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USMLE STEP2 Exam
Step2 (Page 16 )

Updated On: 30-Jan-2026
Page 16 of 149
PDF with 738 Questions

A 35-year-old woman is seen by her primary care physician for a physical examination. She tells him she has a twin brother who has bipolar disorder and has been worried that she will develop it. Which of the following would be most helpful for her to hear?

  1. "You're past the age when bipolar disorder develops, so don't worry about it."
  2. "There is no clear evidence that a bipolar disorder is genetically determined."
  3. "The concordance rate for bipolar disorder for dizygotic twins is 19%."
  4. "The concordance rate for bipolar disorder for dizygotic twins is 79%."
  5. "Prophylactic treatment with lithium is advisable."

Answer(s): C

Explanation:

There is strong evidence for a genetic predisposition to bipolar disorder. Some of the evidence comes from twin studies. The concordance rate for monozygotic twin is 79%, but for dizygotic twin it is 19%. Advising the patient that she is past the age when bipolar disorders develop, using lithium to prevent the disorder, or saying that no genetic link has been determined is very misleading and clinically incorrect.



Of the following, which is considered a cortical dementia?

  1. Huntington's disease
  2. Pick's disease
  3. Parkinson's disease
  4. occult hydrocephalus (normal pressure)
  5. none of the above

Answer(s): B

Explanation:

Pick's disease is considered a cortical dementia, with the preponderance of pathologic findings found in the frontotemporal area. Aphasia, apraxia, and agnosia are signs sometimes seen in these patients.
Huntington's and Parkinson's diseases are caused by pathologic changes in the basal ganglia. Pathologic changes are seen in the ventricles in occult hydrocephalus. Signs seen in subcortical dementia more characteristically involve motor disorders: rigidity, tics, gait difficulties, and incoordination.



A 42-year-old married woman reports being raped in an elevator 1 year ago. Her arms were fractured in the assault but have healed nicely. Still she reports difficulty sleeping, having nightmares of the attack several times per week ever since the assault. She avoids using the elevator and does not want to talk about the incident with anyone. She has been unable to return to work. Her husband feels she has been hypervigilant and irritable, and has been resistive to going out socially. She has a depressed mood. Her husband is encouraging her to seek disability. Which of the following is the most likely diagnosis?

  1. major depression
  2. adjustment disorder with anxious and depressed features
  3. acute stress disorder
  4. malingering
  5. PTSD

Answer(s): E

Explanation:

The lifetime prevalence of PTSD is approximately 8%. For PTSD to be diagnosed, the trauma has to be where serious injury or death were threatened or involved, and the traumatized individual experienced a sense of helplessness, fear, or horror, and has at least one reliving symptom (nightmares of the trauma, recurrent intrusive thoughts of the event, intense psychological stress or physiologic reactivity to internal or external cues that symbolize or
resemble an aspect of the trauma, or flashbacks), two or more symptoms of increased arousal (difficulty falling to or staying asleep, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response), and three or more avoidance symptoms (efforts to avoid thoughts, feelings, or conversations about the trauma, efforts to avoid people, things or places that remind one of the trauma, inability to remember an important aspect of the trauma, diminished participation in activities, feeling detached or estranged from others, restricted range of affect, and/or sense of foreshortened future). The symptoms have to be recurring for at least a month.



A 9-year-old boy has had persisting difficulties in language and interpersonal relationships since the age of 2 years, and, although he can barely read, he is able to perform arithmetic calculations at the fifth-grade level.
Select the diagnosis with which it is most likely to be associated.

  1. childhood depression
  2. childhood schizophrenia
  3. conduct disorder
  4. ADHD
  5. infantile autism

Answer(s): E

Explanation:

Infantile autism, called a pervasive developmental disorder in DSM-IV, typically is diagnosed when children do not demonstrate the acquisition of communication skills. Ability to form interpersonal relationships also is grossly impaired. Other behavioral manifestations of infantile autism include unusual repetitive mannerisms (e.g., spinning), marked anxiety during environmental changes, and high pain threshold. As to be expected, school performance is poor, though autistic children may display isolated areas (islands) of normal or superior intellectual functioning. Behavioral manipulation is useful in trying to contain the behavior of autistic children. Unlike infantile autism, childhood schizophrenia usually develops later in childhood and follows an intermittent course. Deterioration in social or school functioning is a characteristic presenting feature, along with hallucinations, delusions, and other manifestations of psychosis.
Phenothiazine drugs offer effective treatment. Symptoms and signs of depression in children are similar to those in adults. However, children may not be able to recognize depressed feelings. Persistence of puzzling physical problems in association with apathetic, withdrawn behavior is a common presentation.
The use of antidepressants is controversial; family and individual counseling often can be quite helpful.
ADHD once was called hyperactivity and minimal brain dysfunction. Characteristic signs include impulsivity, distractibility, inattention in school, and (usually but not universally) hyperactivity. A variety of pharmacologic agents, including imipramine, dextroamphetamine, and methylphenidate (Ritalin), have been recommended for treatment of ADHD.



An 11-year-old girl has become uncharacteristically and markedly withdrawn in the past 8 months, staying in her room so that she can "talk to the ghosts in the attic." Select the diagnosis with which it is most likely to be associated.

  1. childhood depression
  2. childhood schizophrenia
  3. conduct disorder
  4. ADHD
  5. infantile autism

Answer(s): B

Explanation:

Infantile autism, called a pervasive developmental disorder in DSM-IV, typically is diagnosed when children do not demonstrate the acquisition of communication skills. Ability to form interpersonal relationships also is grossly impaired. Other behavioral manifestations of infantile autism include unusual repetitive mannerisms (e.g., spinning), marked anxiety during environmental changes, and high pain threshold. As to be expected, school performance is poor, though autistic children may display isolated areas (islands) of normal or superior intellectual functioning. Behavioral manipulation is useful in trying to contain the behavior of autistic children. Unlike infantile autism, childhood schizophrenia usually develops later in childhood and follows an intermittent course. Deterioration in social or school functioning is a characteristic presenting feature, along with hallucinations, delusions, and other manifestations of psychosis.
Phenothiazine drugs offer effective treatment. Symptoms and signs of depression in children are similar to those in adults. However, children may not be able to recognize depressed feelings. Persistence of puzzling physical problems in association with apathetic, withdrawn behavior is a common presentation.
The use of antidepressants is controversial; family and individual counseling often can be quite helpful.
ADHD once was called hyperactivity and minimal brain dysfunction. Characteristic signs include impulsivity, distractibility, inattention in school, and (usually but not universally) hyperactivity. A variety of pharmacologic agents, including imipramine, dextroamphetamine, and methylphenidate (Ritalin), have been recommended for treatment of ADHD.



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