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Free STEP2 Exam Braindumps (page: 34)

Page 34 of 185
PDF with 738 Questions

A13-year-old girl had growth of breast buds at 11 years, followed by the appearance of pubic hair between the ages of 11 1/2 and 12 years. Which pubertal event is most likely to occur next?

  1. beginning of accelerated growth
  2. menarche
  3. Tanner stage 5 breast development
  4. maximal growth rate
  5. Tanner stage 5 pubic hair

Answer(s): D

Explanation:

The mean age of onset of any pubertal event is approximately 11 years, beginning with the appearance of breast buds. Pubic hair appears approximately 6 months later, and this is followed by the peak height velocity (greatest rate of linear growth per unit time). Six to 12 months later, menstrual bleeding begins.
Increased rate of growth begins early in the pubertal process. The sequence of pubertal events and the approximate age of appearance of each event is sufficiently predictable that significant variation in age of onset or sequence should lead to an evaluation of a cause of abnormal puberty.



An 18-year-old nullipara has suddenly stopped menstruating. She recently lost 8.6 kg when she started long-distance running. The laboratory test most consistent with her cause of secondary amenorrhea is which of the following?

  1. a serum prolactin level of 86 ng/mL normal <20)
  2. a serum LH level of 48 mIU/mL (normal 635)
  3. a serum estradiol level of 128 pg/mL (normal 40300)
  4. a serum FSH level of 3 mIU/mL (normal 518)
  5. a serum testosterone level of 156 ng/dL (normal 40110)

Answer(s): D

Explanation:

Women with amenorrhea owing to weight loss and stress have decreased hypothalamic secretion of GnRH, and secondarily decreased serum levels of FSH and LH. As a consequence, serum estradiol levels will be low. While women with weight loss amenorrhea may have mild hirsutism, it is probably the result of a decreased estrogen secretion and decreased estrogen: androgen ratio, rather than an increase in serum testosterone levels.



A 22-year-old woman with cystic fibrosis is engaged to be married and asks you about childbearing.
How should you advise her?

  1. An amniocentesis should be done to detect fetal cystic fibrosis.
  2. Pregnancy is contraindicated because maternal mortality is significantly increased.
  3. Her children have a 25% chance of having cystic fibrosis.
  4. Pregnancy and delivery are usually successful with special care and precautions.
  5. She should use nasal oxygen throughout pregnancy to minimize fetal hypoxemia.

Answer(s): D

Explanation:

With improved care, women with cystic fibrosis now survive into the reproductive age and are capable of carrying a pregnancy successfully. No special precautions such as prolonged hospitalization, oxygen supplementation, bed rest, or others are necessary. Likewise, there is no need for routine cesarean section or other labor modifications, except ensuring adequate hydration and normal serum electrolytes. An amniocentesis is unnecessary. There is no constituent of amniotic fluid that is diagnostic of cystic fibrosis.
Also, the fetus is at risk for cystic fibrosis only if the father is a carrier. If not, the fetus will be a carrier only.
Chorionic villus biopsy can be done to determine whether the fetus has cystic fibrosis if the father carries one of the 150+ alleles for cystic fibrosis or the couple had a previously affected child. It is becoming the standard of care to screen routinely pregnant women for the cystic fibrosis gene.
Currently, routine screening will identify approximately 80% of carriers of the cystic fibrosis gene.



On the first pelvic examination of an 18-yearold nulligravida, a soft, fluctuant mass is found in the superior aspect of the right labia majora. This is asymptomatic. She tells you it has been present for several years and seems to be enlarging slightly. There is no defect in the inguinal ring. Which of the following is the most likely diagnosis?

  1. vulvar varicosities
  2. inguinal hernia
  3. femoral hernia
  4. cyst of the canal of Nuck
  5. granuloma inguinale

Answer(s): D

Explanation:

The most likely diagnosis is a cyst of the canal of Nuck. These arise from inclusions of the peritoneum at the inferior insertion of the round ligament into the labia majora. They are analogous to a spermatic cord hydrocele and are typically found at the superior aspect of the labia majora. Vulvar varicosities usually involve most of the labia, occur in older and parous women, and have a classical "bag of worms" appearance. Given the physical findings, a hernia is unlikely. An ultrasound may be useful to distinguish a hernial sac from a cyst of the canal of Nuck. One-third of women with a cyst of the canal of Nuck may have a coexistent inguinal hernia.



Page 34 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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