Behavioral Science Test

Question 1

A 50-year-old man develops difficulty walking while receiving drug therapy for paranoid behavior. Physical examination shows masked facies and diffuse muscle rigidity. He is slow in initiating movement and walks with a shuffling narrow-based gait. Which of the following drugs is the most likely cause of these findings?

Accepted Answer

Phenothiazine

Answer

The patient's symptoms (masked facies, diffuse muscle rigidity, slow initiation of movement, shuffling narrow-based gait) are characteristic of drug-induced parkinsonism, an extrapyramidal side effect. Phenothiazines are a class of first-generation antipsychotics that block dopamine D2 receptors in the nigrostriatal pathway. This dopamine blockade leads to an imbalance in the basal ganglia, mimicking the motor symptoms of Parkinson's disease.

Question 2

A 24-year-old man is brought to the emergency department by his mother after barricading himself in his apartment. For 8 months, he has believed that aliens follow him and control his mind. He was fired from his parttime job 6 months ago because of unusual behavior. There are no other apparent psychosocial stressors. His paternal grandmother has major depressive disorder. He does not use drugs, but his mother states that he frequently drinks beer. There is no disturbance of mood, sleep, or appetite. Examination shows an extremely agitated and suspicious patient. There is a 1 × 1-cm abrasion in the right frontal area. His blood alcohol concentration is 0.5 mg/dL, and serum γ- glutamyltransferase (GGT) activity is 40 U/L (N=5–50). Which of the following is the most likely diagnosis?

Accepted Answer

Schizophrenia, paranoid type

Answer

The patient presents with persistent delusions (aliens controlling his mind) for at least 6 months, significant functional impairment (fired from job), and absence of prominent mood symptoms, which are key diagnostic criteria for schizophrenia. The specific nature of his delusions (persecutory/control) points to the paranoid type. His alcohol level is negligible and GGT normal, ruling out alcohol-induced psychosis as the primary cause.

Question 3

A 43-year-old woman is brought to the emergency department 1 hour after a stranger stole her purse. She is agitated and extremely upset. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); BMI is 34 kg/m2 . Physical examination shows no other abnormalities. Her blood glucose concentration is increased. Which of the following is the most likely explanation for this finding?

Accepted Answer

Normal stress hormone response

Answer

Acute psychological stress, such as experiencing a traumatic event like a purse snatching, triggers the 'fight-or-flight' response. This involves the release of stress hormones like cortisol, epinephrine, and norepinephrine. These hormones promote gluconeogenesis and glycogenolysis, leading to an increase in blood glucose levels as the body mobilizes energy resources to cope with the perceived threat.

Question 4

A 4-year-old girl is brought to the physician by her mother because of a fever for 1 day. The physician is more than 1 hour behind schedule because of two patient emergencies earlier that day. When he enters the room, the mother yells, “Do you know how long we've had to wait? This is totally unacceptable!” It is most appropriate for the physician to initially state which of the following?

Accepted Answer

“It must have been very difficult to be here for so long with a sick child.”

Answer

In this situation, the most appropriate initial response is to acknowledge and validate the mother's feelings. Empathizing with her frustration and difficulty ('It must have been very difficult...') helps de-escalate the situation and shows that the physician understands her perspective. This approach builds rapport and opens the door for a more productive conversation, rather than making excuses or becoming defensive.

Question 5

A 45-year-old man is admitted to the hospital because of chest pain for 1 hour. He has a sedentary lifestyle, and his diet is high in fat and sodium. The diagnosis of acute angina is made, and the appropriate treatment is administered. After the patient’s condition is stabilized, the physician recommends an exercise regimen and a low-fat, low-sodium diet. Two weeks later, the patient returns for a follow-up examination. He indicates that he has not yet returned to work and spends most of the day lying on the couch. He has not had any chest pain, shortness of breath, dyspnea with exertion, or peripheral edema. Which of the following initial statements by the physician is most appropriate?

Accepted Answer

“What do you think is interfering with your ability to resume activity?”

Answer

The patient is not adhering to recommended lifestyle changes. Instead of confronting, judging, or making assumptions, the most effective approach is to use an open-ended question to explore the patient's perspective and identify barriers to change. Asking 'What do you think is interfering...' allows the patient to articulate their challenges, fears, or motivations, which is crucial for collaborative problem-solving and promoting adherence.

NBME Practice Test

NBME Practice Test

Behavioral Science Test