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Behavioral Sciences — Step 1 practice questions
242 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
Covers psychiatry, ethics, communication and the social determinants of health. Questions often have several defensible answers and one best answer, so the skill is ranking options rather than eliminating wrong ones.
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
A widow reports that, 14 months after her husband's death, she remains unable to accept the loss, avoids all reminders of him, and has significant difficulty functioning at work and socially. Which of the following is the most likely diagnosis?
Explanations
A. Adjustment disorder
Adjustment disorder typically resolves within 6 months of the stressor ending, inconsistent with this 14-month persistent, severe presentation.
B. Prolonged grief disorder · correct
Persistent, impairing grief symptoms beyond the expected cultural/social time frame (generally at least 12 months in adults) with significant functional impairment define prolonged grief disorder.
C. Major depressive disorder exclusively, unrelated to grief
While overlapping features can occur, the clinical picture centered specifically on inability to accept the loss and avoidance of reminders more specifically fits prolonged grief disorder than a a purely separate MDD diagnosis.
D. Normal grief
Normal grief, while it can persist in a fluctuating way, does not typically cause this degree of persistent functional impairment well beyond a year.
E. Acute stress disorder
Acute stress disorder is diagnosed within the first month after a trauma, not this delayed timeframe.
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