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