Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled four cases from Kaplan Medical involving senior patients. Each question comes with an expert explanation of the answer. You can check out all posts in this series.
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Think you can answer these questions involving women’s health? Find out now.
A 26-year-old woman comes to the physician because of a one-year history of amenorrhea. She has had occasional discharge from both breasts. She takes no medications. She has a 5-year-old child that she breastfed until age 9 months. There is diffuse enlargement of the thyroid gland. Breast examination shows expression of milk from both breasts. MRI of the brain shows pituitary enlargement. Urine beta-human chorionic gonadotropin negative. Which is the most appropriate next step in management?
A 27-year-old immigrant from El Salvador has a 14-by-12-by-9 cm mass in her left breast. It has been present for seven years and has slowly grown to its present size. Her grandmother has breast cancer and her father has prostate cancer. Physical examination shows that the mass is firm, nontender, rubbery and completely movable, and it is not attached to the overlying skin or the chest wall. There are no palpable axillary nodes or skin ulceration. What is the most likely diagnosis?
A 14-year-old girl comes to the physician because of heavy menstrual bleeding that began with menarche two years ago. Her menstrual periods last eight to 10 days and occur approximately every 28 days. Her last menstrual period ended three days ago. Vital signs are temperature 37.0º C (98.6º F), blood pressure 110/70 mm Hg, pulse 90 beats per minute and respirations 18 per minute. Physical examination shows a slender, calm girl who is in no distress but appears pale. The remainder of the examination is unremarkable. Which is the most appropriate next step in management?
Over a two-month period, a 50-year-old woman with a history of polycythemia vera develops abdominal pain and gross ascites. Physical examination demonstrates smooth hepatomegaly and mild jaundice. Pressure applied over the liver fails to distend the jugular veins. The abdomen is grossly edematous and the abdominal wall shows a tortuous venous pattern. Edema of the legs is prominent. What is the most likely diagnosis?
A 57-year-old female with a history of hypertension comes to the physician because of shortness of breath. She says that she has been experiencing progressively worsening dyspnea while climbing the stairs in her house. She denies both chest pain and dyspnea at rest. She appears comfortable at rest. She is on aspirin and metoprolol. Physical examination shows a regular heart rate and rhythm with absence of murmurs or rubs but does have an S4. Blood pressure is 150/80 mm Hg and pulse 55 per minute. Pulmonary exam reveals rales at the bases. She has lower extremity edema. Echocardiogram shows increased LV filling pressures with a normal ejection fraction. Which is the next best step?
For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.