USMLE USMLE-STEP-2 Exam Questions & Answers

Correct Answer: B

Addison disease, or primary adrenocortical deficiency, commonly results in a low serum Na+, a low serum Cl-, and a high serum K+. Aldosterone deficiency causes loss of sodium in the urine and contributes to the hyperkalemia. The original description of Addison disease summarizes well the key clinical findings: general languor and debility, feebleness of the heart's action, irritability of the stomach, and a peculiar change of the color of the skin. The hyperpigmentation of the skin is often seen on the elbows and in the creases of the hands.

Correct Answer: C

All of the drugs used to treat hypertension can cause adverse reactions, ranging from trivial to life threatening. Thiazide diuretics are associated with hypokalemia, causing arrhythmias; hyperuricemia causing gout; and hyperglycemia due to insulin resistance. The vasodilator hydralazine can cause tachycardia with increased angina and a lupuslike syndrome. As many as 10% of patients on angiotensinconverting enzyme (ACE) inhibitors develop an annoying dry cough. Because they block aldosterone, they can lead to hyperkalemia. ACE inhibitors cause 1025% of all cases of angioedema. Peripheral edema is the most commonly reported side effect of calcium channel blockers, especially amlodipine and nifedipine. Constipation, flushing, and dizziness are also frequently reported. Coombs'-positive hemolytic anemia and hepatitis are idiosyncratic reactions to the central adrenergic-stimulant methyldopa.

Correct Answer: A

Typical neuroleptic antipsychotic medications frequently cause unpleasant side effects, which occur at various times during treatment. The extrapyramidal side effect most likely to occur in the first few days of treatment is an acute dystonia, such as a muscle spasm in the neck. A pill-rolling tremor of the hands and masked facies are signs of Parkinsonian EPS, which tend to have their onset several weeks after treatment is begun; whereas severe restlessness of the arms and legs is caused by an unpleasant sensation called "akathisia," which also tends to have its onset several weeks after treatment is begun. Involuntary lip smacking is a sign of tardive dyskinesia, a sometimes irreversible motor syndrome that tends to occur after months or years of treatment with typical antipsychotics. Anticholinergic medications such as benztropine are effective in treating dystonias and pill-rolling tremors. Propranolol is effective in treating akathisia. Haldoperidol would worsen EPS. Dantrolene uncouples muscle contractions and is used occasionally in severe NMS. L-Dopa would decrease the Parkinsonian EPS, but would worsen the psychosis and therefore is not used. Fluoxetine is an SSRI