USMLE USMLE-STEP-3 Exam Dumps

Correct Answer: A Section: (none)

Explanation:

The patient has symptoms of spinal cord compression and needs an urgent MRI to establish the diagnosis. Spinal cord compression usually develops when patients have metastases to the vertebral body with epidural extension of the tumor, displacing the underlying thecal sac, and causing cord edema and injury. Patients with cord compression usually experience new or worsening pain symptoms days or weeks before the development of motor weakness below the level of compression. Loss of sensation and loss of bowel or bladder control occur even later. Clues that the pain symptoms may represent cord injury include pain that is worse with recumbency or Valsalva and the occurrence of Lhermitte's sign, an electric sensation down the back and into the extremities with extension or flexion of the neck or spine.

Initiation of therapy, such as radiation therapy or neurosurgical intervention, might be necessary later but would be premature before the diagnosis is established with an imaging study. If the patient's history or physical exam suggests spinal cord compression, initiation of corticosteroids should be started immediately while diagnostic imaging is pending. Pain control with adequate narcotic analgesia is important and may be instituted while the appropriate diagnostic studies are being obtained. Delay of 1 week would be inappropriate due to the urgent nature of the problem and risk of neurological compromise. The patient's neurological status at the time of diagnosis is the most important prognostic factor: 7580% of patients who are ambulatory at the time of diagnosis will retain locomotion. But, if already paraplegic, only 10% will regain the ability to walk. While this patient appeared neurologically intact, the development of neurological deficits can progress over a period of days, making rapid diagnosis and institution of appropriate therapy such as corticosteroids and radiotherapy an urgent consideration. Other factors such as age, presence of co-morbid medical conditions, functional status, and tumor androgensensitivity are important to the patient's overall cancer prognosis.

Correct Answer: B Section: (none)

Explanation:

Menstrual disorders, primarily oligo-and amenorrhea, are particularly common among women with eating disorders and are thought to be the result of hypothalamic hypoestrogenism. This patient demonstrates estrogen deficiency (decreased breast size, urogenital atrophy). Her dental caries, oral sores, and hand sores might be a result of self-induced vomiting. Hyperthyroidism would be considered in the differential diagnosis of a young woman with weight loss and menstrual irregularities. In contrast to persons with a medical condition that causes weight loss, those with an eating disorder express a disordered body image and, often, a desire to be underweight. This patient requires additional investigation to assess for the possibility of inpatient admission. Patients with a prolonged, severe eating disorder are at risk for developing dehydration, electrolyte imbalance (especially hypokalemia), cardiac dysrhythmias, and hypothermia. Hospitalization would be considered for those who are severely dehydrated, who have marked electrolyte abnormalities who are <75% of their ideal body weight, or who have a comorbid condition that would require hospitalization, such as a severe psychiatric disorder. Although weight-bearing exercise favors bone formation, when excessive exercise and/or an eating disorder results in amenorrhea, estrogen levels fall. Subsequently, bone mineral density decreases. Persons with eating disorders are at increased risk for comorbid psychiatric conditions including depression, anxiety, obsessive-compulsive disorder, and personality disorders.

Correct Answer: D Section: (none)

Explanation: Explanations: Screening for osteoporosis in women 65 years old or older is a level B recommendation of the USPSTF, as detection and treatment of osteoporosis may reduce fracture risk. In women who have had a hysterectomy (with removal of the cervix) for reasons other than cervical cancer, pap smear screening of the vaginal cuff is not recommended and cytologic screening can be discontinued. Therapy with either estrogen alone (in women who do not have a uterus) or combined estrogen and progesterone (in women who have a uterus) in postmenopausal women is controversial. Based on findings of the Women's Health Initiative and other studies, the USPSTF gives a level D recommendation to the use of combined estrogen and progesterone therapy and level I recommendation for estrogen therapy alone for the prevention of chronic conditions. Screening for asymptomatic bacteruria in all populations other than pregnant women is given a level D recommendation. No benefit from the intervention has been found and overtreatment with antibiotics may produce harm. While mammography for breast cancer screening has been given a level B recommendation, both self-breast examination and clinical breast examination are level I recommendations, with insufficient evidence to show any benefit in morbidity or mortality. According to the Centers for Disease Control, diseases of the heart make up the most common cause of death in women in this age group. Heart disease is responsible for approximately one-third of all deaths in women aged 65 and older. Malignant neoplasms make up the next largest cause of death, followed by cerebrovascular diseases and chronic lower respiratory diseases. PPV-23 is recommended for all adults over the age of 65 and at younger ages for individuals at high risk for pneumonia or complications of pneumonia. These include persons with diabetes mellitus, chronic obstructive pulmonary disease, coronary artery disease, and those who have had a splenectomy or are functionally asplenic. The PCV-7 is recommended for the routine vaccination of children. Hepatitis B vaccine is recommended universally for children and for adults who are at high risk for the disease based on profession or lifestyle. Hepatitis A vaccine is recommended for children who live in certain areas of the United States in which the disease is prevalent and may be offered electively to persons traveling to endemic areas. The MMR vaccine is recommended to all children but is not indicated in adults. Rubella vaccination is recommended for women of childbearing age who may become pregnant and who do not have immunity to rubella, in an effort to reduce the risk of congenital rubella infection