Usmle Step 1 MCQ's # 8

Title: Usmle Step 1 MCQ's # 8

Subject: Behavioral Science

Q NO 8: A 29-year-old woman is admitted to the outpatient surge department for an elective operation. She undergoes general anesthesia and, because of an intraoperative complication requires additional hospital days on the inpatient unit. Two days after surgery, she becomes agitated and starts developing tremors. She says she beds as it insects are crawling on her. A history of which of the following is most relevant in determining this patient’s current medical management?

A. Alcoholism
B. Depression
C. Past LSD use
D. Schizophrenia
E. Traumatic childhood

Explanation: The correct answer is A. The patient’s hallucinations, agitation, and tremor point to the diagnosis of delirium tremens (DT5), which should always be considered in cases in which a patient does not have access to alcohol as they did before admission. Depression (choice B) is nota cause of tremor, although it can be associated with agitation in depression with psychotic features.
Past LSD use (choice C) can lead to flash back visual hallucinations but it would not cause the DT5 that this patient is experiencing.
Schizophrenia (choice D) is a disorder of thought associated with auditory hallucinations. It is not associated with formication the feeling that insects are crawling on one’s skin.
Childhood trauma (choice E) has no demonstrated link to autonomic instability alter a surgical procedure, as in this patient.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-8.html

Usmle Step 1 MCQ's # 7

Title: Usmle Step 1 MCQ's # 7

Subject: Behavioral Science

Q NO 7: A 28-year-old woman visits a cosmetic surgeon for evaluation for surgery to modify the shape of her nose. She has had two other minor surgeries on her nose in the past for cosmetic reasons. During this evaluation, she is accompanied by her mother, who demanded to come to the appointment with her daughter. Her mother asks the surgeon not to perform further cosmetic surgery on the patients nose because she believes that it looks just fine, Instead, she claims that her daughter has been obsessed with the appearance of her nose and spends much of her of time looking at her nose in the mirror. Which of the following is a feature of this disorder?

A. Agoraphobia
B. Disruption of day-to-day functions
C. Pain symptoms
D. Panic attacks
E. Search for secondary gain

Explanation:
The correct answer is B. The patient is most likely suffering from body dysmorphic disorder, a preoccupation with an imagined bodily defect or an exaggerated distortion of a minimal or minor defect. To be considered a mental disorder, the concern must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Patients with this disorder are more likely to go to dermatologists and plastic surgeons than psychiatrists. Additionally, patients with this disorder have a high lifetime prevalence of depressive and anxiety disorders. This patient’s presentation is typical for body dimorphic disorder. The cosmetic surgeon should seek psychiatric consultation.
Agoraphobia (choice A) is a fear of public/open places. It is a specific type of phobia that causes the patient to become introverted and avoid being seen in public.
Pain symptoms (choice C) are associated with somatoform pain disorder, in which a complaint of pain is unsupported by any physiologic process that can be identified by lab tests or physical examination.
Panic attacks (choice D) are a major feature of panic disorder, which is characterized by discrete periods of intense fear and discomfort with palpitations, abdominal distress, nausea, increased perspiration, chest pain, chills, and a choking sensation.
Secondary gain (choice E) is an unconscious drive for medical attention, often accompanying somatoform pain disorders, somatization disorders, or conversion disorders.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-7.html

Usmle Step 1 MCQ's # 6

Title: Usmle Step 1 MCQ's # 6
Subject: Behavioral Science

Q NO 6: A 67-year-old man is admitted to the hospital for a biopsy to confirm suspected lung cancer. The results of the biopsy, sent to his physician the next day, confirm the presence of cancer in an advanced stage. Although a number of treatments are available, life expectancy for patients with this type of cancer is less than 6 months. The physician decides to tell the patient the results of the biopsy immediately. After checking in at the nurse’s station, he walks down the hall towards the patient’s room. Outside the patient’s door, he is met by the man’s adult daughter, who is visibly upset, and asks to speak with the physician in private. “If it is cancer,” she says, “please don’t tell him!” At this point what should the physician reply?

A. “I do need to tell him what we know. Would you like to come in with me while I tell him?”
B. “I know you are concerned, but I have to ask you not to interfere.”
C. “I’d be happy to wait a little bit it you can tell me why I should.”
D. “I’m sorry, but I am required to tell my patient everything, even the bad news.”
“Talk with me about why you don’t want me to tell him.”
F. “Why don’t we go into a quiet room over here and talk about your father a bit.”
G. “Would you have me lie to my patient?”
H. “You seem upset. Please try to compose yourself and then we can talk about it.”

Explanation:
The correct answer is E. The patient needs to be told what the doctor knows, and told in a timely fashion, but something else has occurred that must be dealt with first. Confronted with the daughter’s pleading, the correct response is to seek some information from the daughter to discover if she has any information the physician should know. Be clear that there is nothing the daughter can say that will stop the physician from going into the room and telling the patient what he knows. Rather she may have information that changes they way that he approaches the patient or the method he will use to break this bad news. Notice that with this question the physician is asking for, but not giving information.
Along with these specifics, there is i more general rule here. Don’t get carried away by momentum. The doctor was on his way to talk to the patient. But when new events occur he must change his tack in order to deal with them.
The patient, not the physician should be the one to decide it the daughter should be present. Confidentiality is absolute and should not be violated by inviting the daughter into the discussion (choice A)
Choice B chides the daughter. At best, it misses the chance to seek information from her. At worst it sets up a confrontation that could escalate right outside the patient’s door.
The physician wants to know what the daughter thinks, but should not delay telling the patient (choice C) . The patient has the right to know the results of the test. The physician has no right to tell the daughter he will delay the necessary conversation.
The physician must tell the patient everything, but should take the opportunity to gain additional information about the patient from the daughter. Simply bypassing her (choice D) misses the opportunity.
The physician must respect the patient’s confidentiality. This means not discussing the patient’s health, even with family members, without the patient’s explicit permission. It’s OK to ask the daughter what she knows, but not to tell her about her father (choice F)
Choice C is very challenging and confrontative. It is more likely to lead to an emotional exchange than any useful conversation.
Choice H also misses the opportunity to find out what the daughter knows. In addition, it could be perceived as condescending, that is, treating the daughter like a child, rather than an adult.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-6.html

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.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-5_8.html

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.

Source: http://usmleworldwide.blogspot.com/2012/09/usmle-step-1-mcqs-4.html

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 patient’s 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.

Source: http://usmleworldwide.blogspot.com/2012/09/usmle-step-1-mcqs-3_6.html

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 whatever 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.

Source: http://usmleworldwide.blogspot.com/2012/09/usmle-step-1-mcqs-q-no-2.html

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.

Source: http://usmleworldwide.blogspot.com/2012/08/usmle-step-1-mcqs.html

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 transmits 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.

Source: http://usmleworldwide.blogspot.com/2012/07/usmle-step-2-clinical-knowledge-ck.html