USMLE USMLE-STEP-2 Online Practice Questions and Exam Preparation

USMLE USMLE-STEP-2 Online Questions & Answers

• Question 381:

  A 53-year-old woman with five adult children complains of losing urine shortly after coughing or jumping. She occasionally loses urine while lying in bed if she happens to cough vigorously. She is unable to stop the urine once it has begun to flow.

  Which of the following is the treatment of choice for this woman's urinary incontinence?

  A. a course of nitrofurantoin
  B. a selective serotonin reuptake inhibitor (SSRI)
  C. oxybutynin chloride (Ditropan)
  D. vaginal hysterectomy and anterior colporrhaphy
  E. a Marshall-Marchetti-Krantz urethropexy
  C. oxybutynin chloride (Ditropan)

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  Explanation

  Antibiotics are useful only when there is evidence of cystitis. SSRIs are antidepressants that have not been shown to improve incontinence with detrusor dyssynergia. Surgery is of no value and may actually worsen incontinence in women with detrusor dyssynergia. Bladder retraining, in which the patient embarks on a programmed progressive lengthening of the interval of voiding, forms the basis of therapy. While such retraining is occurring, the use of anticholinergic drugs, such as oxybutynin chloride (Ditropan), propantheline (Pro-Banthine), or flavoxate (Urispas), seems to improve the results over use of any one alone.

• Question 382:

  Food-borne illness has been a recurrent problem in your community over the past year. As a result of this, you ask that the health department's registered sanitarian pay particular attention to which of the following during his inspection of restaurants?

  A. unhygienic food-handling methods
  B. improper storage of rodenticides
  C. inadequate cooking
  D. the use of unlabeled products
  E. use of old utensils
  A. unhygienic food-handling methods

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  Explanation

  The major hazards associated with foodborne illnesses are of biological origin. Although all of the phases of the food preparation process may present opportunities for contamination, the major problem is related to food handling rather than to the quality of the food itself. Poor personal hygiene and improper holding temperatures are the leading factors resulting in contamination with bacterial and viral pathogens. Commonly reported pathogens include Salmonella, S. aureus, Shigella, C. perfringens, E. coli, hepatitis A, and Norovirus (previously described as Norwalk-like virus).

• Question 383:

  A56-year-old woman presents to the clinic for routine health screening. Her concern is the development of breast cancer. She has no current breast-related complaints. Past history is pertinent for fibrocystic changes with atypical ductal hyperplasia and a single fibroadenoma, both diagnosed by open biopsy 5 years ago. She smokes one pack per day and drinks one can of beer daily. Family history is positive for breast cancer in her mother, diagnosed at the age of 85. Current medications include a cholesterol lowering agent, an antihypertensive, and HRT, which she has taken for 5 years. Physical examination is unremarkable. Mammograms show dense breasts, decreasing the accuracy of the study, but no suspicious findings were noted. Which of the following is the most common risk factor in evaluating women for breast cancer?

  A. fibrocystic changes with atypical ductal hyperplasia
  B. alcohol consumption
  C. positive family history
  D. HRT
  E. age
  E. age

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  Explanation

  Anumber of breast cancer risk factors have been identified. These include family history, benign breast disease with atypical epithelial hyperplasia, alcohol consumption, and HRT. The most common and clinically useful risk factors are age and female gender. In most patients (70%) with breast cancer, however, no other major risk factor can be identified.

• Question 384:

  A17-year-old girl comes to the clinic with several weeks of joint pain and rash. The joint pain is most prominent in the hands. She states that the pain is most severe in the morning and tends to improve over the day. She has noted some swelling of her fingers. She has also had a rash on her face that becomes more prominent when she is outdoors. She states that sunlight tends to bother her eyes. On further questioning, she states that she has not felt well for several months. She has had intermittent fever, has been more tired than usual, and has lost weight although she has not been restricting her diet. On physical examination, she looks tired. She has lost 5 lbs since her last visit 1 year ago. She has an erythematous rash on her cheeks. She has several shallow ulcers in her mouth. She has fusiform swelling of her fingers and pain with movement of her fingers.

  Which of the following is the most likelydiagnosis?

  A. systemic lupus erythematosus (SLE)
  B. dermatomyositis
  C. juvenile rheumatoid arthritis
  D. rheumatic fever
  E. Lyme disease
  A. systemic lupus erythematosus (SLE)

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  Explanation

  SLE is an autoimmune disorder that affects multiple organs. The diagnosis is based on the presence of four or more major criteria. These include malar rash, oral ulcers, arthritis, and photosensitivity. This patient has all of these symptoms, as well as the systemic symptoms often seen at presentation. The disorder is predominately a disease of women and, in the pediatric population, is a disease of adolescence. Chronic renal disease is an important and common cause of morbidity and mortality among patients with SLE.

• Question 385:

  Which feature of fibrocystic disease of the breast is associated with the greatest risk of developing breast cancer?

  A. number of nodules
  B. serous nipple discharge
  C. size of the dominant mass
  D. presence of epithelial hyperplasia
  E. presence of a palpable axillary node
  D. presence of epithelial hyperplasia

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  Explanation

  Fibrocystic disease includes a variety of histologic findings. Typical is proliferation and hyperplasia of the lobular, ductal, and acinar epithelium. Histologic variants include variable- sized cysts, adenosis, fibrosis, duct ectasia, apocrine metaplasia, and others. Ductal epithelial hyperplasia and apocrine metaplasia with atypia are the findings associated with the greatest risk of subsequent breast cancer. The presence of histologic atypia increases the woman's chance of breast cancer fivefold.

• Question 386:

  A32-year-old woman is referred to you by her dermatologist for further evaluation. She developed these changes gradually in the last year. Her hands are seen in Figure. What other associated disease is most likely?

  

  A. acquired immune deficiency syndrome (AIDS)
  B. Addison's disease
  C. lymphoma
  D. primary biliary cirrhosis
  E. Hashimoto's thyroiditis
  E. Hashimoto's thyroiditis

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  Explanation

  Up to 30% of cases of acquired vitiligo are associated with thyroid disease, especially Hashimoto's thyroiditis. It also may occur with pernicious anemia, diabetes, and other autoimmune disorders. Vitiligo has not been reported with AIDS. Addison's disease, lymphoma, and biliary cirrhosis can be associated with hyperpigmentation.

• Question 387:

  Select the organism associated with the Furunculosis

  A. aureus
  B. beta-hemolytic Streptococcus
  C. perfringens
  D. Mycoplasma pneumoniae
  E. Haemophilus pertussis
  F. Helicobacter pylori
  G. Escherichia coli
  H. Rickettsia prowazekii
  I. Giardia lamblia
  A. aureus

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  Explanation

  Giardiasis may cause cramping and a chronic diarrheal syndrome, with malabsorption and weight loss. Its distribution is worldwide, particularly where hygienic standards are not high. It also occurs sporadically in high-risk individuals. Streptococcal pyoderma, including erysipelas and impetigo, has been demonstrated to precede acute glomerulonephritis. Even when appropriate antibiotics are given in adequate dosage and duration for these conditions, renal damage may still result. Prevention thus consists of wound care, including cleaning wounds well and removal of crust. Mycoplasma infections are particularly common in families with younger children. They are frequently imported to the family by school-aged children, leading to a low-grade fever and persisting tracheobronchitis in the parents, or more acutely, an atypical pneumonia. G. lamblia is found in up to 20% of homosexual males, and may cause chronic diarrhea, although in these patients it tends to be asymptomatic. E. coli was first reported as a cause of watery diarrhea in nurseries in the 1940s. Although nursery epidemics with enteropathogenic serotypes had decreased in recent years in the United States, the increase of infant- child day care centers has resulted in their relatively frequent occurrence. Furunculosis is most frequently caused by coagulase-positive staphylococcal infections. The public health significance of this largely relates to the hazards of skin infections in food handlers and subsequent staphylococcal toxin in the food, leading to staphylococcal intoxication food-borne disease. H. pylori has been associated with gastric ulcers, but not with duodenal ulcers. Otitis media, whether acute or with effusion, commonly results from viral infection, such as by RSV. Various other organisms may be responsible including Streptococcu pneumoniae, H. influenzae, and others. C. perfringens, with rare exceptions, is transmitted in a meat dish prepared in bulk. Under propitious circumstances for the organism, especially on cooling of the food, bacterial multiplication can be very rapid. Symptoms begin to occur in the affected population in about 12 hours. Epidemic typhus is a rickettsial illness. Man is the host and long-term reservoir. The vectors are body lice (P. humanus corporis). The rickettsia are not present in human excretions and cannot be transmitted by person-to-person contact.

• Question 388:

  A24-year-old female is infected with HIV from an unprotected sexual exposure. What is the median time for this patient to develop clinical disease if she is not treated?

  A. 6 months
  B. 1 year
  C. 5 years
  D. 10 years
  E. 15 years
  D. 10 years

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  Explanation

  The median time from initial infection with HIV to the development of clinical disease is 10 years. The rate of disease progression is highly variable and directly correlates with HIV RNA levels. With high levels of HIV RNA, the disease progresses faster. During the asymptomatic period of HIV infection, CD4+ cells decline at an average rate of 50 L per year.

  Some patients do not progress and show little if any decline in CD4+ counts over time.

• Question 389:

  A24-year-old cocaine addict with no previous psychiatric history, reports that he had been bingeing on cocaine for 2 months earlier in the year. He stopped using cocaine 2 months ago, and he has been very sad and tearful for the entire period since he stopped his cocaine use. Identify the diagnosis below that best describes the situation.

  A. major depressive disorder, recurrent
  B. bipolar I disorder
  C. bipolar II disorder
  D. cyclothymia
  E. dysthymic disorder
  F. mood disorder due to a general medical condition
  G. substance-induced mood disorder
  G. substance-induced mood disorder

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  Explanation

  The criteria for mood disorders depend on the presence or absence and duration of depressive and hypomanic or manic symptoms as well as on their severity, and also on the presence or absence of a causative general medical condition or the ingestion of substances. Major depressive disorder, recurrent, is marked by the lifetime occurrence of two or more major depressive episodes without intervening hypomanic or manic episodes. A major depressive episode is a severe depression which has lasted at least 2 weeks. Bipolar I disorder is characterized by a history of at least one full-blown manic episode, during which the patient's mood has been abnormally and persistently elevated, expansive or irritable for at least 1 week with marked impairment in occupational functioning. Bipolar II disorder, on the other hand, is marked by a history of at least one major depressive episode and at least one hypomanic episode, during which a patient's mood has been elevated, but not to the extent of causing marked impairment in social or occupational functioning. Apatient with bipolar II disorder may not, by definition, have had a full- blown manic episode.

  Cyclothymia is marked by periods of hypomanic symptoms alternating with depressive symptoms that do not meet the criteria for a major depressive episode. Dysthymic disorder is marked by a persistent, low- grade depression occurring more days than not for at least 2 years. Amood disorder due to a general medical condition is a prominent and persistent disturbance in mood that is judged to be the direct physiologic effect of a general medical condition, such as hyperthyroidism. A substance-induced mood disorder is a prominent and persistent disturbance in mood that is judged to be due to the direct effects of a substance, but which continues beyond the usual period of intoxication or withdrawal from a substance.

• Question 390:

  A35-year-old man comes into the hospital with deep sadness and suicidal thoughts. He reports having experienced similar episodes in the past; he says he has also experienced two periods of extremely elated moods, during which he talked nonstop, went without sleep, and believed he was God. Identify the diagnosis below that best describes the situation.

  A. major depressive disorder, recurrent
  B. bipolar I disorder
  C. bipolar II disorder
  D. cyclothymia
  E. dysthymic disorder
  F. mood disorder due to a general medical condition
  G. substance-induced mood disorder
  B. bipolar I disorder

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  Explanation

  The criteria for mood disorders depend on the presence or absence and duration of depressive and hypomanic or manic symptoms as well as on their severity, and also on the presence or absence of a causative general medical condition or the ingestion of substances. Major depressive disorder, recurrent, is marked by the lifetime occurrence of two or more major depressive episodes without intervening hypomanic or manic episodes. A major depressive episode is a severe depression which has lasted at least 2 weeks. Bipolar I disorder is characterized by a history of at least one full-blown manic episode, during which the patient's mood has been abnormally and persistently elevated, expansive or irritable for at least 1 week with marked impairment in occupational functioning. Bipolar II disorder, on the other hand, is marked by a history of at least one major depressive episode and at least one hypomanic episode, during which a patient's mood has been elevated, but not to the extent of causing marked impairment in social or occupational functioning. Apatient with bipolar II disorder may not, by definition, have had a full- blown manic episode.

  Cyclothymia is marked by periods of hypomanic symptoms alternating with depressive symptoms that do not meet the criteria for a major depressive episode. Dysthymic disorder is marked by a persistent, low- grade depression occurring more days than not for at least 2 years. Amood disorder due to a general medical condition is a prominent and persistent disturbance in mood that is judged to be the direct physiologic effect of a general medical condition, such as hyperthyroidism. A substance-induced mood disorder is a prominent and persistent disturbance in mood that is judged to be due to the direct effects of a substance, but which continues beyond the usual period of intoxication or withdrawal from a substance.