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Free STEP2 Exam Braindumps (page: 26)

Page 26 of 185
PDF with 738 Questions

Select the ONE best lettered option that is most closely associated with the question below.

A 60-year-old obese male with Heberden's nodes on his hands and chronic, severe leftsided knee pain.

  1. rheumatoid arthritis
  2. SLE
  3. Wegener's granulomatosus
  4. polyarteritis nodosa
  5. Goodpasture syndrome
  6. fibromyalgia
  7. osteoarthritis (OA)
  8. giant cell arteritis
  9. sarcoidosis

Answer(s): G

Explanation:

Risk factors for OA include age, obesity, major trauma, and repetitive joint use. Bony enlargements of the DIP joint (Heberden's nodes) are the most common form of idiopathic OA. Obesity is a risk factor for knee OA. With severe OA of the knee in particular, obesity is thought to play a large role in pathogenesis.



A92-year-old man is referred from his nursing home for evaluation of lethargy. Examination is unrevealing, but laboratory results are significant for a serum sodium level of 118 meq/L (normal, 135 148). Serum osmolality is 260, urine osmolality is 450, and urine sodium is 80. Which of the following is the most likely cause of this patient's lethargy?

  1. hyperglycemia
  2. hyperlipidemia
  3. hyperproteinemia
  4. SIADH
  5. diabetes insipidus

Answer(s): D

Explanation:

Hyponatremia is a common metabolic derangement. Facititious hyponatremia is seen with severe hyperlipidemia or hyperproteinemia (which lower plasma water content) and with hyperglycemia due to water movement out of cells. Most patients with hyponatremia are hypoosmolar and the diagnosis is based on an estimation of extracellular fluid (ECF) volume status. Decreased ECF volume and hyponatremia are associated with diuretic use, diarrhea, and dehydration. Expanded ECF volume due to decreased effective circulating volume and increased ADH secretion may result in edema and hyponatremia as often seen with congestive heart failure, cirrhosis of the iver, and nephritic syndrome. Euvolemia and hyponatremia can be due to hypothyroidism, drenal insufficiency, and other conditions associated with the SIADH. Diabetes insipidus is a cause of hypernatremia.



Which of the following is the most common cause of nephrotic syndrome?

  1. diabetes mellitus
  2. Hodgkin's lymphoma
  3. heroin abuse
  4. malignant hypertension
  5. renal failure

Answer(s): A

Explanation:

The nephrotic syndrome is characterized by proteinuria of greater than 3 g/day. Hypoalbuminemia, edema, and hyperlipidemia, lipiduria, and hypercoagulability are other defining features. Six entities account for >90% of cases of nephrotic syndrome in adults: minimal change disease (MCD), focal and segmental glomerulosclerosis (FSGS), membranous glomerulopathy, membranoproliferative glomerulonephritis (MPGN), diabetic nephropathy, and amyloidosis. In North America, the most common cause of nephrotic syndrome is diabetes mellitus. Heroin use has been associated with FSGS and lymphoma has been associated with glomerular disorders. Some of the glomerular disorders above may present with nephritic syndrome and if untreated progress to renal failure



A 33-year-old woman experiences visions of flashing lights followed by throbbing left-sided temporal pain and nausea. Which of the following is the most likely diagnosis?

  1. tension headache
  2. transient ischemic attack (TIA)
  3. temporal arteritis
  4. migraine headache
  5. cluster headache

Answer(s): D

Explanation:

The typical migraine attack consists of a visual aura with flashes, scintillating scotomata (field loss), or fortification spectra followed by a throbbing unilateral temporal headache. There may be associated vestibular, GI, or neurologic symptoms. Attacks are often precipitated by stress, fatigue, or foods that contain tyramine (e.g., cheese, yogurt, nuts) or phenylethylamine (wine, chocolate). Symptoms peak within an hour of onset and persist for hours to days. A positive family history is found in as many as 50% of cases. Tension headaches are more often bilateral and described as band like or vise like and are not usually associated with visual auras. TIAs more typically present as transient monocular blindness without aura or headache. Temporal arteritis may present as painless loss of vision without aura, but is usually in older people.
Cluster headaches are much more common in men. Sumatriptan and the other triptans work by inhibiting the release of vasoactive peptides, promoting vasoconstriction, and blocking brainstem pain pathways.
Sumatriptan comes in oral, injectable, and nasal spray form. Ergotamine tartrate, antiemetics, and analgesics may also be used in the acute treatment of migraine headache. Prophylactic medications such as beta-blockers, tricyclic antidepressants, calcium channel blockers, and anticonvulsants are ineffective for acute attacks. Avoidance of known precipitants and control of stress are also important in prevention.



Page 26 of 185



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Alken commented on January 04, 2025
No comments yet Still watching the pattern of exam
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Allen commented on January 04, 2025
Nice approach
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