Behavioral Science Test

Question 1

A 50-year-old man develops difficulty walking while receiving drug therapy for paranoid behavior.
Physical examination shows masked facies and diffuse muscle rigidity.
He is slow in initiating movement and walks with a shuffling narrow-based gait.
Which of the following drugs is the most likely cause of these findings?

Accepted Answer

Phenothiazine

Answer

Barbiturate

Answer

Benzodiazepine

Answer

Monoamine oxidase inhibitor

Answer

Tricyclic compound

Question 2

A 24-year-old man is brought to the emergency department by his mother after barricading himself in his apartment. For 8 months, he has believed that aliens follow him and control his mind. He was fired from his parttime job 6 months ago because of unusual behavior. There are no other apparent psychosocial stressors. His paternal grandmother has major depressive disorder. He does not use drugs, but his mother states that he frequently drinks beer. There is no disturbance of mood, sleep, or appetite. Examination shows an extremely agitated and suspicious patient. There is a 1 × 1-cm abrasion in the right frontal area. His blood alcohol concentration is 0.5 mg/dL, and serum γ- glutamyltransferase (GGT) activity is 40 U/L (N=5–50). Which of the following is the most likely diagnosis?

Accepted Answer

Schizophrenia, paranoid type

Answer

Alcohol-induced mood disorder

Answer

Bipolar disorder, manic

Answer

Brief psychotic disorder

Answer

Schizoaffective disorder

Question 3

A 43-year-old woman is brought to the emergency department 1 hour after a stranger stole her purse. She is agitated and extremely upset. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); BMI is 34 kg/m2 . Physical examination shows no other abnormalities. Her blood glucose concentration is increased. Which of the following is the most likely explanation for this finding?

Accepted Answer

Normal stress hormone response

Answer

β-Cell hypersecretion

Answer

Cushing disease

Answer

Glucagon-secreting adenoma

Answer

Pancreatitis

Question 4

A 4-year-old girl is brought to the physician by her mother because of a fever for 1 day. The physician is more than 1 hour behind schedule because of two patient emergencies earlier that day. When he enters the room, the mother yells, “Do you know how long we've had to wait? This is totally unacceptable!” It is most appropriate for the physician to initially state which of the following?

Accepted Answer

“It must have been very difficult to be here for so long with a sick child.”

Answer

“I am frustrated, too, with being so far behind schedule.”

Answer

“I hope my staff explained about the difficult patients who caused the delay.”

Answer

“My office staff scheduled too many patients for today.”

Answer

“Unfortunately, some patients demand more time than we scheduled for them.”

Question 5

A 45-year-old man is admitted to the hospital because of chest pain for 1 hour. He has a sedentary lifestyle, and his diet is high in fat and sodium. The diagnosis of acute angina is made, and the appropriate treatment is administered. After the patient’s condition is stabilized, the physician recommends an exercise regimen and a low-fat, low-sodium diet. Two weeks later, the patient returns for a follow-up examination. He indicates that he has not yet returned to work and spends most of the day lying on the couch. He has not had any chest pain, shortness of breath, dyspnea with exertion, or peripheral edema. Which of the following initial statements by the physician is most appropriate?

Accepted Answer

“What do you think is interfering with your ability to resume activity?”

Answer

“Are you afraid you might have a heart attack if you exercise?”

Answer

“Are you doing any types of exercise other than channel surfing?”

Answer

“Have you also not been following the diet I recommended?”

Answer

“When would you like to start working on improving your health?”

Question 6

A firstborn 1-year-old girl is hospitalized for evaluation of arrested growth. Pregnancy and delivery were uncomplicated, and development was normal initially. The infant is listless and has a diaper rash. She is below the 5th percentile for length and weight. No other abnormalities are noted. After 1 week of routine hospital care, the infant has gained 1 kg (2.2 lb) and has become more responsive. Which of the following is the most likely explanation for the arrested growth?

Accepted Answer

Parental neglect

Answer

Hypothyroidism

Answer

Infantile psoriasis

Answer

Milk allergy

Answer

Pyloric stenosis

Question 7

A 15-year-old boy with generalized tonic-clonic seizures is brought to the physician by his mother for a follow-up examination. She says he has not been taking his medication regularly. In his presence, she explains to the physician that she is baffled by her son’s behavior and “can’t get him to take his pills, let alone take out the trash.” Even after his mother leaves, the patient stares out the window and refuses to talk. Which of the following behaviors during the interview is most appropriate to assess the patient’s compliance with this regimen?

Accepted Answer

Project a firm, businesslike manner

Answer

Confront the patient about his poor behavior

Answer

Explain the patient’s resistance to him

Answer

Laugh and joke with the patient

Answer

Project a respectful, tolerant attitude and encourage free discussion

Question 8

The children of a 67-year-old woman ask their family physician for advice about their mother’s behavior 4 weeks after the death of her husband of 40 years. They are concerned because she weeps whenever she comes upon an object in her home that she associates with him. Her appetite has decreased, and she has had a 2-kg (4.4-lb) weight loss. She awakens 1 hour before the alarm goes off each morning. She is able to care for herself. Although she does not leave her home for any social activities, she does enjoy visits from her family. Which of the following is the most likely explanation and appropriate management?

Accepted Answer

Normal grief reaction, and she requires no medical attention

Answer

Normal grief reaction, and she would benefit from diazepam therapy

Answer

Pathologic grief reaction, and she should be treated with an antidepressant

Answer

Pathologic grief reaction, and she should be treated with psychotherapy

Answer

Pathologic grief reaction, and she should be encouraged to move in with one of her children

Question 9

A 4-year-old girl is brought to the physician because she consistently uses her left hand. Her mother, who is also left-handed, tells the physician that she wants her daughter to be right-handed because she resents all the obstacles she faced as a left-handed child. She makes her daughter practice with a crayon held only in her right hand. Which of the following responses by the physician is most appropriate?

Accepted Answer

“I know you want the best for your daughter, but pressing her to change is unlikely to work and might cause its own problems.”

Answer

“I understand your concerns, and since she is only 4, your efforts will likely result in her being right-handed by age 7 years.”

Answer

“Times have changed. There is much less discrimination against left-handed people now.”

Answer

“You may be causing irreversible psychological trauma to your child, which could be worse than being left-handed.”

Answer

“You shouldn’t interfere with nature.”

Question 10

A 65-year-old man comes to the physician for a follow-up examination after the results of a bronchoscopy showed squamous cell carcinoma. When the physician tells the patient the diagnosis, the patient becomes tearful and responds, “No, you’re wrong! This must be a mistake. This can’t happen to me. Let’s do more tests.” This patient is most likely at which of the following stages of grief?

Accepted Answer

Denial

Answer

Anger

Answer

Bargaining

Answer

Depression