FIRST AID USMLE STEP 1: PSYCHIATRY 2025 WITH
VERIFIED ANSWERS
Transference? - ANSWER-Patient projects feelings about formative or other important
persons onto physician.
Countertransference? - ANSWER-*Doctor* projects feelings about formative or other
important persons onto patient.
What is the central goal of Freudian psychoanalysis? - ANSWER-Make patient aware of
what is hidden in his/her unconsciousness.
*Primal* urges (food, sex, aggression)
- "Drives" instinct
- Entirely subconcious - ANSWER-ID
*Mediator* between primal urges and behavior accepted in reality - ANSWER-ego
Moral values, *conscience*, can lead to self-blame and attacks on ego - ANSWER-
super ego
Thoughts and behaviors voluntary or involuntary that are used to resolve conflict and
prevent undesirable feelings ( anxiety depression) - ANSWER-EGO Defenses
12 y/o girl dies her hair purple after her parents ground her - ANSWER-Acting out
Ego Defense: Acting Out - ANSWER-Unacceptable feelings and thoughts are
expressed through actions.
*Tantrums*
Temporary drastic change in personality, memory, consciousness or motor behavior to
avoid emotional stress. - ANSWER-Dissociation
Extreme forms of Dissociation can result in - ANSWER-Extreme forms *can result in
dissociative identiy disorder* (multiple personality disorder).
A patient with cancer schedules a full 40 hour work week despite her Oncologist telling
her that she is going to be very fatigued and sick during treatment - ANSWER-Denial
Denial - ANSWER-Avoidance of awareness of some painful reality.
Process whereby *avoided ideas and feelings are transferred to some NEUTRAL
PERSON or OBJECT - ANSWER-Displacement
Mother places blame on child because she is angry with husband.
,Ego Defense: Fixation - ANSWER-Partially remaining at a more childish level of
development vs. regression.
Men fixating on sports games.
Ego Defense: Identification - ANSWER-Modeling behavior after another person who is
more powerful (*though not necessarily admired*).
Abused child identifies himself/herself as an abuser.
Ego Defense: Isolation of affect - ANSWER-*Separation of feelings* from ideas and
events.
Describing murder in graphic detail with no emotional response.
Ego Defense: Projection - ANSWER-An unacceptable internal impulse is attributed to
an external source.
A man who wants another woman thinks his wife is cheating on him.
Ego Defense: Rationalization - ANSWER-Proclaiming logical regions for actions actually
performed for other reasons; usually to avoid self blame.
After getting fired, claiming that the job was not important anyway.
Ego Defense: Reaction formation - ANSWER-Process whereby a warded-off idea or
feeling is replaced by an unconsciously derived emphasis on its opposite.
Patient with libidinous thoughts enters a monastery.
Ego Defense: Regression - ANSWER-Turning back the maturational clock and going
back to earlier modes of dealing with the world.
Seen in *children under stress (bedwetting)* and in patients on dialysis (crying)
Ego Defense: Repression - ANSWER-Involuntary witholding an idea or feeling from
consciousness awareness.
Not remembering a conflictual or traumatic experience.
Ego Defense: Splitting - ANSWER-Belief that people are either all good or all bad at
different times due to intolerance of ambiguity. *Seen in borderline personality disorder.*
Patient that says all nurses are cold and insensitive but that the doctors are warm and
friendly.
, What are the mature/less primitive ego defenses? - ANSWER-Sublimation, Altruism,
Suppression, Humor
Ego Defense: Sublimation - ANSWER-Process whereby one replaces an unacceptable
wish with a course of action that is similar to the wish but does not conflict with one's
value system.
Actress uses experience of abuse to enhance her acting.
Ego Defense: Altruism - ANSWER-Guilty feeling alleviated by unsolicited generosity
towards others.
Mafia boss makes large donation to charity.
Ego Defense: Suppression - ANSWER-Voluntary withholding of an idea or feeling from
conscious awareness (vs. repression).
Choosing not to think about the USMLE until the week of the exam.
Ego Defense: Humor - ANSWER-Appreciating the amusing nature of an anxiety-
provoking or adverse situation.
Nervous medical student jokes about the boards.
What are effects of long-term deprivation of affection in infants? - ANSWER-Decreased
muscle tone, poor language skills, poor socialization skills, Lack of basic trust, Anaclitic
depression (hospitalism), weight loss, physical illness
Severe deprivation can result in infant death. Deprivation for > 6 months can lead to
irreversible changes.
4 W's: weak, wordless, wanting, wary
Physical Abuse Evidence, Abuser, Epidemiology - ANSWER-Evidence- healed
fractures on x-ray, cigarette burnes, subdural hematomas, multiple bruises, retinal
hemorrhage or detachment
Abuser- Usually female and the primary caregiver
3000 deaths/ year in the United States
Sexual Abuse Evidence, Abuser, Epidemiology - ANSWER-Evidence- Genital/ Anal
Trauma, STDs, UTIs
Abuser- known to victim, usually male
VERIFIED ANSWERS
Transference? - ANSWER-Patient projects feelings about formative or other important
persons onto physician.
Countertransference? - ANSWER-*Doctor* projects feelings about formative or other
important persons onto patient.
What is the central goal of Freudian psychoanalysis? - ANSWER-Make patient aware of
what is hidden in his/her unconsciousness.
*Primal* urges (food, sex, aggression)
- "Drives" instinct
- Entirely subconcious - ANSWER-ID
*Mediator* between primal urges and behavior accepted in reality - ANSWER-ego
Moral values, *conscience*, can lead to self-blame and attacks on ego - ANSWER-
super ego
Thoughts and behaviors voluntary or involuntary that are used to resolve conflict and
prevent undesirable feelings ( anxiety depression) - ANSWER-EGO Defenses
12 y/o girl dies her hair purple after her parents ground her - ANSWER-Acting out
Ego Defense: Acting Out - ANSWER-Unacceptable feelings and thoughts are
expressed through actions.
*Tantrums*
Temporary drastic change in personality, memory, consciousness or motor behavior to
avoid emotional stress. - ANSWER-Dissociation
Extreme forms of Dissociation can result in - ANSWER-Extreme forms *can result in
dissociative identiy disorder* (multiple personality disorder).
A patient with cancer schedules a full 40 hour work week despite her Oncologist telling
her that she is going to be very fatigued and sick during treatment - ANSWER-Denial
Denial - ANSWER-Avoidance of awareness of some painful reality.
Process whereby *avoided ideas and feelings are transferred to some NEUTRAL
PERSON or OBJECT - ANSWER-Displacement
Mother places blame on child because she is angry with husband.
,Ego Defense: Fixation - ANSWER-Partially remaining at a more childish level of
development vs. regression.
Men fixating on sports games.
Ego Defense: Identification - ANSWER-Modeling behavior after another person who is
more powerful (*though not necessarily admired*).
Abused child identifies himself/herself as an abuser.
Ego Defense: Isolation of affect - ANSWER-*Separation of feelings* from ideas and
events.
Describing murder in graphic detail with no emotional response.
Ego Defense: Projection - ANSWER-An unacceptable internal impulse is attributed to
an external source.
A man who wants another woman thinks his wife is cheating on him.
Ego Defense: Rationalization - ANSWER-Proclaiming logical regions for actions actually
performed for other reasons; usually to avoid self blame.
After getting fired, claiming that the job was not important anyway.
Ego Defense: Reaction formation - ANSWER-Process whereby a warded-off idea or
feeling is replaced by an unconsciously derived emphasis on its opposite.
Patient with libidinous thoughts enters a monastery.
Ego Defense: Regression - ANSWER-Turning back the maturational clock and going
back to earlier modes of dealing with the world.
Seen in *children under stress (bedwetting)* and in patients on dialysis (crying)
Ego Defense: Repression - ANSWER-Involuntary witholding an idea or feeling from
consciousness awareness.
Not remembering a conflictual or traumatic experience.
Ego Defense: Splitting - ANSWER-Belief that people are either all good or all bad at
different times due to intolerance of ambiguity. *Seen in borderline personality disorder.*
Patient that says all nurses are cold and insensitive but that the doctors are warm and
friendly.
, What are the mature/less primitive ego defenses? - ANSWER-Sublimation, Altruism,
Suppression, Humor
Ego Defense: Sublimation - ANSWER-Process whereby one replaces an unacceptable
wish with a course of action that is similar to the wish but does not conflict with one's
value system.
Actress uses experience of abuse to enhance her acting.
Ego Defense: Altruism - ANSWER-Guilty feeling alleviated by unsolicited generosity
towards others.
Mafia boss makes large donation to charity.
Ego Defense: Suppression - ANSWER-Voluntary withholding of an idea or feeling from
conscious awareness (vs. repression).
Choosing not to think about the USMLE until the week of the exam.
Ego Defense: Humor - ANSWER-Appreciating the amusing nature of an anxiety-
provoking or adverse situation.
Nervous medical student jokes about the boards.
What are effects of long-term deprivation of affection in infants? - ANSWER-Decreased
muscle tone, poor language skills, poor socialization skills, Lack of basic trust, Anaclitic
depression (hospitalism), weight loss, physical illness
Severe deprivation can result in infant death. Deprivation for > 6 months can lead to
irreversible changes.
4 W's: weak, wordless, wanting, wary
Physical Abuse Evidence, Abuser, Epidemiology - ANSWER-Evidence- healed
fractures on x-ray, cigarette burnes, subdural hematomas, multiple bruises, retinal
hemorrhage or detachment
Abuser- Usually female and the primary caregiver
3000 deaths/ year in the United States
Sexual Abuse Evidence, Abuser, Epidemiology - ANSWER-Evidence- Genital/ Anal
Trauma, STDs, UTIs
Abuser- known to victim, usually male
