First Aid for the USMLE Step 1 Casebook – A Student Under Stress

Check out today’s Step 1 Casebook Challenge.

Know the answers? Post them below! Don’t forget to check back tomorrow for an update with the correct answers and explanations.

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 1First 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


2 thoughts on “First Aid for the USMLE Step 1 Casebook – A Student Under Stress”

  1. -Quality of Ego defense : manage internal conflicts between the demands of the id , and the restrictions of superego .Ego wards off anxiety and controls instinctive urges.

    -Humor, Sublimation, Supression .

    -Student is using Suppression

    -Blocking, Regression , Somatization.

    -Regression – Having fun is about “regression”

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