First Aid USMLE Step 1: Psychiatry
Assessment Questions with All Correct
Answers 2025-2026 Graded A+.
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
,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.
,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).
, 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
Peak incidence 9-12 years of age.
Child Neglect - Answer Failure to provide a child with adequate food, shelter, supervision,
education, and/or affection. Most common form of child maltreatment.
Evidence: poor hygiene, malnutrition, withdrawal, impaired social/ emotional development,
failure to thrive.
As with child abuse, child neglect must be reported to local child protective services.
Assessment Questions with All Correct
Answers 2025-2026 Graded A+.
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
,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.
,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).
, 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
Peak incidence 9-12 years of age.
Child Neglect - Answer Failure to provide a child with adequate food, shelter, supervision,
education, and/or affection. Most common form of child maltreatment.
Evidence: poor hygiene, malnutrition, withdrawal, impaired social/ emotional development,
failure to thrive.
As with child abuse, child neglect must be reported to local child protective services.
