{"id":819,"date":"2023-01-25T15:00:00","date_gmt":"2023-01-25T15:00:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=819"},"modified":"2025-10-01T11:40:36","modified_gmt":"2025-10-01T19:40:36","slug":"usmle-step-1-question-of-the-day-depression","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-depression","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Depression"},"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-depression\/#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><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-depression\/#C_Decreased_neural_transmission_of_monoamines\" >C.&nbsp;Decreased neural transmission of monoamines<\/a><\/li><\/ul><\/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-depression\/#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-depression\/#A_Increased_REM_sleep_latency\" >A. Increased REM sleep latency<\/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-depression\/#B_Decreased_serum_levels_of_c-reactive_protein\" >B. Decreased serum levels of c-reactive protein<\/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-depression\/#D_Increased_hippocampal_volume\" >D. Increased hippocampal volume<\/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-depression\/#E_Decreased_serum_cortisol\" >E. Decreased serum cortisol<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-depression\/#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-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-depression\/#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-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-depression\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case focuses on a 38-year-old man who got laid off from work and could no longer concentrate long enough to write poems, which he loved doing in the past, decreased in appetite, and has difficulty going back to sleep. Can you figure it out?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 38-year-old man comes to a clinic for evaluation of low energy and fatigue. He has been stressed since being laid off from work 6 months ago, but he feels he has no motivation to look for new employment. He used to write poetry, but he no longer enjoys it, stating, \u201cI just can\u2019t concentrate long enough to write anything of substance, and every time I try my mind wanders.\u201d His appetite has also decreased, and he has lost 5.4-kg (12-lb) over this time. He awakes early in the morning and has difficulty going back to sleep. Vitals are within normal limits. Physical examination reveals a guarded adult male with slow speech. Which of the following abnormalities is most likely present in this patient?<strong>A. Increased REM sleep latency<br><br>B. Decreased serum levels of c-reactive protein<br><br>C. Decreased neural transmission of monoamines<br><br>D. Increased hippocampal volume<br><br>E. Decreased serum cortisol<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/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<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Decreased_neural_transmission_of_monoamines\"><\/span>C.&nbsp;<strong>Decreased neural transmission of monoamines<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, 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=\"A_Increased_REM_sleep_latency\"><\/span>A. Increased REM sleep latency<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Depression can significantly alter sleep architecture; changes include decreased rapid eye movement sleep latency and slow-wave sleep.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Decreased_serum_levels_of_c-reactive_protein\"><\/span>B. Decreased serum levels of c-reactive protein<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Hormonal and inflammatory factors have been suggested as potentially influencing a depressive state and depressive symptoms, which explains why many patients with unipolar major depression have increased mean serum levels of peripheral inflammatory markers such as cytokines and c-reactive protein.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Increased_hippocampal_volume\"><\/span>D. Increased hippocampal volume<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Depressive episodes are associated with higher levels of cortisol, which has been associated with damage to hippocampal neurons followed by atrophy. Some studies suggest that reduced hippocampal volumes precede the onset of depression.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Decreased_serum_cortisol\"><\/span>E. Decreased serum cortisol<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>An indicator of chronic stress is elevated HPA-axis activity, typically measured by the presence of elevated serum cortisol levels. Increased, not decreased, serum cortisol levels have been found to be associated with depression.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient meets the criteria for&nbsp;<strong>major depressive disorder<\/strong>&nbsp;(MDD), as indicated by his depressed mood, low energy, anhedonia, early-morning awakening, weight loss, and psychomotor depression. A major depressive episode is characterized by a period lasting&nbsp;<strong>at least two weeks<\/strong>&nbsp;with five or more of the following symptoms: depressed mood, anhedonia, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts of death or suicide; at least one of the symptoms must be depressed mood or anhedonia. Neuroendocrine studies in patients with MDD have demonstrated multiple clinical and subclinical alterations of normal human physiology including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Decreased neural transmission of monoamines<\/strong>\u00a0(<strong>s<\/strong>erotonin,\u00a0<strong>n<\/strong>orepinephrine, and\u00a0<strong>d<\/strong>opamine), which can be recalled via the mnemonic \u201c<strong>S<\/strong>u<strong>ND<\/strong>ays are\u00a0<strong>depressing<\/strong>.\u201d\u00a0<\/li>\n\n\n\n<li><strong>HPA-axis overactivity<\/strong>, resulting in subclinical hypercortisolemia with various neurotoxic effects, including volume loss in the frontal lobe and hippocampus.\u00a0<\/li>\n\n\n\n<li><strong>Alterations in sleep architecture<\/strong>, most notably decreased rapid eye movement (REM) sleep latency and slow-wave sleep.\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">P.S. If you or someone you know needs this, here&#8217;s the number for the National Suicide Prevention Lifeline 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Neuroendocrine studies in patients with MDD have demonstrated both clinical and subclinical alterations in normal physiology, including decreased neural transmission of monoamines (serotonin, norepinephrine, and dopamine), hypercortisolemia, and changes in sleep architecture.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">American Psychiatric Association. (2013).&nbsp;<em>Diagnostic and statistical manual of mental disorders (5th ed.)<\/em>. https:\/\/doi.org\/10.1176\/appi.books.9780890425596 &nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Keller, J., Gomez, R., Williams, G. et al.&nbsp;<em>HPA axis in major depression: cortisol, clinical symptomatology and genetic variation predict cognition.<\/em>&nbsp;Mol Psychiatry 22, 527\u2013536 (2017).&nbsp;<a href=\"https:\/\/doi.org\/10.1038\/mp.2016.120\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1038\/mp.2016.120<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bremner, J. D., Narayan, M., Anderson, E. R., Staib, L. H., Miller, H. L., &amp; Charney, D. S. (2000).&nbsp;<em>Hippocampal Volume Reduction in Major Depression<\/em>. American Journal of Psychiatry, 157(1), 115\u2013118. doi:10.1176\/ajp.157.1.115<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sharpley CF, Bitsika V, McMillan ME, Jesulola E, Agnew LL.&nbsp;<em>The association between cortisol:C-reactive protein ratio and depressive fatigue is a function of CRP rather than cortisol. Neuropsychiatr Dis Treat.&nbsp;<\/em>2019;15:2467-2475. Published 2019 Aug 27. doi:10.2147\/NDT.S213839<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><em><strong><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a>&nbsp;<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><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.&nbsp;<\/sub><\/em><\/strong><\/em><\/p>\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. Today&#8217;s case focuses on a 38-year-old man who got laid off from work and could no longer concentrate long enough to write poems, which he loved doing in the past, decreased in appetite, and has difficulty going [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":820,"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-819","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: Depression - 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-depression\" \/>\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: Depression - 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. 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