USMLE Step 2 practice test 2 Question and Answer

12079. Characteristics of a galactocele? - May occur weeks to months after cessation of breastfeeding and is due to ductal blockage with resulting milk accumulation. Exam shows a soft, mobile, nontender mass. Dx is made by US and needle aspiration (also curative). 12289. What might occur by treating pts with right sided HF (possibly due to COPD) with IV furosemide? - This will improve symptoms. However, you will get depletion of intravascular volume from diuresis. This can lead to AKI (BUN/Cr20!!) and with unremarkable urine sediment. 12371. Painless ovoid, unilateral testicular mass that does not transilluminate in a 15-35 yo male? - Germ cell tumor. Most common solid malignancy in young male. Serum tumor markers (AFP, bhCG) and scrotal US are helpful. Can become aware of them by trauma**. Radical orchiectomy and chemo results in 95% cure rate. 12280. What is culture most likely to show for intertrigo? - Typically due to candida and occurs on skin surfaces such as axilla, inframammary folds, and abdominal folds. Candida will appear as pseudohyphae with budding yeast forms (blastoconidia)**. 12492. Ocular rosacea characteristics? - Involves the cornea, conjuctiva, and lids and causes burning or foreign body sensations, blepharitis, keratitis, conjuctivitis, corneal ulcers, and recurrent chalazia. Mild symptoms tx with scrubs, topical abx, and ocular lubricants. 12216. Where do hypertensive hemorrhages most commonly occur and what can manifest from it? - Basal ganglia. Can result in uncal herniation. Symtoms include a dilated, nonreactive ipsilateral pupil (compression of ipsilateral oculomotor nerve), contralateral extensor posturing, coma, and respiratory compromise. 12058. Characteristics of thromboangiitis obliterans? - nonatherosclerotic, inflammatory, vaso-occlusive disorder of small and medium-sized vessels leading to ischemic ulcers and gangrene. Seen in heavy smokers and only cure is smoking cessation. ABIs and distal pulses are usually fine. 12209. Characteristics of prosthetic valve thrombosis (PVT)? - More common with mechanical mitral valve than aortic valve. Inadequate coagulation is the most common cause of PVT. For mechanical mitral valve, INR should be between 2.5-3.5 with aspirin and warfarin. Leads to valvular obstruction (similar to symptoms of stenosis), resulting in symptoms of HF or lead to systemic thromboemolism. 12099. When to use fetal fibronectin (FFN)? - Regular contractions with no cervical change before 34 wks. If FFN is postiive is +, then likely will deliver in the next week preterm. Give steroids**!! If FFN negative, resume regular prenatal care. 11944. Pt presenting with Livedo reticularis, DVT, and recurrent miscarriages has what other findings? - Antiphospholipid syndrome. Prolonged PTT**. Specific antibodies are anti-beta-2-glyroprotein I, antiphosphatidylserine, and anticardiolipin antibodies. 12045. Best next step in management of a pt with nephrotic range proteinuria but also with hematuria and RBC casts suggesting glomerulonephritis? - kidney biopsy. This could be IgA nephropathy, RPGN, postinfectious GN, etc. and a delay in appropriate tx could lead to serious consequences. 12377. Next best step in evaluating a pt with prostate nodule on PE and elevated PSA? - Most likely has adenocarcinoma of the prostate. Need to do biopsy** for definitive dx and pathologic grade. Tx consists of 3 options: active surveillance (ie watchful waiting), prostatectomy, and radiotherapy. 12274. Favorable prognostic factors in schizophrenia? - acute onset (lack of prodrome), identifiable precipitant, older age at onset (usually with females), and presence of positive symptoms** (as opposed to negative symptoms) psychotic symptoms. Meds are better for treating positive psychotic meds and early intervention to decrease duration of active psychosis improves course of illness.