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* nbme 4 1 5
 #442788  
  zoh - 08/31/09 05:45
 
  5. A 14-year-old boy is brought to the physiciah by his parehts because he has beeh ihcreasihgly irritable. disrespectful. and uncooperative during the past 4 years. He refuses to
do any household chores and does hot obey curfew. He may be expelled from school because he is rude ahd threatehihg to teachers and has been cutting classes. He is
tutored for readihg but earns C's ahd D's in his classes. He has been suspended three times durihg the past year for talkihg back to his teachers. He repeated first grade due
to poor academic readiness. He used to have trouble with homework but how he does hot complete ahy homework. He is at the 65th percehtile for height ahd 50th percehtile
forweight. Physical examihation shows HO abhormalities. During the examihation. the patieht is minimally cooperative and freguently rolls his eyes at guestions. Urine
toxicology screenhing is positive for nicotine. Which of the following is the most likely explanation for this patient's behavior?
O A) Attention-deficit hyperactivity disorder
O B) Borderlihe cognitive functioning
O C) Conduct disorder
O D) Oppositional defiaht disorder
O E) Reading disorder
O F) Normal adolescent behavior
 
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* Re:nbme 4 1 5
#1860185
  targetresidency09 - 08/31/09 06:30
 
  answer:D)oppositional defiant disorder.he is simply defying authority figures.if it were C)conduct disorder,he would have exhibited other signs like cruelty to animals,drug abuse,fights in school,destroy property,etc.the problem is for the past 5years.so he doesnt have E)reading disorder,since he was normal prior to that.F)normal adolescent behavior could be a possibility,but he was 10years old when the problem first started.A)ADHD is eliminated,because he is not hyperactive.he is simply uncooperative and rolls his eyes during physical examination,he is not fidgety.B)borderline cognitive behavior=borderline personality disorder,where patients classify the world into positive and negative.no gray shades.  
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