NBME Psychiatry 4

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?

Accepted Answer

Lorazepam

Answer

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?

Accepted Answer

Clonidine

Answer

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?

Accepted Answer

Autism spectrum disorder

Answer

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?

Accepted Answer

Conversion disorder

Answer

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?

Accepted Answer

Warn the identified potential victim and notify law enforcement

Answer

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.

NBME Practice Test

NBME Practice Test

NBME Psychiatry 4