USMLE USMLE Certifications USMLE-STEP-1 Questions & Answers

• Question 61:

  Which of the following has a triphasic abstinence syndrome, the first phase being the "crash"?

  A. alcohol

  B. barbiturates

  C. cannabis

  D. cocaine

  E. opiates

  Correct Answer: D

  Section: Behavioral Science and Biostatics The abstinence syndrome to cocaine is triphasic. Phase 1 is called "crash," phase 2 is a withdrawal phase with protracted dysphoria, and phase 3 is an "extinction" phase that follows the resolution of withdrawal anhedonia. Choices A, B, C, and E do not show this type of triphasic syndrome.

• Question 62:

  The activity of which structure in the pons is suppressed by opioids, alpha-2-agonists, and gammaaminobutyric acid (GABA), and produces most of the noradrenergic input to the brain?

  A. anterior Cingulate Gyrus

  B. locus ceruleus

  C. mammillary bodies

  D. nucleus pulposus

  E. nucleus solitarius

  Correct Answer: B

  Section: Behavioral Science and Biostatics The locus ceruleus, located in the pons, produces most of the noradrenergic input to the brain, and has receptors for opioids and autoreceptors for norepinephrine (?2) as well as GABA. The locus ceruleus seems to be involved in alertness and anxiety response. Choices A, C, D, and E refer to structures elsewhere.

• Question 63:

  A 52-year-old woman tells her doctor that she is experiencing pains in the abdomen and thighs and insists that she is suffering from some form of cancer. A physical examination reveals only the presence of extensive varicose veins. While collecting additional patient history, you find that the woman has become increasingly anxious, with a sense of impending doom, and intensifying abdominal discomfort. You decide to do further medical workup to rule out cancer. Which of the following malignancies is most likely in this patient?

  A. carcinoma of the pancreas

  B. glioblastoma

  C. carcinoma of the stomach

  D. Kaposi sarcoma

  E. pancoast tumor

  Correct Answer: A

  Section: Behavioral Science and Biostatics Carcinoma of the tail of the pancreas often presents with symptoms of depression. Although other carcinomas and neoplasms (choices B, C, D, and E) may also cause depression, pancreatic cancer has to be ruled out first in a patient with severe depression.

• Question 64:

  Which of the following ratios represents the estimated likelihood that a physician will become addicted to narcotics during his/her career?

  A. 1 in 10

  B. 1 in 100

  C. 1 in 1000

  D. 1 in 10,000

  E. 1 in 100,000

  Correct Answer: B

  Section: Behavioral Science and Biostatics Because of easy drug availability and their high-stress occupation, physicians are at high risk for narcotic drug addiction; the incidence is estimated to be 1 in 100, which is 30 to 100 times greater than that of the general population. Choices A, C, D, and E are incorrect.

• Question 65:

  Which of the following is the most common type of substance dependency in the United States?

  A. alcohol

  B. cannabis

  C. cocaine

  D. heroin

  E. tobacco

  Correct Answer: E

  Section: Behavioral Science and Biostatics Tobacco addiction is the most common type of drug dependency in the United States. Nicotine is extremely addictive. Since the Surgeon General's report in 1964 that identified the health risks of tobacco smoking, there has been an encouraging trend in the United States. Approximately 42% of the US adult population smoked cigarettes in 1965. The rate was 37% in 1975 and 30% in 1985. The reduction rate of smoking has been more pronounced in males than in females. Choices A, B, C, and D are incorrect.

• Question 66:

  All patients who have trisomy of autosome 21 who survive to adulthood develop which one of the following conditions?

  A. Alzheimer's disease

  B. lewy body dementia

  C. multi-infarct dementia

  D. Pick disease

  E. secondary dementia

  Correct Answer: A

  Section: Behavioral Science and Biostatics Down syndrome is a congenital mental retardation associated with trisomy of autosome 21. All patients with Down syndrome who survive into adulthood develop the brain pathologies of Alzheimer's disease, rendering support to the notion that at least one form of Alzheimer's disease may be associated with an autosome 21 abnormality. Choices B, C, D, and E are not associated with trisomy of autosome 21.

• Question 67:

  Which of the following is the most treatable dementing disease?

  A. Alzheimer's disease

  B. Creutzfeldt-Jakob disease

  C. multi-infarct dementia

  D. Pick disease

  E. Wernicke syndrome

  Correct Answer: E

  Section: Behavioral Science and Biostatics Wernicke syndrome is caused by thiamine deficiency associated with alcohol withdrawal, and can be treated effectively. Alzheimer's disease (choice A) is the most common primary dementia in the elderly. About 50% of brains of demented patients show evidence of Alzheimer's disease. Creutzfeldt- Jakob (choice B) disease and kuru are slow virus infections that show clinical and histologic features similar to Alzheimer's disease. Multiinfarct dementia (choice C) is secondary to repeated cerebrovascular accidents (CVAs) in patients with underlying atherosclerosis or hypertension. It is more common among men than women. Pick disease (choice D) is a rare cause of cortical dementia. The presence of unilateral cortical atrophy in Pick disease contrasts with the bilateral atrophy evident in Alzheimer's disease. Microscopically, Pick bodies composed of densely packed neurofilaments are seen within diseased neurons.

• Question 68:

  An elderly patient with multi-infarct dementia also suffers from urinary incontinence and ataxia. Which of the following therapeutic procedures may be considered for this type of patient?

  A. benzodiazepines

  B. electroconvulsive therapy

  C. megavitamin therapy

  D. urocholine

  E. ventriculoperitoneal shunt

  Correct Answer: E

  Section: Behavioral Science and Biostatics Normal pressure hydrocephalus is associated with the symptoms of dementia, ataxia, and urinary incontinence. On brain imaging, the ventricles are often enlarged, but cerebrospinal fluid (CSF) pressure is normal. Aventriculoperitoneal shunt is often therapeutic for this condition. Choices A, B, C, and D are inappropriate.

• Question 69:

  Which of the following is the earliest developmental phase according to Piaget?

  A. concrete operations

  B. formal operations

  C. Oedipus complex

  D. preoperational phase

  E. sensorimotor period

  Correct Answer: E

  Section: Behavioral Science and Biostatics Piaget described the development of intelligent thinking in stages. The first is the sensorimotor period, 18 months2 years. This is followed by preoperational phase, 27 years (choice D); and the phase of concrete operations, 711 years (choice A), and the period of formal operations from adolescence through adulthood (choice B). Oedipus complex (choice C) is not a Piagetian stage, but is characteristic of ages 35.

• Question 70:

  According to Erikson, which of the following is a major developmental task for most children around 15 years of age?

  A. developing a clear identity

  B. developing a sense of integrity

  C. developing intimate relationships

  D. learning about sex

  E. learning to be independent

  Correct Answer: A

  Section: Behavioral Science and Biostatics Erikson describes adolescence as the period of identity formation. In this period, a person develops a sense of inner sameness and continuity, a sense of direction and self. Career choices are also made during this phase. Failure of identity formation in this period results in "role confusion." Choices B and C refer to other developmental periods or non-Eriksonian task (choice D and E).