USMLE USMLE Certifications USMLE-STEP-2 Questions & Answers

• Question 21:

  Little sedation, strong serotonin, and norepinephrine effect. Match the antidepressants below with the effect described.

  A. amitriptyline

  B. nefazodone

  C. citalopram

  D. phenelzine

  E. duloxetine

  Correct Answer: E

  The drugs listed in this question are examples of the various classes of antidepressants. These classes include the tricyclics, the SSRIs, the MAOIs, the triazolopyridines, and the serotonin-norepinephrine reuptake inhibitors. Understanding the site of action, neurotransmitter( s) involved, and side effects characteristic of these classes is helpful in selecting an antidepressant for a particular patient. SSRIs that are comparable in their antidepressant effects to the older tricyclics but significantly safer when taken in larger doses, as in suicidal overdose, are frequently used as the first choice in the treatment of depression. An example here is citalopram. Drugs that both inhibit serotonin reuptake and block 5-HT2 receptors are characteristic of the triazolopyridines. The overall effect of these actions is believed to decrease both depression and anxiety in patients. There are two drugs in this class: trazodone and nefazodone. Strong sedation caused by histaminergic and anticholinergic activity is seen in the older antidepressants--the tricyclics. These also have both serotonin and norepinephrine effects that are important in decreasing depression. Amitriptyline is the drug example listed here.

  Drugs demonstrating little sedation and significant serotonin, norepinephrine, and dopamine effects are more characteristic of the serotoninnorepinephrine reuptake inhibitors. They are effective in managing depression because there is no antihistaminergic activity and little sedation is seen. Duloxetine and Venlafaxine are examples. MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine by inhibiting their degradation. The MAOIs, although effective as antidepressants, are used relatively infrequently because of the potential development of a hypertensive crisis induced by consuming tyramine- containing foods while on the MAOI. An example here is phenelzine.

• Question 22:

  Strong sedation, strong serotonin effect, and norepinephrine effect, Match the antidepressants below with the effect described.

  A. amitriptyline

  B. nefazodone

  C. citalopram

  D. phenelzine

  E. duloxetine

  Correct Answer: A

  The drugs listed in this question are examples of the various classes of antidepressants. These classes include the tricyclics, the SSRIs, the MAOIs, the triazolopyridines, and the serotonin-norepinephrine reuptake inhibitors. Understanding the site of action, neurotransmitter( s) involved, and side effects characteristic of these classes is helpful in selecting an antidepressant for a particular patient. SSRIs that are comparable in their antidepressant effects to the older tricyclics but significantly safer when taken in larger doses, as in suicidal overdose, are frequently used as the first choice in the treatment of depression. An example here is citalopram. Drugs that both inhibit serotonin reuptake and block 5-HT2 receptors are characteristic of the triazolopyridines. The overall effect of these actions is believed to decrease both depression and anxiety in patients. There are two drugs in this class: trazodone and nefazodone. Strong sedation caused by histaminergic and anticholinergic activity is seen in the older antidepressants--the tricyclics. These also have both serotonin and norepinephrine effects that are important in decreasing depression. Amitriptyline is the drug example listed here.

  Drugs demonstrating little sedation and significant serotonin, norepinephrine, and dopamine effects are more characteristic of the serotoninnorepinephrine reuptake inhibitors. They are effective in managing depression because there is no antihistaminergic activity and little sedation is seen. Duloxetine and Venlafaxine are examples. MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine by inhibiting their degradation. The MAOIs, although effective as antidepressants, are used relatively infrequently because of the potential development of a hypertensive crisis induced by consuming tyramine- containing foods while on the MAOI. An example here is phenelzine.

• Question 23:

  Both a SSRI and serotonin type 2 (5-HT2) receptor blockade. Match the antidepressants below with the effect described.

  A. amitriptyline

  B. nefazodone

  C. citalopram

  D. phenelzine

  E. duloxetine

  Correct Answer: B

  The drugs listed in this question are examples of the various classes of antidepressants. These classes include the tricyclics, the SSRIs, the MAOIs, the triazolopyridines, and the serotonin-norepinephrine reuptake inhibitors. Understanding the site of action, neurotransmitter( s) involved, and side effects characteristic of these classes is helpful in selecting an antidepressant for a particular patient. SSRIs that are comparable in their antidepressant effects to the older tricyclics but significantly safer when taken in larger doses, as in suicidal overdose, are frequently used as the first choice in the treatment of depression. An example here is citalopram. Drugs that both inhibit serotonin reuptake and block 5-HT2 receptors are characteristic of the triazolopyridines. The overall effect of these actions is believed to decrease both depression and anxiety in patients. There are two drugs in this class: trazodone and nefazodone. Strong sedation caused by histaminergic and anticholinergic activity is seen in the older antidepressants--the tricyclics. These also have both serotonin and norepinephrine effects that are important in decreasing depression. Amitriptyline is the drug example listed here.

  Drugs demonstrating little sedation and significant serotonin, norepinephrine, and dopamine effects are more characteristic of the serotoninnorepinephrine reuptake inhibitors. They are effective in managing depression because there is no antihistaminergic activity and little sedation is seen. Duloxetine and Venlafaxine are examples. MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine by inhibiting their degradation. The MAOIs, although effective as antidepressants, are used relatively infrequently because of the potential development of a hypertensive crisis induced by consuming tyramine- containing foods while on the MAOI. An example here is phenelzine.

• Question 24:

  Primarily a selective serotonin reuptake inhibitor (SSRI). Match the antidepressants below with the effect described.

  A. amitriptyline

  B. nefazodone

  C. citalopram

  D. phenelzine

  E. duloxetine

  Correct Answer: C

  The drugs listed in this question are examples of the various classes of antidepressants. These classes include the tricyclics, the SSRIs, the MAOIs, the triazolopyridines, and the serotonin-norepinephrine reuptake inhibitors. Understanding the site of action, neurotransmitter( s) involved, and side effects characteristic of these classes is helpful in selecting an antidepressant for a particular patient. SSRIs that are comparable in their antidepressant effects to the older tricyclics but significantly safer when taken in larger doses, as in suicidal overdose, are frequently used as the first choice in the treatment of depression. An example here is citalopram. Drugs that both inhibit serotonin reuptake and block 5-HT2 receptors are characteristic of the triazolopyridines. The overall effect of these actions is believed to decrease both depression and anxiety in patients. There are two drugs in this class: trazodone and nefazodone. Strong sedation caused by histaminergic and anticholinergic activity is seen in the older antidepressants--the tricyclics. These also have both serotonin and norepinephrine effects that are important in decreasing depression. Amitriptyline is the drug example listed here.

  Drugs demonstrating little sedation and significant serotonin, norepinephrine, and dopamine effects are more characteristic of the serotoninnorepinephrine reuptake inhibitors. They are effective in managing depression because there is no antihistaminergic activity and little sedation is seen. Duloxetine and Venlafaxine are examples. MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine by inhibiting their degradation. The MAOIs, although effective as antidepressants, are used relatively infrequently because of the potential development of a hypertensive crisis induced by consuming tyramine- containing foods while on the MAOI. An example here is phenelzine.

• Question 25:

  A 50-year-old woman with a long history of taking trifluoperazine is noted to have repetitive chewing motions, and periodically protrudes her tongue. Her arms and shoulders seem to jerk fairly often, and there is a peculiar twisting movement in her right hand. She tried several of the "newer" medications that are not supposed to cause the movement problems, but then her auditory hallucinations started again. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned.

  A. amitriptyline

  B. clozapine

  C. divalproex

  D. fluoxetine

  E. hypericum perforatum

  F. olanzapine

  G. lorazepam

  H. propranolol

  I. temazepam

  J. thiothixene

  Correct Answer: B

  Signs of tardive dyskinesia are evident in this woman. She also was tried on several "newer" medications, one of which may have been olanzapine. This would have to be determined. Assuming this is so, a good choice is clozapine, which does not contribute to the development of tardive dyskinesia.

• Question 26:

  A 65-year-old woman with a history of cardiac problems complains that she has lost her appetite, she cries frequently, and has lost interest in her grandchildren, her gardening, and her craft making. She thinks maybe it is time to die. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned.

  A. amitriptyline

  B. clozapine

  C. divalproex

  D. fluoxetine

  E. hypericum perforatum

  F. olanzapine

  G. lorazepam

  H. propranolol

  I. temazepam

  J. thiothixene

  Correct Answer: D

  This woman is exhibiting signs of severe depression. Because of her cardiac condition, avoiding an antidepressant with negative cardiac effect is important; therefore, amitriptyline would be eliminated. Fluoxetine, an SSRI, would be an appropriate choice.

• Question 27:

  A 36-year-old man complains that he cannot sleep at night. "I just can't settle down; my mind is constantly working." He describes being able to complete a lot of work, being highly energized, and having a lot of fun. He is afraid that without sleep he will "crash." Once before, he took a medication for depression. He requests medication at this time. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned.

  A. amitriptyline

  B. clozapine

  C. divalproex

  D. fluoxetine

  E. hypericum perforatum

  F. olanzapine

  G. lorazepam

  H. propranolol

  I. temazepam

  J. thiothixene

  Correct Answer: C

  Ahypomanic state is described here. This is seen in bipolar I and bipolar II disorders. Atreatment of choice is the mood stabilizer divalproex. If psychotic symptoms were present, the addition of an antipsychotic would be indicated.

• Question 28:

  You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. Which of the following is the best way to monitor these patients for cardiovascular changes?

  A. electrocardiogram (ECG)

  B. chest x-ray (CXR)

  C. angiography

  D. pulmonary function tests

  E. echocardiography

  Correct Answer: E

  Marfan syndrome is an inherited disorder of connective tissue, but at least one-fourth of patients do not have an affected parent. Abnormal metabolism of collagen or elastin is suspected as the cause. Clinical features involve the eyes (upward subluxation of the lenses, myopia), cardiovascular system (aortic dilation, regurgitation, and aneurysms; mitral valve prolapse), and the skeleton (arachnodactyly, pectus deformity, joint laxity). Mental retardation and malar rash are not associated with Marfan. Afrequent finding is increased length of the limbs as compared with the trunk. Aortic root dilatation is a serious complication that can lead to aortic regurgitation, dissection, and even rupture.

  Mitral valve prolapse is also seen, but pulmonary stenosis, VSD, pulmonary hypertension, and CAD are not increased with Marfan syndrome. Echocardiography should be performed to follow the course of the heart. The other tests will not reveal aortic root dilatation or aneurysm formation.

• Question 29:

  You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. The major cause of morbidity and mortality in Marfan patients is cardiac. Which of the following is a common complication?

  A. pulmonary stenosis

  B. ventricular septal defect (VSD)

  C. pulmonary hypertension

  D. aortic root dilatation

  E. coronary artery disease (CAD)

  Correct Answer: D

  Marfan syndrome is an inherited disorder of connective tissue, but at least one-fourth of patients do not have an affected parent. Abnormal metabolism of collagen or elastin is suspected as the cause. Clinical features involve the eyes (upward subluxation of the lenses, myopia), cardiovascular system (aortic dilation, regurgitation, and aneurysms; mitral valve prolapse), and the skeleton (arachnodactyly, pectus deformity, joint laxity). Mental retardation and malar rash are not associated with Marfan. Afrequent finding is increased length of the limbs as compared with the trunk. Aortic root dilatation is a serious complication that can lead to aortic regurgitation, dissection, and even rupture.

  Mitral valve prolapse is also seen, but pulmonary stenosis, VSD, pulmonary hypertension, and CAD are not increased with Marfan syndrome. Echocardiography should be performed to follow the course of the heart. The other tests will not reveal aortic root dilatation or aneurysm formation.

• Question 30:

  You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. What other finding is associated with this disease?

  A. family history in 100% of the patients

  B. upward subluxation of the lenses

  C. mental retardation

  D. malar rash

  E. increased length of trunk compared with the limbs

  Correct Answer: B

  Marfan syndrome is an inherited disorder of connective tissue, but at least one-fourth of patients do not have an affected parent. Abnormal metabolism of collagen or elastin is suspected as the cause. Clinical features involve the eyes (upward subluxation of the lenses, myopia), cardiovascular system (aortic dilation, regurgitation, and aneurysms; mitral valve prolapse), and the skeleton (arachnodactyly, pectus deformity, joint laxity). Mental retardation and malar rash are not associated with Marfan. Afrequent finding is increased length of the limbs as compared with the trunk. Aortic root dilatation is a serious complication that can lead to aortic regurgitation, dissection, and even rupture.

  Mitral valve prolapse is also seen, but pulmonary stenosis, VSD, pulmonary hypertension, and CAD are not increased with Marfan syndrome. Echocardiography should be performed to follow the course of the heart. The other tests will not reveal aortic root dilatation or aneurysm formation.