USMLE USMLE Certifications USMLE-STEP-2 Questions & Answers

• Question 681:

  For each antihypertensive agent listed below, select the set of undesirable side effects with which it is most commonly associated with lisinopril

  A. cough, hyperkalemia, angioedema

  B. positive Coombs test, hemolytic anemia, hepatitis

  C. hypokalemia, hyperuricemia, hyperglycemia

  D. peripheral edema, flushing, and constipation

  E. increased angina, tachycardia, systemic lupus erythematosus (SLE)

  Correct Answer: A

  All of the drugs used to treat hypertension can cause adverse reactions, ranging from trivial to life threatening. Thiazide diuretics are associated with hypokalemia, causing arrhythmias; hyperuricemia causing gout; and hyperglycemia due to insulin resistance. The vasodilator hydralazine can cause tachycardia with increased angina and a lupuslike syndrome. As many as 10% of patients on angiotensinconverting enzyme (ACE) inhibitors develop an annoying dry cough. Because they block aldosterone, they can lead to hyperkalemia. ACE inhibitors cause 1025% of all cases of angioedema. Peripheral edema is the most commonly reported side effect of calcium channel blockers, especially amlodipine and nifedipine. Constipation, flushing, and dizziness are also frequently reported. Coombs'-positive hemolytic anemia and hepatitis are idiosyncratic reactions to the central adrenergic-stimulant methyldopa.

• Question 682:

  For each antihypertensive agent listed below, select the set of undesirable side effects with which it is most commonly associated with hydralazine

  A. cough, hyperkalemia, angioedema

  B. positive Coombs test, hemolytic anemia, hepatitis

  C. hypokalemia, hyperuricemia, hyperglycemia

  D. peripheral edema, flushing, and constipation

  E. increased angina, tachycardia, systemic lupus erythematosus (SLE)

  Correct Answer: E

  All of the drugs used to treat hypertension can cause adverse reactions, ranging from trivial to life threatening. Thiazide diuretics are associated with hypokalemia, causing arrhythmias; hyperuricemia causing gout; and hyperglycemia due to insulin resistance. The vasodilator hydralazine can cause tachycardia with increased angina and a lupuslike syndrome. As many as 10% of patients on angiotensinconverting enzyme (ACE) inhibitors develop an annoying dry cough. Because they block aldosterone, they can lead to hyperkalemia. ACE inhibitors cause 1025% of all cases of angioedema. Peripheral edema is the most commonly reported side effect of calcium channel blockers, especially amlodipine and nifedipine. Constipation, flushing, and dizziness are also frequently reported. Coombs'-positive hemolytic anemia and hepatitis are idiosyncratic reactions to the central adrenergic-stimulant methyldopa.

• Question 683:

  For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated. A 29-year-old diabetic with blood glucose of 280 mg/dL

  pH PaO2 PaCO2

  A. 7.23 64 80

  B. 7.39 88 40

  C. 7.22 74 33

  D. 7.54 75 24

  E. 7.37 67 52

  Correct Answer: C

  ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome. Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.

• Question 684:

  For each antihypertensive agent listed below, select the set of undesirable side effects with which it is most commonly associated with hydrochlorothiazide

  A. cough, hyperkalemia, angioedema

  B. positive Coombs test, hemolytic anemia, hepatitis

  C. hypokalemia, hyperuricemia, hyperglycemia

  D. peripheral edema, flushing, and constipation

  E. increased angina, tachycardia, systemic lupus erythematosus (SLE)

  Correct Answer: C

  All of the drugs used to treat hypertension can cause adverse reactions, ranging from trivial to life threatening. Thiazide diuretics are associated with hypokalemia, causing arrhythmias; hyperuricemia causing gout; and hyperglycemia due to insulin resistance. The vasodilator hydralazine can cause tachycardia with increased angina and a lupuslike syndrome. As many as 10% of patients on angiotensinconverting enzyme (ACE) inhibitors develop an annoying dry cough. Because they block aldosterone, they can lead to hyperkalemia. ACE inhibitors cause 1025% of all cases of angioedema. Peripheral edema is the most commonly reported side effect of calcium channel blockers, especially amlodipine and nifedipine. Constipation, flushing, and dizziness are also frequently reported. Coombs'-positive hemolytic anemia and hepatitis are idiosyncratic reactions to the central adrenergic-stimulant methyldopa.

• Question 685:

  For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated. A30-year-old woman with salicylate intoxication

  pH PaO2 PaCO2

  A. 7.23 64 80

  B. 7.39 88 40

  C. 7.22 74 33

  D. 7.54 75 24

  E. 7.37 67 52

  Correct Answer: D

  ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome. Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.

• Question 686:

  For each clinical setting described below, select the set of ABG determinations with which it is most likely to be associated. A 60-year-old man with morbid obesity

  pH PaO2 PaCO2

  A. 7.23 64 80

  B. 7.39 88 40

  C. 7.22 74 33

  D. 7.54 75 24

  E. 7.37 67 52

  Correct Answer: E

  ABG determinations are essential in the diagnosis of respiratory and acid-based disturbances. Extremely obese patients suffer from increased work of breathing, as well as elevation of the diaphragm with decrease in lung volume. The resultant hypoventilation is characterized by carbon dioxide retention leading to chronic respiratory acidosis with metabolic compensation (ABG set E in the question). When associated with somnolence, excessive appetite, and polycythemia, this is known as the pickwickian syndrome. Modest weight loss can lead to dramatic improvement in respiratory functioning. The earliest derangement in salicylate poisoning is hyperventilation, resulting in decreased PaCO2 and increased arterial pH (ABG set D). Eventually, there is CNS depression with somnolence and hypoventilation resulting in respiratory acidosis. Diabetic ketoacidosis may cause acute metabolic acidosis. In a healthy young adult with no lung disease, appropriate respiratory compensation occurs (ABG set C). Without insulin to reverse this process, the patient may go on to develop worsening acidosis and an inability to compensate adequately. ABG set A reflects acute respiratory acidosis (hypoventilation) without metabolic compensation. ABG set B is normal.

• Question 687:

  For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 55-year-old man complains of abdominal pain and is found to have a kidney stone. Laboratory evaluation reveals hypercalcemia.

  A. Cushing's syndrome

  B. Addison's disease

  C. Klinefelter syndrome

  D. hyperparathyroidism

  E. hypothyroidism

  F. pheochromocytoma

  G. acromegaly

  H. diabetes insipidus

  I. diabetes mellitus

  J. polycystic ovarian disease

  Correct Answer: D

  In primary hyperparathyroidism, increased levels of PTH lead to hypercalcemia and hypophosphatemia. Patient symptoms and signs on presentation include kidney stones, peptic ulcers, mental status changes and less commonly, extensive bony resorption.

• Question 688:

  For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 45-year-old woman has noticed changes in the fat distribution on her body with excess fat over the posterior neck and upper back. On examination, she has high BP and abdominal striae. Laboratory evaluation shows a high glucose intolerance.

  A. Cushing's syndrome

  B. Addison's disease

  C. Klinefelter syndrome

  D. hyperparathyroidism

  E. hypothyroidism

  F. pheochromocytoma

  G. acromegaly

  H. diabetes insipidus

  I. diabetes mellitus

  J. polycystic ovarian disease

  Correct Answer: A

  Cushing's syndrome is caused by overproduction of cortisol by the adrenal gland. Centripetal obesity occurs in 97% of patients, increased body weight in 94%, fatigability and weakness in 87%, and hypertension in 82%. Impaired glucose tolerance is common and attributable to increased hepatic gluconeogenesis and insulin resistance.

• Question 689:

  For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 35-year-old woman complains of constipation, hair loss, and dry skin.

  A. Cushing's syndrome

  B. Addison's disease

  C. Klinefelter syndrome

  D. hyperparathyroidism

  E. hypothyroidism

  F. pheochromocytoma

  G. acromegaly

  H. diabetes insipidus

  I. diabetes mellitus

  J. polycystic ovarian disease

  Correct Answer: E

  The most common symptoms seen in patients with hypothyroidism include tiredness, weakness, dry skin, feeling cold, hair loss, difficulty concentrating with poor memory, constipation, and weight gain.

• Question 690:

  For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 48-year-old man is being evaluated for diabetes and hypertension. On examination, he has mandibular enlargement and large hands.

  A. Cushing's syndrome

  B. Addison's disease

  C. Klinefelter syndrome

  D. hyperparathyroidism

  E. hypothyroidism

  F. pheochromocytoma

  G. acromegaly

  H. diabetes insipidus

  I. diabetes mellitus

  J. polycystic ovarian disease

  Correct Answer: G

  Acromegaly is caused by oversecretion of growth hormone, usually from a pituitary adenoma. Clinical manifestations are indolent, often not diagnosed for 10 or more years. Acral bony overgrowth leads to frontal bossing, increased hand and foot size, and mandibular enlargement. Growth hormone excess also commonly affects the cardiovascular system. Upper airway obstruction with sleep apnea is present in up to 60% of patients.