USMLE USMLE Certifications USMLE-STEP-2 Questions & Answers

• Question 411:

  A study finds that the incidence of asthma in your community is higher than expected, and that 40% of the homes in your community are heated with forced air. Which of the following best describes this study design?

  A. ecological study

  B. cross-sectional study

  C. cohort study

  D. case-control study

  E. prospective study

  Correct Answer: A

  Ecological studies compare groups not individuals. The unit of observation in the above study was a community not individuals. A cross-sectional study design would have looked at the incidence of asthma in those who also owned the particular home heating system at a particular point in time. A cohort study would have taken disease-free individuals in the community who also owned the home heating system and followed them over time to see who developed disease. A case-control approach would have taken individuals with and without asthma and identified how many from each group also had the particular home heating system

• Question 412:

  A young woman who works full time doing manual work in a factory, but who also has secretarial skills, is making her first prenatal visit to your office. Her work involves climbing high ladders, with the risk of falling.

  Which of the following is the best recommendation regarding this patient's job?

  A. Advise the patient not to work.

  B. Recommend that the patient seek alternative work.

  C. Recommend no change in employment but suggest avoiding risk.

  D. Suggest that you provide her with a restriction stating that she is not to work at unprotected heights.

  E. Write a note to the employer requesting reassignment of the patient to a secretarial position.

  Correct Answer: B

  The situation described in the question calls for clinical judgment. Restrictions should be specific and should pertain to what the patient may actually be asked to do. A company may not interdict a woman from performing a job just because she is pregnant. You should offer your best advice to a pregnant woman concerning her health and the health of the fetus. Advice should be given to patients and not to their employers. The vast majority of women can continue to do their jobs without restrictions. Telling a patient to simply avoid risk is impractical, difficult to interpret, and cannot be applied effectively. Advise and offer to write task-specific restrictions, such as, "not to climb ladders and not to lift, push, or pull with more than 20 lbs of force," or "not to work at unprotected heights such as on high ladders." The patient is well advised to discuss her needs with her employer. The physician should not communicate directly with the employer unless that is requested by the patient.

• Question 413:

  Many patients you see in your practice live in homes built prior to 1977. In compliance with the Centers for Disease Control and Prevention (CDC) guidelines, at which of the following ages will you start the relevant routine lead screening of the children?

  A. birth

  B. 3 months of age

  C. 12 months of age

  D. entry to preschool

  E. entry to first grade

  Correct Answer: C

  Lead-based paint was banned from use in residential homes in 1977, and children exposed to environments built before that time should be screened for lead. The age at which children most frequently ingest the largest amounts of lead is during the crawling and walking stage, which is also the oral-anal stage of development that occurs between the ages of 6 months and 2 years. Until children are mobile, they are unlikely to come into contact with objects that might have been coated with lead-based paint. Current guidelines recommend screening beginning at 1 year of age in high-risk populations. Lead levels generally peak at about 2 years of age. After 2 years, children normally have less tendency to put unusual objects and soiled fingers in their mouths.

• Question 414:

  You counsel a 47-year-old smoker who says that she does not intend to quit smoking because she is not worried about the health risks of smoking. All of her relatives smoke, and none have developed lung cancer. You point out that the Framingham studies have indicated that disease of other organ systems is also associated with smoking, and her relatives have had such disease. The Framingham study found smoking to be associated with disease of which of the following?

  A. skeletal system

  B. spleen

  C. cerebrovascular system

  D. thyroid

  E. auditory system

  Correct Answer: C

  The Framingham study found no association between smoking and disease of the bones, spleen, thyroid, and auditory system. Anumber of studies have shown definite increased rate of diseases of the cerebrovascular system due to smoking. There may also be some increase in noise-induced hearing loss and some increased risk of fracture of the femur among smokers.

• Question 415:

  It is reported that an alarming number of fractures are occurring among the elderly in your community. You are contacted by a local radio station for an interview on this subject. You explain that which of the following is the most likely cause of the high number of fractures?

  A. Alzheimer's disease

  B. osteoporosis

  C. obesity

  D. Parkinson's disease

  E. deteriorating eyesight

  Correct Answer: B

  There are many intrinsic factors that lead to falls in the elderly. Iatrogenic causes from medication prescribed commonly impair stability of gait. However, it is osteoporosis, particularly in the elderly female that results in the excess fractures, usually of the femur. Alow BMI is associated with a higher risk of osteoporosis and therefore, fractures. Although the elderly are more likely to have Alzheimer's and Parkinson's diseases, and poor eyesight, these are not as important as osteoporosis in fractures among the elderly

• Question 416:

  It is 2007. You are planning allocation of health department resources to meet the needs of a typical

  A. S. community over the next 10 years. You decide to allocate funding for each opulation group based on anticipated percent of population growth in each age group. The largest proportional increase in funding will go toward which age group?

  B. 0- through 10-year olds

  C. 15- through 34-year olds

  D. 35- through 45-year olds

  E. 65- through 74-year olds

  F. those 75 years of age and older

  Correct Answer: E

  Data from the National Center for Health Statistics indicate that the older age groups will continue to grow more rapidly than the total population. The population age 6574 years will increase from 6 to 10% of the total population between 2005 and 2030. The proportion of the population age 75 years and older is growing at the fastest rate and by 2040 this group will exceed the population 6574 years of age. Disability and quality-of-life issues are very important for this age group.

• Question 417:

  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

  Correct Answer: A

  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 418:

  The health commissioner asks you to propose a primary prevention program for your community.

  Which of the following should you recommend?

  A. annual sigmoidoscopy

  B. routine immunization

  C. mammography

  D. prostate-specific antigen (PSA) testing

  E. isolation of disease contacts

  Correct Answer: B

  Examples of primary prevention include routine immunization of individuals at risk for infectious disease, or healthy diet and exercise for persons at risk for diabetes; presymptomatic and clinical diseases are not present and are being avoided. Screening, such as by using Pap smears, colonoscopy, or mammography, typifies secondary prevention; disease is recognized earlier than it otherwise would be, making improved management of the disease possible. Efforts to reduce the consequences of existing recognized disease, such as isolation of disease contacts, are termed tertiary prevention.

• Question 419:

  You are asked by a company predominantly employing women to design an educational program to reduce morbidity and mortality due to cardiovascular disease. Which of the following statements should you include in this program to describe women's risk of cardiovascular disease?

  A. Men have fewer heart attacks than women.

  B. The underlying cause of heart disease in women is now well understood.

  C. The gender difference in vascular disease is greater in cerebral, aortic, and peripheral vessels than it is in the coronary arteries.

  D. Postmenopausal hormone replacement therapy (HRT) is beneficial in reducing the risk of cardiovascular disease.

  E. In women, cardiovascular disease is more likely to present as angina than in men.

  Correct Answer: E

  Researchers have reported significant disparities between men and women in heart disease. An excess risk is documented in Western society through studies such as the Framingham study and studies in Finland. There appears to be relative protection from estrogens among younger women. However, the Women's Health Initiative demonstrated an increase in risk for heart disease in women using exogenous postmenopausal HRT. Cardiac disease is more likely to present as angina in women. Older women carry more cholesterol as high-density lipoprotein (HDL) than low-density lipoprotein (LDL) compared to younger women. The gender difference in vascular disease is less apparent in the aorta, cerebral, and peripheral arteries than in the coronary arteries. In Eastern Europe, cardiovascular disease is increasing rapidly in women, while in the United States, the agespecific increase in cardiovascular disease is greater among women than men.

• Question 420:

  A 50-year-old slaughterhouse worker complains of intermittent episodes of fever, malaise, weakness, and weight loss over the past several months. Several of his coworkers have experienced flu-like symptoms since last winter.

  Which of the following statements about his illness is correct?

  A. Each Brucella species produces its own distinct human illness.

  B. People who recover from brucellosis are more likely to become reinfected when they are re-exposed to Brucella than they were before their initial infection.

  C. Person-to-person transmission of brucellosis is common.

  D. People with brucellosis generally have a chronic relapsing infection.

  E. Humans are the primary reservoir for Brucella.

  Correct Answer: D

  Human illnesses caused by the various species of Brucella organisms tend to be quite similar. All tend to be chronic, relapsing infections. Reinfection rarely occurs in recovered patients, with immunity to subsequent Brucella infections in 90% of people. Infection is rarely airborne but can be encountered in laboratory and abattoir (slaughterhouse) workers. Personto- person spread is rare. The primary reservoir is in animals. The mode of infection is principally from direct contact with infected animals or by the ingestion of infected unpasteurized milk.