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Behavioral & Nervous Behavioral Sciences — Step 1 practice questions
66 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Behavioral Sciences questions in this section combine two things the exam tests separately elsewhere. Covers psychiatry, ethics, communication and the social determinants of health. Neuroanatomy questions are localisation problems: a deficit is described and you name the lesion site.
Sample questions
Sample question 1
A 19-year-old woman of normal weight has recurrent episodes of eating large amounts of food with a sense of loss of control, followed by self-induced vomiting, with dental enamel erosion and parotid enlargement. Which of the following best describes this condition?
Explanations
A. Bulimia nervosa, in which patients are typically normal weight or overweight, distinguishing it from anorexia nervosa with its low body weight · correct
BULIMIA NERVOSA involves recurrent binge eating with a sense of loss of control followed by inappropriate COMPENSATORY behaviors — vomiting, laxatives, fasting, or excessive exercise — with self-evaluation unduly influenced by body shape. Patients are typically NORMAL weight or overweight, which is why it is frequently missed. Physical signs of purging include dental enamel erosion, parotid enlargement, Russell sign (knuckle calluses), and hypokalemic metabolic alkalosis. ANOREXIA nervosa requires significantly LOW body weight regardless of subtype, and BINGE EATING disorder involves binges WITHOUT compensatory behaviors.
B. Binge eating disorder, which includes compensatory behaviors
Binge eating disorder lacks compensatory behaviors.
C. Avoidant restrictive food intake disorder
ARFID involves restriction without body image disturbance.
D. Anorexia nervosa, binge-purge subtype, requiring low body weight
Anorexia nervosa requires significantly low weight.
E. Normal eating behavior
The pattern is clearly disordered with physical consequences.
Sample question 2
A 22-year-old man has 8 months of auditory hallucinations, persecutory delusions, disorganized speech, and declining self-care and academic performance. Which of the following best describes the symptom categories in this condition?
Explanations
A. Negative symptoms respond better to antipsychotics than positive symptoms
Positive symptoms respond considerably better.
B. POSITIVE symptoms such as hallucinations and delusions respond better to antipsychotics, while NEGATIVE symptoms such as avolition and flat affect respond poorly and drive long-term disability · correct
Schizophrenia requires at least 6 MONTHS of disturbance with at least 1 month of active symptoms — shorter durations define brief psychotic disorder (under 1 month) and schizophreniform disorder (1–6 months). Symptoms group into POSITIVE (hallucinations, delusions, disorganized speech and behavior), which respond relatively well to dopamine antagonists; NEGATIVE (avolition, flat affect, alogia, anhedonia, asociality); and COGNITIVE (impaired working memory and executive function). Negative and cognitive symptoms respond POORLY to medication yet are the strongest determinants of long-term functional outcome.
C. Positive symptoms are the principal determinant of long-term function
Negative and cognitive symptoms drive long-term function.
D. Cognitive symptoms are not part of the illness
Cognitive impairment is a core and functionally important domain.
E. Duration of 1 month establishes the diagnosis of schizophrenia
Six months of disturbance is required.
Sample question 3
An 82-year-old hospitalized woman becomes acutely confused overnight with fluctuating attention, disorganized thinking, and visual hallucinations, having been alert and oriented that morning. Which of the following best distinguishes this from dementia?
Explanations
A. Stable cognition throughout the day
Fluctuation is a defining feature.
B. Acute onset with FLUCTUATING course and impaired ATTENTION, which are the cardinal features of delirium and prompt a search for an underlying medical cause · correct
Delirium is defined by ACUTE onset, a FLUCTUATING course, and inattention, usually accompanied by disorganized thinking or altered consciousness — dementia, by contrast, develops insidiously over months to years with preserved attention until late. Delirium is a medical emergency signaling an underlying cause: infection, medications (especially anticholinergics, benzodiazepines, and opioids), metabolic derangement, hypoxia, urinary retention, constipation, pain, or withdrawal. HYPOACTIVE delirium is more common and more often missed than the agitated form, and carries a worse prognosis.
C. Absence of any identifiable precipitant
A precipitant should always be sought.
D. Preserved attention with isolated memory impairment
Attention is characteristically impaired in delirium.
E. Gradual progressive memory loss over years
Gradual progressive decline characterizes dementia.
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