NBME Psychiatry 4 — Questions and Answers
Question 1: A 50-year-old man with alcohol use disorder is hospitalized and develops tremors, diaphoresis, and seizures 48 hours after his last drink. Which medication is most appropriate for treatment?
- Naltrexone
- Haloperidol
- Lorazepam (Correct answer)
- Methadone
Correct answer: Lorazepam
Benzodiazepines are the first-line treatment for alcohol withdrawal, reducing the risk of seizures and delirium tremens by enhancing GABA activity.
Question 2: A 32-year-old heroin user presents to the ED in acute opioid withdrawal with severe anxiety, mydriasis, piloerection, and cramping. Which agent reduces autonomic symptoms of opioid withdrawal?
- Buprenorphine
- Methadone
- Clonidine (Correct answer)
- Naloxone
Correct answer: Clonidine
Clonidine, an alpha-2 agonist, suppresses the noradrenergic storm driving autonomic symptoms of opioid withdrawal.
Question 3: A 7-year-old boy fails to develop spoken language, avoids eye contact, and engages in repetitive rocking movements. He was hitting all developmental milestones until age 18 months. What is the most likely diagnosis?
- Rett syndrome
- Fragile X syndrome
- Autism spectrum disorder (Correct answer)
- Selective mutism
Correct answer: Autism spectrum disorder
Autism spectrum disorder presents with deficits in social communication and restricted/repetitive behaviors; early development may appear normal before regression.
Question 4: A 26-year-old woman presents with sudden paralysis of her right arm. Neurological exam reveals non-anatomic sensory loss. MRI is normal. She appears unconcerned ('la belle indifférence'). What is the most likely diagnosis?
- Factitious disorder
- Somatic symptom disorder
- Conversion disorder (Correct answer)
- Illness anxiety disorder
Correct answer: Conversion disorder
Conversion disorder (functional neurological symptom disorder) presents with neurological deficits inconsistent with anatomy, often with la belle indifférence, after a psychological stressor.
Question 5: A psychiatrist is treating a patient who reveals plans to harm a specific coworker. The patient has access to weapons. What is the psychiatrist's most appropriate course of action?
- Maintain confidentiality because it is privileged communication
- Warn the identified potential victim and notify law enforcement (Correct answer)
- Hospitalize the patient only and take no further action
- Consult a supervisor but take no independent action
Correct answer: Warn the identified potential victim and notify law enforcement
Under Tarasoff duty-to-protect principles, clinicians must take reasonable steps to protect an identified third party, including warning the victim and notifying law enforcement.
Question 6: A 17-year-old girl has a BMI of 16 kg/m², amenorrhea, lanugo hair, and insists she is overweight despite being visibly emaciated. She restricts caloric intake and exercises excessively. What electrolyte complication is most dangerous?
- Hyperphosphatemia
- Hyponatremia
- Hypokalemia causing arrhythmias (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia causing arrhythmias
In anorexia nervosa, severe hypokalemia from starvation and potential purging can cause life-threatening cardiac arrhythmias.
Question 7: A 45-year-old executive has a pervasive pattern of grandiosity, requires excessive admiration, lacks empathy, and reacts to criticism with rage. Which personality disorder best describes him?
- Antisocial personality disorder
- Narcissistic personality disorder (Correct answer)
- Histrionic personality disorder
- Obsessive-compulsive personality disorder
Correct answer: Narcissistic personality disorder
Narcissistic personality disorder is characterized by grandiosity, need for admiration, lack of empathy, and a sense of entitlement.
NBME Psychiatry 4
A 50-year-old man with alcohol use disorder is hospitalized and develops tremors, diaphoresis, and seizures 48 hours after his last drink.
Which medication is most appropriate for treatment?