NBOME Behavioral Health & Psychiatry 2 — Questions and Answers
Question 1: A 22-year-old woman has a history of unstable intense relationships, identity disturbance, recurrent suicidal gestures, impulsivity, and frantic efforts to avoid abandonment. Which personality disorder is most consistent with this presentation?
- Narcissistic personality disorder
- Histrionic personality disorder
- Borderline personality disorder (Correct answer)
- Antisocial personality disorder
Correct answer: Borderline personality disorder
Borderline personality disorder is characterized by pervasive instability in relationships, self-image, and affect, along with marked impulsivity and fear of abandonment.
Question 2: A 17-year-old girl with anorexia nervosa (BMI 15.0 kg/m²) develops muscle weakness and ventricular arrhythmias. Which electrolyte abnormality is most likely responsible?
- Hyponatremia
- Hypercalcemia
- Hypokalemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia
Hypokalemia is the most life-threatening electrolyte abnormality in anorexia and bulimia, causing muscle weakness and potentially fatal cardiac arrhythmias.
Question 3: A chronic alcohol user is admitted for medically supervised detoxification. Which medication class is first-line to prevent alcohol withdrawal seizures and delirium tremens?
- Haloperidol
- Benzodiazepines (Correct answer)
- Naltrexone
- Disulfiram
Correct answer: Benzodiazepines
Benzodiazepines (e.g., chlordiazepoxide, lorazepam, diazepam) are first-line agents for alcohol withdrawal; they enhance GABA activity to compensate for alcohol-induced CNS suppression being withdrawn.
Question 4: A patient presents with multiple persistent physical complaints including pain, GI symptoms, and fatigue, accompanied by excessive health-related thoughts and behaviors, without a medical condition fully explaining the symptoms. Which DSM-5 diagnosis is most appropriate?
- Illness anxiety disorder
- Conversion disorder
- Somatic symptom disorder (Correct answer)
- Factitious disorder imposed on self
Correct answer: Somatic symptom disorder
Somatic symptom disorder (DSM-5) requires ≥1 distressing somatic symptom plus excessive health-related thoughts, feelings, or behaviors; it replaced 'somatization disorder' from DSM-IV.
Question 5: Which of the following is a first-line pharmacological treatment for ADHD in adults?
- Bupropion
- Methylphenidate (Correct answer)
- Lorazepam
- Risperidone
Correct answer: Methylphenidate
Stimulants, including methylphenidate and amphetamine salts, are first-line pharmacological treatments for ADHD, improving attention by blocking dopamine and norepinephrine reuptake.
Question 6: A patient who has been on haloperidol for 2 years develops repetitive involuntary movements of the tongue, lips, and jaw. Which adverse effect has developed?
- Akathisia
- Neuroleptic malignant syndrome
- Tardive dyskinesia (Correct answer)
- Acute dystonia
Correct answer: Tardive dyskinesia
Tardive dyskinesia is a late-onset (months to years) antipsychotic side effect characterized by repetitive orofacial movements, thought to result from dopamine receptor supersensitivity.
Question 7: According to DSM-5, which criterion is required for a diagnosis of Generalized Anxiety Disorder (GAD)?
- Excessive anxiety and worry about multiple activities occurring more days than not for at least 6 months (Correct answer)
- Panic attacks occurring at least twice weekly for 3 months
- Anxiety triggered only by specific phobic stimuli
- Obsessional thoughts accompanied by compulsive rituals
Correct answer: Excessive anxiety and worry about multiple activities occurring more days than not for at least 6 months
GAD requires excessive, difficult-to-control anxiety and worry about multiple topics, more days than not, for at least 6 months, with associated somatic or cognitive symptoms.
NBOME Behavioral Health & Psychiatry 2
A 22-year-old woman has a history of unstable intense relationships, identity disturbance, recurrent suicidal gestures, impulsivity, and frantic efforts to avoid abandonment.
Which personality disorder is most consistent with this presentation?