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USMLE STEP2 Exam
Step2 (Page 20 )

Updated On: 30-Jan-2026
Page 20 of 149
PDF with 738 Questions

A 51-year-old woman presents to the physician's office with a 2-month history of a right breast bloodtinged nipple discharge. Past history is unremarkable. Family history is positive for postmenopausal breast cancer in a maternal grandmother. Examination reveals no palpable masses or regional adenopathy, but a serous discharge is easily elicited from a single duct in the right breast. Bilateral mammograms show no abnormalities. Cytology from the discharge was not diagnostic. A ductogram was ordered, and the results are shown in the figure below.



Which of the following is the most likely diagnosis?

  1. invasive carcinoma
  2. intraductal carcinoma
  3. intraductal papilloma
  4. fibrocystic disease
  5. duct ectasia

Answer(s): C

Explanation:

The most common cause of a nipple discharge is an intraductal papilloma. Galactography can often demonstrate a filling defect in the terminal ducts as is demonstrated in the figure. Duct ectasia may also cause a discharge, but the discharge is usually thick and pasty. Carcinoma is an uncommon cause of nipple discharge. The next step in management would be excision of the terminal duct containing the papilloma. Repeat cytology would not be useful because a negative result does not preclude biopsy.
Observation would not be prudent, because a diagnosis of arcinoma must be excluded, and the papilloma may enlarge, requiring a more extensive operation at a later date. A more extensive operation, such as a central lumpectomy or mastectomy, would be unnecessary because the lesion is benign.



A 44-year-old man presents with fears that his mathematical abilities have been slowly sucked out of his brain for the last 4 years. He believes an "alien force disguised as a human being" is responsible. To avoid contacting this being, he has isolated himself in a room in a boarding house. His wife divorced him and left with their children. After 10 years teaching math at a local high school, he resigned about 3 years ago. He supports himself by "collecting cans." His affect is blunted. His appearance is disheveled, unshaven, and unwashed.
Which of the following factors in this case would favor a more positive prognosis?

  1. presence of negative symptoms
  2. late onset
  3. being male
  4. being divorced
  5. experience in teaching mathematics

Answer(s): B

Explanation:

Features that weigh toward a good prognosis in schizophrenia include late onset, obvious precipitating factors, good premorbid functioning, mood disorder symptoms, being married, a family history of mood disorders, good support systems, and having primarily positive symptoms.



A young mother seeks psychiatric help because she is unable to remember events surrounding her 3- year-old son's death after being struck by a car 2 months ago. She is worried that maybe she did something that put him at risk. Except for this brief time period, she is able to recall other events both before and after the tragedy.
Of the following treatments, which is the most appropriate to help this patient regain her memory?

  1. electroshock therapy
  2. individual psychotherapy
  3. chlordiazepoxide
  4. sertraline
  5. aripiprazole

Answer(s): B

Explanation:

Individual therapy, which would include exploring the events recalled surrounding the incident, reactions to the child's death, feelings about motherhood, as well as other issues, is considered the most effective treatment for dissociative amnesia. If other symptoms indicate another disorder, then treatment would include appropriate drugs or ECT. In some cases, there is a role for hypnosis or sodium amobarbital interview to help recall. Benzodiazepines may be helpful to reduce anxiety. Integration through psychotherapy of the events of the traumatic episode into one's conscious state is important for recovery.



For each of the following scenarios, select the gas exposure responsible for the signs and symptoms.

Aworker drilling for oil experiences acute tearing, mucous membrane irritation, and onset of a cough while repairing machinery.

  1. carbon monoxide
  2. methane
  3. hydrogen sulfide
  4. ozone
  5. sulfur dioxide

Answer(s): E

Explanation:

Sulfur dioxide is a colorless, pungent gas encountered in drilling for oil, paper production, treatment of fruit, and other processes. Sulfur dioxide is an irritant gas. It causes tearing, mucous membrane irritation, cough, and eventually pulmonary edema. In asthmatics it provokes bronchospasm at low doses. Like other irritant gases, in large quantities, it will damage alveoli and capillary endothelial cells.



For the screening tests listed below, select the screening schedule that is appropriate for women (as per the U.S. Preventive Services Task Force [USPSTF], The Guide to Clinical Preventive Services, 2006)

Mammography with or without clinical breast examination

  1. do not routinely screen
  2. yearly over age 50
  3. at first prenatal visit
  4. every 12 years at age 40 and older
  5. every 12 years at age 50 and older
  6. every 3 years following an initial examination, but not after age 65
  7. every 3 years at age 50 and older

Answer(s): D

Explanation:

The USPSTF recommends that women aged 40 and older have screening mammography with or without clinical breast examination, every 12 years.



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