Usmle Step 1 MCQ’s # 38

Title: Usmle Step 1 MCQ’s # 38
Subject: Behavioral Science

Q NO 38: The mother of a 6-year-old boy brings him to see the local pediatrician complaining that the boy is enuretic from 4 to 5 times a week. She reports that the problem began in the past few months alter she gave birth to a baby girl. Breast4eeding for the new baby has been difficult and has consumed a great deal of her time each day. She says that the boy is very embarrassed about his enuresis and is afraid that the other children where he goes to school will find out and make fun of him. She asks the physician help and advice. The physician’s best course of action would be to do which of the following?

A. Arrange to inter view the boy about his condition
B. Direct her to have a serious discussion with her son about whether anything is bothering him
C. Prescribe a course of imipramine for the boy
D. Refer the mother to a seminar on breastfeeding
E. Send the boy to a child psychologist for counseling
F. Suggest that the mother block out some special time each day and give exclusive attention to her son
G. Tell the mother that the boy’s problem is normal and tempora, and will soon pass if left alone

Explanation:
The correct answer is F. This type of enuresis, the result of the defense mechanism of regression, is very common when new siblings enter the household. The boy feels neglected and returns to response patterns more typical of a younger child either out of anxiety, or as a direct attempt to gain more parental attention. Spending more, separate time with the boy will help to reassure him of the mother’s continued love and affection. With the motive removed, the symptom is likely to dissipate as well.
Having to discuss a problem about which he is already embarrassed with the authority figure of the physician (choice A) is likely to heighten, not reduce, the boy’s discomfort and embarrassment. The issue here is one between mother and child. The physician should encourage that direct relationship and not seek to form an indirect substitute.
The capacity’ of a 6-year-old to articulate the abstract relationship issues which may be bothering him (choice B) will be limited. More likely the child will feel uncertain as to what to say, and may walk away with heightened embarrassment about his enuresis.
This is the correct pharmacology, but the treatment is premature. Imipramine (choice C) will reduce the bed-wetting, but this merely addresses the symptom, not the root cause. Remember that one of the key mechanisms by which imipramine reduces bed-wetting is through the reduction of delta sleep, which is not a long-term solution for the child.
Referring the mother to a breast-feeding seminar (choice D) misses the issue. The core problem presented is that of enuresis, not the mother’s difficulties with breast-feeding. Even if the mother is expert at this skill, the child is still likely to feel slighted by the attention given to the new sibling. The mother must be directed to affirm her relationship to her son on a daily basis, not advised how to bond better with the new baby.
Don’t “pass off” (choice E) the child. You can, and should, deal with this yourself.
Enuresis after age 5 is diagnosable and, therefore, beyond the normal range (choice G). It is distressing to the mother and a cause of embarrassment to the child. The physician can, and should, provide guidance and help.

Source: http://www.usmleworldwide.com/blog/?p=760

Usmle Step 1 MCQ’s # 37

Title: Usmle Step 1 MCQ’s # 37
Subject: Behavioral Science

Q NO 37: A 19-year-old mother brings her first child, a 10-day-old infant, to the pediatrician. In a fearful tone of voice she states: “Every time I drop something or the dog barks, he jumps and jerks his little arms to his chest like he’s afraid. Is something wrong with him?” The pediatrician explains that the behavior is normal and will most likely be naturally extinguished at what age?

A. 1 month
B. 5 months
C. 8 months
D. 12 months
E. Never

Explanation:
The correct answer is B. The Moro reflex can be elicited in the infant by any startling event; it consists of extension and abduction of the arms followed by flexion and adduction of the arms. This is a normal reflex that appears between the ages of 25 and 36 weeks of gestation, and will normally disappear between 3-6 months.
The palmar grasp reflex, characterized by the infant’s hand closing over an object placed in the palm of the hand, normally disappears after 1-2 months of age (choice A)
The tonic neck reflex consists of extension of the ipsilateral leg and flexion of the contralateral arm and leg when the head is turned. This reflex normally disappears between 7 and 8 months of life (choice C)
The Babinski reflex is elicited when the lateral surface of the sole of the foot is stroked, resulting in the great toe going up and the other toes fanning. It normally disappears at 1 year of age (choice D).
Deep tendon reflexes can be elicited by tapping a tendon with a reflex hammer, stretching the tendon and producing contraction in the corresponding muscle. These reflexes are present throughout life (choice E)

Source: http://www.usmleworldwide.com/blog/?p=745

Usmle Step 1 MCQ’s # 36

Title: Usmle Step 1 MCQ’s # 36
Subject: Behavioral Science

Q NO 36: A 40-year-old woman is being seen by a physician for the 10th time this year for evaluation of vague aches and pains. An extensive prior evaluation has excluded the possibility of serious disease. During the inter’ view with this patient, she makes repeated statements along the lines of, “What I want doesn’t matter. Do what you want.” And, “I’m afraid you won’t have time to see me anymore.” The traits this patient is exhibiting are most consistent with which of the following personality disorders?

A. Dependent
B. Histrionic
C. Obsessive-compulsive
D. Paranoid
E. Schizoid

Explanation:
The correct answer is A. This scenario is classic for “dependent” personality. Look for reliance on others, subordination of own needs, and fear of abandonment. Note that in real life, patients may show symptoms of more than one personality disorder.
Histrionic personality disorder (choice B) is characterized by theatricality, suggestibility, a strong desire for attention, and shallowness.
Obsessive-compulsive personality disorder (choice C) also called anancastic personality disorder, is characterized by obsessions, perfectionism, rigidity, and self-doubt.
Paranoid personality disorder (choice D) is characterized by suspiciousness, oversensitivity, querulous ness, and an unforgiving character.
Schizoid personality disorder (choice E) is characterized by emotional coldness, solitude, and social insensitivity.

Source: http://www.usmleworldwide.com/blog/?p=735

Usmle Step 1 MCQ’s # 35

Title: Usmle Step 1 MCQ’s # 35
Subject: Behavioral Science

Q NO 35: A 25-year-old HIV-positive woman gives birth to a 6-pound baby boy at a local health clinic. The woman has received no prenatal care. She is ecstatic about the birth, holds the child closely, and talks softly to the child every chance she gets. Tests performed to assess the child’s HIV status return positive results. When told of these results, the new mother appears unfazed, and says that she will just have to be an even better mother to” help the child through this.” She requests a consultation with a breast-feeding counselor because she says, “I want to make sure I do this right.” The physician tells her that breast-feeding is not advisable, to which she replies,” I know that breast-feeding is best, and I want the best for my baby.” The physician’s best reply would be which of the following?

A. “I’m pleased that you are taking your responsibilities so seriously. I’ll arrange an appointment with the breast-feeding counselor for you myself.”
B. “If you insist on breast-feeding your child, the courts will remove the child from your custody.”
C. “If you really love your child, you will do what is best and not breast-feed.”
D. “It is important that you listen to me carefully. Breast-feeding increases the risk to your child. You must not do it.”
E. “It’s wonderful to see how happy you are. We can talk a bit more about these things alter you’ve has some rest and have recovered from the birth.”
F. “Let me explain. A positive test when the child is this young is not definitive. But if you breast-feed your child, you greatly increase the chances of your child contracting HIV.”
DIG. “Yes, breast-feeding is best in most circumstances, but given your HIV status, I strongly advise against it.”

Explanation:
The correct answer is F. Although all children of HIV-positive mothers will test positive at birth due to the mother’s antibodies, the congenital transmission rate is just under 20%. Women who are HIV-positive should not breast-feed.Breast-feeding increases the chances of congenital transmission to a considerable degree. A number of legal precedents exists in which courts have actually taken custody away from mothers who insist on breast-feeding. Making sure the woman knows this is essential. However, how the woman is told is also important. Authoritarian commands and simple unsupported advice are not the best answer. Instead, explain the reasons for the recommendation in a way that make clear the risk to the child if the advice is not followed.
Choice A is incorrect because breast-feeding greatly increases the chance of the child contracting HIV and is, therefore, not to be allowed.
Choice B is a true statement, but said in a way that is harsh and punitive. The woman is threatened with the loss of her child without a clear explanation as to what the underlying issue is.
Choices C and G tells the patient what the physician advises, but does not explain the reasoning. The patient needs full information, not advice or commands.
The tone of this response (choice D) is one of talking down to the patient. It is a tone that one might use with a child, not with an adult. In addition, the physician does not explain the difference between a positive test result and the child actually having HIV.
The issue must be addressed at once. She may want to breast-feed from the beginning. As a general rule, putting off the conversation until later is not the best answer (choice E) Deal with the issue now.

Source: http://www.usmleworldwide.com/blog/?p=730

Usmle Step 1 MCQ’s # 34

Title: Usmle Step 1 MCQ’s # 34
Subject: Behavioral Science

Q NO 34: A pathologist receives a phone call from a patient who was diagnosed with a 15-cm recurrent, mediastinal seminoma. During the conversation it becomes clear that despite the patient’s obvious intelligence, the man does not really understand that his disease is probably incurable. The patient keeps talking about his long-term plans for the future, and believes that the pathologist must have “misunderstood” how big his tumor was. Later, the surgeon tells the pathologist that he has spent 12 hours over the last six months trying to explain the prognosis to the patient. The patient is most likely using which of the following defense mechanisms?

A. Denial
B. Displacement
C. Reaction formation
D. Regression
E. Repression

Explanation:
The correct answer is A. This is denial, in which a person behaves as if he or she is unaware of something he may reasonably be expected to know. Denial is common in medical settings and this case is a real one. Denial is distinguished from the related concept of repression mostly by the deeper level of sub consciousness at which the latter occurs. People with deeply repressed memories do not usually try’ to argue with someone who talks to them; they simply do not remember.
Displacement (choice B) is a transfer of emotion from one setting to another.
Reaction formation (choice C) is the unconscious adoption of behavior opposite to one’s true feelings and intentions.
Regression (choice D) is the adoption of behavior appropriate to an earlier stage of development.
Repression (choice E) is the deeply subconscious suppression of traumatic events or thoughts.

Source: http://www.usmleworldwide.com/blog/?p=720

Usmle Step 1 MCQ’s # 33

Title: Usmle Step 1 MCQ’s # 33
Subject: Behavioral Science

Q NO 33: A 42-year-old woman who has been diagnosed with psychotic depression is discussing treatment options with her psychiatrist. She is very reluctant to take medication because of tear that she will make her chemical imbalance even worse. She is also looking for something that is going to have a faster effect. The doctor discusses the possibility of electroconvulsive treatment. What is the most common complication of this treatment?

A. Cerebral edema
B. Hypotensive crisis
C. Memory impairment
D. Oneiroid state
E. Status epilepticus

Explanation:The correct answer is C. The greatest concern regarding ECT is memory loss which is usually short term, but occurs in 75% of the patient population. Follow-up data after the full course of treatment indicate that almost all patients are back at their baseline cognitively atter6 months.
The risk of cerebral edema (choice A) is significantly increased in patients with space occupying lesions in the CNS. Otherwise, it is not the most common side effect.
Hypotensive crisis (choice B) may occur in the event of brief postictal bradycardia. Usually, hypertension occurs, and some patients may need to be pretreated with anti hypertensives.
An oneiroid state (choice D) is a dreamlike state seen mostly in schizophrenic patients, who look perplexed. It can also be seen in medical and neurological conditions. The patient is not fully oriented to time and place, and is usually having hallucinations.
Status epilepticus (choice E) can occur during the induction of seizures and is managed with additional doses of anesthetic, however, it is not most common complication.

Source: http://www.usmleworldwide.com/blog/?p=674

Usmle Step 1 MCQ’s # 32

Title: Usmle Step 1 MCQ’s # 32
Subject: Behavioral Science

Q NO 32: An 85-year-old man presents with complaints of pain in his left chest on inspiration. Physical examination reveals bilateral bruises on his upper arms. X-ray films of his chest show three broken ribs on the left side. The most likely explanation for this constellation of findings is

A. alcoholic incoordination
B. elder abuse
C. falling in the bathtub
D. phase III Alzheimer’s disease
E. physical sequela of pseudodementia

Explanation:
The correct answer is B. The bilateral bruises on the upper arms suggest that he has been tightly grabbed. The left-sided rib fractures would support the possibility that he was struck forcefully by someone who is right-handed (as most people are).
Alcoholic incoordination (choice A) characteristically results in bruises on the lateral surface of the body as the person stumbles into door frames, or on the shins at” coffee table” height.
Falling in the bathtub (choice C) is likely to produce bruises localized to one side of the body.
There are no characteristic physical signs of trauma associated with either Alzheimer’s disease (choice D) or pseudodementia (choice E)

Source: http://www.usmleworldwide.com/blog/?p=670

Usmle Step 1 MCQ’s # 31

Title: Usmle Step 1 MCQ’s # 31
Subject: Behavioral Science

Q NO 31: A physician has known a 35-year-old woman for more than 10 years. During this entire period, she has seemed emotionally cold and distant. She has not developed friendships with either men or women and has always appeared preoccupied with her own concerns. Although she is emotionally cold, she does not appear to specifically trigger confrontational scenes and has not shown any bizarre ideation. These features suggest which of the following diagnoses?

A. Histrionic personality
B. Narcissistic personality
C. Paranoid personality
D. Schizoid personality
E. Schizotypal personality

Explanation:
The correct answer is D. This patient has schizoid personality disorder. These individuals tend to have cold, introverted personalities that limit the degree to which they form strong bonds with other people. They tend to tear closeness and to be given to daydreaming rather than action.
Patients with histrionic personality (choice A) tend to have exaggerated, childlike emotions, sometimes with a sexual overlay.
Patients with narcissistic personality (choice B) tend to be grandiose and preoccupied with self.
Patients with paranoid personality (choice C) tend to be very suspicious of other individuals’ motivations.
Schizotypal personality (choice E) is similar to schizoid personality, but is also associated with oddities of thinking (much less severe than in schizophrenia) such as magical thinking, clairvoyance, or paranoid ideation.

Source: http://www.usmleworldwide.com/blog/?p=663

Usmle Step 1 MCQ’s # 30

Title: Usmle Step 1 MCQ’s # 30
Subject: Behavioral Science

Q NO 30: A 35-year-old patient is given a battery of neuropsychological tests. He scores 85 on the Wechsler Adult Intelligence Scale (WAIS) Verbal 10, 135 on the Performance 10 test, and 125 on the Wechsler Memory Scale test. Which of the following is the most likely site of his brain dysfunction?

A. Bilateral frontal lobes
B. Bilateral hippocampal gyri
C. Bilateral occipital lobes
D. Left hemisphere
E. Right hemisphere

Explanation:
The correct answer is D. The pattern presented suggests this person is having difficulties with verbal material (WAIS verbal IC of 85) but not with visual-spatial tasks (performance 10) or memory (Wechsler memory scale). Since the left hemisphere is dominant for speech and verbal material in the majority of individuals the lesion is most likely in the left hemisphere.
Choice A is incorrect since the frontal lobes control socially appropriate behavior, sequencing, and future planning. There is no indication that these are deficient in this person.
Since memory is intact, a lesion in the bilateral hippocampal gyri (choice B) is unlikely.
Bilateral occipital lesions (choice C) would produce problems with visual recognition, which are not apparent in this person.
The right hemisphere (choice E) is related to control of visual-spatial functions (e.g., map reading, locating oneself in space, etc.) rather than verbal ability.

Source: http://usmleworldwide.com/blog/?p=621

Usmle Step 1 MCQ’s # 29

Title: Usmle Step 1 MCQ’s # 29
Subject: Behavioral Science

Q NO 29: A 34-year-old woman is brought to the physician by her husband, who says that her “disabling disorder” is ruining their lives. She is terrified of being “stuck” in a crowd, “trapped” on a bridge, or “locked” in a train or bus. She is “deathly afraid” of leaving the house alone, but she will occasionally go out on the weekends with her husband. She says that this condition began sometime in her 20’s, but cannot recall any event that triggered this behavior. She is very embarrassed about being “house bound.” Which of the following is the most likely diagnosis?

A. Agoraphobia
B. Arachnophobia
C. Avoidant personality disorder
D. Generalized anxiety disorder
E. Social phobia

Explanation:
The correct answer is A. This patient has agoraphobia, which is the intense tear of situations or places where it may be difficult to escape. It is often a disabling condition that causes the individual to have a tear of leaving home. These individuals are embarrassed about their behavior and may feel more comfortable going places with a companion. It can occur with or without panic disorder. Exposure therapy may be effective in these patients.
Arachnophobia (choice B) is an intense fear of spiders that can be triggered by seeing a spider, picturing a spider, or entering a situation where a spider may be encountered.
Individuals with avoidant personality disorder (choice C) are socially withdrawn however they desire relationships and dislike their isolation. They are hypersensitive and tear rejection. The patient in this case is scared of feeling “trapped” or being in a situation where she cannot escape, she is not socially isolated because she is shy or fears criticism.
Generalized anxiety disorder (choice D) is characterized by persistent worry about virtually every aspect of an individual’s life. The anxiety and worry must cause functional impairment, last at least 6 months, and be associated with at least 3 of the following: restlessness, fatigability, irritability, muscle tension, sleep disorders, and difficulty concentrating. The patient in this case is anxious about situations from which escape might be difficult she is not worried about all other aspects of her life.
Individuals with social phobia (choice E) are fearful of situations with unfamiliar people or when they maybe scrutinized by others. This tear must impair everyday activities and relationships. An example of a common social phobia is fear of giving a speech. The woman in this case is not tearful of the scrutiny of others she is scared of being unable to escape a situation or place.

Source: http://usmleworldwide.com/blog/?p=452

Usmle Step 1 MCQ’s # 27

Title: Usmle Step 1 MCQ’s # 27
Subject: Behavioral Science

Q NO 28: A newborn has a heart rate of 130/min, irregular respirations. and active muscle movements with good tone. He coughs and grimaces in response to stimulation; he is pink in color, except for his hands and feet, which are slightly bluish. This neonate’s APGAR score is?

A. 6
B. 7
C. 8
D. 9
E. 10

Explanation:
The correct answer is C. APGARI named alter Virginia Apgar, can be remembered using the mnemonic: appearance, pulse, grimace, activity, and respiration. The APGAR score is taken at 1 minute and 5 minutes alter birth. On each parameter, a maximum score of 2 is possible. In this case, one point was taken off for cyanosis of the hands and feet; one point was taken off for irregular respirations. The neonate received the maximum score of 2 for all of the other parameters leading to an APGAR of 8.

Source: http://usmleworldwide.com/blog/?p=381