NBME Psychiatry 3 — Questions and Answers
Question 1: A 30-year-old man with no psychiatric history suddenly believes he is receiving special messages from the television. He also hears voices commenting on his actions. Symptoms have been present for 3 weeks. What is the most likely diagnosis?
- Schizophrenia
- Brief psychotic disorder
- Schizophreniform disorder (Correct answer)
- Delusional disorder
Correct answer: Schizophreniform disorder
Schizophreniform disorder presents with schizophrenia-like symptoms lasting 1–6 months; duration less than 1 month is brief psychotic disorder.
Question 2: A 25-year-old woman reports chronic feelings of emptiness, frantic efforts to avoid abandonment, and a history of self-cutting when upset. She has had three suicide attempts. What personality disorder best fits?
- Histrionic personality disorder
- Narcissistic personality disorder
- Borderline personality disorder (Correct answer)
- Antisocial personality disorder
Correct answer: Borderline personality disorder
Borderline personality disorder is defined by unstable mood, identity, and relationships, chronic emptiness, fear of abandonment, self-harm, and impulsivity.
Question 3: A 40-year-old woman presents with a 3-month history of believing her husband is being unfaithful despite no evidence. She is otherwise well-functioning. No hallucinations are present. Which diagnosis is most appropriate?
- Paranoid schizophrenia
- Delusional disorder, jealous type (Correct answer)
- Shared delusional disorder
- Paranoid personality disorder
Correct answer: Delusional disorder, jealous type
Delusional disorder involves a non-bizarre delusion lasting at least 1 month with preserved functioning and no other psychotic symptoms.
Question 4: A 10-year-old boy is brought in for difficulty sitting still in class, frequently interrupting others, and losing homework assignments. His teacher reports similar behavior. Symptoms began before age 7. What is the best initial treatment?
- Risperidone
- Methylphenidate (Correct answer)
- Clonazepam
- Fluoxetine
Correct answer: Methylphenidate
Methylphenidate (a stimulant) is first-line pharmacotherapy for ADHD and improves attention and impulse control.
Question 5: A patient on clozapine develops a fever of 39.2°C, sore throat, and an absolute neutrophil count of 450/µL. What is the most appropriate action?
- Reduce clozapine dose by 50%
- Add prophylactic antibiotics and continue clozapine
- Discontinue clozapine immediately (Correct answer)
- Switch to olanzapine and monitor CBC
Correct answer: Discontinue clozapine immediately
Clozapine-induced agranulocytosis (ANC < 500/µL) requires immediate discontinuation and should never be rechallenged.
Question 6: A 72-year-old woman develops acute confusion, disorientation, and visual hallucinations 2 days after hip replacement surgery. Her symptoms fluctuate throughout the day. Which diagnosis is most likely?
- Lewy body dementia
- Delirium (Correct answer)
- Brief psychotic disorder
- Vascular dementia
Correct answer: Delirium
Delirium is characterized by acute onset, fluctuating course, inattention, and disturbance of consciousness, commonly occurring postoperatively.
Question 7: A 35-year-old soldier returning from combat has nightmares, flashbacks, avoidance of crowds, and hypervigilance for 3 months after witnessing deaths of fellow soldiers. What is the diagnosis?
- Acute stress disorder
- Adjustment disorder with anxiety
- Post-traumatic stress disorder (Correct answer)
- Generalized anxiety disorder
Correct answer: Post-traumatic stress disorder
PTSD is diagnosed when intrusion, avoidance, negative cognitions/mood, and hyperarousal symptoms persist for more than 1 month after a traumatic event.
NBME Psychiatry 3
A 30-year-old man with no psychiatric history suddenly believes he is receiving special messages from the television.
He also hears voices commenting on his actions.
Symptoms have been present for 3 weeks.
What is the most likely diagnosis?