First Aid Step 1 Casebook
A newborn boy is found to have an increased head circumference, macroglossia, an umbilical hernia, lethargy, and a hoarse cry. The mother has no significant past medical history, takes no medications, and received adequate prenatal care. His serum thyroxine (T4) concentration is ~50% that of normal infants.
A 4-year-old boy is brought to the emergency department after being seen shaking on the floor. He had been playing with a video game when the episode began. He has no prior history of seizures or neurologic disorders. The episode resolved after 2 minutes.
>>>What is the most likely diagnosis for this patient?
>>>What is the most appropriate treatment for this condition?
>>>What are the side effects of the drugs associated with treatment?
>>>If the boy were in class answering a question and suddenly stopped for 30 seconds, then continued with his explanation, what would be the diagnosis and treatment?
>>>Which two commonly used seizure medications may cause Stevens-Johnson syndrome?
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A bright medical student is studying for the USMLE Step 1 in the library basement. Although he feels that he would much rather be enjoying the company of his friends who have decided to go to the beach that day, he knows that he has to finish his studying first. In order to empty the thoughts of the beach from his mind, he chooses to focus on his studying of behavioral sciences and smirks when he looks over the ego defenses.
>>>What two things qualify an ego defense as a reaction to psychological stress?
An ego defense must be automatic and unconscious.
>>>What are some examples of mature ego defenses?
Some mature ego defenses include Sublimation, Altruism, Suppression, and Humor. As a mnemonic, one can remember the phrase “Mature women wear a SASH.”
>>>What ego defense is this medical student using?
The medical student is using suppression. He is voluntarily withholding the idea of going to the beach from his conscious awareness by focusing on behavioral sciences. The difference between suppression and repression is that suppression is a voluntary process. It is therefore important to note that suppression is an exception to the rule that ego defenses must be unconscious.
>>>What are some examples of immature ego defenses?
Examples of immature ego defenses include acting out, denial, projection, reaction formation, regression, repression, and splitting, among others.
>>>What ego defense would the medical student be using if he could not handle the stress of studying for the examination and instead chose to go to the beach every day?
By involuntarily withholding the idea of taking the test as a reaction to his stress, the student would be exhibiting classic repression, the basic mechanism underlying all others.
This case study was contributed by Rakesh Razdan Ahuja, class of 2010, Yale University School of Medicine; in association with Le TT, Takiar V, eds: First Aid Cases for the USMLE Step 1. New York: McGraw-Hill, 2009.
This practice case study is representative of the studies available in the First Aid™ Cases for the USMLE Step 1. First Aid™ Cases for the USMLE Step 1 features 400 well-illustrated cases to help you relate basic science concepts to clinical situations. Each case includes drawings or clinical images with Q&As that reinforce key concepts. Get more Step 1 study help at USMLE-Rx.com.
A woman rushes her 65-year-old husband into the emergency department after he said he felt crushing chest pain while eating a steak. Blood work is ordered and the physician finds that the man’s cholesterol is very high and that the man most likely had an acute myocardial infarction because of the finding of elevated enzymes. After consultation, the man is put on statins to lower his cholesterol level and told to avoid a fatty diet.
A 22-year-old woman who has recently lost her father in an automobile accident comes to her psychiatrist for psychotherapy. Over the past 7 months of undergoing therapy, she has had an increasing number of symptoms such as hallucinations, including “seeing her father in the hallway,” that are not attributable to the side effects of her drugs or a part of any other obvious physical diagnosis. This morning when speaking to her physician, she begins sobbing uncontrollably and reaches out to the physician for comfort.