{"id":755,"date":"2023-01-11T12:20:00","date_gmt":"2023-01-11T12:20:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=755"},"modified":"2025-10-01T11:40:35","modified_gmt":"2025-10-01T19:40:35","slug":"usmle-step-1-question-of-the-day-autism-spectrum-disorder","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Autism spectrum disorder"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#A_Autism_spectrum_disorder\" >A. Autism spectrum disorder<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#B_Rett_Syndrome\" >B. Rett Syndrome<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#C_Fetal_alcohol_spectrum_disorder\" >C. Fetal alcohol spectrum disorder<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#D_Landau-Kleffner_syndrome\" >D. Landau-Kleffner syndrome&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#E_Fragile_X_syndrome\" >E. Fragile X syndrome<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#F_Selective_mutism\" >F. Selective mutism<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 4-year-old-boy who was brought to the pediatrician for evaluation of unusual behavior. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 4-year-old boy is brought to the pediatrician for evaluation of unusual behavior. His parents are concerned about his intellectual development and state that he is \u201cquiet\u201d and almost always by himself, both at home as well as in daycare. He plays with toy trains for hours daily. If the toys are misplaced, he becomes enraged and throws tantrums, which involve him banging his head against the wall. The patient was born full-term, and the pregnancy was uncomplicated. Weight and height are at the 55th percentile. During the examination, the patient does not make eye contact with the physician and sits in the corner playing with his toy trains. The physician attempts to take a train from the patient, which causes him to shout, cry, and flap both hands. The remainder of the physical examination is noncontributory. Which of the following is the most likely diagnosis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Autism spectrum disorder<br><br>B. Rett Syndrome<br><br>C. Fetal alcohol spectrum disorder<br><br>D. Landau-Kleffner syndrome<br><br>E. Fragile X syndrome<br><br>F. Selective mutism<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Autism_spectrum_disorder\"><\/span>A. Autism spectrum disorder<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Rett_Syndrome\"><\/span>B. Rett Syndrome<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Rett syndrome is an X-linked dominant neurodevelopmental disorder that occurs almost exclusively in females. Affected patients initially develop normally, but then they gradually lose speech and motor capabilities typically around the age of 2.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Fetal_alcohol_spectrum_disorder\"><\/span>C. Fetal alcohol spectrum disorder<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Similar to children with autism spectrum disorder, children with fetal alcohol spectrum disorder (FASD) may have deficits in social and neurobehavioral skills. Children with FASD also have characteristic facial features, such as short palpebral fissures, a thin vermillion border, and a smooth philtrum. In contrast, these facial findings are absent in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Landau-Kleffner_syndrome\"><\/span>D. Landau-Kleffner syndrome&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Landau-Kleffner syndrome is an epileptic condition that presents with regression in language milestones after normal development. However, this patient does not have a history of seizures, and his clinical features are more suggestive of a different diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Fragile_X_syndrome\"><\/span>E. Fragile X syndrome<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Patients with Fragile X syndrome may display autism-like behaviors. However, patients with Fragile X syndrome will also typically have characteristic facial features including a long face, large ears, and a prominent jaw, all of which are absent in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"F_Selective_mutism\"><\/span>F. Selective mutism<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Selective mutism is characterized by intact communication skills in certain settings (e.g. home) but not in others (e.g. school). Additionally, restricted, repetitive behaviors, as seen in this patient, are typically absent in selective mutism.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with social isolation, repetitive stereotypical movements (e.g., hand flapping, headbanging), and a fixated interest in trains. He likely has autism spectrum disorder (ASD). ASD typically manifests within the first several years of life and is 4 times more common in males than in females.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ASD is a complex neurological disorder characterized by impaired social communication, restricted interests, and repetitive behaviors. Patients with ASD may exhibit findings described in the below table. In addition, these individuals often become distressed when their surrounding environment is changed due to limited adaptive capabilities. Children with ASD also have higher rates of co-occurring language problems, intellectual disabilities, and epilepsy than the general population.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"840\" height=\"528\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/clinical-features-management-autisim-spectrum.png\" alt=\"a table of autism spectrum disorder clinical features and management\" class=\"wp-image-756\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/clinical-features-management-autisim-spectrum.png 840w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/clinical-features-management-autisim-spectrum.png?resize=300,189 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/clinical-features-management-autisim-spectrum.png?resize=768,483 768w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Autism spectrum disorder should be suspected in children with impaired social communication, restricted interests, and repetitive behaviors. The condition is more common in males and is often diagnosed within the first few years of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Mughal, S., Faizy, R.M., Saadabadi, A. (2020) Autism spectrum disorder.&nbsp;<em>StatPearls [Internet]<\/em>. Web Address: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK525976\/.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Yochum, A. (2016) Autism spectrum\/pervasive developmental disorder.&nbsp;<em>Primary Care.<\/em>&nbsp;43(2), 285-300. Doi: 10.1016\/j.pop.2016.01.010.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us<\/strong><\/em>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><br><em><strong><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><\/a><\/strong><\/em><br><em><strong><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.\u00a0<\/sub><\/em><\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png?w=700\" alt=\"Osmosis ad\" class=\"wp-image-701\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 4-year-old-boy who was brought to the pediatrician for evaluation of unusual behavior. Can you figure it out? A 4-year-old boy is brought to the pediatrician for evaluation of unusual behavior. His parents are [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":757,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-755","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Autism spectrum disorder - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-autism-spectrum-disorder\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Autism spectrum disorder - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 4-year-old-boy who was brought to the pediatrician for evaluation of unusual behavior. Can you figure it out? A 4-year-old boy is brought to the pediatrician for evaluation of unusual behavior. 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Today's case focuses on a 6-month-old infant facing poor weight gain, weak cry, and muscle hypotonia. With genetic work-up pointing to a PDHA1 gene mutation and elevated serum lactate levels, can you\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: Sleep episodes","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 2x"},"classes":[]},{"id":8911,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-erratic-movements","url_meta":{"origin":755,"position":5},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Erratic movements","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"December 14, 2025","format":false,"excerpt":"A patient presents with psychosis and unusual movements. Discover how family history and other factors may increase risk for certain hereditary neurological disorders.","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 2 Question of the Day: Erratic Movements","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Step-2-Question-of-the-Day-Erratic-Movements.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Step-2-Question-of-the-Day-Erratic-Movements.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Step-2-Question-of-the-Day-Erratic-Movements.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Step-2-Question-of-the-Day-Erratic-Movements.png 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/755","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/202"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=755"}],"version-history":[{"count":1,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/755\/revisions"}],"predecessor-version":[{"id":758,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/755\/revisions\/758"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/757"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=755"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=755"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=755"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}