USMLE USMLE Certifications USMLE-STEP-1 Questions & Answers

• Question 41:

  If laboratory tests determine that the patient has a general medical condition that underlies the symptoms, which of the following is most likely?

  A. Addison disease

  B. cancer of the pancreas

  C. hyperparathyroidism

  D. hyperthyroidism

  E. hypothyroidism

  Correct Answer: D

  Section: Behavioral Science and Biostatics Hyperthyroidism is often associated with anxiety and panic symptoms. Although these symptoms may also occur with any of the other medical conditions (choices A, B, C, and E), depression and slowed mentation are more common in hypothyroidism, hyperparathyroidism, and Addison disease; cancer of the pancreas is often associated with severe depression.

• Question 42:

  Your patient is convinced that she has cancer. She is clearly agitated and is complaining of pain in her abdomen. A workup for cancer is negative, yet your patient refuses to accept the diagnosis and becomes increasingly anxious and expresses an intense sense of impending doom. Which of the following drugs is most appropriate for the treatment of this patient?

  A. carbamazepine

  B. methylphenidate

  C. olanzapine

  D. paroxetine

  E. valproic acid

  Correct Answer: D

  Section: Behavioral Science and Biostatics Paroxetine is a selective serotonin reuptake inhibitor (SSRI), an antidepressant, and is the drug of choice for treating this patient's depression. Carbamazepine (choice A), like valproic acid (choice E), is an anticonvulsant and mood stabilizer which may be used to treat bipolar disorder. Methylphenidate (choice B) is a CNS stimulant; olanzapine (choice C) is an atypical antipsychotic.

• Question 43:

  Ayoung woman presents to the physician with the chief complaint of palpitations. She also complains of feelings that she is going to die, with feelings of dizziness. Which of the following is the most useful question to ask?

  A. Are you anxious?

  B. Do you have a heart disease?

  C. Has anything like this happened before?

  D. What drugs do you use?

  E. Why do you think you will die?

  Correct Answer: C

  Section: Behavioral Science and Biostatics The patient presents with acute anxiety symptoms that might be due to panic or other acute situations. Panic disorder usually is recurrent and history of previous episodes would be extremely helpful. Choice A is inappropriate; the patient is obviously anxious. Choices B, D, and E may be useful but not yield as much information.

• Question 44:

  A 48-year-old woman comes to the doctor complaining of vague pains in the abdomen, legs, and thighs. On physical examination, the only positive findings are varicose veins of 20 years' duration. The patient, upon being told of this, insists on being operated on for the varicose veins immediately. Which of the following is most likely to underlie this wish for immediate surgery?

  A. anxiety

  B. depression

  C. drug dependence

  D. psychosis

  Correct Answer: A

  Section: Behavioral Science and Biostatics Anxiety or concomitant stress is a common trigger for help-seeking behavior, especially if the symptom or sign is of long duration. Although depression (choice B) can cause vague discomfort and precipitate help seeking, insisting on an operation immediately seems to indicate anxiety rather than depression, which is more likely to cause indecision or inaction. A drug-dependent person (choice C) is more likely to insist on drugs. There is no evidence of psychosis (choice D).

• Question 45:

  A 25-year-old man is admitted to the hospital after coming to the doctor carrying a bottle containing bloody urine. All tests were negative, and he was observed stealing a test tube of blood from the laboratory technician's cart. Which of the following is the most likely diagnosis?

  A. antisocial personality disorder

  B. factitious disorder

  C. malingering

  D. schizophrenia

  E. somatization disorder

  Correct Answer: B

  Section: Behavioral Science and Biostatics The essential feature of factitious disorder is the intentional production of physical signs or symptoms in the absence of an external incentive as a motivation. If there is an external incentive for fabricating an illness, then malingering is diagnosed (choice C). Antisocial personality disorder (choice A) requires a pattern of antisocial behavior. Somatization disorder (choice E) is characterized by multiple physical symptoms that are not explained by tissue damage. Schizophrenia (choice D) is incorrect because there is no evidence of psychotic symptoms even though the behavior may be bizarre.

• Question 46:

  A patient has begun exhibiting signs of paranoia and psychosis within the past week. In considering the diagnosis of schizophrenia, which of the following is a crucial piece of information?

  A. The patient does not smoke.

  B. The patient has a history of similar psychotic episodes in the past.

  C. The patient has a history of substance abuse.

  D. The patient is a toxicologist.

  E. The patient is single.

  Correct Answer: B

  Section: Behavioral Science and Biostatics Although all the other items (choices A, C, D, and E) may be significant, schizophrenia cannot be diagnosed if the patient has never had an episode of psychotic symptoms lasting for at least 6 months.

• Question 47:

  A 50-year-old man is brought to the emergency room by the police because he was on the street screaming that the air was being poisoned. The man is very agitated, and requires restraint by the attendants. As you, the on-call physician, try to interview him, he tries to hit you and screams at you. Which of the following is the most appropriate first step in management?

  A. administer amobarbital by mouth

  B. give him an injection of haloperidol

  C. give him an injection of naloxone

  D. perform a physical examination

  E. reason with him that the air is not poisoned

  Correct Answer: B

  Section: Behavioral Science and Biostatics The management of acute psychosis involves use of parenteral antipsychotic drugs, such as haloperidol. Reasoning with a delusional patient (choice E) is usually futile, and an agitated and uncooperative patient is unlikely to permit a physical examination (choice D) or take an oral medication (choice A). Unless you know that the patient is intoxicated with opiates, naloxone (choice C) is unlikely to be of benefit.

• Question 48:

  Naloxone would be contraindicated in an apparently psychotic patient if one were to also discover which of the following?

  A. The patient had a psilocybin-induced psychosis.

  B. The patient has hypertension.

  C. The patient has just suffered a fracture.

  D. The patient is a placebo responder.

  E. The patient is an alcohol abuser.

  Correct Answer: C

  Section: Behavioral Science and Biostatics Naloxone is an opiate antagonist, and would be contraindicated in a patient with fracture who would require rapid pain relief. The placebo analgesic effect seems to be endorphin mediated, and naloxone would block it. The other choices do not deal with naloxone's specific anti-opioid activity.

• Question 49:

  A 7-year-old child has been exhibiting impulsivity and disruptive behaviors at school. When further evaluation reveals that the child has been unable to sleep at night for at least 3 months out of fear that his parents may divorce, which of the following is an important diagnostic possibility?

  A. anaclitic depression

  B. attention deficit hyperactivity disorder

  C. conduct disorder

  D. generalized anxiety disorder

  E. separation anxiety disorder

  Correct Answer: E

  Section: Behavioral Science and Biostatics Separation anxiety disorder involves excessive anxiety concerning separation from the home or someone to whom the child is attached. The disturbance must continue for more than 4 weeks, with onset before age 18. Choices A, B, C, and D are not particularly indicated by the new information provided.

• Question 50:

  According to psychoanalytic theory, which of the following is a function of the superego?

  A. curiosity

  B. guilt

  C. music appreciation

  D. perception

  E. sexual urge

  Correct Answer: B

  Section: Behavioral Science and Biostatics

  The superego is the collection of functions having to do with conscience, social expectations, and guilt,

  which arises from failing to meet the demands of conscience. Id is the reservoir of basic instinctual drives,

  where sexual urge belongs E.. Ego is the collection of functions that mediate relations between the demands of the id and the constraints of social reality and conscience, as well as some innate, nonconflictual spheres of existence such as perception and movement. Choices A, C, and D are ego functions.