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USMLE STEP2 Exam
Step2 (Page 12 )

Updated On: 30-Jan-2026
Page 12 of 149
PDF with 738 Questions

You evaluate a 38-year-old man who complains of muscle weakness. Her appearance is remarkable for a periorbital heliotrope rash with edema and erythema on his upper chest, neck, and face. Which of the following is the most likely diagnosis?



Which of the following examination findings would this patient most likely have?

  1. proximal muscle weakness
  2. distal muscle weakness
  3. ataxic gait
  4. hyperactive deep tendon reflexes
  5. inflamed small joints

Answer(s): A

Explanation:

The heliotrope, purple periorbital rash is seen with dermatomyositis and may even precede the muscle involvement. On examination, these patients will usually show proximal muscle weakness and may complain of difficulty getting up from a chair, climbing stairs, and raising the arms over the head. Ataxia may be present with cerebellar lesions. Deep tendon reflexes should be normal and there is no joint inflammation. Polymyalgia rheumatica generally occurs in older people but is not associated with muscle weakness. Spinocerebellar degeneration, vasculitis, and rheumatoid arthritis are not associated with this rash. Creatine phosphokinase is usually markedly elevated and muscle biopsy will confirm the diagnosis.
Serum creatinine, sodium, and potassium should be normal, and the rheumatoid factor should not be elevated.



Identify the defense mechanisms of a person accusing another of being angry and jealous when the feelings belong to oneself

  1. acting out
  2. altruism
  3. displacement
  4. intellectualization
  5. passive-aggressive behavior
  6. projection
  7. rationalization
  8. reaction formation
  9. sublimation
  10. suppression

Answer(s): F

Explanation:

Defense mechanisms provide a means for dealing with anxiety and affect. The mechanisms chosen range from the very narcissistic and immature to mature. In suppression, a person makes a conscious decision to put the conflict aside until it can be dealt with more appropriately. On the other hand, in acting out, there is little or no attempt to contain the affect, and it is directly expressed, as in name calling. Sublimation provides a channel for the indirect expression of a need or affect. Its use is positive and socially acceptable. In reaction formation, the person acts as if the strong need or affect did not exist and acts out the opposing feeling. In projection, unacceptable feelings and thoughts are denied as part of the self and instead are "put on" the other person.



Match the antidepressant with the side effect or characteristic of an SSRI with a half-life of 46 days

  1. phenelzine
  2. venlafaxine
  3. trazodone
  4. fluoxetine
  5. mirtazapine
  6. nortriptyline
  7. escitalopram

Answer(s): D

Explanation:

Fluoxetine has the longest half-life of the current SSRIs (escitalopram's half-life is shorter--less than 24 hours), phenelzine is an MAOI and foods rich in tyramine can induce a hypertensive crisis. Venlafaxine can induce hypertension, especially at higher doses. Trazodone can rarely induce priapism (a painful sustained erection). Nortriptyline is a tricyclic antidepressant, and at high doses, it can cause arrhythmias.



Match the below medication with the potential blood dyscrasia side effect it can be associated with.
Valproate.

  1. leukocytosis
  2. thrombocytopenia
  3. agranulocytosis
  4. megaloblastic anemia
  5. lymphocytosis

Answer(s): B

Explanation:

Valproate can be associated with thrombocytopenia and platelet dysfunction especially at high doses.
Leukocytosis is a common benign effect of lithium. Clozaril can cause agranulocytosis in 12% of patients.
Agranulocytosis can be an idiosyncratic adverse event with carbamazepine.



Match the below medication with the potential blood dyscrasia side effect it can be associated with.
Lithium

  1. leukocytosis
  2. thrombocytopenia
  3. agranulocytosis
  4. megaloblastic anemia
  5. lymphocytosis

Answer(s): A

Explanation:

Valproate can be associated with thrombocytopenia and platelet dysfunction especially at high doses.
Leukocytosis is a common benign effect of lithium. Clozaril can cause agranulocytosis in 12% of patients.
Agranulocytosis can be an idiosyncratic adverse event with carbamazepine



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