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Retired NBME 24 Answers

nbme24/Block 1/Question#38 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
Borderline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—neonem(629)
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This patient has an unstable mood and a crazy relationship. She's also splitting (a defense mechanism wherein one acts like people are all-good or all-bad) as she talks about the physician and her coworkers. This characteristic is most commonly associated with borderline personality disorder. This one is in Group B ("Wild"), along with antisocial, histrionic, and narcissistic.

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medskool123  i get why its borderline now (I guess I kind of always thought suicide was the biggest part of that) but can someone tell me why its not paranoid? Is it just a matter of the "better" choice? The "youre the only one i can trust" thing lead me to that. +2
drmomo  same here +
aneurysmclip  Paranoid is where they don't trust anyone or are weary of people. because she said she trusts only the physician can be a bit confusing, but she describes her coworkers as jerks, not that "oh they're out to kill me, they're government agents watching me" +1
boostcap23  Splitting association with borderline in FA 2020 pg 555 and 565 +1
failingnbme  got this wrong too but yes I guess paranoid will be suspicious with everyone +
fatboyslim  Paranoid is suspicious of everyone. Like that one question in UWorld where a patient is evaluated in the ER and found to have appendicitis and recommended to have surgery. Patient then tells the doc "you're just trying to make use of my amazing insurance" + when asked about if he has any relatives or people that help care for him he says "I haven't talked to my family in 10 years, they all want something from me" or something along those lines. Borderline usually stands out when you see a malfunctioned relationship +/- post-breakup and the patient does something like try to commit suicide etc. plus having that splitting mentality "you're the only one I can trust, everyone else is a jerk". +



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