MD Psychiatry and Behavioral Science 2 — Questions and Answers
Question 1: A 22-year-old woman has a pattern of unstable relationships, chronic feelings of emptiness, frantic efforts to avoid abandonment, and recurrent self-cutting. Which personality disorder is most likely?
- Narcissistic personality disorder
- Borderline personality disorder (Correct answer)
- Schizotypal personality disorder
- Histrionic personality disorder
Correct answer: Borderline personality disorder
Borderline personality disorder is characterized by unstable identity, intense fear of abandonment, chronic emptiness, and impulsive self-destructive behaviors including self-harm.
Question 2: Which of the following is the single strongest independent risk factor for completed suicide?
- Female sex
- History of a prior suicide attempt (Correct answer)
- Social isolation
- Unemployment
Correct answer: History of a prior suicide attempt
A previous suicide attempt is the strongest predictor of completed suicide, increasing risk approximately 30-fold compared to the general population.
Question 3: Electroconvulsive therapy (ECT) is most clearly indicated for which patient?
- A patient with mild depression who has not tried any antidepressants
- A pregnant woman with severe, treatment-resistant depression and active suicidal ideation (Correct answer)
- A patient with bipolar II disorder in a hypomanic episode
- An adolescent with first-episode schizophrenia
Correct answer: A pregnant woman with severe, treatment-resistant depression and active suicidal ideation
ECT is the safest and most effective option for severe, treatment-resistant depression in pregnancy, where many pharmacological agents pose teratogenic risks and rapid symptom control is essential.
Question 4: A 7-year-old boy has persistent inability to focus, hyperactivity, and impulsiveness affecting school performance since age 5. ADHD is confirmed. What is the first-line pharmacological treatment?
- Methylphenidate (Correct answer)
- Fluoxetine
- Risperidone
- Clonidine
Correct answer: Methylphenidate
Stimulant medications such as methylphenidate are the first-line pharmacological treatment for ADHD in school-aged children, typically combined with behavioral therapy for optimal outcomes.
Question 5: A 40-year-old man with heavy alcohol use abruptly stops drinking. On day 2, he develops tachycardia, hypertension, diaphoresis, tremor, and anxiety. What is the most serious potential complication if left untreated?
- Wernicke's encephalopathy
- Delirium tremens with tonic-clonic seizures (Correct answer)
- Korsakoff's psychosis
- Alcoholic hepatitis
Correct answer: Delirium tremens with tonic-clonic seizures
Delirium tremens is the most severe complication of alcohol withdrawal, typically occurring 48-96 hours after cessation and potentially life-threatening; benzodiazepines are the treatment of choice.
Question 6: A patient taking sertraline and tramadol (prescribed for back pain) develops agitation, hyperthermia, diaphoresis, clonus, and hyperreflexia. What is the most likely diagnosis?
- Neuroleptic malignant syndrome
- Anticholinergic toxicity
- Serotonin syndrome (Correct answer)
- Malignant hyperthermia
Correct answer: Serotonin syndrome
Serotonin syndrome results from excess serotonergic activity and presents with the classic triad of mental status changes, autonomic instability, and neuromuscular abnormalities including clonus and hyperreflexia.
Question 7: A 19-year-old woman has a BMI of 16.5, self-induced vomiting after eating, and an intense fear of weight gain despite being significantly underweight. She has secondary amenorrhea. What is the most likely diagnosis?
- Bulimia nervosa
- Anorexia nervosa, binge-eating/purging subtype (Correct answer)
- Binge eating disorder
- Avoidant/restrictive food intake disorder
Correct answer: Anorexia nervosa, binge-eating/purging subtype
Anorexia nervosa (binge-eating/purging subtype) is defined by significantly low body weight plus purging behaviors; the critically low BMI distinguishes it from bulimia nervosa, where patients are typically normal weight.
MD Psychiatry and Behavioral Science 2
A 22-year-old woman has a pattern of unstable relationships, chronic feelings of emptiness, frantic efforts to avoid abandonment, and recurrent self-cutting.
Which personality disorder is most likely?