USMLE USMLE Certifications USMLE-STEP-2 Questions & Answers

• Question 401:

  You have performed annual examinations on a young mother for the last 3 years. She and her husband are considering having another child in 5 years, and she would like to restart oral contraceptive pills. You review her medical record and find that she had a normal Pap smear at last year's examination and also the year prior to that.

  You recommend that her next Pap smear be performed when?

  A. now

  B. in 1 year

  C. in 2 years

  D. in 3 years

  E. in 4 years

  Correct Answer: D

  After two normal Pap smears, women with normal risk can be screened every 3 years. The USPSTF has found no evidence that annual screening provides better outcomes than screening every 3 years. The majority of cervical cancers in the United States occur in women who have never been screened, those who did not receive appropriate follow-up after an abnormal Pap smear, or those who have not been screened within the past 5 years.

• Question 402:

  A 20-year-old asymptomatic college student presents to your clinic for contraception. She states that she has been sexually active for 2 years with one partner, and that they usually use condoms. Along with a Papanicolaou (Pap) smear and pelvic examination, which of the following should you also recommend?

  A. self-breast examination

  B. screening for chlamydia

  C. screening for syphilis

  D. thyroid-stimulating hormone (TSH) test

  E. screening for gonorrhea

  Correct Answer: B

  The USPSTF strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection.

• Question 403:

  A worker complains of paresthesias, numbness, and tingling that started distally in the lower extremities but that is starting to affect his hands. He is developing muscle weakness. He feels tired, and has a headache and complains of memory deficit. Electromyographic abnormalities suggest axonal degeneration and demyelination. Exposure to which of the following is the most suspect cause of this clinical picture?

  A. lead

  B. benzene

  C. zinc

  D. carbon disulfide

  E. vibration

  Correct Answer: D

  Carbon disulfide causes sensorimotor peripheral neuropathy. Central nervous system (CNS) effects and optic neuritis are also common. Long-term exposure may increase cardiovascular risk. Lower sperm counts and more abnormal spermatozoa are observed than in unexposed subjects.

• Question 404:

  A father you are treating for hyperlipidemia brings his 23-month-old son into your clinic for a routine checkup. He reports that he and his wife are separated and that he is uncertain if the child has received appropriate medical care. The child has no known medical problems and is not a member of any high- risk

  population. The child is new to your clinic, but the father produces an immunization record which states the

  child has received the following vaccines: diphtheria, tetanus, and acellular pertussis at 2, 5, and 7

  months; hepatitis B vaccine at birth, 2 months, and 7 months; H. influenzae type b at 2 and 5 months;

  inactivated poliovirus at 2, 5, and 7 months; and a measles, mumps, and rubella vaccine at 12 months.

  You tell the father that the child has received some of the recommended immunizations late, but that the

  child is adequately protected.

  The infant should receive varicella immunization in addition to which of the following vaccinations?

  A. hepatitis A vaccine now, and again in 6 months

  B. pneumococcus vaccine now, and again in 6 months

  C. oral polio vaccine now

  D. Diptheria, Tetanus, acellular Pertussis (DTaP) vaccine now

  E. oral typhoid vaccination now

  Correct Answer: D

  The fourth DTaP must be at least 6 months later than the third dose. Hepatitis Avaccine is recommended in some high-risk communities, but it is not recommended for all children. Pneumococcus vaccine for children not previously immunized by 23 months should receive two doses 8 weeks apart. Oral polio vaccine should not be used when inactivated poliovirus is available.

• Question 405:

  Repeated thunderstorms have resulted in overflow of municipal wastewater treatment plants by floodwaters. Volunteer sandbaggers downstream from the plants developed health concerns when the overflow became evident. As a public health officer you are asked to evaluate the situation. Which of the following is your most important recommendation to workers in order to prevent illness from exposure to the contaminated water?

  A. Do careful hand washing before meals and cigarette smoke breaks.

  B. Boil all water that is to be used for drinking or cooking.

  C. Offer hepatitis A vaccinations to al work crews prior to the next disaster.

  D. Start prophylaxis with a broad-spectrum antibiotic for all workers who do not have a contraindication.

  E. Offer oral polio vaccine to all eligible workers.

  Correct Answer: A

  Public health sanitation measures in emergency conditions should reduce fecal contamination of food and water supplies. Communicable disease such as typhoid fever, cholera, bacillary and amoebic dysentery, hepatitis, polio, schistosomiasis, various helminthes infestations, and viral gastroenteritis can be transmitted through contact with human feces. Avoiding putting fecal material in the mouth is key to avoiding infection.

• Question 406:

  A hurricane devastates your community. You decide to devote your attention to the aspect of disaster response that is most likely to be inadequate in coping with the disaster. Which of the following is most likely to hamper disaster response?

  A. lack of government resources

  B. failure to triage casualties

  C. failure of management

  D. lack of telecommunications

  E. lack of volunteer helpers

  Correct Answer: C

  Since the 1950s, the single most important failure in coping with disasters has been poor management by those in charge. There has been no significant problem with resources needed or with triage of casualties. Neither has there been evidence of poor response to the need for volunteer helpers. Telecommunications have improved continuously, especially with satellite communications available.

• Question 407:

  Ahealth insurance company decides to market its services to a population that will not incur high charges. The use of health services in the United States is most strongly associated with which of the following characteristics?

  A. age

  B. sex

  C. race

  D. education

  E. income

  Correct Answer: A

  In 1990, there were 3 million persons in the United States aged 65 or more. In 2001, there were 35 million, and by 2030 there may be 71 million. For the population as a whole, usage of health care is high at the time of birth and, to an even greater degree, in the period prior to death.

• Question 408:

  A 16-year old male becomes ill with fever, chills, headache, myalgia, and arthralgia 6 days after hunting prairie dogs with his cousin at his uncle's farm. Examination reveals extremely large, painful, and tender inguinal lymph nodes and a couple of small papules around his ankles. Which of the following is the most likely diagnosis?

  A. influenza C

  B. bubonic plague

  C. tularemia

  D. cat-scratch fever

  E. West Nile virus

  Correct Answer: B

  Bubonic plague is uncommon in the United States. It is almost always contracted through a bite by an infected flea. Asmall local papule or vesicle, and sometimes a local ulceration, may occur at the site of the

  Y. pestis infecting bite. Mucous membranes and broken skin also can be entry sites. After an incubation period of 26 days, illness is manifested by fever, chills, headache, myalgia, and arthralgia. Eventually, there is painful enlargement (the bubo) of lymph nodes draining the inoculation site.

• Question 409:

  A 1-year-old child in a large nursery school develops fever, irritability, confusion, a possible stiff neck, and a petechial rash, over the course of several hours. Which of the following agents is recommended for others in the nursery school who have had contact with the child, to control a possible outbreak?

  A. rifampin, ciprofloxacin or ceftriaxone

  B. gamma globulin

  C. group Ameningococcal vaccine

  D. group C meningococcal vaccine

  E. quadrivalent meningococcal vaccine

  Correct Answer: A

  Rifampin, ciprofloxacin, and ceftriaxone have been recommended for the chemoprophylaxis of close contacts of cases of meningococcal meningitis. Gamma globulin has not been shown to be effective for the prevention of meningococcal disease. Most outbreaks are caused by strains of groups A, B, C, Y, and W- 135. Most outbreaks in children less than 1 year old are caused by group B (for which there is no vaccine). Avaccine for groups A, C, Y, and W-135 is available but is used only when the source has been isolated and typed, which is rarely the case when prophylaxis must be started immediately. The immunogenicity of vaccines for groups Aand C is poor, especially in children. Meningococcal vaccine has been recommended for high-risk groups, including military troops and students living in dormitories. The search continues for a widely applicable vaccine.

• Question 410:

  A particular community is found to have high rates of dental caries. The health commissioner is attempting to institute a program to prevent further dental caries in his community. Which of the following is the most cost-effective method of preventing dental caries within a community?

  A. community fluoridation of the drinking water

  B. promoting dental hygiene

  C. instituting a universal sealant program in school children

  D. instituting dental hygienist visits to local schools

  E. instituting semiannual topical application of fluoride by a professional

  Correct Answer: A

  Community fluoridation is a very costeffective method of preventing dental caries; in fact, it is actually a cost-saving practice. Implementation requires no additional effort on the part of the community in terms of health care utilization and reimbursement. Promoting dental hygiene in and of itself has not been found to be effective in preventing dental caries. Therefore, regular visits to dental hygienists or having dental hygienists visit schools will not by itself prevent dental caries. Sealants are very effective in protecting against dental carries in populations which have deep pits and grooves on the dental surfaces. It is not as effective on smooth dental surfaces. Therefore, it is costeffective but only in a subset of the population. Semiannual topical application of fluoride by a professional, although effective, will be an expensive program to institute especially in populations that do not have dental coverage.