USMLE USMLE Certifications USMLE-STEP-1 Questions & Answers

• Question 51:

  Which of the following is true concerning factitious disorder?

  A. It is a form of psychosis.

  B. It is an integral part of borderline personality.

  C. It is an intentional antisocial act.

  D. It is a sick-role addiction.

  Correct Answer: D

  Section: Behavioral Science and Biostatics The caring environment of hospitalization and exemption from normal responsibilities accompanying the sick-role may be the unconscious motivation for many patients with factitious disorders to undergo very uncomfortable and often painful procedures or self-inflicted injuries to become a patient. There is no clearcut learning, psychosis, or personality disorder that accompanies this condition; choices A, B, and C are incorrect.

• Question 52:

  Sara is a 15-year-old healthy female. With which of the following would one expect a girl of her age to spend a lot of time?

  A. a mixed group of peers

  B. adults

  C. animals

  D. furry toys

  E. older females

  Correct Answer: A

  Section: Behavioral Science and Biostatics An adolescent veers away from childish toys and develops an interest in the opposite sex. Peer relationships include members of the opposite as well as the same sex.

• Question 53:

  James is 3 years old and he will not part with his filthy terrycloth blanket. Whenever it is taken away from him, he throws a temper tantrum to get it back. He holds it, sucks on it, and seems content when he has it. Of which of the following is this an example?

  A. childhood fetishism

  B. codependence

  C. displacement

  D. separation anxiety

  E. transitional object

  Correct Answer: E

  Section: Behavioral Science and Biostatics Transitional objects are "mother substitutes" such as a blanket or a soft toy, to which a child may become attached and that she or he may carry around all the time. This is a normal developmental phenomenon and not a sign of pathology. Choices A, B, C, and D do not refer to this phenomenon.

• Question 54:

  A 48-year-old woman comes to the doctor complaining of vague pains in the abdomen, legs, and thighs. Physical examination reveals no obvious signs of injury or trauma to account for the reported symptoms. If the woman told the doctor, "In spite of what you say, doctor, I know that I have a serious illness, probably cancer," which of the following would be the most appropriate next step in treatment?

  A. ask why she thinks she has cancerB. tell her that she does not have cancer

  B. tell her that she has anxiety

  C. tell her that she has depression

  D. tell her to see a psychiatrist

  Correct Answer: A

  Section: Behavioral Science and Biostatics When a patient presents with a conviction that she has a serious illness, it is important to find out more about why the patient has the notion, because in the process the doctor may be able to diagnose emotional distress in the form of anxiety, depression, or simple misperception, as well as hypochondriasis. All the other choices (B, C, D, and E) bring about a premature closure.

• Question 55:

  "Executive monkeys" as described by Brady tended to develop bleeding ulcers. Which of the following statements best characterizes them?

  A. Alpha monkeys that have the highest level of testosterone in the colony.

  B. Beta-male monkeys having too many decisions to make.

  C. Male monkeys that had too many available females.

  D. Monkeys that had to keep pressing bars to avoid shock.

  E. Monkeys that had to press a bar to get a pellet of food.

  Correct Answer: D

  Section: Behavioral Science and Biostatics Monkeys that were placed in a highly complex operant conditioning program to avoid electric shock developed bleeding gastric ulcers, while yoked controls who received the same amount of shock, but did not have to perform the complex task, did not. The lack of a confirmatory feedback (such as a safe light or food to indicate a shock-free interval) seems to be especially ulcerogenic in Brady's "executive monkeys." Choices A, B, C, and E are incorrect.

• Question 56:

  Which of the following personality traits would most likely result from anal-phase fixation?

  A. dependency

  B. fierce competitiveness

  C. parsimony

  D. narcissism

  Correct Answer: C

  Section: Behavioral Science and Biostatics The anal phase of development occurs around age 2, around the time of toilet training. Developmental difficulty around this time may result in "anal-phase fixation," in which some characteristics of this phase may unduly influence the adult personality. Such characteristics include struggles over the issue of control.

  Excessive cleanliness and orderliness, or the opposite, as well as parsimony and hoarding may occur. Dependency (choice A) is characteristic of oral phase, and fierce competitiveness (choice B) may be characteristic of the Oedipal phase. Narcissism (choice D) is a complex phenomenon that develops from very early life and not confined to any particular stage of development.

• Question 57:

  Aphysician is treating a patient whom he suspects of factitious disorder. If the physician learns that the patient would have been incarcerated for a criminal offense if he had not been hospitalized, which of the following diagnoses becomes most likely?

  A. antisocial personality disorder

  B. borderline personality disorder

  C. malingering

  D. Munchausen syndrome

  E. sick-role addiction

  Correct Answer: C

  Section: Behavioral Science and Biostatics When there is an external incentive for causing the symptom or injury, malingering is more likely than factitious disorder (Munchausen syndrome), the motivation for which is often quite unclear. Although there may be concomitant personality disorders, malingering is not diagnostic of any specific personality disorder. Choices A, B, D, and E are less likely because there seems to be an obvious and conscious motivation in this case.

• Question 58:

  According to Piaget, in which of the following do children of middle teenage years typically engage?

  A. abstract thinking

  B. circular reactions

  C. cognitive map

  D. concrete operations

  E. preoperational activities

  Correct Answer: A

  Section: Behavioral Science and Biostatics According to Piaget, at about the time of puberty (which is on the average about age 11 in girls), the final stage of maturation in cognitive functioning, the period of formal operations, occurs. The individual's thought processes become more flexible, and transcend the here and now. Propositional thinking and hypothesis testing are prominent features of this stage.

• Question 59:

  Which theory concerning pain postulates that non-pain sensations, such as vibration or pressure, may affect the transmission and perception of pain sensation?

  A. bradykinin theory

  B. gate control theory

  C. pattern theory

  D. peptide theory

  E. specificity theory

  Correct Answer: B

  Section: Behavioral Science and Biostatics The theories involving pain perception are: (1) the specificity theory (choice E), postulating that there are specific pain receptors transmitting specific pain signals through specific neurons to specific areas of the brain; (2) the pattern theory (choice C), postulating the existence of "reverberating circuits" to explain phantom pain; and (3) the gate control theory (choice B), postulating an interaction between pain sensation and other sensations competing for transmission at the spinal cord level. Choices A and D do not postulate the interaction with non-pain sensations.

• Question 60:

  Unmyelinated C fibers are thought to carry which of the following pain sensations?

  A. aching

  B. burning

  C. dull

  D. gnawing

  E. pricking

  Correct Answer: B

  Section: Behavioral Science and Biostatics It is now believed that specific pain receptors (free nerve endings) are stimulated mainly by chemicals such as bradykinin, and that two types of pain sensations ("pricking" and "burning") are transmitted by different types of nerves. The burning pain sensation is transmitted by small C-fibers, and the pricking pain sensation is transmitted by larger, myelinated A-delta fibers. The pain fibers eventually terminate in the thalamus in a somatotopical fashion. Choices A, C, D, and E are incorrect.