic aneurysm.
Obstructive pulmonary disease (e.g. - asthma)
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
> 5.5 cm - rapidly enlarging - symptomatic - or ruptured
Aseptic (viral) meningitis


19. RTA associated with aldosterone defect.
Type IV (distal) RTA
Bacillus cereus
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed


20. The most common 1
Agranulocytosis
Multiple myeloma
Radiation
Consider Fitz - Hugh - Curtis syndrome


21. Name the organism:
Lesions of 1
Salmonella
Immediate cardioversion
Intraductal papilloma


22. Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Monoclonal gammopathy - Bence Jones proteinuria - 'punched - out' lesions on x- ray of the skull and long bones
Lead - time bias
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Type I (distal) RTA


23. Signs of active ischemia during stress testing.
Wiskott - Aldrich syndrome
Angina - ST- segment changes on ECG - or ? BP
Number of live births per 1000 women 15-44 years of age
Conflict of interest


24. Vaccinations at a six- month well - child visit.
Displacement
Contact dermatitis
HBV - DTaP - Hib - IPV - PCV
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins


25. Tests to rule out shaken baby syndrome.
Pasteurella multocida
Ophthalmologic exam - CT - and MRI
Metformin
Seborrheic keratosis


26. An agent that reverses the effects of heparin.
Treat existing heart failure and replace the tricuspid valve
Protamine
A patient's family cannot require that a doctor withhold information from the patient
Calcium oxalate


27. T- wave flattening and U waves.
A patient's family cannot require that a doctor withhold information from the patient
Anemia - thrombocytopenia - and acute renal failure
1
Hypokalemia


28. Not contraindications to vaccination.
1
Abdominal ultrasound and CT
Mild illness and/or low - grade fever - current antibiotic therapy - and prematurity
Headache


29. 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?
Chloramphenicol - sulfonamides - radiation - HIV - chemotherapeutic agents - hepatitis - parvovirus B19 - EBV
Usually resolves spontaneously; may require IVIG and/or corticosteroids
BP > 140/90 on three separate occasions two weeks apart
Legionella pneumonia


30. When can a physician refuse to continue treating a patient on the grounds of futility?
Arthralgias - migratory polyarthropathies - Bell's palsy - myocarditis
Obstructive pulmonary disease (e.g. - asthma)
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
Avascular necrosis


31. Name the organism:
Anticholinergics (oxybutynin) or Beta- adrenergics (metaproterenol) for urge incontinence.
Pneumococcus - meningococcus - H. influenzae. Treat with cefotaxime and vancomycin
Alopecia areata (autoimmune process)
Pseudomonas


32. Sensitive tests have few false negatives and are used to rule _____ a disease.
Suspect retinoblastoma
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
Incidence and prevalence
Out


33. Thrombotic thrombocytopenic purpura (TTP) pentad?
OCP and barrier contraception
Immediate cardioversion
Pentad of TTP
Type II (proximal) RTA


34. 'Stones - bones - groans - psychiatric overtones.'
Nephrotic syndrome
Mallory- Weiss
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
Signs and symptoms of hypercalcemia


35. Name the organism:
Small cell lung cancer (SCLC)
Pasteurella multocida
Endometrial or estrogen receptor - breast cancer
Phototherapy (mild) or exchange transfusion (severe)


36. A 55-year - old man has sudden - excruciating first MTP joint pain after a night of drinking red wine. Diagnosis - workup - and chronic treatment?
INH - penicillamine - hydralazine - procainamide
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
HBV immunoglobulin
Gout. Needle - shaped - negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid


37. Eight surgically correctable causes of hypertension.

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38. Name the defense mechanism:
Regression
Prostate cancer is the most common cancer in men - but lung cancer causes more deaths
Abdominal obesity - high triglycerides - low HDL - hypertension - insulin resistance - prothrombotic or proinflammatory states
Actinomyces israelii


39. A patient presents with pain on passive movement - pallor - poikilothermia - paresthesias - paralysis - and pulselessness. Treatment?
Absence seizures
Flumazenil
All - compartment fasciotomy for suspected compartment syndrome
Antipsychotics (neuroleptic malignant syndrome)


40. A neonate has meconium ileus.

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41. Class of drugs that may cause syndrome of muscle rigidity - hyperthermia - autonomic instability - and extrapyramidal symptoms.
Patient on dopamine antagonist
Kl
Lesch - Nyhan syndrome (purine salvage problem with
Antipsychotics (neuroleptic malignant syndrome)


42. Characteristics of 2

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43. Lung cancer associated with SIADH.
Lobular carcinoma in situ
IV penicillin or ampicillin
Headache
Small cell lung cancer (SCLC)


44. A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Bacillus cereus
Nephritic syndrome
Edrophonium


45. Identify key organisms causing diarrhea:
Conduct disorder
Oral or topical metronidazole
Stasis - hypercoagulability - endothelial damage
Vibrio - HAV


46. A first - born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe - consider a Pavlik harness to maintain abduction
Number of live births per 1000 population
Acute pancreatitis
Selective IgA deficiency


47. Attributable risk?
PT
The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed
IVIG or plasmapheresis
Protamine


48. Name the organism:
Pseudomonas
Acute pancreatitis
Neisseria meningitidis
Highly sensitive for TB


49. Asplenic patients are particularly susceptible to these organisms.
Uterine atony
Hypovolemic shock
Encapsulated organisms -- pneumococcus - meningococcus - Haemophilus influenzae - Klebsiella
Acute mania - immunosuppression - thin skin - osteoporosis - easy bruising - myopathies


50. Name the defense mechanism:
Elevated ICP - RBCs - xanthochromia
Pseudogout
Conversion disorder
Displacement