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

Correct Answer: B

Cow's milk allergy may occur in 23% of infants and toddlers. After elimination from the diet, by age 3, 85% no longer have symptoms on food challenge. Older children and adults may also lose sensitivity to an offending food when it is eliminated from the diet for 12 years. The exceptions are IgE-mediated allergies to peanuts, nuts, fish, or shellfish.

Correct Answer: C

Cognitive psychotherapy would be helpful to this man to see and understand how cognitive distortions about himself, others, and the future bring about his depressive feelings. Psychoanalysis, a process lasting several years with a weekly commitment of three to four sessions, would require this person to be willing to explore and work through issues and conflicts that have their source in childhood. Behavioral therapy has as its goal the disruption of inappropriate behaviors with the substitute of more appropriate behaviors. It is intended for the treatment of phobias and various psychosomatic disorders (e.g., migraine, hypertension). Supportive psychotherapy could also be of some value. This is used frequently in conjunction with medication. Group therapy may be of some value after this patient has had the opportunity to work in a one-to-one situation in which understandings about himself have developed. Proper preparation is essential before entering group therapy.

Correct Answer: B

Pharyngoesophageal (Zenker's) diverticulum is the most common esophageal diverticulum and typically occurs in the 3050 age group and, therefore, is believed to be acquired. Its symptoms include cervical dysphagia, regurgitation of undigested food, and recurrent aspiration. It is categorized as a pulsion type, creating protrusion of mucosa, resulting in a false diverticulum. An underlying neuromotor abnormality exists, which is responsible for increased pharyngeal pressure. The most important aspect of treatment is a cricopharyngeal muscle myotomy, which can be combined with resection or diverticulopexy.