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SHELF / USMLE Step 2 Practice Questions > Psychiatry

Posted Oct 30 2008 6:18pm

SHELF / USMLE Step 2 Practice Questions> Psychiatry

Q1) A 4-year-old boy has just been reunited with his biological mother after spending 6 months in foster care. He was initially removed from his home for severe neglect secondary to substance abuse. The boy is noted to play in a destructive and disorganized manner, throwing and breaking his toys. When the mother tries to stop him from throwing blocks at her, he starts kicking and biting. Which of the following is the most likely diagnosis?

a) Oppositional defiant disorder (ODD)
b) ADHD
c) Reactive attachment disorder
d) PTSD
e) Major depression
Q2) Secondary prevention is best exemplified by which of the following?
a) Enrollment of a 2 year-old in a play group in the hopes of preventing antisocial behaviors.
b) Restraing a violent teen after a suicide attempt.
c) Visiting the home of a child after a neighbor reports that the child is being neglected.
d) Treating new onset feelings of depression and anhidonia with an SSRI.
e) Enrolling siblings of bipolar patients in group therapy.

Q3) A 56-year-old man is brought to your office by his wife because she has noted a personality change in the past 3 months. While the patient is being interviewed, he continually discusses event on the news, what he ate for lunch and other topics unrelated to the questioning prior to providing appropriate answers to your questions. Which of the following symptoms best fits this patient's behavior?
a) Negative symptoms
b) Disorientation
c) Concrete thinking
d) Perseveration
e) Circumstantiality


A1) c - Reactive attachment disorder results from a severely dysfunctional early relationship between the principal caregiver and the child. When caregivers consistently disregard the child's physical or emotional needs, the child fails to develop a secure and stable attachment with them. This failure causes a severe disturbance of the child's ability to relate to others, manifested in a variety of behavioral and interpersonal problems. Some children are fearful, inhibited, withdrawn, and apathetic; others are aggressive, disruptive, and disorganized with low frustration tolerance and poor affect modulation. This condition is often confused with ODD or ADHD.
A2) d - Treating new onset feelings of depression and anhidonia with an SSRI. he goal of secondary prevention is to address problems at an early stage to avoid future more severe problems.
A3) e- Circumstantiality is a disturbance in which the patient digresses into unnecessary details before communicating the central idea.

Must have book on your psych rotation: Psychiatry, 2006 Edition
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