United States Medical Licensing Step 2: USMLE-STEP-2

Correct Answer: C

Hypocalcemia is not a cause of constipation. On the contrary, it increases irritability of nerve cells and may result in diarrhea. Hypothyroidism, lead poisoning, and Hirschsprung disease all may be associated with constipation. Congenital hypothyroidism and Hirschsprung disease (a congenital disorder characterized by regional absence of ganglion cells from the myenteric plexus of the colon) present at birth. Lead poisoning is more common after the child becomes mobile. Functional constipation is the most common cause of constipation at this age. It is usually due to dietary factors.

Correct Answer: B

Recurrent suicidal behaviors, affective instability, unstable interpersonal relationships, chronic feelings of emptiness, and rejection sensitivity are all traits of borderline personality disorder.

Correct Answer: C

In a patient who has undergone surgical resection for colon cancer, elevated CEA, and liver function tests must be followed by an evaluation for metastatic disease, including the possibility of extrahepatic disease. The CT scan is the most useful examination to evaluate both intra- and extrahepatic disease. Various CT scans have been advocated for liver tumors, including dynamic and portography scans. PET scans may detect occult extrahepatic disease and studies are underway to define the role of this modality in metastatic colon cancer. MRI shows promise as a useful examination and can be useful to characterize lesions of uncertain significance. Radionuclide liver scans have been supplanted by more accurate scans. Surgical resection, if possible, is the treatment of choice for metastatic colorectal cancer to the liver. Chemotherapy is reserved for patients who are not surgical candidates or refuse surgical treatment. Radiation therapy is not usually used in these patients. Observation and repeat imaging delays the treatment for patients who may be respectable. The expected 5-year survival has been shown in multiple studies to be greater than 20%, usually in the range of 25 and 35%.