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Behavioral & Nervous Pharmacology — Step 1 practice questions
67 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
Pharmacology questions in this section combine two things the exam tests separately elsewhere. Pharmacology is examined as mechanism, effect and adverse effect, rarely as dosing. Neuroanatomy questions are localisation problems: a deficit is described and you name the lesion site.
Sample questions
Sample question 1
A hospitalized patient develops tremor, tachycardia, hypertension, diaphoresis, and anxiety 12 hours after his last drink. Which of the following is the most appropriate management?
Explanations
A. Beta blockade alone to control autonomic symptoms
Beta blockers mask autonomic signs without preventing seizures or delirium.
B. Observation without pharmacologic treatment
Untreated withdrawal can progress to fatal delirium tremens.
C. Symptom-triggered benzodiazepine dosing guided by a withdrawal severity scale, with thiamine, and monitoring for progression to seizures or delirium tremens · correct
Alcohol withdrawal follows a predictable timeline: autonomic hyperactivity and tremor at 6–24 hours, withdrawal SEIZURES at 12–48 hours, alcoholic hallucinosis at 12–24 hours with intact sensorium, and DELIRIUM TREMENS at 48–96 hours with confusion, severe autonomic instability, and meaningful mortality. BENZODIAZEPINES are the cornerstone because they are cross-tolerant with alcohol at the GABA-A receptor, and SYMPTOM-TRIGGERED dosing using a scale such as CIWA reduces total dose and duration. THIAMINE precedes glucose to prevent Wernicke encephalopathy.
D. Immediate discharge with outpatient follow-up
Discharge during active withdrawal is unsafe.
E. Antipsychotics as monotherapy
Antipsychotics lower the seizure threshold and do not treat withdrawal.
Sample question 2
A patient who overdosed on a tricyclic antidepressant develops widened QRS complex on EKG and hypotension. Which of the following is the most appropriate treatment?
Explanations
A. N-acetylcysteine
N-acetylcysteine is the antidote for acetaminophen overdose, unrelated to TCA toxicity.
B. IV insulin and glucose
This is a treatment for calcium channel blocker or beta-blocker overdose (hyperinsulinemia-euglycemia therapy), not TCA overdose.
C. Flumazenil
Flumazenil reverses benzodiazepines and can precipitate seizures, particularly dangerous in TCA overdose (which already lowers seizure threshold), so it is not appropriate here.
D. IV sodium bicarbonate · correct
TCA overdose causes sodium channel blockade, producing QRS widening and cardiotoxicity; IV sodium bicarbonate helps by increasing extracellular sodium concentration (overcoming the blockade) and alkalinizing the blood (which favors the less-toxic, less-protein-bound form of the drug), the standard treatment for this cardiotoxicity.
E. Naloxone
Naloxone reverses opioids, unrelated to TCA overdose.
Sample question 3
A patient has intrusive unwanted thoughts about contamination that cause marked anxiety, relieved temporarily by hours of daily hand washing that she recognizes as excessive. Which of the following is the most appropriate treatment?
Explanations
A. Reassurance that the thoughts are untrue is the definitive treatment
Providing reassurance feeds the reassurance-seeking compulsion.
B. Standard antidepressant doses are always sufficient
Higher doses are typically required.
C. Encouraging her to perform the compulsions more efficiently
Facilitating compulsions reinforces the disorder.
D. Exposure and response prevention therapy, with an SSRI often at higher doses than used for depression · correct
Obsessive-compulsive disorder involves intrusive, unwanted OBSESSIONS generating anxiety and COMPULSIONS performed to neutralize it — a cycle maintained by the temporary relief the compulsion provides, which negatively reinforces it. EXPOSURE AND RESPONSE PREVENTION is the specific and most effective therapy: confronting the trigger while REFRAINING from the compulsion allows anxiety to habituate and the feared consequence to be disconfirmed. SSRIs are effective but typically require HIGHER doses and LONGER trials (8–12 weeks) than in depression. Reassurance seeking is itself a compulsion that perpetuates the cycle.
E. Benzodiazepines as first-line treatment
Benzodiazepines are not effective for the core disorder.
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