Usmle Step 1 MCQ’s # 50

Title: Usmle Step 1 MCQ’s # 50
Subject: Behavioral Science

Q NO 50: A 55-year-old man with a history of alcoholism and hepatitis C undergoes an orthotopic liver transplant. His surgery goes well, and he is taken to the intensive care unit. On postoperative day 4, the patient’s sedation is discontinued, and he is extubated. On postoperative day 5, the patient begins to experience tremor, tachycardia, hypertension, nausea, and malaise. He begins to have visual hallucinations. On examination, his wound is clean, dry, and intact. No unexpected abdominal tenderness is elicited. Which of the following pairs best explains the patient’s symptoms and gives the appropriate treatment?

A. Alcohol withdrawal/administer benzodiazepines
B. Mallory-Weiss syndrome /administer benzodiazepines
C. Mallory-Weiss syndrome/ administer thiamine
D. Wernicke-Korsakoff syndrome/administer benzodiazepines
E. Wernicke-Korsakoff syndrome/administer thiamine

Explanation:
The correct answer is A. Patients with a history of alcoholism should always be watched for symptoms of alcohol withdrawal because the sequelae can be life-threatening. In this case, the patient exhibits many of the classic findings of alcohol withdrawal: tremor, tachycardia, hypertension, malaise, nausea, hallucinations, and delirium tremens. Delirium tremens is a constellation of signs and symptoms including autonomic instability, tachycardia, hypertension, delirium, and death. Treatment for withdrawal can include replacing the alcohol or giving benzodiazepines.
Choice B does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. In Mallow-Weiss syndrome, patients develop longitudinal lacerations at the gastroesophageal junction. Itis caused by excessive vomiting with failure of the LBS to relax, and can lead to fatal hematemesis. Treatment may include preventing the emesis and/or managing hemorrhage. Choice C does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. See above (choice B) for explanation. Choice D does not correctly identify this patient’s condition, nor does it properly address the treatment for Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is caused by a thiamine deficiency, and results in psychosis, ophthalmoplegia, and ataxia. Untreated it may progress to memory loss, confabulation, and confusion. Treatment is thiamine replacement.
Choice E correctly matches the disease with the treatment, but it tails to correctly identify the symptoms seen in this patient.

Source: http://www.usmleworldwide.com/blog/?p=1312

Usmle Step 1 MCQ’s # 49

Title: Usmle Step 1 MCQ’s # 49
Subject: Behavioral Science

Q NO 49: A 50-year-old woman presents for a follow-up visit alter being diagnosed with diabetes one month ago. At that visit, her physician verbally requested that she have some labs drawn before today’s appointment. The patient did not remember to have the labs drawn. Which of the following would be most likely to improve the patient’s compliance?

A. Ask the patient to make a behavioral change in addition to the laboratory work
B. Provide the patient with a written laboratory request with clear instructions
C. Peter the patient to a physician with expertise in “difficult patients”
D. Repeat the lab requests lowly and more loudly
E. Show photographs of patients who had an amputation due to uncontrolled diabetes

Explanation:
The correct answer is B. Providing written diagnostic and treatment recommendations, including requests for labs has been shown to increase compliance. Many patients become anxious and ire less likely to remember and follow verbal recommendations, particularly when receiving difficult news.
Compliance is increased with simple clear instructions, and instituting a behavioral change (choice A) will overwhelm the patient. It is best to institute one behavioral change t a time.
Referral to another physician (choice C) is not the plan of choice except under extreme circumstances (not in a case such as this), and is likely to distress the patient.
Repeating i verbal instruction (choice D) does not facilitate compliance and may increase noncompliance and frustration on the part of both patient and physician.
Scaring or intimidating patients (choice E) is not recommended to increase compliance and could also have i negative impact on the physician-patient relationship.

Source: http://www.usmleworldwide.com/blog/?p=1234

Usmle Step 1 MCQ’s # 48

Title: Usmle Step 1 MCQ’s # 48
Subject: Behavioral Science

Q NO 48: A 56-year-old man visits his primary care physician complaining of difficulty while having sexual relations with his wife. In the past two months, he has often been unable to achieve an erection. When he does achieve an erection, he is unable to maintain it for a sufficient duration to permit intercourse. The patient appears distressed. He has been married for over 30 years and says that he has never encountered this problem before. To further assess this man’s problem, the physician’s next question should be which of the following?

A. Are you afraid that this will not go away by itself?
B. Have you ever heard of something called a ‘snap gauge’?
C. Have you heard about a drug called sildenafil?
D. How much alcohol do you usually consume in the course of the week?
E. Is this the reason that you feel distressed, or is there something else you would like to tell me?
F. What do you know about how sexual functioning changes as you age?
G. What is your wife’s reaction to all of this?
H. Would you like me to make an appointment for you with a specialist with whom you can talk about this?

Explanation:
The correct answer is D. More information is required before a course of action to address this man’s erectile dysfunction can be decided upon. Before more invasive interventions are considered, the physician should first explore the effect that life circumstances may be having on the man’s sexual functioning. In particular the physician should ask about: 1) alcohol use, 2) smoking 3) diabetes 4) marital conflict and 5) work-related stress. It is critical to gain a sense of the etiology of the condition before moving on to a discussion of treatment options.
Drawing attention to the patient’s anxiety (choice A) distracts from gathering information that will help diagnose the patient’s condition. While noticing and even commenting on the patient’s emotional state is good practice, itis unlikely to reassure the patient that the physician is ting to solve the problem that is presented. Discussing the patient’s distress will most likely be more effective once the patient’s condition is better understood.
Discussing diagnostic options before fully exploring the patient’s lifestyle and life circumstances (choice B) is inappropriate. A “snap gauge” is a device used to help determine whether the erectile disorder is primarily physiological or psychological. The device is fitted around the penis before the man goes to sleep at night and responds to any erections the man achieves during REM sleep. If the man does achieve an erection during sleep physiological problems can be ruled out.
Discussing therapeutic options before making a diagnosis is inappropriate. Sildenafil (Viagra; choice C.) is one of the most commonly prescribed mediations for male secondary impotence. However the prescription is inappropriate before the etiology is fully explored.
Choice E suggests that the physician believes that the patient may be hiding something. Such a direct confrontation, at this early point in the interaction, risks offending the patient, and does little to foster sense of support and rapport.
Although the incidence of erectile dysfunction does increase with age (choice F), this degree of sexual dysfunction is not a natural part of the aging process. To ask this question suggests to the patient that that is the case. The physician should seek specific proximate causes, and not hide behind misconceptions of aging. Many individuals will be able to have sexual relations for the lull duration of their life.
The locus should be on the patient, his symptoms, his life and his reactions. Turning the focus onto his wife’s reactions (choice G) is at best premature.
The physician can in all likelihood treat this patient on his/her own. Even if a referral to a specialist (choice H) is ultimately needed a preliminary inquiry’ needs to be completed before this step is considered.

Source: http://www.usmleworldwide.com/blog/?p=1230

Usmle Step 1 MCQ’s # 47

Title: Usmle Step 1 MCQ’s # 47
Subject: Behavioral Science

Q NO 47: The parents of a 5-year-old girl ask their family physician for advice regarding their child. The mother had walked into the girl’s bedroom without knocking and discovered the child stimulating her genitals. The parents are concerned, but seem to be receptive. The best response the physician could give is which of the following?

A. Do you think that someone’s been molesting her?
B. Don’t you think you should knock before going into her room?
C. She probably has a vaginal infection. Bring her in so I can examine her.
D. This is perfectly normal behavior for a child this age.
E. What disturbs you about this behavior?

Explanation:
The correct answer is E. Before the physician can provide guidance for the parents, the parents’ concerns need to be understood. While the described behavior is perfectly normal for a 5-year-old (choice D) , and it is appropriate for parents to knock on the door of their child’s room before entering (choice B) to teach children respect for privacy through modeling1the parents’ concerns must first be understood.
To immediately assume there is something physically wrong with the child (choice C) or that the child has been sexually abused (choice A) suggests that the physician may have some personal issues with children’s normal sexuality.

Source: http://www.usmleworldwide.com/blog/?p=1222

Usmle Step 1 MCQ’s # 46

Title: Usmle Step 1 MCQ’s # 46
Subject: Behavioral Science

Q NO 46: A 28-year-old woman complains to her doctor that she is in danger of losing her job. She states that she is late to work almost eve day because, before she leaves for work, she must check all of the faucets to make sure the water is turned off. She also needs to repeatedly check to make sure that her stove is off. When she is finally ready to leave, she returns from her car several times to ensure that her doors and windows are locked. Which of the following drugs will her physician most likely prescribe?

A. Buspirone
B. Chlorpromazine
C. Clomipramine
D. Imipramine
E. Phenelzine
F. Zolpidem

Explanation:
The correct answer is C. This patient is suffering from obsessive-compulsive disorder. Clomipramine, a tricyclic antidepressant, and the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are effective in this disorder. None of the other answer choices listed constitute effective therapy for this disorder. Buspirone (choice A) is a non-benzodiazepine anxiolytic that does not have marked sedative or euphoric effects. Unlike the benzodiazepines, buspirone is devoid of hypnotic, anticonvulsant, and muscle relaxant properties. Chlorpromazine (choice B) is an antipsychotic (phenothiazine) drug. Imipramine (choice D) is a tricyclic antidepressant.
Phenelzine (choice E) is a monoamine oxidase inhibitor type of antidepressant. Zolpidem (choice F) is a non-benzodiazepine hypnotic agent.

Source: http://www.usmleworldwide.com/blog/?p=1167

Usmle Step 1 MCQ’s # 45

Title: Usmle Step 1 MCQ’s # 45
Subject: Behavioral Science

Q NO 45: Alter his spouse dies from advanced malignant melanoma, a man comes to his family physician stating that he is experiencing a great deal of guilt about his wife’s death and feels that he could have done more to save her. Which of the following is the best response the physician can make to this patient at this time?

A. Don’t talk like that.
B. I think every one goes at their appointed time.
C. Nobody could have saved her.
D. Tell me more about your feelings of guilt.
E. You did the best you could.

Explanation:
The correct answer is D. When a person loses someone who is close to them the most important thing they need to do is to talk about the loss. Any response that does anything other than allow and encourage the person to verbalize their feelings is inappropriate. “Tell me more about your feelings of guilt” is the only statement that encourages the patient to talk.
The other choices are all statements that will dissuade the person from talking more about the loss.

Source: http://www.usmleworldwide.com/blog/?p=1123

Testing

Testing:

The USMLE program has established rules to govern administration of the examinations to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise. The rules include standard test administration conditions consistent with the principles on which the examinations are developed and scored. For example, examinations are designed to sample knowledge across specified content domains, and unauthorized access to examination content prior to testing violates that principle.
If there is a reason to believe that the integrity of the examination process is jeopardized, the USMLE parent organizations may invalidate all or any part of an examination. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the USMLE parent organizations reserve the right to suspend or cancel test administration.

• Testing Regulations and Rules of Conduct

• Personal Items

• Admission to the Test

• Step 1, Step 2 CK, and Step 3

• Step 2 CS 

Source: http://www.usmleworldwide.com/blog/?p=1115

Usmle Step 1 MCQ’s # 44

Title: Usmle Step 1 MCQ’s # 44
Subject: Behavioral Science

Q NO 44: A 53-year-old widowed female is brought to the emergency room by her family after they noticed increasing irritability, agitation, and abusiveness. She recently had a loud altercation with a new neighbor. Her past history is significant for depression, which was treated with paroxetine for 4 years. Recently, the woman has been staying up all night doing housework, and denies feeling tired the next day. She recently surprised a family friend with sexually inappropriate, seductive remarks. She denies any hallucinations at the present time, but acknowledges that she has heard voices in the past, telling her to kill herself. She currently denies suicidal ideation and states that life is “just great” except that she is woring about her grandchildren while she is in the hospital. Which of the following is the most likely diagnosis?

A. Adjustment disorder
B. Anxiety disorder
C. Mood disorder
D. Personality disorder
E. Thought disorder

Explanation:
The correct answer is C. The patient has a history of depression. She now presents with symptoms of mania, including increased goal-directed activity, possible hyper sexuality (seductive remarks), irritability, and decreased need for sleep. While the primary diagnosis has been unipolar depression, the current presentation is consistent with bipolar disorder (manic-depressive). Both depression and bipolar affective disorder are mood disorders.
A healthy individual should be able to adjust to new conditions such as a new neighbor, but the patient is clearly exhibiting symptoms of an affective disorder, rather than an adjustment disorder (choice A)
Anxiety disorder (choice B) is characterized by excessive worrying. This alone does not explain the current presentation; anxiety disorder can occur simultaneously with mood disorder, or as part of it.
Personality disorders (choice D) are diagnosed when maladaptive and rigid traits in an individual produce distress and/or functional impairment; these traits are usually stable and predictable. Personality disorders are classified as axis II in DSM IV. Diagnosis of axis II is usually deferred until the patient’s axis I disorder (the mood disorder) is stabilized.
The patient has history of auditory hallucinations, which suggest the presence of a thought disorder (choice E) such as schizophrenia. However, mood disorders can present with psychotic features. This patient heard voices telling her to kill herself, probably during a period of severe depression; these hallucinations were congruent with her likely mood at the time, evidence that they were part of the underlying affective disorder.


Source: http://www.usmleworldwide.com/blog/?p=1119

Usmle Step 1 MCQ’s # 43

Title: Usmle Step 1 MCQ’s # 43
Subject: Behavioral Science

Q NO 43: A 3-year-old girl is brought to the physician for a well child examination. She was born at term after an uncomplicated pregnancy. Physical examination shows no abnormalities. She rides a tricycle. can build a tower of 8 blocks, and speaks in sentences. Which of the following is an accurate assessment of this patient’s development?

A. Normal gross motor, normal fine motor, and normal language development
B. Normal gross motor, delayed fine motor, and normal language development
C. Normal gross motor, normal fine motor, and delayed language development
D. Delayed gross motor, delayed fine motor, and normal language development
E. Delayed gross motor, normal fine motor, and normal language development

Explanation:
The correct answer is A. This patient has normal developmental milestones. A 3-year-old child should be able to ride a tricycle, balance one ach foot for 1 second build a tower of 8 blocks imitate a vertical line and speak with almost understandable sentences. This patient is not delayed in any area making choices B, C, D, and E incorrect.
Common developmental milestones are:
Newborn- regard faces, suckle Moro, and grasp reflexes
6 months- babbles sits alone passes a cube
12 months- says 1-2 words begins to walk waves bye-bye
24 months- combines words can build a tower of4-6 cubes kicks a ball
3 years- combines words to form almost understandable sentences rides a tricycle builds a tower of 8 cubes

Source: http://www.usmleworldwide.com/blog/?p=1085

Changes to USMLE procedures for reporting scores

“Changes on December 26, 2012″

As previously reported, the USMLE program has begun the process of eliminating the reporting of results on the 2-digit score scale to parties other than the examinee and any state licensing authority to which the examinee sends results. This process began on July 1, 2011 with elimination of 2-digit scores from USMLE transcripts reported through ERAS.

The USMLE program will extend this change in reporting to include ALL score recipients (e.g., examinees, state medical boards). This means that scores on the 2-digit scale will no longer be calculated or reported. We expect to eliminate the 2-digit score on or about April of 2013. This change pertains to the Step 1, Step 2 CK, and Step 3 examinations only; Step 2 CS will continue to be reported as pass or fail.

 

Background

Since its beginning in the 1990s, the USMLE program has reported two numeric scores for the Step 1, Step 2 CK, and Step 3 examinations, one on a 3-digit scale and one on a 2-digit scale. The 3-digit score scale is considered the primary reporting scale; it is developed in a manner that allows reasonable comparisons across time. The 2-digit scale is intended to meet statutory requirements of some state medical boards that rely on a score scale that has 75 as the minimum passing score. The process used to convert 3-digit scores to 2-digit scores is designed in such a way that the 3-digit minimum passing score in effect when the examinee tests is associated with a 2-digit score of 75.

The USMLE program requires its governing committees to reevaluate the minimum passing score for each Step every three to four years. This process has, at times, resulted in changes in the minimum passing score, expressed on the 3-digit scale, and an accompanying change in the score conversion process, to ensure that a 2-digit score of 75 is associated with the new minimum passing requirement. A by-product of the adjustment of the score conversion system over time has been a shift in the relationship between the two score scales. This shift has no impact for USMLE score users who use the 3-digit scoring scale or for those using the 2-digit scale with a primary interest in whether the examinee has a passing 2-digit score of at least 75. However, it may create challenges in interpretation for score users who are focusing on 2-digit scores, other than 75, and are doing so for purposes of comparing USMLE scores that span several years.

To eliminate the misuse of and confusion surrounding the 2-digit scale, the USMLE Composite Committee, the governing body of the USMLE program, directed staff to discontinue its reporting.

Source: http://www.usmleworldwide.com/blog/?p=1018

Additional changes to USMLE procedures for reporting scores

“Changes October 03, 2011″

As was reported previously, the USMLE program has begun the process of eliminating the reporting of results on the 2-digit score scale to parties other than the examinee and any state licensing authority to which the examinee sends results.

Because USMLE will continue to report the 2-digit score to examinees and to state licensing authorities, the program will be making changes in scoring procedures to minimize the impact of future shifts in the relationship between 2-digit and 3-digit scores that result from USMLE’s periodic review of standards. The new scoring procedures will be implemented with the reporting of results for examinees who take a Step 1, Step 2 CK, or Step 3 examination on or after October 1, 2011.

The change in scoring procedures will introduce a more stable relationship between score scales in the future. Those receiving 2-digit score results under the new system will note that, in most instances, the 2-digit score associated with a specific 3-digit score will be substantially lower than it was prior to this change.

The change in scoring procedures described above does not correct the challenges associated with using the 2-digit score scale for decisions other than those that use a score of 75 or higher to identify examinees who have passed the examination. It is highly recommended that the 3-digit score scale be used for comparisons among examinees, especially for examinees who have tested at different points in time.

Source: http://www.usmleworldwide.com/blog/?p=1013

Changes to USMLE procedures for reporting scores

“Changes on May 04, 2011″

Starting July 1, 2011, USMLE transcripts reported through the ERAS reporting system will no longer include score results on the 2-digit score scale. USMLE results will continue to be reported on the 3-digit scale. This affects the Step 1, 2 CK, and 3 examinations only; Step 2 CS will continue to be reported as pass or fail. These changes do not alter the score required to pass or the difficulty of any of the USMLE Step examinations.



Since its beginning in the 1990s, the USMLE program has reported two numeric scores for the Step 1, Step 2 CK, and Step 3 examinations, one on a 3-digit scale and one on a 2-digit scale. The 3-digit score scale is considered the primary reporting scale; it is developed in a manner that allows reasonable comparisons across time. The 2-digit scale is intended to meet statutory requirements of some state medical boards that rely on a score scale that has 75 as the minimum passing score.  The process used to convert 3-digit scores to 2-digit scores is designed in such a way that the 3-digit minimum passing score in effect when the examinee tests is associated with a 2-digit score of 75.

The USMLE program requires its governing committees to reevaluate the minimum passing score every three to four years. This process has, at times, resulted in changes in the minimum passing score, expressed on the 3-digit scale, and an accompanying change in the score conversion process, to ensure that a 2-digit score of 75 is associated with the new minimum passing requirement. A by-product of the adjustment of the score conversion system over time has been a shift in the relationship between the two score scales. This shift has no impact for USMLE score users who use the 3-digit scoring scale or for those using the 2-digit scale with a primary interest in whether the examinee has a passing 2-digit score of at least 75. However, it may create challenges in interpretation for score users who are focusing on 2-digit scores, other than 75, and are doing so for purposes of comparing USMLE scores that span several years.

To simplify matters and make interpretation of USMLE information more convenient for score users, the USMLE Composite Committee has asked staff to report 2-digit scores only to those score users for whom the scale is intended, i.e., the state medical boards. The Committee also asked that examinees continue to receive scores on both scales so that they are fully informed about the information that will be reported when they ask that results be sent to a state medical board. When examinees request that their results be sent to other score users, only the 3-digit score will be reported. Current plans call for these changes to begin with the elimination of the 2-digit score from USMLE transcripts reported through the ERAS reporting system starting July 1, 2011. Other systems and procedures for reporting results will be similarly modified as soon as possible after the July 1, 2011 date.

Source: http://www.usmleworldwide.com/blog/?p=1010

Usmle Step 1 MCQ’s # 42

Title: Usmle Step 1 MCQ’s # 42
Subject: Behavioral Science

Q NO 42: While driving home at the end of an evening on call, a second year resident encounters an automobile accident. She decides to stop and render whatever aid she can. The accident involves two cars. In the first car, the driver was cushioned by an airbag and suffered only minor bruises and abrasions. In the second car, the driver was thrown against the steering wheel and against the wind shield, causing severe thoracic and closed head trauma. Fearing a fire, the resident pulls the driver out of the second car, and proceeds to do what she canto stop the loss of blood. In spite of her best efforts, the second driver dies. Subsequent autopsy determines that moving the driver from the car exacerbated a spinal injury and contributed to the driver’s death. The driver’s family sues the resident and the hospital at which she works, claiming negligence. The complaint states that the resident should have known not to move the patient and that the hospital bears responsibility for not training the resident adequately, and the lack of sleep resulting from the night on call. The most likely outcome for this legal case is which of the following?

A. Civil, but not criminal penalties, for both the resident and the hospital
B. Civil, but not criminal, penalties for the hospital, and no penalties for the resident
C. Civil, but not criminal, penalties for the resident, and no penalties for the hospital ‘O
D. Criminal and civil penalties for both the resident and the hospital
E. Criminal and civil penalties for the hospital, but not for the resident
F. Criminal and civil penalties for the resident, but not for the hospital
G. Neither civil nor criminal penalties for either the resident or the hospital

Explanation:
The correct answer is G. The issue here is a simple one the Good Samaritan law says that physicians do not have to stop to help in a non-medical situation like an accident. However to encourage them to stop, the physician is shielded from legal liability as long as he or she: 1) acts within their area of competency 2) does standard procedures, 3) stays until relieved by competent medical personnel and 4) receives no compensation. The physician can still be sued but is protected from any adverse judgment. In the present case all four of these conditions are met. Moving the patient when there is a threat of fire is perfectly reasonable. The physician is shielded from liability.
The hospital is also shielded from liability. The resident is technically an employee but was traveling home alter a night on call and therefore “off duty.”
Finally neither the physician nor the hospital is subject to any criminal charges. There was no malicious conduct nor any perverse neglect nor anything else that would rise to the level of criminal action.

Source: http://www.usmleworldwide.com/blog/?p=957

Usmle Step 1 MCQ’s # 41

Title: Usmle Step 1 MCQ’s # 41
Subject: Behavioral Science

Q NO 41: A 47-year-old man comes to the physician 1 year after his wife died in an automobile accident. Ever since the accident, he has had feelings of worthlessness, self-blame, insomnia, and fatigue. He does not go out with friends and never goes to football games anymore, formerly his favorite pastime. He is “sad all the time1” has lost 15 pounds frequently spends nights and weekends crying on the couch, and finds it difficult to move. Sometimes he cannot even get up to go to work. He says that his symptoms have been worsening over time. He is not so sure that wants to “be around” without his wife anymore. Which of the following is the most likely diagnosis?
A. Conversion disorder
B. Dysthymic disorder
C. Major depressive disorder
D. Normal grief
E. Separation anxiety disorder

Explanation:
The correct answer is C. This patient most likely has major depressive disorder. He has had depressed mood insomnia fatigue, weight loss anhedonia, psychomotor retardation, feelings of worthlessness, and suicidal ideation for a year. These symptoms are causing severe distress and functional impairment. They are severe enough to meet the criteria for a major depressive episode and are not better accounted for by normal grief and bereavement. Normal grief (choice D) is usually characterized by a depressed mood, feelings of loss crying spells, and decreased enjoyment in life. Dysfunction may occur, however alter several months the individual should led less sad and become more functional with time. Suicidal ideation, psychomotor retardation, and marked functional impairment are consistent with depression and not normal grief.
Conversion disorder (choice A) is characterized by the sudden onset of motor or sensory symptoms and dysfunction that are without an identifiable physical cause. The symptoms are temporally related to a psychological stressor, however the deficit is not intentionally produced. This patient does not have motor or sensory symptoms.
Dysthymic disorder (choice B) is a chronic, persistent feeling of mild depression that lasts for more than 2 years. These patients do not meet the criteria for a major depressive episode. The patient in this case meets the criteria for major depression.
Separation anxiety disorder (choice E) is an anxiety disorder that occurs when the individual leaves home or relatives. It is most common in children and often presents with headaches stomach cramps nightmares and school avoidance. The patient in this case is not experiencing anxiety, he is depressed.

Source: http://www.usmleworldwide.com/blog/?p=861

Usmle Step 1 MCQ’s # 40

Title: Usmle Step 1 MCQ’s # 40
Subject: Behavioral Science

Q NO 40: A 5-year-old girl is brought by her parents to the emergency room because she is complaining of stomach pain. Physical examination reveals multiple bruises on the child’s body in different stages of healing. X-ray examination of the chest demonstrates two cracked ribs and the child says. “Mommy hit me.” The parents deny any abuse of their children. The physician’s most appropriate response would be which of the following?

A. Call the police immediately
B. Hospitalize the child for further studies
C. Notify Child Protective Services
D. Tape her ribs and make the parents promise me that they will not strike the child again
E. Tape her ribs and tell the parents to bring the child to the outpatient clinic in the morning

Explanation:
The correct answer is C. All signs, including the child’s report, suggest child abuse; however, there can be mitigating circumstances that are present. All states have laws requiring everyone to protect children by reporting the suspicion of child abuse to Child Protective Services. It is the responsibility of this agency to prove or disprove the suspicion, and to establish supervision of the child if abuse is verified.
“I am going to call the police right now” (choice A), is only appropriate if the Child Protective Services is not available immediately.
Choices B, D, and E do nothing to address the issue of the mandatory report of the suspicion of child abuse to the appropriate authorities.

Source: http://www.usmleworldwide.com/blog/?p=857

Usmle Step 1 MCQ’s # 39

Title: Usmle Step 1 MCQ’s # 39
Subject: Behavioral Science

Q NO 39: A nurse on an inpatient internal medicine ward comes to see the attending physician. While drawing blood for routine laboratory tests ordered by the medical staff, the nurse inadvertently stuck herself with a hypodermic needle, in which were several drops of the patients blood. The nurse is anxious, and wants the physician to order that the patient’s existing blood sample be tested for HIV. The physician is aware that the patient has a history of homosexual encounters, although neither the physician nor the nurse are aware of the patient’s HIV status. At this point, the physician should do which of the following?

A. Assure the nurse that the probability of contracting HIV by this method is relatively low, but that she should be more careful in the future.
B. Convene a meeting of the nursing staff and ask it anyone on the ward is aware of the patient’s HIV status.
C. Order the test, as the nurse requests.
D. Review the patient’s chart and medical histor’ for clinical signs consistent with HIV infection.
E. Talk to the patient and order the test only if the patient gives his permission.
F. Tell the nurse that you will order the test if she can obtain the patient’s permission.

Explanation:
The correct answer is C. The general rule is that patient’s conl9dentialitv is to be respected at all times. This means that no medical procedure, including laboratory tests, can be run on a patient without his or her consent. There is one exception: threat of harm to self or others. The guidelines of the American Medical Association explicitly state that the exception applies in this case. The nurse may be at risk. If the patient is HIV-positive, treating her quickly greatly reduces the chance of becoming HIV-positive and increases her life span should she become HIV-positive.
The nurse has aright to treatment and the right to know if she needs treatment. She needs more than reassurances (choice A). She needs the test performed to know the patient’s HIV status.
This is an escalation that breaks the confidentiality of both the patient and the nurse. Simply running the screening test constitutes much less of a breach than initiating a general discussion with in the hospital staff (choice B)
Knowing that the patient is homosexual already places him in one of the high-risk groups. It is unlikely that reviewing the medical chart (choice D) will produce information that would obviate the need for HIV testing.
Because of the threat of harm clause the patient’s permission is not required (choices E and F).

Source: http://www.usmleworldwide.com/blog/?p=769