Usmle Step 1 MCQ's # 5

Title: Usmle Step 1 MCQ's # 5
Subject: Behavioral Science
  
Q NO 5: A 19-year-old woman is brought to the emergency department by the police. She had run away from home alter another battle with her mother. She has been hospitalized several times for overdoses, and she has numerous scars on her wrists. The psychiatrist notes that all of her relationships have been stormy, and that she seems to regard people as either “all good” or “all bad.” She is admitted with a diagnosis of major depression because of the apparent depth of her depression, however, by the next morning, she is completely recovered and is “well” with no vegetative symptoms. Which of the following is the most likely diagnosis?

A. Antisocial personality disorder
B. Borderline personality disorder
C. Histrionic personality disorder
D. Narcissistic personality disorder
E. Passive-aggressive personality disorder

Explanation:
The correct answer is B. Borderline personality disorder is characterized by short term psychotic episodes (e.g., the depression noted in this case), self mutilation, “splitting” persons into the “good-bad” extremes on a continuum and markedly unstable interpersonal relationships.
The person with antisocial personality disorder (choice A) operates in opposition to society’s rule and customs. Criminal behavior is common.
The person with histrionic personality disorder (choice C) is flamboyant and seductive.
The person with narcissistic personality disorder (choice D) is impressed with himself and operates from a position of entitlement.
The person with passive-aggressive personality disorder (choice E) expresses his anger by passive means such as procrastination, chronic tardiness, and sabotaging productivity.

Usmle Step 1 MCQ's # 4

Title: Usmle Step 1 MCQ's # 4

Subject: Behavioral Science

Q NO 4: A 49-year-old patient is evaluated for suicidal ideation after he is found laying on train tracks by police. The man is disheveled and malodorous and states that he has “reached the end” and would rather die. He admits to depressed mood, anhedonia, poor energy and appetite; he feels miserable and regrets what he has done with his life and wants to put an end to it. He states he has felt this way since age 26, alter he was discharged from the military. The man indicates that his life was “great” until he increased his drinking, which caused a divorce at age 30. He has had two arrests for driving under the influence. He was in jail for 6 months alter he had an accident while drunk that resulted in public property damage. He remembers that he initially felt sick in jail, with sweating, vomiting, shaking, and he experienced a seizure. He then improved alter a few days and felt better during the rest of his imprisonment without any depression. Which of the following criteria most strongly suggests alcohol abuse?

A. Desire to cut down
B. Recurrent drunk driving
C. Seizure alter withdrawal
D. Suicidal ideation
E. Tolerance

Explanation:
The correct answer is B. The DSM criteria for alcohol abuse are recurrent use resulting in failure to fulfill obligations, recurrent use in hazardous situations, recurrent legal problems related to use, and continued use despite negative consequences.
A persistent desire or unsuccessful efforts to cut down (choice A) is also a symptom of dependence.
Seizures (choice C) are a symptom of severe withdrawal in chronic alcoholics. When the patient develops withdrawal symptoms and tolerance, requiring larger amount to achieve the desired effect, he or she has met the criteria for dependence.
Suicidal ideation (choice D) in this patient is a consequence of his depression, which in turn, is secondary to alcohol use. Continued use of a substance despite knowledge of persistent or recurrent physical or psychological problems is also a criterion for dependence.
Tolerance (choice E) is defined as the need to increase substance use to achieve the desired effect, or diminished effect with continuous use of the same amount. Tolerance is a major criterion of dependence.

Usmle Step 1 MCQ's # 3

Title: Usmle Step 1 MCQ's # 3

Subject: Behavioral Science

Q NO 3: A 67-year-old man presents at his physician complaining of discomfort in his lower abdomen and difficulty with urination. The man is 5 feet 11 inches tall and weighs 220 pounds. Although he used to smoke cigarettes, he was able to quit when he retired at age 65. Physical examination reveals an enlarged prostate. Suspecting the possibility of cancer, the physician orders a PSA test and tells the patient he will be contacted when the results are available. The patient is visibly upset at hearing the word “cancer” and in spite of the physician’s reassurances of the low probability of malignancy, is physically shaking when he leaves the office. Several days latter the results of the test are received. The patient has a PSA of 3.5, elevated, but below the commonly used screening test cutoff. At this point the physician’s best course of action would be to do which of the following?

A. Arrange an appointment to talk with the patient in the next several days and review the results in person

B. Call the patient at once to deliver the news and offer guidance

C. Call the patient to deliver the news and congratulate him on his overall health.

D. Call the patient to deliver the news and schedule the patient for a follow-up appointment to review what he can do to improve his overall health.

E. Have the nurse employed by the practice call the patient to deliver the news and take time to answer any questions he may have.

F. Schedule an appointment to talk to the patient about the results and offer him a referral for counseling

G. Send the patient a letter detailing the test results and suggesting the next course of action.

Explanation:

The correct answer is D. All communication with a patient is best handled face to face. When this is not possible because of the need to deliver news in a timely manner, as in the present case the phone conversation should be followed up by a visit. The follow-up visit is also needed to discuss some of the patient’s other health issues, including his weight. This patient’s body mass index (weight/height) is too high.

The patient is likely to have high anxiety over the next several days as he waits to hear the results (choice A). Alleviate the anxiety by telling him as soon as possible.

The phone call gets the good news to the patient quickly, but does nothing to either further the building of a good long-term relationship with the physician or address the patient’s other health concerns (choice B)

Choice C while getting the patient the news quickly, and in a cheery manner, does not address the patient’s other health condition.

The physician himself should deliver the news not a nurse (choice E) or other member of the office staff. The practice of having the physician call with bad news and a staff member call with good news only heightens patients anxiety anytime the physician calls. The physician is in the best position to answer any questions that the patient has, and to talk about the next steps to improve health.

The patient is likely to have anxiety waiting for days to hear the test results. Also the physician himself should do counseling, and not refer to patient to someone else (choice F).

A letter from the physician (choice G) takes time to get to the patient, always creates anxiety and offers no one to discuss meaning of the results.

Usmle Step 1 MCQ's # 2

Title: Usmle Step 1 MCQ's # 2
Subject: Behavioral Science

Q NO 2: A 25-year-old woman is brought to the hospital by her husband. The patient complains of severe pain and tenderness in her lower left abdomen. She is diagnosed with appendicitis and scheduled for an emergency appendectomy under general anesthesia. A 2nd year resident performs her surgery. Surgery reveals that the appendix is normal and without inflammation. However, the resident notices a large tumor attached to the patient’s left ovary At this point the resident’s best next course of action would be to do which of the following?

A. Biopsy the tumor and terminate the surgery
B. Excise as much of the tumor as possible without coming into contact with the ovary?
C. Exercising common standards of care, remove the patient’s ovary to eliminate the tumor
D. Seek permission to excise the tumor from the patient’s husband, who is sitting in the waiting room
E. Seek the advice of the supervising surgeon
F. Talk with the patient’s husband, who is in the waiting room, about how his wife would probably want to proceed

Explanation:
The correct answer is A. A competent patient has the right to make all treatment decisions for themselves, including refusal of treatment. If you can access the patient’s wishes by direct conversation, then this must be done. After woman recovers from the anesthesia, she is entitled to full informed consent including descriptions of the: 1) nature of the procedure, 2) the purpose or rationale, 3) the benefits, 4) the risks, and 5) the availability of alternatives. With this information presented, the patient herself can make what ever treatment decision seems best to her.
Excising the tumor (choice B) is treatment without the patient’s consent and permission.
Patient’s wishes, not” common standards of care” (choice C), are what guide treatment decisions. Only if we could not access the patient’s wishes in any way, AND the situation was critical, would we act using judgment as to what would be reasonable care.
Choices D and F are incorrect, because the woman has primary say over her own body. If she were in a coma of some duration, then we might ask the husband under the doctrine of substituted judgment. But here, we can wake her up and ask her directly.
The resident has all of the information required to know the correct actions to take without consulting a superior (choice E). In general, consulting a superior will be the wrong answer on the Step 1 exam.

Usmle Step 1 MCQ's

Title: Usmle Step 1
Subject: Behavioral Science

Q NO 1: A 29-year-old man presents with a dramatic flourish to his physician’s office, dressed in a “flashy” manner, and describes having brief, superficial relationships. On his way out, he asks the nurse for
a date. Which of the following might also describe the patient?
A. Allows others to make decisions for him
B. Has a restricted range ob emotion
C. Is socially withdrawn
D. Is the “life of the party”
E. Participates in criminal behavior

Explanation:
The correct answer is D. This individual has histrionic personality disorder, characterized by acting in a theatrical manner, which would include being the center of attention at a party. Such individuals are sexually provocative and have difficulty maintaining intimate relationships.
This patient would not have difficulties in self-confidence that would warrant having others make decisions for him (choice A). This describes a patient with dependent personality disorder.
Instead of being limited in expression of feelings (choice B), such as a patient with schizoid personality disorder, this patient expresses feelings openly, often in a yew superficial manner.
This patient would be the opposite of being socially withdrawn (choice C), and would be more likely to be socially gregarious and lively. A patient with avoidant personality disorder would be more likely to be socially with drawn.
While at times they make choices that reflect impulsivity, patients with histrionic personality disorder are not more likely to engage in criminal behavior (choice E). Criminal behavior would more likely be seen in those with antisocial personality disorder.

USMLE Step 2 Clinical Knowledge (CK) Minimum Passing Score

USMLE examinations are mandatory for all first and then a clinical internship, engage thereafter as a doctor. Preparation for USMLE Step 2 Clinical Knowledge can be a stressful business. It comprises of multiple choice questions on clinical applications of medical knowledge divided on eight 44 question sets. It requires many hours of dedication. USMLE scores are unfortunately the only real way to a residency program can evaluate the qualifications of a candidate. For this reason, many students feel extreme pressure to get the highest score possible. This pressure is even greater on foreign graduates. For many, they begin to lag the United States without any clinical experience, a language barrier and many years of lay-off of a traditional classroom. But despite these obstacles, it is worth the challenge.
  
    Most foreign graduates are married, have children and have a job, the usual scenario. The most important thing a student has to do is set a time line and transmit this timeline to your significant other very clearly and honestly. Without (or in some cases parents) your spouse's full support you will not achieve your goal. They need to know how long it will take, where do you stand now and what is your plan. If you share this information with them openly and completely your trip will free ride, and especially you have zero stress from your life, which is invaluable, while preparing for the USMLE Step 2 in particular.

    The score of USMLE Step 2 Clinical Knowledge is reported in 2 digits and 3 digits scores. The minimum score required to pass this exam is 75 in the two digits score and 189 in 3 digits score; however, from 1st July 2012 the passing score is increased to 196. Good luck and work hard. Hard work always pays.

Attempt Limit for USMLE Examinations

All doctors wishing to practice medicine in the United States must take the USMLE (United States Medical Licensing Exam), beyond who have graduated in that country or outside it. Medical graduates from outside the U.S. must take the USMLE before entering a residence or a research program. After approving the USMLE and received the certificate from the Commission for Foreign Medical Graduates Educational (Educational Commission for Foreign Medical Graduates - ECFMG) there is no distinction between foreign and American physicians when applying for residencies and other programs. In the perspective of attempt limits regarding the USMLE examinations, the http://blogs.askdoc-usmle.com provide the useful updates regarding that as per this blog, “Examinees who have made six or more attempts to pass a Step or Step component, including incomplete attempts, should be aware that all applications to register for additional attempts will not be processed unless they are submitted on or before December 31, 2012. This limit was first announced in August of [last year]. The effective date for the six-attempt limit depends upon whether an examinee has taken any Step or Step Component (including incomplete attempts) before January 1, 2012. Examinees who had NOT taken any Step or Step Component before January 1, 2012
if you did not take any Step or Step Component before January 1, 2012, the six-attempt limit went into effect for all exam applications that you submitted on or after January 1, 2012. Examinees who have taken any Step or Step Component before January 1, 2012.
If you have taken any Step or Step Component (including incomplete attempts) before January 1, 2012, the six-attempt limit is in effect for all exam applications that you submit on or after January 1, 2013.  After that date, all attempts at a Step or Step Component will be counted toward the limit, regardless of when the exams were taken.” To have further detailed, a particular individual can go ‘Bulletin of Information’ section of this blog. There are several source provides a rich online environment where medical students can prepare their vital clinical examinations. These web sites offers preparatory exams direct medical professional assessments such as the USMLE Step 2 Clinical Skills. In the perspective of preparation USMLE Step 2 Clinical Skills there are several source on the web is a very comprehensive program with availability on convenience of taking courses online. There are several source offers a unique interactive experience that provides the opportunity to enhance learning and readiness of the medical examination candidates.

In the perspective of Review of Step 2 Clinical Skills. Evaluates if the applicant can demonstrate mastery of basic skills examination for essential patient care safely and effectively. There are three sub-components theme of the review of clinical skills step 2:

Another cutthroat advantage of these sources is that it uses only Board certified health professionals to develop and implement the contents. Web based USMLE courses are available in different lengths. Usually registration is simple and payments are accepted only paypal to protect the subscriber information.