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Download DemoVendor: USMLE
Certifications: USMLE Certifications
Exam Code: USMLE-STEP-2
Exam Name: United States Medical Licensing Step 2
Updated: Mar 17, 2024
Q&As: 738
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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.
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.
A 35-year-old woman presents to the clinic for a discussion on breast cancer risk. Her family history is pertinent for a grandmother who died of breast cancer at age 53, a mother who died of premenopausal breast cancer, and one of three sisters with breast cancer diagnosed at age 42. The sister with breast cancer underwent genetic testing and was found to have a BRCA1 mutation. Subsequently, the 35- year-old woman underwent genetic testing and was found to be a carrier of the same deleterious BRCA1 mutation. For this patient, which of the following strategies represent an accepted management option for her high-risk status?
A. yearly self-breast examinations
B. semiannual mammography
C. bilateral breast irradiation
D. prophylactic unilateral mastectomy
E. chemoprevention with tamoxifen
Correct Answer: E
Deleterious mutations in the BRCA1 and BRCA2 genes are associated with markedly elevated lifetime risks of breast cancer. The risk initially quoted was determined from families with high penetrance or expression of the disease, in the 8090% range. Asubsequent study, based on a larger population of gene mutation carriers, demonstrated a lower risk of 56%. Therefore, the risk generally quoted for mutation carriers is in the range of 5080%. Management options for known mutation carriers, or other high-risk women, include intensive surveillance with monthly self-breast examinations, annual or semiannual clinical breast examinations, annual mammography starting 10 years prior to the earliest age of onset of breast cancer in a family member, chemoprevention with tamoxifen, and prophylactic mastectomy. The data supporting these options in BRCA-mutation carriers, however, are limited to small series. Evidence for imaging of these high-risk women using MRI as a screening modality is promising.
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