NBME Psychiatry 3

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?

Accepted Answer

Schizophreniform disorder

Answer

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?

Accepted Answer

Borderline personality disorder

Answer

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?

Accepted Answer

Delusional disorder, jealous type

Answer

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?

Accepted Answer

Methylphenidate

Answer

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?

Accepted Answer

Discontinue clozapine immediately

Answer

Clozapine-induced agranulocytosis (ANC < 500/µL) requires immediate discontinuation and should never be rechallenged.

NBME Practice Test

NBME Practice Test

NBME Psychiatry 3