USMLE USMLE Certifications USMLE-STEP-2 Questions & Answers

• Question 261:

  An 8-year-old boy suffers from compulsive eating, obesity, small stature, hypogonadism, and mental retardation. Which of the following is his most likely diagnosis?

  A. phenylketonuria

  B. Prader-Willi syndrome

  C. Down syndrome

  D. fragile X syndrome

  E. Cri-du-chat syndrome

  F. disorientation

  Correct Answer: B

  All of the listed syndromes cause mental retardation, but Prader-Willi syndrome is also typified by compulsive eating and obesity, hypogonadism, and small stature. It is thought to be due to a small deletion on chromosome 15. Phenylketonuria is an autosomal-recessive trait which can cause mental retardation in children who do not eat a low phenylalanine diet. Down syndrome, or trisomy 21, causes mental retardation and distinctive facies. Fragile X syndrome causes mental retardation, short stature, and postpubertal macroorchidism. Cri-du-chat syndrome, caused by a deletion on chromosome 5, is characterized by severe mental retardation, microcephaly, and a cat-like cry in infants due to laryngeal abnormalities

• Question 262:

  Afamily brings in their 7-year-old boy because he has not been fitting in at school. The mother says he has not made any friends and tends to play mostly by himself. He exhibits repetitive hand flapping. When you interview him, he does not provide any eye contact, and the mother says this is typical for him. His speech seems age appropriate and per history has developed normally. This past year his IQ was tested to be normal. Which of the following is the most likely diagnosis?

  A. autism

  B. Asperger disorder

  C. Rett disorder

  D. attention deficit hyperactivity disorder (ADHD)

  E. borderline personality disorder

  Correct Answer: B

  Children with Asperger disorder show severe sustained impairment in social interaction, and restricted repetitive patterns of behavior. Unlike autistic disorder, in Asperger disorder language and cognitive development are not delayed. In Rett disorder, a child shows deterioration of developmental milestones, head circumference, and overall growth. In Rett disorder, verbal abilities are usually lost completely.

• Question 263:

  A5-year-old girl had been doing well at home and with her playmates until she started kindergarten 1 month ago. She cries whenever her mother and father go to drop her off at school, and she complains of fearing that she will never see them again. She complains of nightmares and refuses to go to school due to severe stomachaches. Which of the following is the most likely diagnosis?

  A. generalized anxiety disorder

  B. separation anxiety disorder

  C. social phobia

  D. specific phobia

  E. obsessive-compulsive disorder

  Correct Answer: B

  Separation anxiety disorder is the name given to the problem of a child's developmentally excessive anxiety concerning separation from home and parents. Children who are more globally anxious may suffer from generalized anxiety disorder, while children who avoid playmates may suffer from social phobia. Children who have an unrealistic fear of, for example, dogs, have a specific phobia; whereas, those who suffer from intrusive anxious thoughts that lead them to spend much time performing rituals such as hand washing suffer from obsessive-compulsive disorder.

• Question 264:

  A fourth-year medical student on an emergency medicine clerkship is fascinated by the number of personality disordered patients who come to the emergency room on weekends. Which of the following personality disorders belongs to cluster A (odd, eccentric) in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision) classification of personality disorders?

  A. schizoid personality disorder

  B. borderline personality disorder

  C. antisocial personality disorder

  D. avoidant personality disorder

  E. obsessive-compulsive personality disorder

  Correct Answer: A

  Schizoid personality disorder is characterized by a pattern of pervasive social detachment with a narrow range of emotional expression. Schizoid persons seem to be fairly content with a lack of intimacy and are considered odd by persons around them. This contrasts with the picture of individuals with avoidant personality disorder, who long for social interaction, but feel inadequate and riddled with self-doubt in social situations. Like individuals with obsessive-compulsive disorder, people with avoidant personality disorder are categorized as having a cluster C (anxious, fearful) personality disorder; whereas, those with borderline personality disorder or antisocial personality disorder have problems characterized by engaging in impulsive behaviors and are classified as having a cluster B (dramatic, impulsive) personality disorder.

• Question 265:

  Which of the following delusions would most likely be observed in a psychotically depressed person?

  A. "My mind's eye is perfused with a radiance of the gods."

  B. "I've been targeted by the FBI."

  C. "My body is rotting inside out."

  D. "I have been hand-picked to be the world's leader; I am awaiting the signal to bring the masses together."

  E. "All I need to do is clutch the book to myself and all the knowledge pours into me."

  Correct Answer: C

  Patients with severe psychotic depression will often have delusions that are mood congruent and reflect the depth of their despair and self-abhorrence. Patients with mania are more likely to have delusions that are mood congruent that would reflect their grandiosity, paranoid feelings, inflated self-esteem, and feelings of having special powers.

• Question 266:

  A70-year-old woman was brought to the emergency department following her involvement in a minor car

  accident. She had sustained no injuries but was very upset and was, therefore, referred to a psychiatrist.

  After speaking at length about her part in the accident and sharing her reactions, she still remained

  tremulous, anxious, and tearful. She has no history of addiction. You decide to use an anxiolytic to help

  her.

  Which of the following is the best choice?

  A. diazepam

  B. clorazepate

  C. lorazepam

  D. buspirone

  E. temazepam

  Correct Answer: C

  Lorazepam, because of its relatively short half-life, intermediate rate of onset, and absence of active metabolites, would be an appropriate medication for this elderly woman. Diazepam and clorazepate both have long half-lives as well as active metabolites. These properties lead to more severe side effects in older patients, such as prolonged sedation, respiratory depression, confusional states, and disorientation. Temazepam, although it has no active metabolites and a relatively short halflife, is very sedating and is used to promote sleep. Buspirone, a nonbenzodiazepine, is an effective antianxiety agent, but it may take up to a week to exert its effect. The woman in this case needs medication that will help her quickly

• Question 267:

  A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities You encounter this patient 1 year after the onset of his symptoms. He has not been very compliant with his medications, or appointments. Now he reports he rarely leaves his home and avoids places and social situations where he feels he cannot readily escape. When he does go places, he reports having an escape plan arranged. Which of the following best describes this condition?

  A. social phobia

  B. claustrophobia

  C. arachnophobia

  D. agoraphobia

  E. simple phobia

  Correct Answer: D

  Agoraphobia is most often associated with panic disorder. It involves a severe fear of and avoidance of entering social situations where it is difficult to get help or escape from. Arachnophobia is the phobia of spiders, claustrophobia is a phobia of closed spaces. Social phobia is an excessive, persisting fear of social situations in which embarrassment can occur. Specific (simple) phobias are among the most common mental disorders and involve an excessive fear of an object or specific situation which produces an avoidance of the object or situation.

• Question 268:

  A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities

  If this patient continues to experience similar episodes over the next 2 months, with substantial apprehension about the episodes, which of the following drugs would be most appropriate for the treatment of this patient's condition?

  A. paroxetine

  B. buspirone

  C. ziprasidone

  D. propranolol

  E. haloperidol

  Correct Answer: A

  If the patient continues to suffer panic attacks for a substantial period, he is said to be suffering from panic disorder. SSRIs, such as paroxetine, are frequently effective and generally safe drugs for the treatment of panic disorder. Despite its usefulness in treating generalized anxiety disorder, buspirone seems to be ineffective in treating panic. Beta-blockers such as propranolol may block symptoms of palpitations or tremor, but are generally not as effective against panic attacks as are SSRIs. Antipsychotic medications such as ziprasidone and haloperidol are not appropriate medications for the first-line treatment of uncomplicated panic disorder.

• Question 269:

  A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities. Which of the following is the most likely diagnosis?

  A. myocardial infarction

  B. panic attack

  C. hypochondriasis

  D. multiple sclerosis

  E. generalized anxiety disorder

  Correct Answer: B

  Panic attacks most frequently have their onset sometime between the late teens and early thirties. Most patients describe their initial panic attack as coming out of the blue. They frequently suffer from palpitations, sweating, trembling, shortness of breath, a feeling of choking, chest pain, nausea, light headedness, derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of going crazy, fear of dying, numbness, and hot flashes or chills. Individuals who suffer from recurrent, unexpected panic attacks with at least 1 month of persistent concern about the attacks or their implications, or a significant change of behavior related to the attacks suffer from panic disorder. If a patient with panic disorder avoids situations in which panic attacks have occurred or endures the situations, such as shopping in a mall, with marked distress or anxiety about having a panic attack, the patient is said to suffer from panic disorder with agoraphobia. This patient's negative ECG makes myocardial infarction an unlikely diagnosis. Hypochondriasis is the term given to a longterm preoccupation with fears of having a serious disease based on the misinterpretation of bodily symptoms; it does not generally present in the sudden manner in which panic attack presents. Multiple sclerosis usually causes many neurologic disturbances which vary across time. Generalized anxiety disorder is not typified by the sudden onset of severe anxiety characteristic of a panic attack.

• Question 270:

  A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. If this man had Pick's disease, where would the preponderance of pathology be found?

  A. cerebellum

  B. caudate nucleus

  C. hippocampus

  D. frontotemporal areas

  E. parietotemporal areas

  Correct Answer: D

  Pathologic changes will be seen in the frontotemporal cortex in patients with Pick's disease. Alzheimer's disease, also a cortical dementia like Pick's, has pathologic changes in the parietotemporal areas.