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Free STEP2 Exam Braindumps (page: 27)

Page 27 of 185
PDF with 738 Questions

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?

This patient is most likely to benefit from acute treatment with which of the following substances?

  1. propranolol
  2. prednisone
  3. sumatriptan
  4. heparin
  5. oxygen

Answer(s): C

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.



A 27-year-old female complains of dysuria and urinary frequency. Urinalysis reveals 1020 WBCs per high- power field and numerous gram-negative bacteria. She denies fevers, chills, and has no flank pain or tenderness.

Which of the following statements concerning urinary tract infections is true?

  1. A single dose of an antibiotic may be sufficient treatment.
  2. Pregnant women with bacteriuria should not be treated if asymptomatic.
  3. Patients with flank pain or fever should be hospitalized.
  4. Hematuria indicates renal involvement.
  5. Urologic investigation is indicated after the treatment course is completed.

Answer(s): A

Explanation:

Urinary tract infections are extremely common in young women. For simple infections uncomplicated by fever, chills, or flank pain, a single dose of an antibiotic may be curative. In the presence of symptoms suggesting renal parenchymal infection (i.e., pyelonephritis), treatment should continue for as long as 2 weeks, and parenteral antibiotics may be required (e.g., fluoroquinolone). Bacteriuria in pregnant women should be treated regardless of symptoms; whereas, bacteriuria in patients with indwelling catheters should probably be treated only in the presence of symptoms. Chronic suppressive antibiotic therapy in the latter group has not been shown to be useful. Radiologic investigation for underlying anatomic abnormalities should be undertaken in girls up to age 6, in all males after their first infection, and in women of any age with recurrent urinary tract infections. The most common pathogen is E. coli, accounting for greater than 80% of infections. Other organisms frequently encountered include Klebsiella, Proteus, and Enterobacter species.



A 27-year-old female complains of dysuria and urinary frequency. Urinalysis reveals 1020 WBCs per high- power field and numerous gram-negative bacteria. She denies fevers, chills, and has no flank pain or tenderness.

Which of the following bacteria is most likely responsible for this patient's urinary tract infection?

  1. Klebsiella
  2. Chlamydia
  3. Escherichia coli
  4. Pseudomonas
  5. Candida

Answer(s): C

Explanation:

Urinary tract infections are extremely common in young women. For simple infections uncomplicated by fever, chills, or flank pain, a single dose of an antibiotic may be curative. In the presence of symptoms suggesting renal parenchymal infection (i.e., pyelonephritis), treatment should continue for as long as 2 weeks, and parenteral antibiotics may be required (e.g., fluoroquinolone). Bacteriuria in pregnant women should be treated regardless of symptoms; whereas, bacteriuria in patients with indwelling catheters should probably be treated only in the presence of symptoms. Chronic suppressive antibiotic therapy in the latter group has not been shown to be useful. Radiologic investigation for underlying anatomic abnormalities should be undertaken in girls up to age 6, in all males after their first infection, and in women of any age with recurrent urinary tract infections. The most common pathogen is E. coli, accounting for greater than 80% of infections. Other organisms frequently encountered include Klebsiella, Proteus, and Enterobacter species.



A 49-year-old woman with a history of migraine headaches reports 6 days of persistent headache, nausea, and recurrent vomiting. On examination, the patient is orthostatic. Electrolytes show a bicarbonate of 42 and a blood gas is obtained revealing a pH of 7.53, carbon dioxide of 53, and PO2 of
85. What is the underlying acid-base abnormality?

  1. metabolic acidosis
  2. metabolic alkalosis
  3. respiratory acidosis
  4. respiratory alkalosis
  5. respiratory alkalosis and metabolic acidosis

Answer(s): B

Explanation:

The pH of 7.53 indicates alkalosis as the primary disorder (normal pH is 7.40). A high bicarbonate is consistent with a metabolic cause of the alkalosis. The high carbon dioxide of 53 (normal is 40) is compensating for the primary disorder (alkalosis) in an attempt to bring the pH closer to normal. Metabolic alkalosis results from renal bicarbonate reabsorption. Processes which maintain persistent high reclamation of bicarbonate include dehydration, hypokalemia, hypercapnea, and mineralocorticoid excess.



Page 27 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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